Alternative Medicine vs Evidence-Based

Alternative medicine is no small issue. Surveys note that Americans spend billions on alternative medicine yearly. How can we tell if a product or treatment statement is true? Let the buyer beware, the old Latin proverb goes. A Yale physician stated there is no such thing as alternative medicine — something is either proven to work or it isn’t. Marketing with detailed assertions and a few testimonials of satisfied clients is often presented as evidence, but that falls short. Claims must have reliable, repeatable proof.

Evidence-based proof is expensive. What we call randomized, placebo-controlled, double-blind clinical trials (aka randomized controlled studies) are both the gold standard of medical evidence and required by the FDA for approval of new drugs. Research and well-designed studies are spendy and time consuming. It is noted that for every thousand new chemicals developed or studied, only one will go on to become a useful medicine that goes to market. Thus it is estimated that it actually ends up costing nearly one billion dollars to get a new medicine FDA approved and brought to the public.

It is a fair criticism to point out that lots of things we doctors do medically are not all as evidence-based as we like to think. That is why there has been such a push in the medical community to provide evidence-based information and treatments to patients and make clear what is not and why. There are plenty of problems out there for which we physicians don’t even have solid diagnosis, let alone proven treatments. That is very frustrating for both the doctor and the suffering patient. We don’t like having to tell patients that we really don’t yet have anything proven to be helpful for their problem. However, it is precisely these people who need to be the most wary of being sold a false hope, because they the most vulnerable.

Many maladies have vague and overlapping symptoms. Fatigue is found in many conditions. However, simply being fatigued does not necessarily mean one has a disease, let alone a serious one. Yet many sales pitches start with asking if we all have some vague, common symptom and then promise to have the sure fire fix for the awful illness presumably behind it.

Beware of overly broad statements. There is no one thing that causes all diseases, let alone most of them — neither “free radicals,” “toxins,” vitamin deficiencies, magnetic field imbalances, microbes, nor anything else (except sin).

Beware of broad categories in a presentation such as “toxins”, “free radicals”, “vitamin deficiencies” and such, as well as terms like health, wellness, technology, highest quality, purity, immune boosting, and cleansing, among others, which create an aura of credibility without actually proving anything. For example, saying this “highest quality product is shown to cleanse your body of toxins known to cause many diseases” sounds very impressive and appealing, but it doesn’t make it true or proven. Furthermore, cells in our bodies replace themselves often, so be suspicious of products claiming, for example, to cleanse or detoxify us of items that supposedly sit in our colons for years.

Beware of the allegedly entirely good product, and panaceas (cure alls) in general, fixing the allegedly entirely bad item . Just because something can cause problems does not mean that it doesn’t also have positive functions in the body. Just because some additional vitamins are proven to be helpful in some cases does not mean one cannot overdose on the same vitamins without potentially harmful effects. Overdoses of certain vitamins can actually cause cancers and worsen several illnesses. Immune boosting in patients with autoimmune diseases is actually harmful. Remember the maxim about moderation in all things. God’s creation is far more complex than even the most learned know.

Beware of presentations and conspiracy theories that try separating you from trained professionals. The only reason to drive a wedge between you and your doctor, dentist, pastor, or such is to isolate you from contradictory data that a trained professional is likely to have. Know when you are being made to distrust.

A particularly troubling use of complementary-alternative medicine is when it delays the early diagnosis and evidence-based treatment of serious diseases. It is precisely early intervention that grants much of the superiority of modern medical care. To wait until an alternative approach seems to be inadequate before consulting a physician can be a lethal mistake.

Beware of those who would try to prove their claims by using medical equipment/devices which are either not FDA approved or which are indeed FDA approved but not for the use in question.

Beware of doctors or other medical providers who sell things in their offices. It might seem handy that your provider markets vitamins, supplements, equipment, medications or such thereby saving you a trip elsewhere, but several medical organizations actually consider this a conflict of interest and advise against it.

Beware of being rushed. If we have to buy now, we should walk away.

Children are at risk with complementary-alternative medicine (CAM). Physiologically and in other ways, they are not just small adults. Medications, herbs, and vitamins known to be safe in adults can harm or kill a child. The proper dosages of herbs and herbal compounds for children are often still unknown. Massage and acupressure are deemed safe in children, as they do not affect chemistry or risk physical injury. The point is to think twice before subjecting children to CAM, especially if it delays proper medical care.

The question one must keep in mind regarding any medicine, herb, vitamin, technique or therapy is whether or not it has been repeatedly shown to work and be of more help than harm, i.e. is it proven safe and effective? It is not necessary to know exactly how and why something works to meet this level of proof. On the other hand, the fact that something is ancient does mean it is proven, it just might have been all that was available or culturally ingrained.

That’s a quick take on evidence-based medicine and how to keep from being mislead. For details on specific practices, Alternative Medicine: The Christian Handbook by Donal O’Mathuna, Ph.D. & Walt Larimore, M.D. (Zondervan, 2006) is a good reference, as is Professional’s Handbook of Complementary & Alternative Medicines by Charles Fetrow, PharmD and Juan Avila, PharmD. The web site QuackWatch is also helpful.