"alternative" health practices

Why is "alternative" health care so popular?

The New England Journal of Medicine reported on a study in January 1993 which showed that about one-third of American adults sought some sort of unorthodox therapy during the preceding year. Why is "alternative" health care [AHC] so popular? There are several reasons.

1. Drugs and surgery are not part of AHC. Fear of surgery and of the side effects of drugs alienate many people from scientific medicine. AHC is attractive because it does not offer these frightening types of treatments. Furthermore, scientific medicine often harms patients. AHC treatments are usually inherently less risky and less likely to cause direct harm.

Selective thinking and confirmation bias can easily lead one to focus on cases where surgeons amputate the wrong limb, remove the wrong part of the brain, or kill a patient by administering too much anaesthetic or radiation. Many people ignore the millions of patients who are alive and well today because of surgery or drugs. They focus instead on the cases of patients who die after "routine" surgery, who are permanently disabled because of an adverse reaction to a drug, or who are killed by a deranged nurse acting as a self-appointed "mercy" killer.

This fear and skepticism regarding drug treatment, hospitalization, and surgery is not without foundation. Some harm is caused by malpractice; some is the tragic but inevitable outcome of unpredictable reactions to drugs or surgery. Because there are often legal issues involved, physicians and hospitals are often not forthcoming with details of patient deaths for which they might be responsible. Confidence in medicine erodes with each report of "therapeutic misadventures."

Are these "therapeutic misadventures" rare? As far as I know, there has never been a national study of the issue. There was a study done in New York in 1991 (The Harvard Medical Practice Study) which found that nearly 4 percent of patients were harmed in the hospital and 14 percent of these died, presumably of their hospital-inflicted injuries. Lucian L. Leape, a Boston physician, extrapolated from this data that as many as 180,000 Americans may be dying each year of medical injuries suffered at the hands of medical care providers. He notes, for dramatic effect, that this is the equivalent of three jumbo-jet crashes every two days. ("Truth about human error in hospitals," by Abigail Trafford, editor of the Washington Post's health section, printed in the Sacramento Bee, March 21, 1995, p. B7.)

On the other hand, the risks of being positively harmed by an "alternative" practitioner such as a homeopath, for example, are negligible when compared to the risks of being harmed by a physician dispensing powerful drugs and performing risky surgeries. This is because a homeopath is not intervening in any significant way. The doses they give are not likely to have any effect on anyone. A homeopath is not likely to ever kill a patient by mistake. "Alternative" medical treatments are essentially non-interventionist and their risks are generally negative, not positive. The harm to the patients comes not from positive intervention but from not getting treatment (drugs or surgery) which would improve their health and increase their life span.

While it is true that scientific medicine is not without its risks--even fatal risks--it is unreasonable to reject it altogether on these grounds. Reasonable people can't ignore the diabetics now alive and well, thanks to their drugs, or the millions of people who owe their lives to vaccinations against lethal or crippling diseases. We can't ignore the millions whose pain is gone thanks to surgery, or who owe their continuing existence to successful medical treatment involving both drugs and surgery.

A reasonable response to the very real risks of treatment by health care providers who use up-to-date scientific treatments is to take greater responsibility for one's treatment. A reasonable patient cannot have blind faith in his or her physician, no matter how godlike the doctor may seem or try to present himself. (A very dear friend of mine who lived to be 80 thanks to pills and surgery, found great humor in telling her physicians she knew M.D. stands for "medical divinity.") We have to become more knowledgeable of the drugs prescribed to us. We have to participate more in our own treatment, which means we have to ask lots of questions and assume nothing. We can't assume that the drug the nurse wants us to swallow is the one our physician has prescribed. (Just ask, "What's this pill?" You should know whether you're supposed to take it or not.) We need to seek second and third opinions, which doesn't mean look for another doctor who will tell you what you want to hear. It means do research. Read about your illness and the prescribed treatment for it. We can never eliminate risk altogether when we must depend on human beings, fallible and imperfect as we are. But we can reduce our risk by being more responsible for our health care and being less passive. Some faith in the competence of our health care providers is necessary, but it need not be blind faith. You may have to have surgery to have a limb removed or an artery widened, but you may need to make sure that the surgeon ready to operate doesn't think he's supposed to remove your gall bladder. The young boy who was to have a leg amputated and had written in large ink letters on his good leg "NOT THIS ONE" may have gotten a laugh from the hospital personnel. We can admire the boy's humor, but it is his lack of blind faith that is most admirable to a skeptic. 

