CAM proponents often present a picture of the relationship between CAM and mainstream medicine that is as dramatic as it is fanciful, and it bears a resemblance to the myth of David and Goliath. Scientific medicine is portrayed as a venal cabal of big corporations and corrupt government bureaucracies determined to maintain a lucrative monopoly on health care by suppressing safe and effective, but unprofitable natural cures such as herbs, homeopathy, acupuncture, chiropractic, reiki, and so on. CAM, in contrast, is portrayed as a loosely-affiliated network of individual healers all dedicated to promoting health and well-being and to bringing people the freedom to choose their own path to wellness outside the rigid and coercive structures of government, the Cancer Industry, Big Pharma and the rest of the nefarious medical-industrial complex.
Like most myths, this one contains a few grains of truth amidst the chaff of fantasy and marketing. The pharmaceutical industry, for example is enormous, wealthy, and driven primarily by profit. While there are many individuals working in pharmaceutical and biotechnology research who are dedicated to relieving suffering through science, the institutions exist as entities of the market, and as such they often prioritize their efforts based on profitability, and they often work vigorously to manipulate health care providers, consumers, and government in ways that have more to do with return on investment than promoting health and welfare. Any corporate, for-profit company must consider making money a goal or it ceases to exist. This is true for pharmaceutical companies veterinary hospitals, and — hey, wait a minute. It’s true for herbal medicine manufacturers, dietary supplement companies, chiropractors, acupuncturists, and all those CAM folks too!
Reliable figures are hard to come by, but there’s no doubt CAM is big business. In 2005, consumers spent more than $21 billion on supplements in the U.S. and $66 billion worldwide, according to the Nutrition Business Journal (1). One study estimates total annual CAM sales at £4.5 billion in the UK, $2.4 billion in Canada, and $80 million in Australia.(2) Many of these supplements are sold by corporate giants such as Herbalife (2008 earnings $2.15 billion) and GNC (2008 earnings > $16 million). And even 10 years ago mainstream pharmaceutical giants were getting involved in the vitamin, supplement, and herbal products market, and this involvement has only increased. Most veterinary herbal and neutraceutical products are manufactured by the same pet food and drug giants the CAM community so derides. So in many ways, Big Pharma is Big CAM.
The image of alternative medicine providers as individuals fighting to practice and tell their side of the story against the organized opposition and censorship of mainstream medicine is also disingenuous. The supplement and herbal medicine industry is highly organized and has a vigorous, well-funded lobby that has successfully fought government attempts to regulate their products in a way comparable to other medicines on the market. The United Natural Products Alliance and the Council for Responsible Nutrition are among the biggest supplement industry advocacy and lobbying groups, and they have aggressively and successfully supported a fox-guarding-the henhouse strategy of industry self-regulation and opposed government attempts to require published evidence of safety and efficacy for their products.
Chiropractors are also highly organized, well-funded, and politically active. They successfully defeated the efforts of the American Medical Association to curtail the acceptance of chiropractic as legitimate by government and the health insurance industry. After organizing to defend individual chiropractors against injury lawsuits, the chiropractic lobby supported a successful anti-trust lawsuit which has left the AMA very reluctant to oppose the spread of chiropractic despite its poor evidence of efficacy and its very real risks. (3)
And in the United Kingdom, The British Chiropractic Association has successfully pursued a libel lawsuit against Simon Singh, a journalist who wrote an article in the Guardian Newspaper critical of their promotion of chiropractic for childhood asthma, colic, and other conditions for which chiropractic is proven ineffective. Hundreds of thousands of pounds have been spent by the chiropractic lobby suppressing the evidence-based opinion of one journalist in one newspaper article. This is hardly consistent with the image the industry promotes of itself as the well-meaning and plucky underdog.
CAM proponents often complain about the resistance to their ideas in academic institutions, and portray themselves as inheritors of folk tradition and wisdom that does not require academic validation. Yet they aggressively promote their agendas in these same academic institutions and set up their own credentialing and degree programs to take advantage of the legitimacy and respectability conveyed by the imprimatur of academic institutions they disdain.(2) And while CAM proponents talk about “health care choice” and keeping government out of the business of regulating the claims of health care products, they have successfully supported spending over $1 billion of taxpayer money through the National Center for Complementary and Alternative Medicine at the NIH on research which has yet to validate and clinically significant CAM therapy.
So while the CA as David and the Medical/Industrial Complex as Goliath marketing strategy has been creative and effective, it is not an accurate portrayal of reality. In both CAM and scientific medicine, there are mostly hard-working people genuinely dedicated to relieving suffering. And in both areas, there are venal and unscrupulous individuals seeking money, fame, and other self-serving goals. This has no bearing on the issue that should be the center of any discussion about CAM and science-based medicine, which is what works and what doesn’t. The David and Goliath frame is a fantasy designed to distract from the realities of the evidence and to shield the CAM industry from the scrutiny and supervision mainstream medicine is expected to undergo.