Alternative medicine

Alternative medicine is any medical treatment that is not part of conventional evidence-based medicine, such as one would learn in medical school, nursing school or even paramedic training. Much, if not most, of the "alternative medicine" world lacks any scientific proof of its effectiveness, and that which does have real effectiveness, tends to be palliative[note 1] rather than curative. Any alternative medicine with scientific evidence behind it is simply called medicine.

Against allopathy
Alternative medicine
Clinically unproven
v - t - e
“”"By definition", I begin
"Alternative Medicine", I continue
"Has either not been proved to work,
Or been proved not to work.

You know what they call alternative medicine
That’s been proved to work?

Medicine."
—Tim Minchin, Storm[1]

The term "alternative medicine" is also a politically correct term for medical marijuana.

Alternative medicine includes "traditional medicines" (i.e. "medical" systems developed prior to or outside of "Western Medicine", such as traditional Native American remedies, or traditional Chinese medicine), "folk remedies" (e.g., herbalism, tinctures, and rubs that were commonplace "treatments" often passed around via urban legend), and an ever-growing class of "religious" or "spiritual" treatments that have their sources in Eastern religions, but are filtered through a pay-as-you-go, for-profit (see "New Age") mindset. These terms are still used today to describe the various substances of unclear efficacy sold for a profit through advertising. These cures are not always sold by malicious, deceptive con men. Many promoters are true believers, making their claims even more convincing.

And if you don't think it's real, or don't think people who have funding to spend notice it, the National Center for Complementary and Alternative Medicine is run by the National Institute of Health.[2]

Rebrandings
They go up and down — holistically, of course![3]
“”Alternative medicine people call themselves "holistic" and say it's the "whole" approach. Well, if it's the whole approach, let it be the mind as well. Use logic, use sense, use the incredible five wits you were given by creation.
—Stephen Fry[4]

The rebranding of alternative medicine is analogous to the endless rebranding of creationism to try to evade the First Amendment, or the renaming of racialism to try and avoid the status of "racist". The original term, alternative medicine, was trivially unmasked as alternatives to medicine, and emphasized its being outside of scientific medical practice. There are many legitimate complementary therapies such as massage, counselling and so on, and by claiming to be part of this, rather than acknowledging its status as being apart from medicine, these rebrandings hope to gain a halo effect and imply a legitimate place in medical practice. The purpose is to gain greater acceptance, and hopefully funding, for pseudomedicine - a stalking horse for woo.[5]

  • CM (Complementary medicine) "is a term used for a wide variety of health care practices that may be used along with standard medical treatment";[6] as Stephen Barrett puts it, "several years ago a survey done in New Zealand found that most cancer patients who used 'alternative' therapies were satisfied with their medical care and regarded 'alternative' care only as a supplement",[7] that is, all alternative "medicine" is actually "complementary" to the real medicine.

  • CAM (Complementary and Alternative Medicine) denotes a philosophical dumping ground for all medical approaches that have been rejected by science. Like alternative medicine before it, CAM has now become so debased as a term that it has been rebranded yet again:

  • IM (Integrative medicine) is the practice of supplementing medicine which works with pseudomedicine that doesn't. The general justification is that patients will like it more. The fatuity of this idea can be readily understood by considering the effect of "integrating" apple pie with cow pie. Does this make the apple pie taste better or worse? What's the harm?

  • HM (Holistic Medicine) is ostensibly the belief that medical practitioners should look at the "whole person" when treating a patient, meaning that the doctor should not just diagnose and treat the illness, but also consider the patient's lifestyle, stress levels, emotional situation, and other factors that could be of relevance for the person's health, as well as treat the patient with respect, rather than just dismissively diagnosing them and giving them some pills. This is a perfectly good and desirable concept. However, in practice, if a practitioner calls themself "holistic", it almost always means that they believe in woo. They also very often summarize the holistic approach in the phrase "treat the patient, not the disease" — this is actually a pretty accurate assessment, given that alternative treatments generally don't affect the disease anyway. One site states that holistic medicine "encompasses all stated modalities of diagnosis and treatment including drugs and surgery if no safe alternative exists."[8] The claim is that "holistic" means they look at the entirety of the situation, not a mere mechanical model of treatment, which is why you can buy holistic tartar control treats for your dog off-the-shelf at a supermarket. The term is ironic: medicine supposedly is not, since doctors routinely treat melanoma patients with band-aid to cover their bleeding moles, for example, rather than actually looking at medical history.Do You Believe That?

