Alternative medicine

• 1. Introduction

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  Alternative medicine is the name given to practices that aim for the healing effects of medicine but that, by definition, lack biological plausibility, testability, repeatability, or any supporting evidence of effectiveness. That definition does most of the work. These practices sit outside evidence-based medicine, and they do not arise from the scientific method at all. Instead they draw on testimonials, anecdotes, religion, tradition, superstition, belief in supernatural energies, pseudoscience, errors in reasoning, propaganda, or fraud. The journalist John Diamond put it bluntly. He wrote that there is really no such thing as alternative medicine, just medicine that works and medicine that doesn't. So how did an entire profitable industry grow up around treatments that the evidence does not support? Why do so many people feel helped by them? And what happens when someone chooses these treatments instead of the medicine that does work? This documentary follows those questions through the words, the energies, the history, and the harm.

• 2. A Forest Of Names

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  New Age medicine, pseudo-medicine, unorthodox medicine, holistic medicine, fringe medicine, unconventional medicine. The terms pile up, and they shift over time to match the branding that practitioners prefer. They are used almost interchangeably, with little distinction from quackery. The renaming is visible inside the United States government itself. The department of the National Institutes of Health that studies these practices is now the National Center for Complementary and Integrative Health. It began as the Office of Alternative Medicine, then became the National Center for Complementary and Alternative Medicine, before arriving at its current name.

  The word "alternative" carries a quiet implication that there is an effective alternative to medical science. Critics say that implication is deceptive, since alternative medicines that have been tested nearly always show no measurable positive effect compared to a placebo. Loose terminology can also invent a divide that does not exist. The phrases "Western medicine" and "Eastern medicine" suggest a cultural gap between the Asian east and the European west. The real difference is between evidence-based medicine and treatments that do not work.

  Complementary medicine is the label used when these practices are added to mainstream treatment in the belief that they improve it. The US Center for Disease Control and Prevention draws the line cleanly. Complementary medicine is used in addition to standard treatments, while alternative medicine is used instead of them. The cancer-research charity Cancer Research UK and the UK National Health Service make the same distinction. Acupuncture, the piercing of the body with needles to influence a flow of energy, is offered as the example of a practice believed to complement science-based care.

  David Gorski, a surgical oncologist, has described integrative medicine as an attempt to bring pseudoscience into academic science-based medicine. He and David Colquhoun use a pejorative for this: quackademia. Mainstream institutions including the Cleveland Clinic, the Mayo Clinic, Stanford University, UCLA and Northwestern University run integrative or functional medicine departments, which is exactly the infiltration Gorski warns about.

• 3. The Functional Rebrand

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  Jeffrey Bland created functional medicine in the early 1990s as part of one of his companies, HealthComm. He founded The Institute for Functional Medicine, based in the US state of Washington, which became a registered non-profit in 2001. Mark Hyman joined its board and became a prominent promoter. Gorski, who works at Wayne State University, says the field is not well defined, that it runs expensive and generally unnecessary tests, and that its vagueness is a deliberate tactic to make it hard to challenge.

  The model itself reads like an invented vocabulary. Practitioners speak of antecedents, triggers, and mediators, meant to map onto underlying causes, immediate causes, and the particular features of a person's illness. From these factors a practitioner builds what is called a matrix to guide treatment. Patients may be told to follow unnecessary diets that limit their food choices. Joe Pizzorno, a major figure in the field, claimed that 25 percent of people in the United States have heavy metal poisoning and need detoxification. Many scientists call such detox supplements a waste of time and money, and detox itself has been called mass delusion.

  American family physicians drew a line in 2014. The American Academy of Family Physicians withdrew course credits for functional medicine courses, having identified some treatments as harmful and dangerous. In 2018 it partly lifted the ban, but only for overview classes, not for teaching the practice. Jonathan Stea has written that functional medicine, integrative medicine and complementary and alternative medicine are marketing terms designed to confuse patients, promote pseudoscience, and sow distrust in mainstream medicine. Writing for McGill University, Jonathan Jarry warned that testing enough people yields false positives, which generate anxiety, more invasive tests, and sometimes unnecessary treatments.

