Discussion: Alternative Medicine

Anyone who knows me well understands that there are three subjects I am unlikely to ever shut up about: censorship, religion, and alternative medicine. The latter most subject seems to be taking a position in the spotlight more often lately, particularly on my social media profiles. My opinion on the subject of woo and quackery is best digested in abbreviated, humorous mediums, as explained by those with more wit and grace than I could ever hope to possess. If you let me talk at length about alternative medicine, there is a good chance I will shrug off the expectation that I treat the subject with respect and instead become the cynical British comedian that is really the essence of my being. That being said, I poke fun at the industry as often as possible, because who doesn’t love an easy target? Sometimes it sparks debate. This week, it definitely sparked something.

When I posted a satirical article from The Science Post about a naturopath trying to play the role of doctor in flight, joking that I was horrified that at first I was only 70% sure it was satire, consumers of woo came out of the woodwork in its defense.

Why were you only 70% [this is satire]? Naturopaths don’t act like that.

In light of numerous horror stories making the headlines about patients suffering the consequences of following strict treatment plans of naturopaths, I don’t think anyone can make a definitive statement that alternative medicine doesn’t encourage practitioners to ignore a patient’s need for medical help and instead prescribe plans that inflate their ego and their wallets. Marilyn Bodnar, a naturopath in Sydney, Australia, was recently arrested for prescribing a strict raw food diet for a breastfeeding mother as treatment plan for the baby’s eczema. Marilyn also instructed the mother to stop all steroidal cream use and instead substitute aloe vera juice. The baby was left emaciated, malnourished, and requiring hospitalization. This was not Marilyn’s first rodeo, either: see newspaper stories here and here. Want something a little more relevant, a little more local? What about this nationally headlining story about the child whose untreated bacterial meningitis lead to death. The boy’s parents “treated him for 2½ weeks with remedies that included hot peppers, garlic, onions and horseradish and a product from a naturopathic doctor aimed at boosting his immune system” reports CBC News.

There are also an equal number of stories about doctors/surgeons that have been negligent/incompetent in their work. The number of malpractice law suits against doctors is quite large.

So, that’s what we are doing now? Excusing one shitty catastrophe because there is another, equally shitty catastrophe that co-exists? (Guys, it’s OK that Trump is openly calling for the violation of human rights of anyone that doesn’t fit his image of the ideal white nationalist, because Hitler totally did it first!)

It is true that there are plenty of doctors/surgeons with complaints and/or lawsuits being brought against them for negligence/incompetence; and, they should be held to the standards of their practice without excuses being made for their failure to provide adequate care. That being said, I am not inclined to believe that one health practitioner should be held to a different level of scrutiny than another. Actions performed by practitioners of alternative medicine should be regulated and examined with the same fervor as actions taken in the name of standard medicine. Further to that, alternative medicine should be required to have proven efficacy before it can be administered to a patient.

[Naturopaths are qualified to administer medical guidance] otherwise they would not be allowed to practice in Canada. And the MSP program and other medical insurance programs would not cover your costs when you go to see one.

Just because they are allowed to practice in Canada doesn’t mean anything.

I just had a boo at the advertising policy of the College of Naturopathic Physicians of British Columbia. This is the college established to regulate naturopathic practices in BC:

3. Claims
3.1 Any Marketing undertaken or authorized by a Registrant in respect of his or her
professional services must not be:
a. false,
b. inaccurate,
c. reasonably expected to mislead the public,
d. unverifiable or
e. contrary to the public interest in the practice of the profession.
3.2 Marketing violates section (3.1) if it:
a. is calculated or likely to take advantage of a weakened state, either physical, mental
or emotional of the recipient or intended recipient;
b. is likely to create in the mind of the recipient or intended recipient an unjustified
expectation of the results which the Registrant can achieve;
c. implies that the Registrant can obtain results
i. not achievable by other Registrants,
ii. by improperly influencing a public body or official or any corporation, agency
or person having any interest in the welfare of the recipient or
iii. by any other improper means; or
d. compares unfairly or in bad faith the quality of services provided with those
provided by:
i. another Registrant,
ii. a person authorized to provide health care services under another
enactment, or
iii. another health profession.

Considering the guidelines established by the college, I Googled for a local, top ranking naturopath in BC, finding the CrossroadsClinics. They have a page advertising the benefits of chelation. (Never mind that there is definitely a risk of death as a result of undergoing chelation. You’re right. Asthma is much harder to deal with.)

