Comparing CAM to Science-based Medicine

Who should prevail in this struggle between naturalistic healers and ass-kickers with syringes full of chemotherapy?

Last week, as I was diligently reading my favorite online news source, Slate, I cam across a very strange article in their science column called Alternative Universe: The homeopathic crowd meets academic medicine. I should preface the rest of what I’m going to write by saying that, after their truly great art column, the science column is my second favorite. Their main writer, Will Saletan, I find level-headed, agreeable, and even funny on occasion. On SlateV, which produces video articles, has a segment with Dr. Sydney Spiesel who unapologetically presented the truth and nothing but the truth when questioned about one of today’s hot button issues, vaccines and autism. So thus far, Slate has had a great scientific track record. Maybe that is one of the reasons that this latest article had me so confused. I expected to read it and find the same level of adherence to logic and evidence that has been the trademark of Slate’s science column since I started reading it two years ago.

After reading the first few paragraphs I wasn’t sure where the author stood. It was obvious that he was at least a bit sympathetic to CAM (complimentary + alternative medicine), but he seemed to also understand that science-based medicine had the upper hand. He was towing that old line of “Western medicine may cure diseases, but alternative medicine makes people feel better.”

Then he dropped this bomb:

The enforcers of the Western orthodoxy are the preening evidenced-based medicine crowd, those notorious killjoys who operate on the almost amusing premise that every square inch of medicine is built upon reason, the product of a rationally ordered stainless-steel world.

I wish this author would have given is even just ONE aspect of real medicine that is not built upon reason as an example to support this statement. (Although we later learn that he doesn’t believe something needs evidence for it to be true.) Just one. Just one drug or one therapy or one surgery that hasn’t been rigorously tested. A statement like this demonstrates that this author, although he is a physician, has yet to grasp the scientific process. I’ve been thinking and thinking of even the slightest part of evidence-based medicine that could be called irrational, and the only thing I can come up with is the personal superstitions of its practitioners. Maybe as you go in for that appendectomy your surgeon will slip on his pair of lucky underwear. Maybe you could also say that since some of the foundations of modern medicine and modern science are the product of mistakes (i.e. forgetting to put the lid on that bacteria culture and discovering penicillin the next morning) that they are not founded on reason, but those discoveries were still tested repeatedly, and papers were still written about them and subjected to peer review.

He then goes on to say:

If no evidence, they insist, then no truth. And if no truth, get thee out of my medical center. They briskly have swept away the entire alternative field, viewing chelation, St. John’s wort, and music therapy, for example, as interchangeably absurd.

I really like to avoid discussing the philosophy of truth. I’ll be honest, I’m not very good at philosophy. Kant and others have a lot to say on this topic, but I opt for a simpler route, especially in this case. The things that we consider to be “true” in science are constantly expanding. Every new discovery, every satellite picture from space, every beetle found in the forest contributes to our concept of what is true. But all of these pieces of new truth are indeed founded on evidence. Without proof of something, how can we possibly call it “true”? If we allowed things to be true without solid evidence, if we relied up anecdotes or personal emotions to define the truth, then I think we would find that our concept of “truth” had grown so broad that it no longer means anything significant. In order to truly isolate “truth,” there has to be criteria, and that criteria is solid, reproducible evidence.

The author then claims that this adherence to truth has caused the practitioners of evidence-based medicine to generalize and dismiss all forms of CAM as bunk. He doesn’t say it outright, but he suggests that these treatments are unstudied and dismissed out of hand because of nothing more than their “alternative” label. He mentions three things specifically: chelation, St. John’s wort, and music therapy.

Chelation is an especially strange thing to bring up, in my opinion. It’s a legitimate, evidence-based therapy for removing heavy metals from the blood on the occasion of heavy metal poisoning, but it has been hijacked by the CAM crowed and “used” to “cure” all sorts of diseases from autism to heart disease. The National Institute of Health has decided to launch a large well controlled study which will end in 2010. This alternative treatment is receiving attention, despite the fact that reviewing the current literature presents “no scientific evidence to demonstrate any benefit from this form of therapy,” according to the American Heart Association. CAM proponents are trying to get a study going to test chelation for autism, but because this pet theory lacks even the veneer of a plausible scientific basis, and because chelation therapy can actually be harmful to those who undergo it, the study is considered by many to be unethical. The idea that chelation could cure autism is based on the false idea that autism is caused by a build-up of mercury in the bodies of young children. The mercury is said to come from a preservative that used to be used in routine childhood vaccines. That mercury-containing preservative has since been removed, but autism rates continue to rise, proving that mercury has nothing to do with it. So why on earth would chelation help?

St. John’s wort has known medical effects. It is a drug. It’s a combination of chemicals. Any doctor, pharmacist, or chemist will tell you that it is an actual drug with actual effects. They’ll also tell you that there is clinical evidence that it can be helpful in treating mild depression. The problem that your average GP has with St. John’s wort is that, while it is a drug, it has fallen under the umbrella of herbal dietary supplements, and thus is unregulated and unpurified. They prefer to prescribe drugs that are monitored by the FDA for safety and efficacy. It’s the same reason that they’ll prescribe Aspirin instead of willow bark, despite the fact that they both contain salicylic acid and both can reduce your fever.

If you want to hear a skeptical neurologist’s take on music therapy, then check out this radio discussion. To summarize: music therapy can be beneficial, but it can’t do what some claim it can. It can relieve stress, it can effect mood, it can even help certain brain injuries heal, but it can’t rewire you brain, and it can’t make a mentally disabled child into a normal child with a normal brain.

The author then moves on to complain that CAM modalities are not receiving enough funding for testing, despite the fact that earlier in the article he admitted that they get $300 million a year–the same amount alloted to study gene therapy and stokes.

The last paragraph of the article I found especially vexing:

Alternative medicine needs money and many years to find its way, and despite the early setbacks for echinacea and other treatments, it would be a mistake to call off the federal investment. Such an absolutist stance ignores the observations of thousands of people over thousands of years as well as the true pace of medical progress, which is at best herky-jerky and aimless. That’s not to say that alternative medicine is the equal of Western medicine, or will prove to be, many millions of research funds later.

First of all, right smack dab in the middle is a giant logical fallacy: the argument from antiquity coupled with the argument ad populi. Just because certain medical practices have been used for thousands of years does not make them scientifically true. And just because thousands of people have used certain medical therapies also does not make them scientifically true. The rest of the paragraph is built upon a false premise: that alternative medicine progresses. Lack of all progress is actually what characterizes CAM. The fact that a therapy like acupuncture has been unchanged for thousands of years is something that its practitioners laud. Actually, the author lauded it too in his first logical fallacy. He is asking that millions more dollars be spent conducting studies on these alternative modalities, waiting for them to progress, when they never ever will.

Let’s consider something like homeopathy. When a new study on homeopathy is conducted, the homeopaths don’t analyze the data do see how they can improve their treatment. They don’t change homeopathy to bring it nearer to the goal of a positive study. So when it’s time for a new study they bring their same old homeopathic sugar pills and come up with the same old negative results. Homeopathy, and any other CAM modality you can think of, will never progress because they never change. It doesn’t matter how many studies are conducted and how much money is thrown at researchers.

The dogma of CAM practitioners–the fact that they are so certain, despite the lack of hard evidence, that their treatments work–is their undoing. If they were less certain and less dogmatic that their therapies worked as-is, then they would be open to the trial-and-error process of scientific medicine, and then CAM would actually progress. That is, in essence, the difference between CAM and science-based medicine.