Alternate names

Critics of alternative medicine have come up with some of their own terms for it:

  • Patent Medicine
  • Quackademic Medicine[9]
  • Academic Medical Woo[9]
  • SCAM (Supplementary, Complementary and Alternative Medicine)
  • Snake oil
  • Functional medicine

Problems with alternative medicines

False hope and zero-sum medicine

Often holistic healers will convince their patients to forgo proper medical care, usually combined with misrepresentations of studies or emotional appeals, to undergo holistic therapies. Since there is no valid evidence that holistic therapies are capable of curing deadly ailments, this kind of malpractice is dangerous to offer patients.

All alternative medicine, even the "effective" therapies, have the danger of convincing an unwell person to forgo actual medical treatments because they think they are getting better (which can happen with palliative remedies and placebos) or they choose to trust their alternative practitioner who is offering a "cure". For example, a person with cancer may convince themself to try a homeopathic remedy. Also, many herbal remedies can actually interfere with prescription drugs, lessening their effect or even causing dangerous side effects. Since almost all alternative medicines are unproven, many advocates (known to some as "alties") tend to appeal to "health freedom", rather than actually try to prove that their nostrums work. Expensive homeopathic remedies sold at whole foods supposedly contain tiny bits of the molecules of the illnesses they are supposed to cure intended to promote the immune system of the user to fight whatever it is that the medicine is supposed to fight. In reality, they are tasty bits of sugar.

Many practitioners exploit vulnerable patients. They give false hope to people who are incurably sick and frequently charge high prices for useless treatments. The belief that alternative medicines are somehow "less risky" or "less harsh" than conventional medicine has led some to take alternative medicine over conventional actual medicine. While this may often be true (though don't say that to someone who's lost skin or body parts to black salves sometimes used for skin cancers), the potential health risks of not taking conventional medicine for an illness far outweigh the risks from the side effects of these medicines.

Anecdotal evidence and regression to the mean
See the main articles on this topic: Anecdotal evidence and Regression to the mean
“”Alternative medicine is a trick of the mind. You want it to work, so you believe it does. The bullshitter gives patients lots of attention — and attention makes us all feel better.
—Penn Jillette, Penn & Teller: Bullshit![10]

Often, alternative medicine practitioners claim that, unlike "allopathy", they help the body's natural self-healing powers. Yet many of them will describe anecdote after anecdote showcasing medical recoveries (involving such transitory things as colds) while seemingly refusing to believe that the disease could ever have gone away on its own. These recoveries must be due to whatever remedy they used. So on the one hand, they extol the healing powers of the human body, while at the same time denying that illnesses could ever go away by themselves – or in other words, that the body could actually heal itself.

Lack of testing

Alternative medicines or therapies range from being scientifically provable to scientifically disproven, and can be benign (and often ridiculous) all the way to downright dangerous. Medical science has only recently started to do quality and quantity research into alternative medicine. With the exception of some surprising and exciting treatments that have true medical potential, the vast majority of the therapies do little if anything beyond the placebo effect. Even when the treatment actually does something, the reasons given by practitioners for why the treatment is effective are almost never based on correct scientific information. Benign treatments have the advantage of not directly injuring a patient, other than money and at worst precious time going out the window. The ridiculous cannot possibly have any medical effects (beyond that of the placebo effect at best), or may be actively dangerous to the patient.

Unfalsifiability
See the main article on this topic: Falsifiability
“”Whenever you see the word "holistic" being applied to a medical issue or treatment, nine times out of ten you’ll get the true correct meaning by substituting the word "quackery".
—Orac[11]

Holistic medical practitioners defend their treatments to the general public that there is documented proof that they work, but when faced with empirical evidence that does not support their claims, certain practicioners often state that holistic medicine cannot be readily tested by scientific means.

In other words: if it's not tested, then they think it works. Once it's tested, they'll tell you the test is wrong and it works.