Now have a look at the FDA’s stance on chelation.

These are NDs that are licensed by the College, directly violating the advertising policy right on their website (oh hey, look – the same violation of advertising policy is happening in Ontario). Though, maybe at this point, it might be important to note that these are self-regulatory bodies. That poor boy with meningitis mentioned earlier? The College of Naturopathic Doctors of Alberta is investigating the naturopath responsible for the medical care of the child in this case – because 43 doctors all across Canada prompted them by signing a letter of complaint calling for an investigation on the grounds that there was a failure to meet standard of care to the patient.

It was at about this point that my post caught the attention of friends-of-friends with very different views of the efficacy of alternative medicine. Enter personal stories about their positive experience with alt medicine – which is fine – I welcome all discourse on the subject, not just the viewpoints I happen to agree with. That being said, you can’t bring feels to a facts discussion and expect them to be considered with the same weight as proof through clinical trial, which was the crux of the entire thread thus far.

My personal experience with a naturopath CURED me, so don’t dismiss alternative medicine! I am proof!

While I am glad that your personal health is improving, that is still little more than anecdotal evidence. And no amount of anecdotal evidence will change my mind regarding the legitimacy of alternative medicine.

It is important to note that correlation ≠ causation. An observed improvement in health while following an alternative medicine treatment plan does not necessarily mean that the treatment itself is effective. Is the patient experiencing natural fluctuations in the range and strength of symptoms of the condition? Are there other influences on how the symptoms are perceived, such as bedside manner of the practitioner? Is the patient undergoing supplementary treatment that may have an effect on the symptoms? Three things come to mind when I hear personal stories of the curative properties of alternative medicine:

  1. Natural cold remedies. There is no proof that any natural remedies have influence on the length or severity of the common cold. Perhaps the two most cited natural cold remedies, echinacea and vitamin C, have both returned negative results when testing for consistent efficacy of treatment and prevention of the common cold. Improvement in symptoms is likely the result of the natural progression of the ailment.
  2. Acupuncture. There is no unbiased documentation of acupuncture being effective for the treatment of any ailment. Currently, there is a large push for acupuncture in the treatment of depression; however, determining the effectiveness of acupuncture in treatment of depression becomes problematic when considering issues with researcher bias, positive expectancy, and influencing variables when conducting trials. In a panel with 4 other scientists for Scientific American, Harriet Hall, retired family physician, says, “In studies of depression any intervention may be helpful, even talking with a friend, so it is difficult to tease out the specific contribution of acupuncture. There appears to be no specific effect of the needles, only nonspecific treatment effects. For instance, patients get to relax for half an hour or so with personal, hands-on attention by someone who is convinced he or she is helping.”
  3. Margin of error. There are many conditions/diseases that mimic the symptoms of other diseases. There are also a number of conditions which have wildly differing ways of presenting themselves. Lastly, there are a number of diseases that go undiagnosed when there is a concurrent diagnosis because patients or practitioners believe the symptoms to be a part of another illness. All of these possibilities must be considered in the treatment and progression of any medical matter.

When alternative medicine starts showing results other than the placebo effect – when it is no longer alternative medicine and accepted instead as part of modern medicine via verifiable results (through repeated, non-biased, large sample size, peer-reviewed clinical evaluation) – then I will stop ragging on it as hard as I do. Until then, it is the red-headed stepchild of proven medical practices.

Naturopaths provide nutrition advice, and if they also sell a homeopathic remedy that is just a placebo anyway, what’s the harm?

Correct – you don’t need to dig into a database to try and defend nutrition against proponents of evidence-based medicine because, in fact, it is a recognized, proven, key component of medicine. It is not an alternative and you don’t need to pay a naturopath for guidance on the subject of nutrition. The bulk of the population can manage proper nutrition themselves simply by maintaining a balanced and varied diet to ensure meeting requirements for minerals, vitamins, and calories. Those that have nutritional deficiencies, dietary restrictions, or other medical complications can consult with a dietician (I did for FREE through my GPs office when it was discovered I have severe iron deficient anemia).

I think people are missing my core argument here. I am not opposed to supplementary measures to ensure proper health. I am opposed to unproven methods sold by charlatans. I refer, yet again, to my earlier comment:

When alternative medicine starts showing results other than the placebo effect – when it is no longer alternative medicine and accepted instead as part of modern medicine via verifiable results (through repeated, non-biased, large sample size, peer-reviewed clinical evaluation) – then I will stop ragging on it as hard as I do. Until then, it is the red-headed stepchild of proven medical practices.