• 4. Energies And Doshas

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  Qi is the supernatural energy at the heart of traditional Chinese medicine, a system built from Chinese practices and beliefs along with modifications made by the Communist party. Its herbal medicine, acupuncture, the massage called Tui na, the exercise called qigong, and dietary therapy rest on Chinese astrology, Chinese numerology, a belief that the tongue holds a map of the body, and an incorrect model of the internal organs.

  The doshas anchor Ayurveda, the traditional medicine of India. It holds that three elemental substances, called Vata, Pitta and Kapha, govern health when balanced and cause disease when out of balance. Treatments lean on plant-based medicines, some animal products, and added minerals including sulfur, arsenic, lead and copper(II) sulfate. Two US studies found about 20 percent of Ayurvedic Indian-manufactured patent medicines contained toxic levels of heavy metals such as lead, mercury and arsenic. A 2015 study of users in the United States found elevated blood lead levels in 40 percent of those tested.

  Innate Intelligence was the supernatural vital energy that chiropractic was built to unblock. Spinal manipulation aims to treat vertebral subluxations, claimed to press on nerves, though vertebral subluxation is a pseudoscientific entity not proven to exist. Reiki practitioners place their palms near chakras, believed to be centers of supernatural energy, in the belief that energy passes from palm to patient. The astrophysicist Carl Sagan, who wrote The Demon-Haunted World: Science as a Candle in the Dark, lambasted the lack of empirical evidence for the energy fields these therapies depend on. Naturopathy and homeopathy round out the belief systems. Homeopathy was developed before knowledge of atoms and molecules showed that its repeated dilution produces only water.

• 5. Why It Feels Like It Works

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  A placebo is a treatment with no intended therapeutic value, an inert pill or even a sham surgery, and the placebo effect is the perception of improvement after taking it. Placebos do not physically affect diseases or improve overall outcomes, though patients may report relief in subjective measures like pain and nausea. A 1955 study suggested much of a medicine's impact came from this effect, but later reassessments found the study methodologically flawed. The opposite is the nocebo effect, where someone expecting harm perceives it, and distrust of conventional medicine can trigger that response toward effective drugs.

  Regression toward the mean offers a second explanation. An extreme result tends to be followed by a less extreme one, so a patient who takes an inert treatment may recover naturally or simply pass through a fluctuation in a long-term condition, then credit the treatment. Assuming the treatment was the cause without evidence is the regression fallacy. A person never diagnosed by science-based medicine may never have had a real illness at all.

  Bias inside studies adds a third layer. Asbjorn Hrobjartsson and Peter C. Gotzsche wrote in their 2010 systematic review that even with no true placebo effect, one would expect differences between placebo and no-treatment groups because of the bias from a lack of blinding. Politeness, experimental subordination, observer bias and the wording of questions all push reported results upward. Gorski argues that alternative treatments should be regarded as placebos rather than as medicine, since almost none have performed significantly better than placebo in clinical trials.

• 6. Weighed And Disproven

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  Edzard Ernst was the first university professor of Complementary and Alternative Medicine, and his verdict is among the most cited. In 2011 he estimated that about 7.4 percent of alternative techniques rested on sound evidence, and even that he suspected was an overestimate. He concluded that 95 percent of the therapies his team studied, including acupuncture, herbal medicine, homeopathy and reflexology, were statistically indistinguishable from placebo treatments. Still, he believed conventional doctors could learn from chiropractors and homeopaths about the therapeutic value of the placebo effect.

  The Cochrane Library gave reviewers a body of work to weigh: 145 CAM-related Cochrane systematic reviews. Across them, 38.4 percent concluded a positive or possibly positive effect, 4.8 percent concluded no effect, 0.7 percent concluded a harmful effect, and 56.6 percent concluded there was insufficient evidence. A 2003 project funded by the CDC identified 208 condition-treatment pairs, of which 58 percent had been studied by at least one randomized controlled trial.

