I have often referred to CAM as “faith-based medicine” due to its reliance on belief over evidence for validation, and I have commented on my perception that such a belief-based approach resembles religion, for which I have been soundly chastised by some as raising a divisive issue. Nothing stirs passions and animosities like a discussion of religion in America. Nevertheless, while I respect people’s right to believe as they choose, and I see a lot of good come from many religious traditions, there does seem to me to be a strong relationship between various forms of non-evidence based belief. A recent article in the Journal of Alternative and Complementary Medicine would seem to support the link between religion, or at least religiosity, and CAM. Unfortunately, without paying for a subscription, I can only access the abstract and first page, but here are some tidbits:
“Naturopaths and acupuncturists were three times as likely as internists and rheumatologists to report no religious affiliation (35% versus 12%, p<0.001), but were more likely to describe themselves as very spiritual (51% versus 20%, p<0.001) and to agree they try to carry religious beliefs into life’s dealings (51% versus 44%, p<0.01). Among physicians, increased spirituality and religiosity coincided with more personal use of CAM and willingness to integrate CAM into a treatment program.”
“Religion, spirituality, and complementary and alternative medicine (CAM) are related to one another in complex ways. Religious practitioners and CAM supporters are critical of conventional biomedicine’s reductionism and impersonality…Additionally, reflecting religious traditions, CAM supporters see patients as “whole persons—spiritual beings.” Thus, we might expect those who are more religious to be attracted to CAM practices.”
The article does discuss the concern of some fundamentalist members of mainstream religions with the “universal notion of spirituality over particular and concrete practices of religion,” but it does suggest that overall a supernaturalist outlook is correlated with an openness to vitalist, non-scientific approaches to medicine.
We generally believe ourselves in this country to be past the days when one’s religious faith determined one’s beliefs about the ordinary physical world. Most people of faith accept the reality of the geocentric model of the universe, evolution by natural selection, probabilistic quantum mechanics, and many other scientific discoveries that explain phenomena previously given supernatural explanations. CAM, however, is an area in which all too often faith trumps reason, and belief is considered sufficient to validate a practice that cannot be supported by objective scientific evidence.
If we acknowledge the clear connection between a bent towards vague, supernaturalist beliefs and CAM, I think we can strip away the misleading patina of science that disguises much CAM and lends it an undeserved appearance of legitimacy. Certainly, there are CAM proponents who are committed to a scientific, evidence-based approach, and we should encourage and support these. But when others clearly base their practices on spiritual belief rather than real science, we should make that clear for all to see as well.
Addendum
A reader was kind enough to forward a complete copy of the article, and there were a few more interesting comments I wanted to pass along. Overall, the article makes a strong case, though with limited data, that CAM use is about worldview more than about safety and efficacy. The authors state “[Astin, JA, 1998] hypothesized that ‘growing interest in alternative medicine may represent a type of cultural (Kuhnian) paradigm shift regarding health beliefs and practice…part of a broader value orientation and set of cultural beliefs, one that embraces a holistic, spiritual orientation to life.” Our finds support this hypothesis.”
They also argue their paper is “another in a growing body of research that underscores the important roles religion and spirituality play in shaping physicians’ clinical judgment.” Personally, I find this idea frightening. I would prefer my doctor to use science and facts as the basis of clinical judgment, not religious beliefs. Sure, religion may play a role in how a physician approaches personal interactions and ethical questions. But their medical judgment should not be a reflection of their religious beliefs, since science and history illustrate quite clearly that religious approaches to medicine are inferior to scientific approaches. All the holy water and burning sage in the world won’t cure a staph infection.
Finally, the authors give a strategic suggestion which I suspect their peers will be likely to accept readily: “In light of these findings, proponents of CAM may ant to focus their efforts on healthcare providers who are more self-consciously spiritual, and/or focus on spiritual themes, encouraging such providers to consider integration of CAM into their practices.” Having failed to make their case on the basis of evidence, they hope to persuade people to adopt their approaches out of respect for faith and religion. I would like to believe such a strategy would be as unsuccessful as it is misguided, since it clearly will not be in the best interests of patients. I fear, though, such will not be the case.
If you’d like the full paper please let me know and I can forward a copy to you (eors.gloomy.place (at) gmail.com).
That is an interesting article, and one of the few really useful things I have sen from that journal. While I agree that we like to think we are beyond the days where religious beliefs inform our views of the physical world, I am not sure that is the case for a significant segment of the population. The strong anti-science and anti-intellectual zeitgeist that seems to be present in society may be a reaction to a perception that science and materialist explanations of the universe threaten peoples dearly held religious beliefs.
Sometimes these beliefs are a part of an organized religion, or they may be more personal forms of “spirituality”. Many forms of CAM are indeed fetishized belief systems that give people an illusion of personal control over things that may truly be beyond control, at least by religion or whatever other belief it is that they hold.
Peter Lipson had an interesting post about this idea recently as well;
http://scienceblogs.com/whitecoatunderground/2009/09/shamans_in_the_hospital—have.php
Bartimaeus,
Absolutely agreed. Sadly, the heyday of public respect for science was after WWII, when people remembered before vaccines and antibiotics and felt that technology had saved them from the Nazis. For all the good that came out of the social changes of the 60s and 70s, there also came a profound sspicion of science and intellectuals, and a postmodern relativism that when carried to extremes denies the validity of all knowledge.
Note, I have made an addendum to this post as the result of a kind reader forwarding me a copy of the complete article.
Science has produced some scary things (nuclear weapons, DDT, etc.) that have not been the answers to problems that we thought they would be, but I cannot think of anything worse than combining competing forms of religion or spirituality and technological advances. Even though science makes mistakes, it is the only system that intends to self correct, even if such corrections often come quite slowly. Religious views tend to change too, but even more slowly, and often with huge steps backward or through violence and destruction. Despite it’s human flaws, the scientific worldview still seems much superior, and this article shows one of the reasons why. I too would hope that efforts to appeal to clinicians spiritual views would be unsuccessful, but fear that will not be the case.
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