Lack of regulation
“”Of all the nations in the world, the United States is most afflicted by its healers. Besides those holding the degree M. D., signifying doctor of medicine and, nowadays, some seven years of study following high school graduation, a host of queer practitioners pervade the medical field. They have conferred on themselves strange combinations of letters, indicating the peculiar systems of healing which a somewhat lax system of legislation and law enforcement permits them to practice on an unwary public.
—Morris Fishbein, 1932[12]

When a student wants to become a physician, he or she must attend a certified medical school, pass rigorous medical exams, and participate in carefully monitored and regulated internships all regulated by the governmental bodies who license the doctor. For the majority of alternative medicine, no such regulation is in place. For a few specific alternative therapies like chiropractic work and massage therapy, regulatory bodies do exist. However, pretty much every other field of alternative medicine has no regulation at all. Call yourself a color therapist, and lo and behold, you are one.

There is also a lack of regulation in the products sold as "alternative" or "herbal" medicines. You cannot, for example, know what is in a "sleep healing tea", how much of each ingredient, how potent the pills are, or even whether it contains the listed ingredient(s) at all (many herbal products, in fact, do not contain the herb(s) listed on the label).[13] Also, as there is little scientific research, "doses" are always a guess. "Try one pill. If that doesn't work, take two."

Use of outdated, refuted, or misrepresented scholarly works

Sometimes an alternative medicine supporter will present a scholarly work as "proof" that the alternative medicine works and is being suppressed by "regular" medicine. The problem is the work is either outdated, has been refuted by later research, or (worse) is misrepresented.

Weston Price's work on focal infection and nutrition is a prime example of this type of handwaving. Given what was known at the time his work was perfectly valid...for its time, which was 1939. The thing is the world as well as our understanding of both focal infection and nutrition have changed so drastically that Price's work would have to be reevaluated in a modern framework... something that really hasn't been done. The fact Price himself questioned the focal infection theory is also not brought up by either side or that what Price actually did and what his supporters claim he did (and was) are so different that it is a clear misrepresentation.

Homoeopathy serves as another example as supporters can point to K. Linde, N. Clausius, G. Ramirez, et al., "Are the Clinical Effects of Homoeopathy Placebo Effects? A Meta-analysis of Placebo-Controlled Trials," Lancet, September 20, 1997, 350:834-843...while ignoring the refutiation in "The end of homoeopathy" The Lancet, Vol. 366 No. 9487 p 690. The Vol. 366 No. 9503 issue (Dec 27, 2005) and by 14 studies from 2003 to 2007.[14]

Colloidal silver was used as an antibiotic, germicide and disinfectant clear into the 1940s. Publications such as New Orleans Medical and Surgical Journal (1907), The Journal of the American Medical Association (1918), The Journal of the American Dental Association (1934) all had articles regarding the uses and limits of colloidal silver. Antibiotics were far more effective (and safer) so the use of colloidal silver effectively ended.

In many respects this is the most dangerous form of alternative medicine as it cloaks itself in the garb of genuine medicine using scholarly publications to support its claims.

Kinds of alternative medicine

You can't neatly brush it all into the quack corner. Some of them work, but not all of them.

(Some) Proven palliative effect
  • Massage therapy — massage has real benefits such as temporary pain relief and increased circulation, as anything that feels pleasurable will have at least some short-term therapeutic effect, but like all other woo, some less ethical therapists will sell it (and a line of smelly herbal additives) as a cure for almost anything.
  • Chiropractic — has been shown to relieve some back and joint pain and mitigate some chronic headaches, although no more than standard therapy (e.g. taking acetaminophen). Has the disadvantage that it can damage soft tissues if done wrong, and it increases the risk of stroke. Also, a significant risk of death or paralysis from injury.[15]
  • Medical marijuana — Some adhere to the smokable version of this despite issues with proper dosing; some of its medicinal properties are also found (and precisely dosed) in Marinol, its synthetic version. The palliative effect derives from pleasurable sensations, not from any medicinal properties of marijuana.
  • Neti pot — can help relieve symptoms of allergies, sinus infections, and colds. It should not be used more than once per day, and using unsanitary water can lead to potentially serious infections that can be lethal.
  • Osteopathy — In North America it is a variant of mainstream medicine, albeit one with slightly different approaches to medicinal problems. Outside of the US there appears to be a great deal more quackery involved.