2. Scientific medicine often fails to discover the cause of an illness or to relieve pain. This is true of AHC as well. But practitioners of scientific medicine are not as likely to express hopefulness when their medicine fails. "Alternative" practitioners often encourage their patients to be hopeful even when the situation is hopeless. 

3. When scientific medicine does discover the cause of an illness, it often fails to offer treatment that is guaranteed to be successful. Again, AHC offers hope when scientific medicine can't offer a safe and sure cure. A local television news anchor rejected chemotherapy for her breast cancer in favor of Gerson Therapy, a treatment approved of by Prince Charles. Pat Davis followed a rigorous 13-hour-a-day regimen of diet (green vegetables and green juices), exercise, and coffee enemas (four a day) developed by Dr. Max Gerson. Davis’ mother had had breast cancer twice, undergoing chemotherapy and a mastectomy. Davis knew the dangers of chemotherapy and the effects of breast surgery. She refused to accept that there were no alternatives. Gerson therapy gave her hope. When it was clear that the Gerson treatment was ineffective, Davis agreed to undergo chemotherapy. She died four months later on March 20, 1999, at the age of 39, after two and one-half years of fighting her cancer. Could chemotherapy have saved her had she sought the treatment earlier? Maybe. The odds may have been against her, but the slim hope offered by scientific medicine was at least a real hope. The hope offered by Gerson is a false hope through and through.

4.AHC often uses "natural" remedies. Many people believe that what is natural is necessarily better and safer than what is artificial (such as pharmaceuticals). Just because something is natural does not mean that it is good, safe, or healthy. There are many natural substances that are dangerous and harmful. There are also many natural products that are ineffective and of little or no value to one’s health and well-being. 

5. AHC is often less expensive than scientific medicine. This fact has made "alternative" treatments attractive to Health Maintenance Organizations (HMOs) and to insurance companies, both of whom are coming to realize that it is cheaper and thus more profitable to offer "alternative" treatments. If "alternative" therapies were truly alternatives, it would make no sense to pay more for the same quality treatment. However, most so-called "alternative" therapies are not truly alternatives; they are not equally effective treatments. Thus, the fact that they are cheaper is of little significance.

6. AHC is often sanctioned by state governments, which license and regulate "alternative" practices and even protect "alternative" practitioners from attacks by the medical establishment. Chiropractors, for example, won a major restraint-of-trade lawsuit against the American Medical Association in 1987. A federal judge permanently barred the AMA from "hindering the practice of chiropractic." Being government licensed, regulated, and protected is seen as legitimizing AHC. Actually, much of the licensing and regulation is aimed at protecting the public from frauds and quacks. 

7. Many doctors who use scientific medicine treat diseases first and people secondly. Alternative" practitioners are often "holistic," claiming to treat the mind, body and soul of the patient. Many people are attracted to the spiritual and metaphysical connections made by AHC practitioners. Many AHC patients claim that their "healers" treat them as persons and seem to care about them, whereas doctors who use scientific medicine often seem to lack good "bedside manner." The claim that practitioners of scientific medicine are uncaring automatons is not based on empirical study, but it propaganda spread by some members of the alternative health community.

Practitioners of scientific medicine often work out of large hospitals or HMOs and see hundreds or thousands of patients for their specialized needs. "Alternative" therapists, on the other hand, often work out of their homes or small offices or clinics, and see many fewer patients. More important, those who seek help from a practitioner of scientific medicine usually do not care what his or her personal religious, metaphysical, or spiritual beliefs are. Those who seek "alternative" medicine often are attracted to the personality and worldview of their practitioner. For example, a person with diabetes who goes to an endocrinologist probably will not be interested in his or her physician’s belief in chi or any other spiritual or metaphysical notions. Whether the doctor believes in a god or the soul is irrelevant. What matters is the doctor’s knowledge and experience with the disease. If the doctor is kind and personable, that is all the better. A cold and indifferent "alternative" practitioner would not have much business. A cold and indifferent practitioner of scientific medicine may have patients standing in line for treatment if he or she is an excellent physician.

