Note: This is the second in an ongoing series of posts on NIB (Natural is Better) ideology. The first can be found here. More to come.
In 1992, JAMA published an article that began with the following statement:
A new paradigm for medical practice is emerging. Evidence-based medicine de-emphasizes intuition, unsystematic clinical experience, and pathophysiologic rationale as sufficient grounds for clinical decision making and stresses the examination of evidence from clinical research. Evidence-based medicine requires new skills of the physician, including efficient literature searching and the application of formal rules of evidence evaluating the clinical literature.
Many people are surprised to learn that “evidence-based medicine” (EBM) is a relatively new and controversial approach in modern medicine. Hasn’t medicine relied on evidence for a long time, certainly long before the end of the 20th century?
It depends on what one means by evidence. The EBM movement stresses using research from randomized controlled trials (RCTs), but a lot of what the best-trained doctors routinely do is founded in tradition, custom, personal experience, intuition, and scientifically-grounded logic – not on RCTs. RCTs are not the only scientific pathway to evidence, but they are the best. EBM defined more broadly is using procedures that are supported by the best available evidence.
There is an awful lot that scientific medicine does not know and surely a lot of what we think we know will be proven wrong in time. Furthermore, many sick and suffering people fail to find the help they are looking for from scientific medicine. When this happens, many people turn to “alternative medicine” (AM) for help. AM encompasses a huge number of approaches and techniques. Some of these approaches are based on ancient techniques and folk remedies, but what almost all of them share in common is any lack of scientific evidence. AM is a (probably too kind) euphemism. A more accurate term might be “non-scientific medicine,” “non-evidentiary medicine,” or even more appropriately, “people making stuff up to take other people’s money.”
Sometimes AM is couched in a scientific sounding language, and sometimes it appeals to spirituality or religion (however, your priest probably won’t charge you for a blessing—which is a crucial distinction). But probably the most common draw is an appeal to nature. A large part of AM is naturopathic medicine, which is based on two main ideas: first, that the human body has been endowed by nature with the ability to heal itself of disease and injury (true to an extent, for sure); second, that the cause of much disease is the result of humans creating toxic environments that cause disease to develop (certainly some truth there). When naturopathy is reduced to concepts such as eating whole foods instead of processed ones, getting exercise, reducing stress, getting sleep, maintaining strong personal relationships, and acting in a moral fashion, it has a lot to add, since conventional medicine often ignores these ideas and is too quick to jump to medication, surgery and treatment (that is what they do, after all).
But naturopathy and AM more generally can be pernicious. Much of what is going on in AM is simply just complete crap. Nonsense. Fraud. A multitude of examples abound. One particular example goes by the name of “therapeutic touch,” which is a pseudo-scientific attempt to manipulate the patient’s “energy flow” by waving one’s hands near the surface of the skin, but not actually touching them (I kid you not!) A word of advice: if any AM practitioner mentions “energy flow” to you, you should grab tight to your wallet and run away fast. My favorite medical article of all time appeared in JAMA several years ago (April 1, 1998) and contained the result of an elementary school science experiment done by a young girl named Emily (I use this study in my statistics classes, since it is so fun and simple to grab on to). Emily tested a group of experienced practitioners to see whether they could detect her energy field by placing her hand over one of the practitioner’s hands and them asking the practitioner if he/she could tell which hand she was near (they all thought they would be able to). You can guess the result. They made the right choice about 50% of the time, a little less actually, and their rationalizations were hilarious.
All this would be quite amusing if people weren’t spending loads of money on this nonsense. It has even being taken seriously by nursing schools, and many practitioners are certified RNs. Emily’s study dealt a blow to the practice, but it continues to thrive. At least having someone manipulate one’s energy flow doesn’t do any damage other than to one’s pocketbook.
Another very popular claim these days in the AM market are substances which are supposed to do “detoxification.” Colonics, in which the large intestine is flushed out (I won’t describe how), have been in use a long time, though they have never shown any medical benefit in controlled studies. The sale of these products relies on two key elements of the NIB ideology. The first is that modern society produces vast amounts of un-natural toxins that need to be removed to restore health. The second is that whatever “natural” substance one takes into one’s body will be healthy, which is a clearly unfounded and potentially dangerous assumption (hemlock, anyone?).
Many hawkers of “natural” products and services make claims of effectiveness, but it is the rare case when legitimate research verifies these claims (Quackwatch.com is an excellent web-site for the public). The reason that AM doesn’t have evidence is that this multi-billion dollar industry does not want to look for evidence. One might think that companies making nutritional supplements, for instance, would divert part of their huge marketing budget to doing RCTs that could be peer-reviewed and published in legitimate scientific outlets—just like the drug companies do (partly because they are forced to). But when you can make billions of dollars just making stuff up, why spend the money to prove your claims? Is any industry going to do research that will drive it out of business?
But the main downside of the AM movement is that it leads some people to eschew proven, effective medical treatment and others to miss out on correct diagnoses that a competent medical professional can make. I have a good friend who lost his mother because she refused to receive cancer treatment that would very likely have resulted in her being able to spend a lot more time with her grandchildren. She chose a “natural” approach instead. That is the real tragedy that AM practitioners don’t want people to know about. Modern medicine doesn’t know everything by any means, but it knows some things, and it can increase life expectancy and well-being for many sick people.
How do I know this? Because there is a lot of evidence for it.
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