Alternative medicine - alternative views

So-called cures for which no scientific evidence exists are not only useless but can be dangerous, says Dr Brian Hughes, senior lecturer in psychology at NUI Galway

Last year saw the death from cancer of Steve Jobs, the entrepreneur who brought us the iPhone, a visionary credited with enhancing the lives of millions through insight and intellectual brilliance. Nonetheless, although acclaimed as a technological sophisticate, Jobs had a proclivity for the esoteric.

When diagnosed with pancreatic cancer, he chose to eschew ordinary medicine and instead turned to complementary and alternative medicine. His therapies included dietary treatments, ‘hydrotherapy', acupuncture, naturopathy and even the occasional visit to a psychic.

Many pancreatic cancers are aggressive. Ironically, Jobs had a rare form (an islet cell neuroendocrine tumour) for which ordinary medical treatments offer excellent survival rates. But by initially confining himself to complementary medicine, he did not see much benefit.

Instead, his tumour progressed inexorably to dangerous levels. He then had a poignant change of heart and underwent radical mainstream treatment, including pancreatoduodenectomy and a liver transplant. But it was too late. He died in October 2011, aged 56.

Steve Jobs was by no means the first famous figure to find complementary medicine a poor substitute for ordinary medicine. Readers might remember Peter Sellers, the British actor made famous as Inspector Clouseau in the Pink Panther movies.

At the age of 40, Sellers suffered a myocardial infarction that permanently damaged his heart. Ignoring advice to undergo bypass surgery, he instead visited 'psychic' surgeons on a regular basis. He died in 1980, aged 54, all too predictably from a massive heart attack.

Or how about Barry Sheene? A World Champion motorcycle racer, Sheene was a boyhood hero of mine. Watching him angle his way at high speeds through dangerous bends, I felt he could defy death itself. Indeed, one of his claims to fame was having recovered so quickly from a bone-shattering crash in Daytona as to be back racing within seven weeks. In later life, Sheene was diagnosed with throat and stomach cancer.

But he rejected chemotherapy. "I believe I can beat this thing with natural therapy," he insisted. He was dead within months.

Complementary medicine uptake is not confined to celebrities. While statistics vary, consumer organisations and public health bodies advise that a very large portion of society, perhaps even the majority, have at one time or another turned to complementary medicine. Usually, such treatments are marketed as being ‘safe' or ‘organic' or ‘pure', but in reality a very simple principle applies to all therapeutic endeavours.

Any treatment that purports to change the functioning of the human body will certainly carry some risk of adverse side-effects; if a procedure genuinely has no side-effects at all it will be because it is doing nothing to change any element of how your body is affected by illness.

In the main, consumers (and sometimes medical professionals) believe that at least some complementary medicine therapies have been shown to be efficacious.

However, this is not the case. For most of these treatments, research on efficacy is practically non-existent, while for the more common approaches (such as acupuncture, chiropractic and homoeopathy) the jury is still very much out.

Indeed, this is what makes such treatments ‘complementary' or ‘alternative' in the first place: despite thousands of published studies, there is still no firm biological evidence to support their claims to be ‘medicinal' in the mainstream sense of the term.

Obviously, complementary medicine is extremely dangerous if it discourages people with life-threatening illnesses from receiving proper treatment.

As well as celebrity cases, coroners have dealt with a multitude of ordinary citizens who have met similarly tragic ends. I think even the most ardent complementary medicine proponent would agree that advocating these treatments for terminal illness is both reckless and immoral (but nonetheless, it continues to happen).
But what's so wrong about recommending complementary medicine for minor illnesses or symptoms, or as a fall-back for when ordinary medicine has no effective solution (such as in many cases of chronic pain)?

Well, apart from wasting money and time, and raising false hopes for a ‘cure', the widespread pushing of complementary medicine is akin to the active promotion of scientific illiteracy and the nullification of consumer scepticism. And this certainly does come with costs, what some social scientists call ‘the costs of misinformation'.

These treatments have failed their scientific road-tests. When proponents tell consumers that this doesn't matter, they are indirectly encouraging people to be suspicious of evidence-based arguments of all kinds. It is little different from urging citizens to reject the evidentiary case on climate change or the historical evidence for the Holocaust.

Commentators sometimes accuse science and scientists of ‘arrogance'. However, I can think of few claims more arrogant than that of complementary medicine proponents who assert that their particular experiences, anecdotes and personal judgements are more valuable than information that is accumulated objectively.
If evidence doesn't matter, then what does?