8.Many people apparently do not understand that scientific medicine has the same shortcomings as all other forms of human knowledge: it is fallible. It also is correctable. Systems of thought that are fundamentally metaphysical in nature are not testable and can therefore never be proven incorrect. Hence, once they get established they tend to become dogmatically adhered to and never change. The only way to change dogma is to become a heretic and set up your own counter-dogma. When scientific medicine errs, it errs in ways that can be corrected. Treatments and practices that are ineffective or harmful are eventually rejected.

"Alternative" practices and treatments are often based upon faith and belief in metaphysical entities such as chi and lend themselves to ad hoc hypotheses to explain away failure or ineffectiveness. In scientific medicine there will be disagreement and controversy, error and argument, testing and more testing, etc. Decisions will be made by fallible human beings engaging in the fallible practice of scientific medicine. Some of those decisions will be bad decisions, but in time they will be discovered for what they are and treatments which were once standard will be rejected and replaced with other treatments. Medicine will grow, it will progress, it will change dramatically. Homeopathy, iridology, reflexology, aromatherapy, therapeutic touch, etc. will not change in any fundamental ways over the years. Their practitioners do not challenge each other, as scientific medicine requires. Instead, "alternative" practitioners generally do little more than reinforce each other. 

9. "Alternative" therapies appeal to magical thinking. Ideas with little scientific backing, such as those of sympathetic magic, are popular among "alternative" practitioners and their clients. Scientific medicine is rejected by some simply because it is not magical. While scientific medicine may sometimes seem to work miracles, the miracles of modern medicine are based on science not faith. 

10. The main reason people seek "alternative" health care, however, is that they think it "works." That is, they feel better, healthier, more vital, etc., after the treatment. Those who say "alternative" medicine "works" usually mean little more than that they are satisfied customers. For many AHC practitioners, having satisfied customers is all the proof they need that they are true healers. In most cases, however, a person's condition would have improved had he or she done nothing at all. But since the improvement came after the treatment, it is believed that the improvement must have been caused by the treatment (the post hoc fallacy and the regressive fallacy). In many cases, the successful treatment is due to nothing more than the placebo effect. In some cases, treatment by scientific medicine is very painful or it causes more harm than good and the improvement one feels is due to stopping the science-based treatment rather than to starting the "alternative" one. (One reason spirit healers in pre-modern medicine times may have had better success rates on the battlefield than non-spirit healers is due to the fact that the non-spirit healers often harmed their patients: e.g., infecting them by touching them during treatment. Spirit healers, who did nothing to the wound, didn't infect the patient, who often healed thanks to the body's own internal healing mechanisms.)

In many cases, the cure was actually effected by the scientific medicine taken along with the "alternative" therapy, but the credit is given to the "alternative." Also, many so-called cures are not really cures at all in any objective sense. The patient may have been misdiagnosed in the first place, so no cure actually took place.ⁿ Also, a patient subjectively reports that he or she "feels better" and that is taken as proof that the therapy is working. Psychological effects of therapies are not identical to objective improvements, however. A person may feel much worse but actually be getting much better. Conversely, a person may feel much better but actually be getting much worse.

11. Finally, many advocates of "alternative" therapies refuse to admit failure. When comedian Pat Paulsen died while receiving "alternative" cancer therapy in Tijuana, Mexico, his daughter did not accept that the therapy was useless. Rather, she believed that the only reason her father died was because he had not sought the "alternative" therapy sooner. Such faith is common among those who are desperate and vulnerable, common traits among those who seek "alternative" therapies.

Another reason so-called alternative medicine (or CAM, as it is now mostly referred to) is popular may be that such things as dieting, exercising, meditating, and praying are considered "medicine" or "therapy" by agencies such as the NCCIH.

