Essay:The Problem with Alternative Medicine
This essay is an original work by Krej. The original author has freed it for editing by other editors.
This article will attempt to address some common arguments used in favor of alternative medicine.
In my experience, it works
One common argument is that a given anecdote is too unlikely to be a coincidence. For instance, some person may have been ill for many years, and got better only a short time after commencing treatment, as in the following stories:
“”I having ministered [tobacco] to many people as well men as women, in great number, and being grieved of ten, and of twenty years they have healed old rotten sores in legs, and other parts of the body, with only this remedy to the great admiration of all men.
“”[Bloodletting] removes coma. Mr. Henry Clymer was suddenly relieved of this alarming symptom, in the fever of 1794, by the loss of twelve ounces of blood.
|—Benjamin Rush, A Defense of Blood-letting|
“”When a cook in [Jean] Nicot's household nearly cut off his thumb with a chopping knife, the steward ran for the tobacco plant and bound the thumb back on; after five or six dressings of the same sort, the wound healed.
|—Medicinal uses of tobacco in history|
But suppose you have 1000 people with a given disease, and that they all will treat their disease with the same therapy. If the odds of a given recovery being a coincidence is only 0.1%, there will still be at least 1 "miraculous", yet completely coincidental, case. If it is 1%, there will be 10. Now, just think that every person will be afflicted in their lives by some disease, where "disease" can be from anything as mundane as pain or nausea, or as serious as pneumonia. Suppose there is an average of 300 such events per person, and that each one of these 1000 people will attempt to cure each event through some therapy which, for argument's sake, we will assume is ineffective. In total, then, there will be 300,000 such events, each of which, or a large number of which, will involve an attempted cure through some ineffective treatment. Obviously, out of such a large number, there will be many remarkable coincidences. Even if the treatment is effective, many of the "cures" will be coincidental. Now consider that there are not 1000, but millions or even billions of people today and in the past who use or have used alternative medicine. The total number of events thus rises into the millions or even billions. Even assuming the majority of treatments are effective, there will be a large number of coincidences in this enormous pool of events. Consider the following paragraph by Oliver Wendell Holmes:
“”Suppose, then, a physician who has a hundred patients prescribes to each of them pills made of some entirely inert substance, as starch, for instance. Ninety of them get well, or if he chooses to use such language, he cures ninety of them. It is evident, according to the doctrine of chances, that there must be a considerable number of coincidences between the relief of the patient and the administration of the remedy. It is altogether probable that there will happen two or three very striking coincidences out of the whole ninety cases, in which it would seem evident that the medicine produced the relief, though it had, as we assumed, nothing to do with it. Now. suppose that the physician publishes these cases, will they not have a plausible appearance of proving that which, as we granted at the outset, was entirely false?!
"But wait," you might reply, "There must be a reason for all these stories. After all, many of them involve incurable diseases. How can these anecdotes not demonstrate effectiveness when they involve people recovering from incurable diseases?"
Right you are. There must be a reason. But there are in fact several possible explanations, which may not be immediately obvious. Imagine the following scenario. Someone goes to a doctor and is told they have cancer. Having read up about alternative treatments, they decide to go to some alternative practitioner of their choice, and 20 years later, they are perfectly fine, having never had to go through the ordeal of suffering from cancer, and are busily spreading the word of the wonderful treatment they used. This must mean that whatever they did worked! Right? Well, not necessarily. It could be that they were misdiagnosed. Their doctor could have told them they had cancer, when in reality he was mistaken and they were not ill at all. When the person went to an alternative practitioner, they were thus treating a disease they did not even have.
Another possible explanation is that the person in the anecdote was not actually cured, but merely believed so. Here is one example. A cancer patient named Kim Tinkham decided to treat her cancer by following an alkaline diet. She even went on the Oprah Show claiming she had been cured. However, a few years later she died of the supposedly "cured" cancer. Similarly, there are anecdotes on the internet describing how so-and-so cured his cancer by using cansema, with before-and-after photos of cancerous and then non-cancerous skin. But though the cansema may have burned off the cancer that was on the surface, there is almost certainly still cancer underneath that will flare up again in the future, which will not be reflected in the original anecdote. Anecdotes do not include eventual deaths or reoccurences of disease occurring after their publication.
