In Switzerland, as in many other European countries, the government pays for extensive health insurance coverage for its citizens. Naturally, the government and the citizenry want cost-effective healthcare for their money. One important aspect of achieving this is not to pay for therapies that don’t work. So it is understandable that in 2005, the Swiss Interior Ministry stopped paying for several alternative therapies, including homeopathy and Traditional Chinese Medicine (TCM), that failed to meet their criteria for adequate scientific proof of efficacy.
What is less understandable, is that in 2009 60% of the voters in Switzerland voted to force the government to pay for these therapies. Apparently, these voters were, as so often proponents of alternative medicine tend to be, less interested in whether the therapies worked than in their “right” to use them, even if other taxpayers had to foot the bill. The government’s own review panel recommended outright rejection of these therapies, but in a pragmatic political move the government has decided to continue funding them for a 6-year trial period, during which a supposedly independent review of existing scientific research is supposed to be conducted to determine, yet again, if there is adequate evidence of efficacy to justify providing these therapies at taxpayer expense.
One possible candidate for this external review agency is the National Center for Complementary and Alternative Medicine (NCCAM) here in the U.S. Given that NCCAM has spent over $1 billion dollars of U.S. taxpayers’ money, has failed to find solid evidence to support any specific CAM approach, and is nevertheless actively promoting an entire academic industry dedicated to researching CAM therapies (see these posts at Science-Based Medicine for details), it hardly seems a neutral party. Another candidate is the British National Institute of Clinical Excellence (NICE). This seems a better choice in that the organization exists to evaluate all medical therapies froman evidence-based perspective.
However, the unfortunate reality is that the negative findings of the original Swiss government panel were not sufficient to dissuade Swiss voters from demanding the government pay for CAM. And the extensive work NICE has done in Britain, along with strong statements from British physicians organizations about the complete fiction that is homeopathic medicine, the British National Health Service still pays for homeopathic hospitals. The negative findings of NCCAM here in the U.S. have had no discernable impact on the popularity of CAM therapies here. So the hope that a balanced, rational review of the evidence, which I have no doubt would lead to the conclusion that these methods are unproven at best or, as in the case of homeopathy, complete nonsense, is a slim one indeed.
The more I look at the evidence and people’s responses to it, including the vicious hostility of so many comments posted here by those who feel I am wrong about the evidence, the more CAM begins to look like a religion, not a rational approach to healthcare.
Perhaps the remarkable turning-one’s-back-to-scientific-evidence approach could be looked at from a Discourse Analysis* perspective i.e., what are people DOING with their attitudes and statements about “alternatives”? After all, the same evidence is available to everyone and it’s dodgy to assume that those who go the “alternative” route are just defective thinkers.
I would suggest (as you know, I am utterly sceptical of “alternatives” myself) that these ideas provide three services:
1) Granting a sense of control to users;
2) Providing an accessible users’ discourse which can be used to construct “alternative” identities and communities;
3) in practical terms, easing the burden on “real” health care – it seems impossible to provide “real” health care for everyone – scant personal attention, long waits etc. “Alternatives” take some folk out of the lists (permanently in some cases, alas!).
What does anyone think of this off-the-top-of the-head thinking?
* postmodernist alert.
Well, to start with I hope it’s clear I never said, or implied, that “those who go the “alternative” route are just defective thinkers.” We are ALL “defective” thinkers in that the human brain has certain hardwired ways of functioning that can be efficient heuristic devices but that can also lead us astray. For example,
1. We have faulty memories and continuously reconstruct our narrative memories to be consistent with our current views.
2. We prefer stories to statistics and find narratives inherently more cogent than facts even though they are in reality less reliable guides to what is true.
3. We think teleologically, seeing meaning, purpose, and agency where it is not and underestimating the role of random chance in events.
4. We seek to confirm our beliefs and attend to confirmatory information while ignoring or dismissing conradictory information.
5. We believe others to be biased and ourselves to be fair and objective.
There are many others, but these are universal characteristics of human thought, across cultures as far as we can tell from current data, and we diminish the impact of these processes only through conscious effort and education, and then only to a limited extent and, probably, only if we already are inclined by temperment to be comfortable with a certain degree of self doubt and existential uncertainty. All of this makes it inevitable that we will come to wrong conclusions and then stick with them. The questions then are how can we recognize this and commit to trying to overcome it, and can we be successful on a large scale? I don’t know the answers, but of course part of the reason I do this is because at least a part of me hopes we can accomplish these things.
None of this means 1 and 2 above aren’t correct, it’s just a different way of looking at the problem. I think 1 and 2 are very good proximal explanations of the phenomenon, and understanding them might give us some purchase on the edifice of belief constructed to house alternative medicine.
I have to disagree with 3, though. I think CAM fills a need in that it gives people the sense of hope and control they can’t get when they have chronic or mysterious conditions for which conventional medicine has no effective treatment, and I do believe it is most popular among those who don’t yet have access to scientific health care. However, I don’t think CAM adds value to the healthcare system, and I think the issue of access to real healthcare is really separate from the issue of CAM. We can or cannot provide adequate science-based healthcare to everyone based on political will, economic factors, and so on regardless of whether people turn to CAM. And CAM siphons resources away from more effective scientific medicine, as evidenced by the money spent at NCCAM, which has failed to find any meaningfully effective new therapies and yet has not noticeably discouraged the use of those not shown to be effective.
Masterly summation of human functioning – I’m borrowing it!
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Thank you, Skepvet, for this great article. We have translated it to Portuguese and placed it on the Portuguese 10:23 campaign site. Hope that’s alright with you.
Keep up the fantastic work!
Pedro
ups, forgot the direct link! – http://1023portugal.wordpress.com/2011/01/19/a-verdade-e-de-novo-um-concurso-de-popularidade/