The Appeal of Simplicity |

One of the great marketing advantage complementary and alternative medicine (CAM) has over mainstream science-based medicine is the appeal of simple explanatory narratives. Sometimes we get to take advantage of this in scientific medicine. Bacteria cause infections, antibiotics kill bacteria and the infections go away. This is a simple, satisfying story that can be told in a 25 or 30-minute office visit, and it gives the pet owner a sense that they understand the problem and the solution. But sadly, real life, and real medicine, isn’t always that clear cut.

Explaining the pathogenesis of cancer, or Cushing’s disease, or some idiopathic condition we don’t yet fully understand can be very frustrating for the vet and the pet owner. Without a clear and comprehensible description of the problem, and without a straightforward treatment or prognosis, the client begins to doubt the competence of their vet.

One of the best indications that many CAM approaches are not correct is that they seem never to face this problem. A chiropractor can always find a subluxation to blame for back pain. And if there is no pain, why that’s because the subluxation was corrected before it got bad enough to cause symptoms!

Homeopathy has a consistent and appealing narrative in the Law of Similars. This says that miniscule amounts of a substance which causes a symptom (or merely the energetic resonance left behind by the substance after it has been diluted away) can actually remove the symptom from the patient. The fact that this makes no physiologic sense, that most homeopathic remedies haven’t undergone “provings” to see if they can cause the symptoms they are used to treat, and that clinical trials have shown the stuff doesn’t work anyway is irrelevant. There is always a ready answer and a ready solution with a simple link between the two.

Unbalanced Ch’i or yin/yang, mysterious “toxins,” vertebral subluxations, and many other such entities all share some essential characteristics that make them appealing and persistent as explanations for disease.

They are unfamiliar to most people since they can only be identified by specially trained practitioners. This gives them a mysterious and sinister aura that makes it easy to inspire worry about their malign effects in people’s minds. Infectious agents don’t fit the role of villain nearly as well since people have come to expect, through the hard won success of vaccines and antibiotics, that if these were really the causes of their problem doctors should be able to find and eliminate them with no trouble. And complex sources of disease such as the multiple genetic and environmental and random chance effects spread out over decades that lead to most cancers are not sufficiently clear and circumscribed causes to fill the role of villain, nor can the practitioner of scientific medicine claim to be able to easily identify and vanquish them.

The sources of disease claimed by many CAM methods also share the characteristic of being ephemeral and not amenable to consistent, objective. Chiropractors almost never agree with one another about where the dreaded subluxation is, and homeopaths seeing the same patient seem to come up with widely different assessments and prescriptions. This seems like it should be a disadvantage to those of us accustomed to the scientific notion that one must clearly establish the objective reality of something before blaming disease on it. But actually the intangible quality of these etiologies makes them perfect villains. The CAM practitioner can always find them when they need an explanation for something, no one can gainsay this explanation since there is no objective standard for verifying the diagnosis, and if the patient gets better the practitioner can claim the cause is no longer there, again without any fear of being proven wrong. Sadly, in science-based medicine we are much more often forced to honestly admit when we cannot find the cause of a patient’s symptoms, we cannot ethically prescribe a treatment without some legitimate indication, and we can’t automatically claim the credit for improvement.

People desperately want simple, clear explanations for what is wrong with their pets. They want to know what the chances are of the problem getting better. And they want to know what needs to be done. All of these things allow the pet owner to either feel more in control of the scary thing that is happening to their pet, or at least to adjust their expectations and emotions to the inevitable. What people do not want is to be told that the cause of their pet’s illness is unknown, that the doctor cannot say with certainty what will happen, and that any treatment is an educated guess at best. To be fair, I have seen some CAM practitioners admit to not knowing what is wrong or to not being sure if their treatments will work. But far more often, where the science-based medical approach calls for painful honesty about the uncertainty involved, the CAM approach allows for confident, simple explanations of the problem and confident treatment recommendations.

Not being tied to an objective, verifiable physical reality, many CAM approaches can give people what they want and need emotionally when their pets are sick, even if they can’t actually offer anything of benefit to the patient. This is an advantage in terms of appealing to the public that scientific medicine cannot co-opt or undermine. Of course, scientific medicine often has the advantage of being right about the real causes and the appropriate treatments, and this often trumps the lack of appealing simplicity in scientific explanations. Very few CAM therapies have established themselves as popular treatments for acute, life-threatening diseases because they simply cannot compete with scientific medicine in terms of results. But when it comes to the vague and the chronic complaints that science does not yet have clear answers to, and for which indeed there may not even be clear answers to be found, we shall have to accept the disadvantage of being honesty about the complexity and uncertainty of these conditions. It is the price paid for holding out for real answers rather than simple, appealing, but ultimately empty stories.