You may be wondering, "But what about all the cases of pain going away immediately after treatment?" Well, consider the following paragraph from Mark Twain's Christian Science.
When I was a boy a farmer's wife who lived five miles from our village had great fame as a faith-doctor—that was what she called herself. Sufferers came to her from all around, and she laid her hand upon them and said, "Have faith—it is all that is necessary," and they went away well of their ailments. She was not a religious woman, and pretended to no occult powers. She said that the patient's faith in her did the work. Several times I saw her make immediate cures of severe toothaches. My mother was the patient. In Austria there is a peasant who drives a great trade in this sort of industry, and has both the high and the low for patients. He gets into prison every now and then for practising without a diploma, but his business is as brisk as ever when he gets out, for his work is unquestionably successful and keeps his reputation high. In Bavaria there is a man who performed so many great cures that he had to retire from his profession of stage-carpentering in order to meet the demand of his constantly increasing body of customers. He goes on from year to year doing his miracles, and has become very rich. He pretends to no religious helps, no supernatural aids, but thinks there is something in his make-up which inspires the confidence of his patients, and that it is this confidence which does the work, and not some mysterious power issuing from himself.
In the 19th century, a doctor named Elisha Perkins invented some metal rods (which he called "Tractors") he claimed were made of a special alloy and could cure everything. These tractors were extremely popular and had many testimonials in their favor. However, some doctors found that it made no difference whether the rods were made of a "special alloy" or anything else; they had the same effect regardless. Oliver Wendell Holmes recalls a case involving these "fake" tractors:
“”Ann Hill had suffered for some months from pain in the right arm and shoulder. The Tractors (wooden ones) were applied, and in the space of five minutes she expressed herself relieved in the following apostrophe: "Bless me! why, who could have thought it, that them little things could pull the pain from one. Well, to be sure, the longer one lives, the more one sees; ah, dear!"
The doctor Henry Beecher, during World War II used saline injections as a painkiller, because of morphine shortages, and found his patients experienced pain relief as well as when they received morphine. In addition, one man had a vasectomy and was mistakenly injected with saline solution instead of anesthetic, but he experienced pain relief anyway.
Not to mention that anecdotes are used in support of many contradictory therapies. For instance, there are many systems involving laying on of hands that claim to cure everything, and yet they are based on mutually exclusive theories. Some claim that hand-waving will only work if one has been "initiated" (but only into their particular version; the others being worthless); otherwise, the movements do nothing. Others claim that no initiation is needed, and that merely following the hand movements as told is sufficient. These contradictory systems all have the same types of "miraculous" anecdotes involving immediate pain relief, and recoveries that have other possible explanations (as noted above) besides "supernatural forces" being at work. What this shows is that symptomatic relief will occur with any treatment, regardless of whether it is effective or not. This is, of course, the famous placebo effect, which causes pain relief by making the body release endorphins and other analgesic substances,
Some will claim that homeopathy (or ionized/alkaline water) cannot be plain water, because plain water does nothing, while homeopathic (or alkaline, or ionized) water is obviously an effective cure for everything. Others claim, however, that plain water is indeed an effective cure. There are also many contradictory "true causes of all disease," as you can see in our article on panaceas.
Clearly, it is impossible for all of these theories and treatments (which include tobacco and bloodletting, among other things) to be right, since many of them are mutually exclusive. Yet they all have the same type of anecdotes supposedly demonstrating their effectiveness. This indicates that "miraculous" anecdotal evidence will occur regardless if the treatment is effective or not. Even if a treatment is effective, many cases involving its use will be flukes, and it's impossible to tell which is which. As Oliver Wendell Holmes noted:
“”Of course a large number of apparent cures were due solely to nature; which is true under every form of treatment, orthodox or empirical[note 1]. Of course many persons experienced at least temporary relief from the strong impression made upon their minds by this novel and marvellous method of treatment.