It is difficult to find good quality objective data on the popularity of particular CAM interventions, and many of the surveys that have been done are potentially misleading. For example, the 2007 CDC National Health Interview Survey (NHIS) is widely cited as showing that about 30% of Americans use CAM therapies. A careful look at the details of this survey, however, shows that many of the supposed CAM therapies are really relaxation or exercise practices, such as massage and yoga, not medical therapies. Chiropractic is the only medical therapy generally classified as alternative that was used by more than 10% of people in the survey. And that was primarily for idiopathic lower back pain, an indication for which it is generally accepted, even by skeptics such as myself, as having some demonstrated benefit, about equal to standard medical interventions. These usage numbers haven’t changed in decades, which belies the notion that CAM is growing in popularity.

Similarly, much was made by the media of a recent CDC survey that supposedly showed widespread use of CAM therapies in hospice care facilities. A close analysis of this survey also shows that most of the therapies listed are not truly alternative medical interventions and that fewer than half the facilities surveyed offered true CAM therapies, and fewer than 10% of patients in those facilities actually employed the CAM practices offered.*

For example, only 6.5% of Americans reported ever using acupuncture in the 2007 survey.

The fact is that CAM is not that popular: most American adults don’t use acupuncture, energy healing therapy, reiki, naturopathy, Qi gong, Tai chi, or homeopathy. NCCIH exaggerates the popularity of CAM to validate not only the various modalities it lists, but to validate its own existence. The fact that nothing worthwhile has issued from NCCIH despite the 2.5 billion tax dollars it has spent in its more than two decades of existence might make a citizen question the continued funding of the agency. The fact is that CAM modalities do not become validated by how many people use them, but by whether they have been shown to have a prositive effect on health that is superior to doing nothing or to placebo effects.*

See Topical index for entries on numerous "alternative" health practices.

See also acupuncture, chiropractic, energy healing, homeopathy, integrative oncology, multiple chemical sensitivity, naturopathy, natural cancer cures, the placebo effect, and traditional Chinese medicine.

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   ⁿA study by researchers at the Johns Hopkins Hospital in Baltimore of 6,000 patients diagnosed with cancer found that one out of every 71 cases was misdiagnosed (a 1.4% error rate). See "Misdiagnosing Cancer" by John McKenzie, May 9, 2001, ABCNews.com.

reader comments

further reading

I have written several articles and short pieces about alternative-health related topics. The following is a list of those I think are most relevant to the article above.

Evaluating Personal Experience

Energy Healing: Looking in All the Wrong Places

Evaluating Acupuncture Studies: Laughable vs. Dangerous Delusions

The trouble with acupuncture, homeopathy, etc.

Sticking Needles into Acupuncture Studies

How safe are alternative therapies?

Oprah and Oz spreading superstition at the speed of night

Ancient Wisdom

Prescribing Placebos

Mesmerized by hypnotherapy

Statistics and Medical Studies

Review of R. Barker Bausell's Snake Oil Science: The Truth about Complementary and Alternative Medicine

Bunk 7 - Needles and Nerves

Acupuncture shown NOT to ease back and neck pain after surgery

cosmetic acupuncture

Medical Suburban Myths (from the Suburban Myths Page

Myth 2. Prescription drugs are one of the leading causes of death.

Myth 3. Most medical treatments have never been clinically tested.

Myth 19. Medical doctors typically know nothing about nutrition.

Myth 21. Faith healing works.*

Myth 22. Dr. Randolph Byrd scientifically proved that prayer can heal.

Myth 23. Even if Dr. Byrd failed, others have succeeded in proving scientifically that prayer heals.

Myth 25. Transplant organs carry personality traits which are transferred from donors to receivers.

Myth 31. Crimes, mental illness, suicides, and emergency room visits increase when there is a full moon.

Myth 43. Suicide increases over the holidays.

Myth 46. Switching to a low-tar, low-nicotine cigarette will reduce one's chances of being exposed to the carcinogens in cigarette smoke.

Myth 47. Vaccination* of children with the (MMR) vaccine to prevent measles, mumps and rubella causes autism.*

Myth 53. Sugar causes hyperactivity in children.

Myth 54. Alcohol, especially red wine, is good for your health.*(read this one carefully and to the end) and *

Myth 55. A migraine is just a bad headache and not life-threatening.*

Myth 58. The moon can trigger ovulation and bring on fertility  depending on what phase the moon was at when you were born.