Potentially provable
  • Herbal supplements — some are fairly effective for some conditions, others close to useless, and some are highly dangerous (e.g. aristolochia). Herbal medicine varies a great deal in effectiveness and quality. Lax regulation means the consumer must be very diligent about brand choice, and always takes on some degree of risk.
  • Oil pulling — does have some effect against tooth decay. Not much else, though.
  • Salt therapy (or Mummification) involves staying in a salt cave to breathe the air and treat respiratory problems. It's quite popular in Eastern Europe (Poland, for example, is renowned for its salt mines).[16] Not much research has been done on the subject, and the effectiveness of the treatment remains up in the air (no pun intended).[17]
  • Biofeedback therapy has been found to have some positive effect on headaches[18][19]

Benign
  • Aromatherapy — smelling nice has some social advantages, may reduce anxiety and won't kill you. To cure anything other than the above, however, it's nonsensical.
  • Reflexology[20] — as a massage therapy it can reduce stress, but there is nothing it can cure.
  • "Himalayan" salt lamps — do nothing except slightly light up the room.
  • Halotherapy is related to salt lamp use, which involves lighting a candle or electric light inside a salt rock to "release negative ions".
  • Bach flower remedies — since some of the issues these treat are psychosomatic, and some of the users are neurotics and hypochondriacs, flower remedies are perhaps the best thing for them.
  • Homeopathy — using dilute solutions with no remaining active ingredient to treat conditions.
  • Cupping — often used in conjunction with bloodletting.
  • Magnetic field therapy
  • Psychic surgery
  • Reiki

Somewhat benign, occasionally dangerous
  • Acupuncture ("Pointillism", as it is known in the art world) — like the caricature of using voodoo dolls, but practiced on the victimpatient directly. Can give pain relief due to the placebo effect, but this is quite outweighed by the risks that could occur if not performed "properly".[21]
  • Chiropractic — to cure anything except back pain. Sometimes done on children and babies, which could risk breaking their spines.
  • Colloidal silver — an alleged "natural" antibiotic, its only possible use is for that very tiny segment of the population that has a burning desire to look like a smurf.
  • DMSO — an industrial solvent by-product of paper manufacture, used topically for a variety of health claims.
  • Ear candling — a silly practice alleged to draw toxins out of the ears and/or remove earwax. Potential danger of hot wax burning the inner ear, which may result in hearing loss.
  • Faith healing — attempts to use raw prayer and faith to heal. Too bad practitioners don't have any. Not harmful in and of itself, but its practitioners usually encourage avoiding traditional medicine ("Don't visit the doctor, God will cure you better than any doctor can!").
  • Inversion therapy - reverse conditions by reversing positions.[22]
  • Male enhancement capsules — to cure the desire to buy a large SUV.
  • Hypnosis — can aid with smoking addiction or weight loss in some cases. Problems arise with possible implanting of false memories. And some people may not "snap out" of a trance.
  • Vaginal steaming — typically just uses warm water rather than actual steam. If steam *is* used, the scalding can be very nasty.
  • Osteopathy — should always be done by someone properly trained.

Dangerous
  • Black salve — (a.k.a. cansema) a paste made from bloodroot (Sanguinaria canadensis) that is said to "draw out" cancer cells in tumors; known for causing massive disfiguration. If chemotherapy is slash'n'burn, this stuff is a West Coast thousand-acre wildfire.[23][24]
  • Laetrile — attempting to cure cancer using cyanogen compounds found in stonefruit pits, particularly apricots.
  • coffee enemas — as ridiculous as ear candling, but exponentially more disgusting (and allegedly addictive). Cup o' joe, anyone?
  • New German Medicine — attempting to cure cancer using psychological conflict resolution.
  • Trepanation — intentionally drilling a hole in one's head.
  • Sungazing — staring at the sun cures all ills, especially chronic eyesight.
  • Bloodletting — killed Lord Byron and possibly George Washington. Do not be fooled into thinking this is extinct. It isn't. (Bloodletting is still the routine treatment of iron toxicity, but in the veinal blood donating style of bloodletting, which is actually safe.) Leeching is effective for a few conditions under medical supervision.
  • Rebirthing — don't even get me started.[25]
  • Dynastic gymnastics — swing babies around. Dangerous enough to be illegal in most of the civilised world, except Russia, where it's fairly popular.

Motivations

Manheimer 2003, which studied IV drug users, found that:[26]

Having a higher education and lower self-rated health were the two strongest predictors of CAM use, followed by having a regular doctor or clinic, being white and younger. There was a high level of self-perceived effectiveness of CAM therapies (4.1 on a scale of 1-5), and CAM users were likely to use CAM for reasons related to their addiction.

