It doesn't.
Do you know what we call alternative medicine that works? Medicine.
Do you know what we call alternative medicine that works? Medicine.
Often it's just hard to patent and/or isn't financially lucrative to get FDA approval.
Also lifestyle in general is terribly handled in medicine. MDs know nearly nothing about what matters and what they should recommend. They are decades behind the available evidence.
I agree that lifestyle stuff is important, can be handled by none MD folks, and can have a huge impact on life and health in general. What gets my goat is the CAM proponents who claim they can cure anything and everything with their woo.
Well the MDs do give you lifestyle advice. And the "professionals" that should care about this stuff (esp. dieticians) also suck badly. They often just regurgitate the food pyramid.
I completely agree otherwise.
Herbal medicine is medicine. "Alt-med" is reserved for treatments that are not and will not ever be evidence-based.
You're investing in their false modality by using it to define actual medicine, in the same way that people market "homeopathic" OTC based on actual ingredients and not "water memory".
It's unscientific to elevate your anecdotes above actual studies because you subjectively feel there's something there. This is why we have studies.
I don't know why it works but it's unscientific to ignore the evidence simply because you don't understand it.
Classic. Homeopathy enthusiasts always wheel this out and it's hilarious. "Just because you don't understand how it works you shouldn't ignore it!". I don't understand how it works because it doesn't! And this has been shown over and over again!
I have no idea about the paleo diet, but if it seems to do good things for people we should first establish whether that is true and then find out how it's true. Alt med always misses step 1.
OK, anecdotes are not good evidence, and cannot be used as evidence because they suffer from nearly all the problems that a good study accounts for and real evidence gathering processes account for and mitigate. Anecdotal data suffers from confirmation bias, from selection bias, it has a small enough sample size to be meaningless, and is as a result worthless.
Better?
You can keep saying "it doesn't work" as many times as you like but you'll still be wrong.
[Citation Needed]
You'd be crazy to only use alt med for cancer treatment, but as an addition studies have shown it to be effective.
http://www.cancer.org/treatment/treatmentsandsideeffects/com...
I wouldn't call that supporting evidence that CAM works, in fact I'd say that whole page doesn't give it any support at all, nor does it excuse naturopathy from having harmful effects -
"Substances used in alternative medical practices may have not been thoroughly tested to find out how they interact with medicines, foods, or dietary supplements. Even though some reports of interactions and harmful effects may be published, full studies of interactions and effects are not often available. There may also be lesser-known methods used, other than the ones discussed here, which could potentially cause harm. Because of these limitations, any information on ill effects below should be considered incomplete."
"Other aspects of naturopathic medicine, like healthy nutrition, have been shown to lower the risk of illnesses such as heart disease and cancer. Some aspects of naturopathic medicine may be useful when used along with conventional medical treatment."
Like I said, you're simply choosing to ignore the evidence. If you'd like to stay ignorant of it then that's your right and your privilege.
"Look, we do this common sense thing, therefore the rest of our stuff must be true!"
Eating well, getting rest and exercise, these things are not alt med, not naturopathic, not 'integrative', they are well supported aspects of evidence based medicine.
Why do you pick specifically that reference, which sits very carefully on the fence in order to find something good about naturopathic therapies? ("good diet" and "counseling" are, of course, quite common recommendations of any doctor)
Why not reference an actual research organization which also has patient outreach? I'm thinking specifically of The National Center for Complementary and Alternative Medicine, of the NIH, at http://nccam.nih.gov/health/cancer/camcancer.htm . They've gotten into political hot water because it was started and funded to find how if CAM is useful, only to report that no, it nearly isn't useful at all.
That site NCCA describes only on the treatments which are specific to CAM, and not shared with standard medical practice.
A naturopath may suggest that you always wear a seatbelt when driving a car. That doesn't make the suggestion part of naturopathy.
A naturopath may suggest that you keep the safety on when carrying a firearm. Again, that's a good suggestion, but it's not something specific to naturopathy.
The examples you pointed out on the Cancer Society web page are not unique to naturopathy. I interpret them as trying to say something good about naturopathy, probably because of so many complaints about how naturopathy is being 'suppressed by Western thought', or something like that.
The NIH site I pointed you to reports on the CAM practices which are specific to CAM. Very few of them "work" in any fashion, and none of them are treatments.
At least, that's how I interpret it. The full context is:
analog: "Paleo diet has worked, and also alt medicine", followed by Nursie: "I don't understand how it works because it doesn't!"
The immediate context for 'it' is homeopathy, but I think, based on Nursie's other statements, that it should apply to all of alt.med. It doesn't apply to (to coin an abbreviation), "std.med", because it seems that Nursie finds convincing evidence that std.med does work.