Many, again, influenced by the sanguine hopes of those about them, like dying people, who often say sincerely, from day to day, that they are getting better, cheated themselves into a false and short-lived belief that they were cured; and as happens in such cases, the public never knew more than the first half of the story.
Natural is better
Many people believe that natural substances must be healthier than synthetic ones. They will point to the serious side effects of "synthetic" pharmaceuticals, compared to the practically nonexistent ones of supplements, and say that this difference is due to there being a fundamental difference between natural and synthetic compounds.
However, this comparison is not really valid. Though the alternative medicines on the market today are not particularly dangerous, this is more a result of regulation than anything else. In real traditional herbal medicine, as practiced hundreds of years ago in Western countries, or in many areas of the world today, there are many toxic and natural remedies used. For instance, lead, asbestos, tobacco, aconite, birthwort, and many others. Now, by contrast, such products have been banned, so that only the harmless (and generally, though not always, useless) ones remain.
In a world where all medicines were "natural" and unregulated, the medical profession's arsenal of herbs and salves would, just as before the 19th century, and just as in many parts of the world today, undoubtedly include many not particularly safe ones. The difference between the poisonous medicines of today and those of yore is, of course, that the former have been tested for their efficacy.
Another point to be made is that drugs are tested very thoroughly, by means of trials involving very large numbers of people and extending over long periods of time, and there are reporting systems in place to detect any possible (and potentially very rare) adverse effects they may have, after they have been launched on the market, leading to the well known lengthy lists of side effects. Side effects for herbal products, as well as non-herbal supplements, on the other hand, are not as well monitored or recorded, meaning that a herbal product could indeed have side effects (serious or otherwise) that, because of lack of regulation or research, have simply not been discovered. As Steven Novella noted in an article on birthwort:
“”Common use may be enough to detect immediate or obvious effects, but not increased risk of developing disease over time. That requires careful epidemiology or specific clinical studies. We know about the risks of prescription drugs only because they are studied, and then tracked once they are on the market. Without similar study and tracking there is simply no way to know about the risks of herbal products.
Indeed, before the advent of evidence-based medicine, many harmful natural remedies — such as birthwort (Aristolochia spp.), asbestos, and tobacco — were, and in some places still are, used as medicines without their harms being known at all (anecdotal evidence and personal observation being very bad at detecting long-term side effects). It is true that science-based medicine is flawed. Harmful effects of some therapies may take a long time to be discovered. But such effects will be revealed eventually. Science-based medicine, in other words, improves, and is constantly working to correct itself. While some facts regarding medical treatments may take decades to be revealed, this is still a much better track record than traditional medicine's, where harmful therapies (such as bloodletting or asbestos) were used for hundreds or even thousands of years without their side effects being discovered until the advent of statistical methods for evaluating treatment effectiveness. If alternative medicines were studied as extensively as pharmaceuticals are now, previously-unknown side effects of many more natural remedies would undoubtedly be discovered.
Alternative medicine practitioners will often argue in the superiority of "natural" medicines, but do not specify exactly what the difference between "natural" and "synthetic" molecules is supposed to be. Such a belief assumes that there is some method by which a "natural" molecule can be turned into its synthetic counterpart (for instance, "natural" water into "synthetic" water). That is, there should be an experimentally demonstrable sequence of chemical reactions that could turn "natural" salicylic acid (for instance) into "synthetic" salicylic acid. However, no such procedure has been shown to exist, and you will certainly not find it in any chemistry textbook. Proponents of the appeal to nature never explain, in detail, exactly how one is supposed to turn a "synthetic" molecule into an identical "natural" one. Thus there is no reason to believe that such a natural-synthetic distinction exists.
The word "natural" is often used to mean a substance not formed from chemical reactions caused by human intervention. This would indeed include drugs. During the infancy of chemistry, substances were taken from nature, and combined to create products (in the chemical sense). These substances, the result of combining entirely natural substances, would also be considered synthetic. But the water and carbon dioxide obtained from the reaction of sodium bicarbonate and vinegar or lemon juice would also be synthetic, according to this logic. All drugs and synthesized compounds have their origins in nature. If a human happened to combine the reactants, why should that make any difference? If the water obtained from the reaction of vinegar and baking soda isn't synthetic, then what if that water were used for a further, second reaction? Would the resulting product be synthetic? At what point does a molecule cease to be "natural"?