Patients should not be denied the benefits of complementary therapies just because imperfect scientific methods have yet to validate their worth, says, says Dr Brendan Fitzpatrick, Slievemore Clinic, Dublin

Stockholm, October 2005: Marshall and Warren, two Australian researchers, receive the Nobel Prize in Medicine for their discovery in 1983 that ulcers are caused by bacteria.

The citation states: "With tenacity and a prepared mind they challenged prevailing dogma when stress and lifestyle were considered the main factors in this disease." The prize winners stated that "nobody believed us for 10 years" and the President of the American Gastroenterology Society admitted that "I thought they were crazy" at the time. This illustrates the time lapse between research discovery and acceptance of a new treatment.

While I am first and foremost a conventional medical doctor (with MRCPI and postgraduate diplomas in paediatrics, obstetrics and dermatology), I have had a special interest in complementary medicine for 25 years.

It has survived and even thrived despite vigorous opposition from many quarters. It is an easy target for criticism as the scientific rationale for complementary medicine is often hard to explain by any conventional medical or scientific thinking. However, I believe blanket condemnation by critics of all aspects undermines some valid objections. Generalisations are misleading in that it comprises more than a hundred treatment forms with many differences in beliefs and practices.

As a profession, we should recognise that for all our scientific knowledge and labelling of disease, we do not know the fundamental cause of most illnesses which are often multi-factorial, ie. a combination of genetic, infection, allergy, diet, lifestyle and unknown factors. The practice of medicine is not as scientific as we would like to believe.

Prescribing rates of drugs, eg. antibiotics for respiratory infections, and operation rates vary widely between practitioners both in Ireland and overseas. The effectiveness of some physiotherapy treatments remains uncertain.

As a psychiatric registrar in the distant past, diagnosis in psychiatry/psychology is often imprecise. The relative effectiveness of different treatment forms remains unproven and treatment is often empirical. Studies of antidepressants show only a modest benefit, ie. only 5-10% over placebo.

It is ironic that people within many medical disciplines often criticise complementary medicine for not meeting a standard of proof which is not present in their own practices.

In reality, illness does not always present in the tidy forms shown in medical textbooks. Patients often present with multiple symptoms, eg. tiredness, irritable bowel, joint pains, sinus, bladder or hormonal symptoms.

Providing appropriate investigations are normal, the patient is assured that there is nothing ‘seriously wrong' and local treatment may be prescribed for each individual symptom.

Complementary medicine has taught me that many of these symptoms can be linked and that, in general, parts of the body should not be considered in isolation.

As well as many chronic medical conditions, these multiple-symptom patients are often helped with appropriate complementary approaches including allergy management, acupuncture, nutritional supplements and herbal medicines. For all the benefits of specialisation, the overall picture can be lost, and most specialists have a diminishing level of interest in symptoms outside their particular area.

Over time, practices commonly used in complementary medicine for many years gradually become accepted by the medical profession, eg. fish oils, probiotics, acupuncture and the role of food intolerance/sensitivity, which has been largely disregarded by the medical profession and over-diagnosed within complementary medicine.
Last year, I attended a paediatric allergy and gastroenterology meeting in the UK.

Gastroenterologists are finally be-ginning to accept that many paediatric patients with GIT problems, eg. reflux and enterocolitis, are related to milk allergy/intolerance. Ironically, I and many others have been using trial elimination of dairy diets for many years in these conditions when medical consultants were adamant that diet was not involved.

Delayed diagnosis works both ways and I regularly meet patients angry that they were deprived of successful treatments in complementary medicine by cynical health professionals leading to needless suffering. I would not advocate an ‘everything goes' policy, but critics should acknowledge that it is difficult to strike a balance between the need for a patient to find an answer to their present suffering and science's need for absolute proof.

Proving complementary medicine can be genuinely difficult, eg. treatment of IBS may involve elimination diets, probiotics, stress management and acupuncture.

I have seen medical practitioners who were strongly opposed to complementary medicine in principle seek its help when they or their family have problems which conventional medicine cannot solve. In general, side-effects compare favourably to conventional medicine as is reflected in very low insurance premiums.

It is estimated that anti-inflammatory medication contributes to the deaths of 2,000 people annually in the UK and a considerable minority of hospital admissions are related to drugs' side-effects.

In summary, healing is very complex, but I strongly believe, despite all its well publicised problems, cautious and selective use of complementary medicine can be of significant benefit to many patients, used either alone or in conjunction with conventional medicine.

This article also appears in Modern Medicine, published by MedMedia, which also publishes

You can view Brian Hughes'  blog here


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