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.

I frequently find that advocates of alternative medicine present themselves as converted skeptics. Of course, many came to veterinary medicine with a preconception that alternative methods were beneficial. But quite a few veterinarians or MDs who promote alternative methods tell stories about coming from a position of doubt or even outright antagonism towards unconventional practices to a position of strong belief.

These narratives have the effect of establishing the doctor’s credentials as a hard-nosed, critical thinker, which presumably makes the methods they are selling seem more legitimate. Such “spin” is necessary only because many people recognize that some alternative practices are highly implausible and require an element of faith without evidence to accept. So promoters of such methods wish to present themselves not as excessively credulous but as skeptics won over by the undeniable strength of the evidence.

I have no doubt that these folks tell these narratives honestly. I am fairly sure they are genuine, though I am less convinced they are accurate. It is clear from extensive research in psychology that such biographical narratives, and human memory in general, are seldom accurate factual reproductions of the past. Rather, they are stories continuously revised to fit into the current structure of our beliefs about the world and ourselves (for more detail, see Don’t Believe Everything You Think, On Being Certain, and Mistakes Were Made: But Not By Me). Neat parables about one’s conversion from skeptic to believer seem a perfect example of how such unconscious revisionism sevres to reinforce our beliefs and self-concept.

Such conversion stories are remarkably consistent thematically, though of course there is variation in the details. Often, the practitioner relates how they initially practiced conventional medicine but became frustrated by the limitations of scientific care. They also frequently describe miraculous individual cases, or even experiences involving their own health, that convinced them there was real validity to alternative methods.

Obviously, there are diseases we don’t understand and cannot treat very effectively, and it is natural for any caring doctor to be frustrated by suffering they cannot relieve or illness they cannot prevent. Unfortunately, this understandable emotion born out of compassion and empathy becomes harmful  when it leads us away from a sound, scientific pursuit of better understanding and interventions and towards a comforting but mistaken faith in unproven, ineffective, or even entirely magical treatments. And while individual experiences are very psychologically compelling, they are not reliable as proof that a therapy is safe or effective. So if they lead us to believe that ineffective practices work, they may be relieving our frustration while not actually doing a better job of treating our patients.

This example of such a conversion narrative illustrates both the frustration with the limitations of medicine and also the experience of having come to believe in alternative therapies through a perceived benefit for one’s own health. Since the conversion was to a belief in homeopathy, which is about as magical and unscientific a therapy as one can find, it is also a clear example of how one can be mislead by emotion and experience into rejecting useful practices for useless ones.

“Homeopathy is one of the rare medical approaches which carries no penalties – only benefits”
— Yehudi Menuhin, Violinist

Yehudi Menuhin’s statement reflects an important reason that I became interested in homeopathy. After practicing traditional Western medicine for roughly ten years, I became disenchanted with chemical drugs as being the only approach in dealing with disease. I was frustrated with the lack of effective treatments for chronic disease, behavior problems, and the epidemic of allergic conditions. During my search for alternatives, my personal health was greatly improved with homeopathic treatment, leading me to the study of homeopathy and the incorporation of this great system of medicine in my veterinary practice.

These stories often have an implicit, or even explicit, religious tone to them, illustrating an opening of the mind to realms of healing beyond the physical body, which is where medicine traditional directs its efforts. For example:

[I] practiced traditional veterinary medicine for 16 years. Gradually I became frustrated at the limitations of these methods and went abroad to Europe and South America to study healing methods practiced by holistic medical doctors. I incorporated these methods of natural healing in my own practice and found I could do so much more for my sick and painful patients… Why? It has to do with the philosophy, cause and effect of the two different methods of diagnosis and treatment of the patient…

Cure CANNOT be achieved in the physical body alone. Cure cannot be achieved by focusing on symptoms but on CAUSE, the true nature of symptoms exhibited. It is as if there is a dirty spot on a lens of a slide projector that is projecting an image on a screen. The traditional doctor works away on scrubbing the spot off the screen, while the holistic doctor cleans the lens, the cause of the spot on the screen…

Holistic medicine benefits Body, Mind (Emotional) and Spirit and recognizes these are also interdependent in maintaining health. Traditional medicine mainly concentrates on the body.

Some of these conversion stories do claim that the transition from skeptic to believer was brought about by thoughtful consideration of real scientific evidence. Here is one example. It manages to read like a pure religious conversion, with a series of miracle stories and even fainting brought on by the power of the revealed truth, and yet it claims to be an awakening based on a scientific approach to knowledge:

Before I knew about integrative medicine, it was easy to tell someone that nothing else could be done… There was truth in the statement and in knowing that “we had done everything we could,” but there was also sadness and loss in the failure that burned quietly at the core of my being.