So the question to you is, what puts the "alt." in "alt.med"? If practice X is part of "alt.med" and is part of "std.med" then is how is X "alt"?
It's possible that something started as alt.med and became part of std.med, but the practices listed on the ACS page have been part of std.med since pretty much since the dawn of evidence-based medicine, so it's not like std.med recently took those parts from alt.med.
Therefore, you should interpret those quote of Nursie to mean:
"[The part of alt.med which is specific to alt.med] doesn't [work]" and "I don't understand how [the alt. part of alt.med] works because [the alt. part of alt.med] doesn't [have any demonstrated effectiveness]".
The use of prayer is definitely part of alt med, and has been shown to work, therefore Nursie is incorrect when he says "alt med does not work".
Rather, what do you mean by "work"? If people who pray feel more relaxed, then yes, it works for some people. So does meditation. So does reading a book, or watching a movie. Or playing cards, or talking with friends.
If by "effective" you mean that people who pray have a higher longevity, higher rate of being cured, etc. then no, it doesn't work. This type of prayer is usually called intercessory prayer.
Take for example http://www.ncbi.nlm.nih.gov/pubmed/16569567 .
> Intercessory prayer is widely believed to influence recovery from illness, but claims of benefits are not supported by well-controlled clinical trials. Prior studies have not addressed whether prayer itself or knowledge/certainty that prayer is being provided may influence outcome. We evaluated whether (1) receiving intercessory prayer or (2) being certain of receiving intercessory prayer was associated with uncomplicated recovery after coronary artery bypass graft (CABG) surgery. ...
> CONCLUSIONS: Intercessory prayer itself had no effect on complication-free recovery from CABG, but certainty of receiving intercessory prayer was associated with a higher incidence of complications.
Take for another example http://www.ncbi.nlm.nih.gov/pubmed/19370557 .
> OBJECTIVES: To review the effects of intercessory prayer as an additional intervention for people with health problems already receiving routine health care.
> AUTHORS' CONCLUSIONS: These findings are equivocal and, although some of the results of individual studies suggest a positive effect of intercessory prayer, the majority do not and the evidence does not support a recommendation either in favour or against the use of intercessory prayer. We are not convinced that further trials of this intervention should be undertaken and would prefer to see any resources available for such a trial used to investigate other questions in health care.
"Spiritual well-being and coping. An analysis of 43 studies on people with advanced cancer noted that those who reported spiritual well-being were able to cope more effectively with terminal illnesses and find meaning in their experience. Major themes of spiritual well-being included self-awareness, coping with stress, connectedness with others, faith, empowerment, confidence, and the ability to live with meaning and hope."
http://www.cancer.org/treatment/treatmentsandsideeffects/com...
That said, it's interesting that the paragraph you quoted doesn't mention the word "prayer" at all. It refers to "spiritual well-being." Earlier in that page it pointed out that spirituality "is often expressed through religion and/or prayer"", but it doesn't say that it's the prayer which leads to any change.
More specifically, it also says that "Meditation, twelve-step work (as practiced in Alcoholics Anonymous and similar groups), and seeking meaning in life all involve spirituality. Even simple practices such as silent observation, listening, or gratitude can become part of an open-ended spirituality that can infuse everyday life. Some people express their spirituality by spending time with nature, doing creative work, or serving others."
It notably doesn't say (as you suggest) that prayer is an effective method to reduce stress, nor does it say that prayer is any more effective than 'spending time with nature' or 'doing creative work.' (To that list I'll add 'talking with a counselor.')
So I don't understand your point. That page doesn't show that prayer "works", except perhaps as pallative treatment for those who already believe that prayer is effective. But then that's not very surprising, is it? And other forms of palliative care would also be effective. Perhaps even more effective?
You must certainly acknowledge that "spiritual well-being" as given on that page is a rather broad term. Telling a patient to spend time relaxing in the mountains, as an example of spending time with nature, is not specific to alt.med. Indeed, a century ago, going to a spa in the countryside, where one could get away from the stresses of life was the common treatment for well-off people with tuberculosis, 'consumption', and other hard-to-cure diseases. So it's not like these suggestions are foreign or even recent to standard medicine.
(Though once we figured out how to cure tuberculosis, this treatment for tuberculosis disappeared. That's why palliative care is different than treatment.)
Also, don't you find the circular reasoning rather odd? As you quoted, "those who reported spiritual well-being were able to cope more effectively with terminal illnesses and find meaning in their experience", but as I quoted in the second paragraph, "seeking meaning in life [involves] spirituality." In a rather direct sense it says that those who seek meaning are more able to find meaning in their experience. Should anyone be surprised about that?