Regarding placebos: I know some people believe “what is the harm if it is working as well as a prescription, sans side effects?” This, for me, raises two major red flags:

  1. It may not be causing (visible) side effects – but what is the effect on the patient financially?
  2. This becomes a question of ethics, in that it is a violation of patient autonomy and informed consent. Misleading patients is a massive violation of trust and is wildly inappropriate. (Doctor John C. Bailar III wrote an excellent piece on the ethics of deception in the medical profession in the New England Journal of Medicine. The Washington Post wrote and article on the connection between placebos and alternative medicine.)

At this point, the conversation derails and accusations of personal attacks are made while the woo-peddlers verbally fellate each other. I watched as the same thing that occurs in discussions regarding religion vs. reason happened: persecution complexes came out in full force. I forgot that having a dissenting opinion and placing the burden of proof on the claimant actually means that you are, in fact, calling the person human garbage. Refusal to accept personal experience as absolute truth is not equivalent to dismissing the possibility of its legitimacy. It is, however, a request for evidence of legitimacy. This is the crux of the burden of proof: substantial claims require substantial proof. Provide evidence for why your statement is true, and we can talk! Our understanding of science is of course incomplete. But it was far less complete thousands of years ago and we didn’t get to this level of understanding by simply accepting that a thing is true without investigation.

We are all so much better than this. Ad hominem? Correlative fallacy? Fallacy of composition? At what point did it become not only an acceptable but a sanctioned tactic to ignore facts in favour of personal bias? Why do rational discussions spiral toward personal attacks when a differing opinion is presented? When will we start giving more recognition to the issue of cognitive dissonance in debates?

I am not a scientist. At this point, I lack even a rudimentary understanding in any of the sciences; therefore, I will not attempt to boast a superior expertise in health and medicine. That being said, I am skeptical of significant claims until they are demonstrably true. I believe that most miracle cures are one of two things: either a hypothesis that requires testing, or a lie told as part of an agenda to drive profits.

In the first case, I absolutely wish for the hypothesis to be true, if for no other reason than to broaden our understanding of chemistry, biology, and physiology. When a theory is posited it must, of course, be subject to repeat examination via the scientific method. If a result can be reliably reproduced under non-bias trial, science adjusts its view of how the world works. Unfortunately, to quote Tim Minchin, “alternative medicine has either not been proved to work or been proved not to work.” A recent example: the claim that cranberry capsules are an effective treatment for urinary tract infections (Full disclaimer: this is a belief I bought into until careful review of the evidence.) This is one of the more widely subscribed to beliefs in alternative medicine and has been debunked in a recent study.

In the case that a claim is made as a mechanism to increase profit margins, it takes a significant amount of time and effort to discern the truth. From a research perspective, it requires a no small amount of funding and preparation to produce clear, relevant, and unbiased results when testing theories. Unfortunately, public funding for scientific research endeavors is a contentious subject at best, leaving minimal ability to test the numerous alternative medicine claims being generated. Additionally, in the technological landscape built on one-click “Like” and “Share” buttons, social media platforms provide a very effective vehicle for the spread of pseudoscience. Trying to discern the truth by Googling a subject often doesn’t help, with the rise of fake news stories and Google’s search algorithm, which sustains the woo industry’s circle jerk. Add in unchecked statistical bias in published works, and cognitive bias in the reader, and suddenly the truth becomes very hard to detect, indeed.

itknows

Ah, The Onion. It knows.

The ability to exercise critical thinking is paramount when approaching the subject of alternative medicine’s legitimacy. Who stands to benefit from the claim that is being made? Where did this idea come from and how does it conflict with our current knowledge? What are the benefits and drawbacks of this discovery? What evidence is there to support this idea? Can the result be reproduced multiple times? Are there specific conditions that must be met in order to reproduce the result, and if so, what are the implications of those conditions? Are the beliefs of the study participants influencing the data or the analysis of the data? Is there a better way to approach the experiment to yield more definitive answers?

We are in an age where anyone can make a website or use Photoshop to craft a narrative, and this isn’t the first time technology is being utilized to push an agenda (printing press, anyone?).

Doubt everything…

post-16093-philosophical-graffiti-questio-yloh

Take your cues from sarcastic graffiti if you must.



Categories: health, woo

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