Myth 59. The mercury in dental amalgam is poisoning people.*

Myth 60. You should drink eight glasses of water a day for good health.* One study, however, does seem to have good evidence that drinking five glasses a day is better than drinking two or fewer with respect to fatal coronary heart disease.

Myth 71. A diet low in animal fat will prevent high cholesterol which will prevent atherosclerosis which will make you immune to having a heart attack.

Myth 72. Pasteur renounced all his works on his death bed.

Myth 73. Laetrile is an effective cancer treatment whose humanitarian discoverer has been persecuted, depriving millions of people of the benefits of this wonder drug.

Myth 74. Peptic ulcers are caused by stress and eating spicy food.*

Myth 83. A study was published in the Western Journal of Medicine that showed changing the letters EPHO (each letter representing a drug being used to treat small-cell lung cancer) to HOPE led to a spectacular increase in positive response to the treatment.

Myths 86-89, thanks to the British Medical Journal:

Myth 86. There are several effective cures for a hangover.

Myth 87. People who eat late at night gain more weight than those who eat the same amount of food earlier in the day.

Myth 88. More heat escapes from the head than any other part of the body.

Myth 89. Poinsettias are poisonous.

Myth 92. Fruit must be eaten on an empty stomach in order for the body to absorb it properly.

Myth 93. Drinking cold water after meals causes cancer.

books and articles

Barrett, Stephen and William T. Jarvis. eds. The Health Robbers: A Close Look at Quackery in America, (Amherst, N.Y.: Prometheus Books, 1993).

Bausell, R. Barker. (2007). Snake Oil Science: The Truth about Complementary and Alternative Medicine. Oxford University Press.

Ernst, Edzard MD PhD, Max H. Pittler MD PHD , Barbara Wider MA. 2006. The Desktop Guide to Complementary and Alternative Medicine: An Evidence-Based Approach. 2nd ed. Mosby.

Fraser, Muriel. 2014. Hitler's Contribution to "Alternative Medicine"

Gardner, Martin. Fads and Fallacies in the Name of Science (New York: Dover Publications, Inc., 1957).

Gardner, Martin. "Water With Memory? The Dilution Affair," in The Hundredth Monkey, ed. Kendrick Frazier (Buffalo, N.Y.: Prometheus Books, 1991), pp. 364-371.

Park, Robert L. Voodoo Science: The Road from Foolishness to Fraud (Oxford U. Press, 2000).

Randi, James. The Faith Healers (Amherst, N.Y.: Prometheus Books).

Raso, Jack. "Alternative" Healthcare: A Comprehensive Guide (Amherst, NY: Prometheus Books, 1994).

Raso, Jack. "Mystical Medical Alternativism," Skeptical Inquirer, Sept/Oct 1995.

Sampson, Wallace and Lewis Vaughn, editors. Science Meets Alternative Medicine: What the Evidence Says About Unconventional Treatments  (Prometheus Books, 2000).

Shapiro, Rose. 2008. Suckers: How Alternative Medicine Makes Fools of Us All. Random House 

Singh, Simon and Edzard Ernst. 2008. Trick or Treatment: The Undeniable Facts about Alternative Medicine. W. W. Norton.

Stalker, Douglas. 1995. Evidence and alternative medicine. Mt. Sinai Journal of Medicine.

Why the National Center for Complementary and Alternative Medicine (NCCIH) Should Be Defunded by Wallace I. Sampson, M.D.

Too many quacks in alternative medicine By Michael Bradley May 31, 2004

Social and judgmental biases that make inert treatments seem to work by Barry L. Beyerstein (1999)

Why Bogus Therapies Often Seem to Work by Barry L. Beyerstein, Ph.D.

Glucosamine for Arthritis: The Evidence Is Conflicting by Stephen Barrett, M.D.

websites

The Scientific Review of Alternative Medicine

Who Gets to Validate Alternative Medicine?

QuackWatch - Dr. Stephen Barrett

A Special Message for Cancer Patients Seeking "Alternative" Treatments by Dr. Stephen Barrett

How Quackery Harms Cancer Patients by William T. Jarvis, Ph.D.