In the 80s a series of crazy life changing events lead me to discover something wonderful.

… a mutual friend told me that her lovely Golden retriever had lymphoid cancer and she was being ripped off by a “quack alternative medicine doctor…” I decided that this “quack” should not be practicing and became determined to end his professional career.

I flew to New York to spend a week investigating the doctor, and found things that literally made me faint… I simply passed out rather than face the fact that the man I thought was a crook was actually a gifted healer…

One of the “snake oils” used to treat that dog for cancer was a mixture called Poly-MVA… After 30 years of testing over 20,000 products, Dr Garnett discovered Poly-MVA. His discovery created an entirely new field called electrogenetics, which is the study of electrical activity on the DNA. Poly-MVA appears to shuttle electrons in such a way that the susceptible cancer cells die while normal cells continue to survive.

… Gradually, scientific investigators began looking at Poly-MVA… The first major clinical veterinary study of its kind looked at 800 animals treated for various cancers and showed a clear improvement in quality of life.

…I began my quest into integrative medicine so many years ago to prove that this substance was quackery because I “knew” that there was no such solution. Through my scientific training and through common sense investigation, we found that it was useful and began treating patients with Poly-MVA over 15 years before further study demonstrated its usefulness. And now through proper scientific method, we are understanding that the dose needs to be further evaluated.

This narrative represents a skeptic as one who arrogantly rejects ideas they know nothing about. It illustrates how watching seemingly miraculous events should convince the open-minded skeptic that the things they believe are nonsense are actually true. And it claims that 15 years after seeing the truth, the revelation has been validated by science.

Unfortunately, skeptics are not those who judge things as false based on ignorance, but those who reserve judgment until reliable, scientific evidence is provided. Anecdotes, testimonials, and individual “miracles” do not constitute such evidence, because they are frequently misleading. And in this particular case, Poly-MVA is still an unproven nostrum based on questionable theory and without sound scientific validation.

Here’s what the American Cancer Society says about Poly-MVA:

Available scientific evidence does not support claims that Poly-MVA is effective in preventing or treating cancer….­reports of Poly-MVA’s effectiven­ess are anecdotal or small studies that have not been confirmed or published in scientific journals.

No studies of Poly-MVA in humans have been published in peer-revie­wed medical journals..­.

The potential risks and side effects of Poly-MVA are not known, as no results from human studies have been reported. Palladium compounds have the potential to cause allergic reactions in some people. Because lipoic acid is a powerful antioxidan­t, Poly-MVA may make radiation therapy or chemothera­py less effective. While this concern is based largely on theories of how cancer treatments work, it is supported by some recent studies. 

And here’s a comment from Dr. Andrew Weil, who certainly cannot be accused of not being open-minded and friendly to alternative medical therapies:

I have seen no scientific evidence demonstrating that Poly-MVA either prevents or effectively treats cancer. Indeed, I have found no reports of any well-controlled scientific studies. Most of the “success stories” cited by promoters are simple testimonials or come from studies that have not been published in scientific journals. Poly-MVA may not be dangerous in and of itself, but when you’re dealing with a life-threatening illness such as cancer, it is always ill advised to substitute an unproven treatment for one that has been scientifically demonstrated to help. At best, Poly-MVA would do no harm. At worst, by using it as an alternative cancer treatment you could lose valuable time that might be better spent fighting the disease with therapy that has some medical merit.

Poly-MVA may or may not have benefits in cancer patients. At this point, no one really knows since there are no controlled research studies on the question. If poly-mva played a role in converting this doctor from a skeptic to a believer in the promise of alternative medicine, it is not because the scientific evidence proved his skepticism unfounded.

Obviously, people do sometimes experience profound shifts in their world view. And there is nothing inherently wrong with sharing these experiences with others. However, these medical conversion stories are frequently held up as examples of the flaws of science and skepticism and as paradigms for how a skeptic should, if they are really open-minded, become a believer in some deeper and more effective approach to medicine simply because of a few seemingly miraculous cases. They make nonsense seem scientific and legitimate and rejection of nonsense seem dogmatic and closed-minded. And they are ultimately examples of circular logic since they only make sense if we accept that “truth” discovered by the storyteller is actually true, which it often is not.

Oops, looks like I just missed the party! Apparently, yesterday was National Holistic Pets Day. This holiday was created by Colleen Paige… I was going to give a brief description of who exactly Ms. Paige is, but I don’t think I can. Her website describes her this way:

Colleen Paige is one of America’s premier Family & Pet Lifestyle Experts…She is also an Animal Behaviorist, Best Selling Author, Interior Designer for both people and pets, Artist, Gourmet Cook, Beauty Expert, former Paramedic, Child & Pet Safety Expert, Family Crisis Counselor, Wellness Aficionado and Publisher of Pet Home and Style & Bliss Magazines.