  Cancer is where the language hardens. The cancer researcher Andrew J. Vickers wrote that many alternative cancer treatments have been investigated in good-quality clinical trials and shown to be ineffective, so the label "unproven" is inappropriate; it is time to call them disproven. Ernst went further, saying any alternative cancer cure is bogus by definition. His reasoning is mechanical. If anything looked halfway promising, mainstream oncology would scrutinize it, and anything real would become mainstream almost automatically. Richard Dawkins reached the same place in his 2003 book A Devil's Chaplain, defining alternative medicine as a set of practices that cannot be tested, refuse to be tested, or consistently fail tests.

• 7. The Cost Of Believing

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  Four children died in Australia between 2001 and 2003 because their parents chose ineffective naturopathic, homeopathic, or other alternative medicines and diets instead of conventional therapies. That is the sharpest edge of what the Institute of Medicine catalogues as three harms: direct harm to the patient, economic harm that costs money without a health hazard, and indirect harm that delays appropriate treatment or feeds unreasonable expectations. The danger sharpens for diseases not expected to improve on their own, such as cancer or HIV infection, where multiple studies have shown significantly worse outcomes when patients turn to alternative therapies.

  Some treatments are actively dangerous on their own terms. Amygdalin can cause cyanide poisoning, and people have intentionally swallowed hydrogen peroxide. Biologically active remedies can also collide with real medicine. Alastair MacLennan of Adelaide University reported a patient who almost bled to death on the operating table after taking a powerful anticoagulant in "natural" potions meant to build up her strength before surgery. Herbal preparations can interfere with the blood thinner warfarin, and herbal remedies can clash with chemotherapy, radiation therapy, or anesthetics.

  The appeal to nature fallacy props much of this up, the idea that what is natural cannot be harmful. Conventional treatments are tested for side effects; alternative therapies generally are not. Patients with impaired liver or kidney function are more vulnerable still. Homeopathy is the odd exception on safety, since its preparations are diluted far past the point where a single molecule of the original ingredient is likely to remain. Since 1938 the FDA has regulated those products differently, exempting them from finished-product testing for identity and strength.

• 8. An Industry With A Lobby

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  Billions of dollars have been spent studying alternative medicine, with few or no positive results and many methods thoroughly disproven. The National Center for Complementary and Integrative Health has spent more than 2.5 billion US dollars on such research since 1992 without demonstrating efficacy, and as of 2011 its sister organization in the NIH Office of Cancer Complementary and Alternative Medicine had given out grants of around 105 million dollars a year for several years. Steven Salzberg, a genome researcher at the University of Maryland, said plainly that one concern is that the NIH is funding pseudoscience. R. Barker Bausell, author of Snake Oil Science, said it has become politically correct to investigate nonsense.

  The sector is a highly profitable industry with a strong lobby, and it has successfully pushed for far less regulation than conventional medicine faces. Regulation varies widely. Chiropractic has achieved full regulation in North America, while other approaches have none at all. In Germany herbs are tightly regulated, with half prescribed by doctors and covered by health insurance. In most countries alternative therapies can be marketed without any proof of efficacy, a disincentive for manufacturers to fund research, and many treatments are not patentable, which dries up private money further.

  Use keeps climbing. In Africa, traditional medicine is used for 80 percent of primary healthcare. In the United States, a 2002 national survey found 36 percent of adults used some form of complementary and alternative medicine, with prayer the most common at 45 percent. By 2008 more than 37 percent of American hospitals offered alternative therapies. Ernst blamed the providers, the customers, and the doctors, saying people are told lies by tens of millions of websites, and that it needs gullibility for the industry to succeed. His sharpest warning came in November 2011, when he said the level of misinformation had become dangerous and unethical, and that alternative medicine had remained an ethics-free zone that it was time to change.