Prevalence
Year published Sample size Group surveyed Item(s) surveyed Results Citation
2003 548 "persons with a history of intravenous drug use, recruited from a needle-exchange program and a methadone maintenance clinic, both in Providence, Rhode Island" "Overall prevalence of any CAM use in the past 6 months, frequency of use of individual named CAM therapies and domains, and demographic and clinical characteristics associated with CAM users, reasons for CAM use and self-perceived effectiveness of CAM." "45% reported use of at least one CAM therapy. The top three therapies - religious healing, relaxation techniques, and meditation - were all from the mind-body domain." Manheimer (2003)[26]
2011 37,596 (total[note 2]), highly representative of USA population "NHANES data for adults aged 20 and over" "the prevalence of dietary supplement intake for three time periods (1988–1994, 1999–2002, and 2003–2006) by demographic characteristics for five supplement categories: 1) any supplement, 2) multivitamin/ multimineral (contains at least three vitamins and may or may not contain minerals), 3) supplement with folic acid, 4) supplement with vitamin D, and 5) supplement with calcium, including antacids containing calcium." The percentage of the U.S. population who used at least one dietary supplement increased from 42% in 1988–1994 to 53% in 2003–2006. Gahche (2011)[27]

Video
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gollark: Arrays should be zero indexed.
gollark: YOU do, maybe.
gollark: Oh, other stuff has bugs, sure.
gollark: PotatOS is, lua isn't.
gollark: Oh, you mean the potatOS thing? No, it's bugless.

See also
For those of you in the mood, RationalWiki has a fun article about Quacktionary.

Notes
  1. Any medication or treatment that helps a patient cope with an illness and its side effects, but does not actually affect the underlying disease.
  2. 18,504 in NHANES 1988–1994; 9,660 in NHANES 1999–2002; and 9,432 in NHANES 2003–2006.

References
  1. Tim Minchin's Storm, the Animated Movie
  2. NIH's CAM center (NCCAM)
  3. http://www.skeptic.com/carbon-comic/holistic-airlines-the-natural-way-to-fly/
  4. http://www.youtube.com/watch?v=-hnABeM2I7c
  5. The evolution of quackery
  6. Complementary Medicine - Topic Overview, WebMD.
  7. Common Misconceptions About Quackery, Quackwatch.
  8. "What is holistic medicine?" http://www.holisticmed.com/whatis.html
  9. As coined by R.W. Donnell
  10. Penn & Teller: Bullshit! - "New Age Medicine" (S06E02)
  11. If you want some cancer woo, and you want it now, who ya gonna call?
  12. Fads and Quackery in Healing: An Analysis of the Foibles of the Healing Cults, with Essays on Various Other Peculiar Notions in the Health Field by Morris Fishbein (1932) Blue Ribbon Books, 382 pp.
  13. DNA barcoding detects contamination and substitution in North American herbal products, Newmaster et al.
  14. Clinical Trials (2003-2007)
  15. Chiropractic Manipulation of Neck: Stroke Risk? American Heart Association releases statement saying risk may be increased if artery wall is torn
  16. Speleotherapy (Cave Therapy) and Halotherapy
  17. Speleotherapy for asthma, Cochrane Summaries.
  18. Nestoriuc Y, Martin A (March 2007). "Efficacy of biofeedback for migraine: a meta-analysis". Pain 128 (1-2): 111–27. doi:10.1016/j.pain.2006.09.007. PMID 17084028.
  19. Nestoriuc Y, Martin A, Rief W, Andrasik F (September 2008). "Biofeedback treatment for headache disorders: a comprehensive efficacy review". Appl Psychophysiol Biofeedback 33 (3): 125–40.
  20. claims as cure all
  21. http://www.youtube.com/watch?v=pp5eiHUdwb4
  22. See the Wikipedia article on inversion therapy.
  23. http://www.medsafe.govt.nz/safety/EWS/2013/black-salve.asp
  24. See the photos
  25. http://www.youtube.com/watch?v=dgN7a_vdIIc at 18:26.
  26. Manheimer, E., B. J. Anderson, and M. D. Stein. "Use and assessment of complementary and alternative therapies by intravenous drug users." The American journal of drug and alcohol abuse 29.2 (2003): 401."
  27. Gahche, Jaime, et al. "Dietary supplement use among US adults has increased since NHANES III (1988-1994)." NCHS data brief 61 (2011): 1-8.
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