I also think the idea that one should "find meaning in their experience" is a biased term. What meaning is there in going through cancer treatment? Other than the obvious - a combination of genetic and environmental factors, plus random chance lead to having cancer, and it's pain in the ass to get cancer treatments - why should anyone seek a deeper meaning?
Of course, if you think the universe is constructed around you, perhaps because there's a God or universal spirit who intercedes on your behalf and 'works in mysterious ways', then perhaps thought, prayer, and reflection might help revel that hidden meaning, or perhaps help you accept that it's all for the best. But then it's rather biased metric, because those who don't think there is meaning to cancer will also tend be those who don't have a religious or spiritual faith.
Or go and look up the examples that the med student provided, Inositol or Theanine. I expect you'll find reasons to ignore the evidence there too though, that's the problem with zealotry.
Do you agree with this argument? If not, why not? If both std.med and alt.med make the same recommendation then what's "alt" about alt.med? Otherwise I continue.
You point out that prayer is effective. I respond that intercessory prayer has not been shown to be effective, despite several large-scale experiments. Yes, prayer can be part of palliative care, since it might make some people feel better. But palliative care is not treatment.
It also leads to questions like, is reading a good book on the topic of death or dealing with terminal cancer (as with http://en.wikipedia.org/wiki/Bibliotherapy) a better, more effective palliative care than telling people to read the Good Book?
You point out that the ACS says that prayer is effective. I point out that you've misread the page, because the ACS page does not say that prayer is effective. It only says that prayer is a visible aspect of how some people carry out their 'spiritual life', and that a spiritual life may help some people feel better.
Furthermore, the definition of 'spiritual life' on that page is so ill-defined that it includes, say, the hobbies of a dyed-in-the-wool hard-core reductionist, atheist, anti-CAM person. Which might also be hobbies that a std.med practitioner would suggest. There is nothing "alt" about a doctor suggesting that someone relax by taking a holiday in the countryside, away from computers and phones.
So no, it's not good enough me as evidence that alt.med is effective. Nor should it be good enough for you.
Yes, there are perhaps a dozen dietary supplements and herbs which might be useful. These are overshadowed by the array of supplements on the market that have no redeeming quality except perhaps to enrich the pockets of the multi-billion dollar supplement manufacturing industry.
Which means that yes, Nursie and I are wrong in that there is a thin sliver of possibly useful treatments to come from alt.med. Most interestingly, these tend to be for anxiety and depression, where effectiveness is much harder to evaluate than "can cure a staphylococcus infection." Thin evidence, I say, but I'll concede that sliver.
Your argument though is that those dozen possible treatments justify the entire alt.med industry? Color me doubtful.
You say that I ignore the evidence. What I ask is that you present the evidence. The ACS page does not seem to provide the evidence that you say it does. The ACS page is, of course, a summary and cannot be held up to full scrutiny, which is why, in order to strengthen my argument, I've made references to some of the experimental research papers on the topic, and they concur with my position.
Surely if there is the good evidence that you say there is then you can either find more experimental research with conclusions that strengthen your viewpoint, or can highlight the flaws in the papers I cite, yes?
"Your argument though is that those dozen possible treatments justify the entire alt.med industry?"
Again I ask you the question, what puts the "alt." in "alt.med"?
If a practice is common to both std.med and alt.med, when should we attribute its discovery or common use to alt.med?
Obviously you shouldn't say that open heart surgery is part of natropathy, but why not? It works, so why doesn't alt.med claim it as its own?
You can't, for example, say that food supplements are only part of alt.med because fluoride in (some) water systems, vitamin D in milk, and iodine in salt are three food supplements that medical researchers successfully insisted be part of the standard food supply, in order to improve public health.
What makes 'alt.med' alt?
But in some sense you're right. The old canard is that we have a name for alt. medicine that works - it's called "medicine." Because fundamentally, modern medicine is based on trying to find what works. The thing is, very little of alt.med "works", by almost any definition except palliative care, and even then, no more helpful than other forms of care.
Take a look at any of the research papers on the subject, where the alt.med methods were put to a test, and you'll see that any signal that is there is about as strong as the noise.
Compare that to the first people who were treated with penicillin. Compare that to the children who no longer got polio. Those are examples of clear, strong signals of effective treatments.
If we don't have scientific evidence that something works then pretty much by definition we can't say it works because we don't have the proof. It's sort-of tautological.