If the substances happened to be combined by some random force, would the product would be natural? Apparently, yes. Why? Why are some substances "synthetic" and therefore inferior, simply because a sentient being combined the reactants leading to its formation? If reactants are brought together by a human as opposed to by the random forces of nature or by some animal other than homo sapiens, why should that somehow modify the nature of the particles? Do humans have some negative aura that influences substances from a distance? Why is a product formed from the combination of reactants by a human more dangerous than one formed from the combination of reactants by random forces such as wind or gravity? And why doesn't this apply to homeopathy, which claims man-made homeopathic water is better than natural water?
Besides which, each alternative medicine practitioner has a different conception of what "natural" means. What is a toxic synthetic pharmaceutical for one naturopath may be a perfectly acceptable naturopathic treatment for another. Some blast botox as being a horrible poison, while others use it quite happily. Many alternative medicine advocates will complain about "allopathy" using "chemicals" (meaning isolated substances) instead of plants, yet at the same time see no contradiction in using isolated active ingredients such as glucosamine, glutamine, laetrile, Miracle Mineral Supplement, or any of the other countless non-herbal alternative medicines available, many of which are synthetic – like pharmaceuticals – and differ from conventional drugs only in that they are (usually) unapproved and unproven. Grapefruit seed extract is criticized by some for consisting of unnatural chemicals, while others hail it as a natural remedy. Some believers in the superiority of nature (some naturopaths, for instance) have no qualms using conventional pharmaceuticals, but arbitrarily classify some as being "good" and others as being "bad" for no apparent reason other than "I said so." All this shows that not even believers in the appeal to nature agree on what is "natural" and what isn't.
- The Futility of Anecdotal Evidence
- Why Bogus Therapies Seem to Work, Barry Beyerstein
- Why We Need Science: “I saw it with my own eyes” Is Not Enough, Harriet Hall
- Here used in the sense (attested in dictionaries) of "based on experience," or, in other words, anecdotal evidence. The word "empirical" is commonly used this way in documents of the period. The 19th-century doctor Dan King, in a skeptical book about unconventional treatments, repeatedly called them "empirical" and referred to the "devious paths of empiricism"; one of the dictionary definitions of empiricism is "undue reliance upon experience, as in medicine".
- Of the Tabaco and of His Greate Vertues
- A Defence of Blood-letting, as a Remedy for Certain Diseases
- Homeopathy and Its Kindred Delusions
- Cancer: "Miraculous Recoveries", Quackwatch.
- Christian Science, Mark Twain, Chapter IV.
- The Powerful Placebo.
- Harriet Hall, Women Aren't Supposed to Fly: The Memoirs of a Female Flight Surgeon, quoted in Acupuncture, Skepdic.
- Brain's Own Pain Relievers At Work in Placebo Effect, Study Suggests, Scientific American, Sarah Graham, Aug 24, 2005.
- Herbal Medicine and Aristolochic Acid Nephropathy, Steven Novella, Science-Based Medicine.
- Anti-Botox Fillers: The Case Against
- 9 Tips your Naturopath wants you to know about flawless skin. Tip 5: "My advice would be to avoid Botox as it is the most deadliest poison for the skin."
- Natural versus “natural” in CAMworld, David Gorski, Science-Based Medicine.
- Grapefruit seed extract, Global Healing Center.
- grapefruit seed extract is vile, deplorable, adulterated
- The Truth about Grapefruit Seed Extract
- FDA Bans Natural Pain Treatment to Protect Patented Drug That Does Same Thing, Alliance for Natural Health. The "natural pain treatment" in question is the pharmaceutical colchicine.
- What naturopaths say to each other when they think no one’s listening, Science-Based Medicine, David Gorski. Includes examples of naturopaths using things like Benadryl and hydrochloric acid.