The Economist says, “There is no alternative medicine.”

It’s rare to see the popular press cover alternative medicine in anything but a friendly way. Because those selling CAM are selling hope and faith as an integral part of most of their remedies, there tends to be a positive feeling in the public’s mind about these approaches even when the facts don’t support the specific claims being made. However, The Economist recently published two stories which say what I think the public most needs to hear about CAM in general: Most of it doesn’t actually work as medicine but it does have clear placebo effects.

One article, entitled There is No Alternative Medicine, puts it quite clearly (though I’m a bit skeptical that the specific percentage provided is reliable):

A few treatments (mostly herbs containing active drug molecules) do have proven benefits. A few others look worthy of further investigation. But from acupuncture, via homeopathy, to “quantum healing”, the vast majority, some 95%, offer nothing more than the placebo effect…

Globally, the industry is estimated to be worth some $60 billion a year. That is a lot to pay for placebos.

The world’s advertising-standards offices should thus crack down on bogus claims—including the idea that there is such a thing as “alternative medicine” in the first place. If it works, it is a medicine and should be regulated like one.

…the alternative-medicine industry plainly excels as a placebo delivery service.

I do think the author goes a bit too far in crediting the placebo effect with true improvements in a patient’s state of health, rather than improvements only in how the patient feels, which is a quite different, though still very important, thing. The evidence that placebo effects actually change the course of disease is very weak, and their primary benefit seems to be in alleviating highly subjective symptoms such as pain, nausea, depression, and so on.

Nevertheless, I agree that there are lessons to be learned from the success of the alternative medicine industry, and that chief among these is that science-based medicine must find ways to provide the same kind of psychological support people find in their CAM therapists without giving up rigorous scientific standards of evidence for the actual safety and efficacy of our interventions.

The second article, Think Yourself Better, makes this point in more detail, focusing on the work of Edzard Ernst in revealing the lack of good evidence for biological effects of most alternative therapies while also pointing out that people seek these therapies despite their lack of effectiveness because of the psychological support and comfort they provide. The tremendous success of scientific medicine is based on the principle that therapies cannot be justified only because they “seem” to work but that they must also be validated by controlled research that eliminates the influence of human psychology and cognitive weaknesses on the results. However, as strongly as I support that approach, I agree that in the real world of patient care, even in veterinary medicine, human psychology plays a critical role in the success of failure of our attempts as clinicians to manage the health of our patients. We need to stick to our epistemological guns and be certain we are offering truly effective therapies, but we also need to be effectively supportive of our patients or clients feelings about health and disease. If we are unable to do this, due to constraints on time or resources, deficits in our training, or other factors, then our clients will continue to be vulnerable to being sold ineffective therapies provided in ways that meet the psychological needs associated with their health even when they don’t meet the biological needs healthcare interventions should meet as a basic precondition of being employed.

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