Thinking About Complementary and Alternative Medicine

Complementary and alternative medicine, also called CAM is the general category of products and practices that are not part of the standard care offered by medical doctors. Examples include, but are not limited to chiropractic, naturopathy, traditional Chinese medicine, homeopathy, minerals and nutritional supplements. CAM is a multi-billion dollar industry, but one that is often considered controversial. Some people swear by it and live it as a philosophy; others feel that it is nothing more than fraud on a mass scale. It’s also important to note that what constitutes CAM is not fixed. Treatments, which were considered at one time to be “alternative,” can become main-stream after undergoing testing and proving efficacious. Comedian and musician Tim Minchin commented, “Do you know what they call alternative medicine that’s been proved to work? Medicine.”

Think about the claim, not the practice

The important thing to assess is not the product or practice, but its claim. Shiatsu or traditional Chinese medicine is considered to be a form of CAM. It wouldn’t be right to suggest that shiatsu is fraud however or that one shouldn’t waste money on shiatsu. Many people regard shiatsu as a form of massage, and are convinced that it leads to stress reduction, and a sense of well being. If the practitioner claimed that shiatsu cures cancers, however, this is a claim that can be refuted. Current scientific evidence simply doesn’t support this claim.

Verifiability

Does this mean that all unverified claims are fraudulent? No. All scientific laws were at one point untested hypotheses, and existing ones can become revised in light of new evidence. Some matters are more challenging than others to verify in clinical trial settings. For example, the claim that certain foods trigger acne has a lot of anecdotal evidence to support it; a large number of acne sufferers have personal experiences which lead them to believe that certain foods strongly influence worsening acne. However the evidence supporting foods as a trigger for acne is mixed at best under clinical trial conditions. Does it mean that the acne sufferers who feel that certain foods trigger their acne are deluded? Not necessarily. It’s extremely challenging to isolate all the factors in a test like this which may include diet as well as other unknown factors. It’s also challenging to get a sufficient sample size in clinical trials for symptoms that are highly individual. To say that CAM is unproven simply means that it’s incongruent with the current scientific understanding that we have.

When should you be suspect about claims?

Practically, when should you be wary of claims by CAM?

  • When claims are unverifiable or require a belief in systems that are unverifiable.
  • When a product or practice seems to help chronic conditions that are typically challenging to cure.
  • When a product or practice claims to alleviate non-specific symptoms.
  • When a claim seems too good to be true.

The first point is clear, but the other points require some explanation. Quite simply, there are a host of conditions for which current medicine struggles to find an easy cure for varied reasons. Some examples include: Eczema, acne, hay fever, psoriasis, nail fungus, and the common cold. Eczema, hay fever, and psoriasis are immune-related conditions, in which our understanding is limited. Acne can be treated, but results are slow and treatment can be frustrating. Nail fungus is similarly challenging to treat and the cure rate isn’t high. The common cold has no convenient cure; you have to fight it out. What all of these concerns have in common is that they are common, they cause frustration, have high variation from person to person, and that there is no easy cure. These create a breeding ground for CAM to make claims which are difficult to prove or disprove.

What should I keep in mind about CAM?

When you have a medical condition, you should follow the advice of your medical doctors. If you intend to use complementary or alternative therapies, you should ask your medical doctor first. There are many medications that interact with other substances (even natural ones), and they need to be aware of them. Medical doctors prefer evidence based medicine; this is not a conspiracy with drug companies, but simply a matter of following the best scientific evidence available. When you have a medical condition, seek the advice of your doctors.

  • Doctors can provide a proper diagnosis. Often different conditions have seemingly generic symptoms, and require an expert or the help of tests to properly diagnose.
  • If you are using CAM or intend to use it to treat a medical condition, you need to let your doctor know. Some treatments will interact with your medical therapy, and natural products are no exception.