Quackwatch's Index of Questionable Treatments

The National Council Against Health Fraud - Resource Documents

DC's IMPROBABLE SCIENCE page - Professor David Colquhoun, FRS

Chirobase (on chiropractic)

Alternative Medicine and the Laws of Physics by Robert L. Park

FTC: 'Miracle' Health Claims

Mystical Medical Alternativism by Jack Raso

The Quackery Index by Dave W.

colloidal mineral supplements

colloidal silver

live blood cell analysis

oxygenated water

St. John's Wort

News stories

Scientists urge unis to axe alternative medicine courses In Australia, more than 400 doctors, medical researchers and scientists have formed a powerful lobby group to pressure universities to close down alternative medicine degrees.

Almost one in three Australian universities now offer courses in some form of alternative therapy or complementary medicine, including traditional Chinese herbal medicine, chiropractics, homeopathy, naturopathy, reflexology and aromatherapy. But the new group, Friends of Science in Medicine, wrote to vice-chancellors this week, warning that by giving "undeserved credibility to what in many cases would be better described as quackery" and by "failing to champion evidence-based science and medicine," the universities are trashing their reputation as bastions of scientific rigor.

$2.5 billion spent, no alternative cures found (Big, government-funded studies show alternative health treatments work no better than placebos. "It's the fox guarding the chicken coop," said Dr. Joseph Jacobs...."This is not science, it's ideology on the part of the advocates." The National Center for Complementary and Alternative Medicine (NCCAM), formerly the Office of Alternative Medicine (OAM), is a division of the National Institutes of Health (NIH). It's now called the National Center for Complementary and Integrative Health. "The center was given $50 million in 1999 (its budget was $122 million last year) and ordered to research unconventional therapies and nostrums that Americans were using to see which ones had merit. That is opposite how other National Institutes of Health agencies work, where scientific evidence or at least plausibility is required to justify studies, and treatments go into wide use after there is evidence they work — not before.")

'Quack' degrees will damage our university say academics

Alternative medical degrees anti-scientific

New Respect Between East, West

UK universities are teaching "gobbledygook" following the explosion in science degrees in complementary medicine

Consumer Group Labels White House Panel's Proposals "Irrational" and "Contrived" NCAHF News Release

blogs

Are more physicians really prescribing CAM? from Respectful Insolence by Orac
CAM appears to be more popular than it really is by including such things as yoga, meditation, and breathing exercises as "alternative" medicine. These are no more "alternative" than back-stretching exercises are "alternative" medicine. Here's an example: http://www.newswise.com/articles/health-care-providers-are-prescribing-nontraditional-medicine

More from the endless suppliers of bogus remedies in the Asian "medical" tradition: 1) vaginal mugwort tea steam bath, 2) vaginal tea tree oil douche, and 2) elk antler velvet. For more on the antler velvet see Swift.

CAM and the Law, Part 1: Introduction to the issues When I write or talk about the scientific evidence against particular alternative medical approaches, I am frequently asked the question, “So, if it doesn’t work, why is it legal?” Believers in CAM ask this to show that there must be something to what they are promoting or, presumably, the government wouldn’t let them sell it.

CAM and the Law Part 2: Licensure and Scope of Practice Laws My goal here is to highlight a few of the ways in which licensure and scope of practice laws intersect the practice of CAM and give a few representative examples.

CAM and the Law Part 3: Malpractice ...malpractice laws apply to alternative medicine practices in ways that are broadly similar, but sometimes subtly and significantly different, from how they apply to scientific medicine. 

Uff Da! The Mayo Clinic Shills for Snake Oil by Kimball Atwood "What’s most noticeable about the tone of the book is it’s ponderous, ditzy blandness (if there is any hope that woo-philic readers will tire when they finally realize that they are being treated like small children, this book will be invaluable). Such blandness, of course, is common to apologetic, quackademic expositions. So are the misleading language devices mentioned above (and more: chiropractic becomes “chiropractic care”; homeopathy becomes “homeopathic medicine,” which “seeks to stimulate the body’s ability to heal itself by giving small doses of highly diluted substances [that] are derived from natural substances,” and so forth)."

Longing for a past that never existed "There once was a time when all food was organic and no pesticides were used....Advocates of alternative health have a romanticized and completely unrealistic notion of purported benefits of a “natural” lifestyle. Far from being a paradise, it was hell."

Last updated 16-Dec-2015