Wow! She also apparently likes to create holidays, usually to raise awareness and money for some animal-related cause; 19 holidays according to her foundation website. She sounds like a remarkable person, and browsing through her various web sites, I am impressed by her energy, creativity, and the depth of her commitment to her vision of animal welfare. She is undoubtedly doing a lot of good things for pets and people.

Unfortunately, as is so often the case, sincerity and a commitment to doing what is best for pets don’t always correspond with a deep or accurate understanding of what actually is best, at least in the area of healthcare. Her description of National Holistic Pets Day includes all too many of the usual myths and misconceptions and fuzzy thinking that characterize the meaningless buzzword “holistic.” Ms. Paige dedicates this holiday to a companion she lost to cancer, and her description of the experience is both touching and representative of the mixed up thinking behind the idea of holistic medicine:

After the Feb. 2010 death of my fur child Tinkerbelle, from a brain tumor…I began to think about her diet and health regimen and wondered if somehow I could have done better in terms of her health care. I gave her filtered water, fresh filtered air at home and only all-natural food and treats void of corn, wheat, sugar and chemicals.

I didn’t however, give her vitamins and supplements. Could the addition of these have fought against free radicals and other toxins in her body that caused this tumor? Maybe, maybe not, but it made me really uneasy to know that there were other things I could have done that would have at least left me with the surety that I did everything I could.

Already committed to the belief that illness is caused by mysterious “toxins,” despite the lack of evidence for most specific chemical suspected to be harmful and ignoring the role of genes, age, and simple random bad luck, Ms. Paige followed many “holistic,” and completely pointless, guidelines in trying to protect her pet from “this overly toxic world we live in.” When her pet unfortunately developed cancer anyway, did this cast any doubt on the theories or practices she followed? No. Sadly, Ms. Paige was just filled with a vague guilt that she hadn’t kept her pet’s life “pure” enough and was somehow responsible for the cancer. So she rededicated herself to adding still more unproven and largely irrational preventative measures to her pet care routine. If her subsequent companions develop cancer, will she follow the same road even further? And if they don’t, will this constitute “proof” that the new additions worked?

This is an understandable but very dangerous pattern of thought that we are all in danger of succumbing to. We fear pain and illness and loss, naturally, so we try to prevent them and comfort ourselves with the idea that we are in control of our fate, that if we do the “right” things in terms of our physical and spiritual care of ourselves and our loved ones, we can prevent the suffering and pain we fear. But the universe gives little us little reason to believe that our magic rituals really work. The only thing in all the history of humankind, with all the myriad of lifestyle and spiritual practices we have employed, that has ever made a dramatic and unequivocal improvement in the length and quality of our lives has been the development of science, and the growth of true understanding and effective manipulation of the world science has allowed us. Many things are, maddeningly, beyond our control. But magical thinking, however sincere and well-intentioned, is not truly the best way to give our pets the best lives we can.

Other supporters of National Holistic Pets Day go even farther than Ms. Paige in misleading the public with comforting nonsense. This press release (ostensibly from the PetMD web site, though I can find no mention of the holiday on the PetMD site, and it would be a bit inconsistent for this company to promote the myth of holistic medicine since it runs a pet food and pet pharmacy business selling all the “toxins” the holistic crowd) contains the usual clichés from some of the usual sources.

homeopathy can treat the deepest constitutional causes of dog diseases and cat diseases…”While the ‘find it and kill it’ Western medical approach may work for infectious diseases, holistic medicine takes preventative measures by treating the whole body,” says Dr. Nancy Scanlan, executive director of the American Holistic Veterinary Medicine Association (AHVMA). “Holistic veterinary care can be much more effective when treating chronic illnesses like heart disease.”

While I respect Ms. Paige’s motives and efforts to improve the lives of pets in many different ways, it is unfortunate that her misconceptions about medicine have led her to throw those efforts behind the kind of nonsense that only drains energy, talent, and resources away from finding and employing truly effective healthcare for our pets. Many of the pets in the U.S. have too little access to preventative healthcare, or even treatment for illness, due to both economic factors and misconceptions about the need for regular care and the reliability of information found on the Internet. A campaign to raise awareness about the need for veterinary care should focus on those measures that are proven to benefit our pets, and despite Dr. Scanlon’s assurances, this is not the case for so-called holistic medicine. Perhaps we need a National Science-Based Pet Medicine Awareness Day?