The other comment "I don't understand how it works because it doesn't" was specifically in reference to Homeopathy, which has been shown over and over again to be no better than placebo (i.e. doesn't work). The example was to show that there's no point in investigating how something works, and it's silly to chastise people for not understanding how something works, unless we can first show that something works and that there is even something to investigate.
Apply this to paleo - I have no reason to suspect it works or not. Before investigating this miraculous diet, lets do a proper study to see if it actually is of benefit to the general population, or just to a subset, or if actually the benefits reported are by a tiny number of self-selected people and not really significant at all.
When we actually know (rather than suspect from anecdote) that it does something, then is the time to look at how.
It helps to pick something that is actually CAM then, and not part of mainstream health advice that has been coopted by CAM. Eating well and getting lots of exercise isn't exactly revolutionary, outside-the-box, non-mainstream thinking.
"Other aspects of naturopathic medicine, like healthy nutrition, have been shown..."
Perfectly true information. Just irrelevant because those are aspects of mainstream medicine too.
--edit-- but were I american and had medical credentials to my name, yes I absolutely would be writing to them to protest the existence of that page in its entirety. As it stands I'm just a British skeptic.
They all probably recommend getting enough sleep and drinking enough water.
In a related question, what is "healthy nutrition"?
When Ayurveda says that onions "stimulate the central nervous system, and can disturb vows of celibacy" and should not be eaten as food (at least not by yogis), while nutritionists and researchers find no evidence that onions have those non-nutritional effects on the body and recommend that you can eat them if you like the taste, then whose advice should be followed, and why?
If it works for you then you still have a sample size of one but this would be good enough.
For instance in the case of terminal cancer, some people get ripped off by charlatans to the tune of hundreds of thousands of dollars. The anecdotal data around these assholes is all overwhelmingly positive and claims no side effects, because people who are ripped off and then die tend not to talk about it but the very few who survive for reasons unknown shout a lot. The reason you might not try it is because you'd be bankrupting the family you're going to leave behind, or funneling good-will donations to a conman.
There are numerous examples of alt-med 'cures' that are dreadfully harmful (black salve, sodium hypochlorite enemas). This idea that CAM is fine to try if you're out of options because it has no side effects is itself very dodgy. Hell, even acupuncture carries some elevated risk of infection because you're pushing needles through the skin.
But if it was something minor, cheap and there really were no side effects, sure - why not?
--edit-- But telling if there really are no side effects does require some basis in provable fact, or you're just necking unknown quantities of unknown stuff, which may not be a great plan.
This is true for any medical treatment. You weigh up the costs, risks, benefits and then you decide if you want to go ahead with it.
There are also numerous examples of normal medicine cures that have been dreadfully harmful. Thalidomide and SSRIs to name a couple off the top of my head,
I also want to say that this is pretty disingenuous as a statement because I named harmful CAM treatments in response to your question "if you have heard of a treatment which anecdotally works, and has no reported side effects, then why wouldn't you try it?". I was pointing out that alt med really cannot claim to have no side effects. It often does claim this, but it cannot.
Many medicines have dreadful side-effects, yes, even the ones we still use, but these are measured and quantified and (in theory) the treatments are only used if the main effect is worth it.
With alt med there often are side effects and there is no proof that any of it works, by definition.
Absolutely, but medical treatments should have reliable data available (not saying they always do). In contrast alt med never does (that's what makes it alt), but instead has cheerleaders and woo.
"There are also numerous examples of normal medicine cures that have been dreadfully harmful. Thalidomide and SSRIs to name a couple off the top of my head,"
Yup, and now we know the harms and don't use these things. (What's your point?). Whereas with alt-med this doesn't seem to happen.
If you talk to those people for whom it worked, then great! there may be evidence there.
However, let's say that of the people who decided lose weight through other means (a low calorie diet, more exercise, gastric bypass, whatever), 10% were successful.
With this additional information, it's hard to conclude that choosing a paleo diet makes a strong difference.
In other words, looking at the success cases doesn't give a conclusion, only a possible path for followup investigation. It's unscientific to say that something "works" by only looking at the successful cases. You also need to track the failure cases (those who tried paleo but where it didn't work), and the success and failure cases for other methods.
The same for medicine. If someone tries X (aspirin, herbs, whiskey, zinc, penicillin, etc.) for the flu then gets better within a couple of days, then it doesn't mean that X actually "worked". There could be other reasons for why the person got better, like the person's own immune system. (For the record, none of those 'medicines' will work against the flu, though a few of them will help relieve some of the symptoms.)
That's why these anecdotal accounts, while true and even heart-felt, don't suffice to make a scientific conclusion.