A new survey adds evidence to a contention I’ve made before, that the growth in the popularity of alternative therapies has little to do with a growth in the evidence that they are safe and effective. Demand is driven by perception, and perception is created through marketing. Once the perception exists that an intervention is safe and beneficial, or unsafe and harmful, the demand for that intervention among patients (or in the veterinary field, clients) will drive the availability of the product or service. A rational analysis of the evidence for or against an intervention has far less impact on the use of that treatment.
A recent survey of hospitals found, “The number of hospitals offering complementary and alternative medical services has tripled since 2000, driven principally by patient demand…” This will undoubtedly be seized upon by advocates of alternative medicine as evidence that these therapies are now “mainstream” and this must mean they work. But the details of the survey tell a different story.
Forty-two percent of the 714 hospitals surveyed said they provide unconventional therapies, and executives listed patient demand as the top criterion in choosing which therapies to offer… “They are responding to the needs of their patients and the communities they are serving, while trying to differentiate themselves in the marketplace,” said Sita Ananth, a Samueli Institute researcher who wrote the report… Though 70% of executives at hospitals providing unconventional therapies said they are doing so because they are clinically effective, only 42% said they use patients’ health outcomes to gauge the success of the alternative medicine programs. Instead, they are principally using patient satisfaction and volume as evaluation metrics, the report said. The programs were most often started by hospital administrators, with physicians championing the idea 20% of the time.
Clearly, patient demand and perception, not proof of efficacy, are driving the expansion of alternative therapies in these hospitals.
Most of the growth in alternative services is in the alternative services offered comes in the “soft” aspects of CAM- treatments like “massage, guided imagery, meditation and the “healing touch” practice known as Reiki.” This is consistent with the results from previous surveys of hospice providers and with the National Health Interview Survey of 2007, which found that practices which focus primarily on psychological comfort and relaxation, and which arguable aren’t truly medical interventions intended to affect a patient’s physical health, make up most of the CAM use in the United States. “Hard” CAM practices, like homeopathy, chiropractic, acupuncture, TCM, herbs and supplements, and others that claim to prevent or cure disease, are far less widely used.
Personally, I have no objection to relaxation and comfort therapies, and I suspect they have some meaningful psychological value for people struggling with illness. But it is misleading and disingenuous to label these as “alternative medicine” and then either claim they are truly medical therapies, rather than forms of supportive care. There is no consistent or high-quality evidence that suggests these sorts of therapies have meaningful effects on disease outcome or physical health, and for some, such as Reiki, the evidence is quite clear that they do not. And it is equally misleading to cite the popularity of these therapies and then imply that other, “hard” CAM treatments are widely accepted as safe and effective medical treatments.
The question then arises, what harm is there in the acceptance of such comfort therapies in mainstream hospitals? I would argue that the therapies themselves are unlikely to be harmful, particularly since they are rarely substituted for science-based therapies, and they probably do offer legitimate comfort to human patients (though the case is far less clear for veterinary patients). However, there is an inherent problem in allowing patient demand, rather than scientific evidence of safety and benefit, to dictate what care hospitals offer. It is very easy to stray into areas of alternative therapy where the risk to benefit ratio is far less favorable.
And insofar as these “soft” CAM interventions form a bit of a bait-and-switch, in which the positive feelings and negligible risk of these comfort interventions are implicitly extended to more questionable practices which share the ideological/political label of CAM, thus opening the door to these interventions as well, then the overall quality of healthcare patients received may be at risk.
There is no question that part of the appeal of CAM is that providers of such therapies often address the psychological needs of patients more effectively than the mainstream medical system. We should certainly be willing to accept that conventional medicine has its flaws and that there are useful things to be learned from the approach many CAM providers take to communicating with and comforting their patients. But this cannot be at the expense of a rigorously scientific approach to evaluating the safety and efficacy of particular interventions, or we will risk diluting the unprecedented strength of the scientific medical approach, which has proven its superiority to any other countless times in actually preventing and treating disease.