October 1st, 2012 -Complementary and alternative medicine (CAM) continues to thrive as numerous physicians and very credible institutions – including the Mayo Clinic – embrace many of the therapies. A surprisingly large number of Americans, estimated as high as 70%, have tried CAM—acupuncture/acupressure, herb/vitamin therapy, hypnosis, chiropractic/massage, aromatherapy, magnetic therapy, and reflexology—to cure their ills. A new term—integrative medicine
— is now being employed as traditional evidence-based medicine is combined with CAM for better treatment outcomes.
Statistics indicate that more Americans have tried CAM than have visited primary care physicians in recent years. Public awareness and the use of CAM are complex phenomena that have grown extraordinarily this past decade, according to MD Consult
, an internet source of medical information. This public knowledge is easily obtainable online and, when combined with the spiraling upward costs of modern healthcare, the growth of CAM has continued to accelerate.
Advertising and recommendations for CAM products are ubiquitous and pervasive, even though there has been very little support or encouragement from the traditional medical community. Often, patients, their families and friends are very well informed with the currently available information, which they believe is reliable, only to find out subsequently, that there are new “facts” disproving their previous beliefs.
Obtaining evidence-based CAM would be the next major breakthrough for everyone—patients, physicians, and the purveyors of integrative medicine. The question is: How effective are complementary and alternative medicine (CAM) therapies?
The answer is—although you’d never know it from all the people who have been persuaded by the unsubstantiated claims and high-octane sales pitches to try these treatments—nobody really knows for sure but there is definite progress with scientific studies being reported in credible medical journals.
We have indications that some of these therapies may be helpful. Acupuncture, for example, may provide a number of medical benefits, from reducing pain to helping with chemotherapy-induced nausea. But the fact is, we lack any conclusive efficacy data about any of these alternatives.
One thing we do know: CAM therapies are expensive—very
expensive. Estimates of the costs of CAM to Americans range $34 to $47 billion every year.
Consequently, the real questions we ought to be asking ourselves is: Can we afford to continue to spend precious healthcare dollars on therapies of questionable scientific value, particularly at a moment when we are trying to control health care costs in general, in order to help the economy recover? We should encourage more resources being directed to proving the efficacy of CAM.
The National Center for Complementary and Alternative Medicine (http://www.nih.gov/about/almanac/organization/NCCAM.htm/
), which has been funded with close to a billion dollars of taxpayer revenue over the past decade or so, brings a scientific approach to CAM. The results, especially for devotees of alternative medicine, are not what they want to believe. For example:
- Echinacea, a vitamin that reputedly fights infection, does not appear to prevent colds or other infections, based on most of the rigorous scientific studies.
- St. John’s Wort, touted to be a natural antidepressant, is similarly questionable. Two large scientifically-controlled studies showed that placebo and St. John’s Wort were equally effective.
- Anti-oxidants have been shown many times not to prevent cancer in large well- controlled scientific studies.
If the results of these alternative medicines are so inconclusive, you might ask: Why are they so popular?
Well, for one thing, healthcare practitioners have known for centuries that just being kind and directing personal attention to people who are suffering and upset can make them feel better. This phenomenon is known as the “placebo effect.”
When people think they are receiving a therapy they believe will be beneficial, there is a much greater chance that the therapy will be efficacious. This may explain why 70% of Americans report they have benefited from CAM therapies.
In this context, I must admit that I have tried elderberry to ameliorate the effects of an upper respiratory infection, no doubt due to a viral infection. I thought the twice-a-day lozenges helped, but I can’t be sure.
How do we find out whether these therapies really
work? The answer is really rather simple. We should study them.
Specifically, we should subject them to the same research to which traditional medicine is subject; for example, rigorous, double-blind, controlled studies to demonstrate benefit or not. Results of such testing should be widely shared, so that all would benefit either from using the medicine or moving on in a more promising therapeutic direction.
Medicine, after all, is based on science. And we, as an ethical society, must demand rigorous scientific study to protect unsuspecting, vulnerable, worried—yet hopeful—people from being taken advantage of by unproven and expensive therapies. Ironically, people will often get better—with little connection to the medicine they take to cure their “illness.” The natural course of many diseases is that they are self-limited.
Let me be clear. I am not contending that conventional therapies are perfect or without side-effects. Nor am I saying, as in the case of acupuncture, that all CAM therapies are without some benefits.
But what is irrefutable is that whether traditional or alternative, the efficacy of treatments must be substantiated through evidence-based medicine, scientifically supported by solid data. Only then will we know if they really “work.”
Such scientific testing is our best course as a nation, not only to more effectively marshall our precious healthcare dollars but, more importantly, improve the future of America’s health..