Robert Todd Carroll
Suckers: How Alternative Medicine Makes Fools of Us All by Rose Shapiro Feb 2008 |
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(the Google ads on this page are for those who don't trust me) integrative medicine
Integrative medicine is a synonym for "alternative" medicine that integrates sense with nonsense. It integrates the scientific with the untested and the discredited. The expression was popularized by Andrew Weil, M.D. Dr. Weil graduated from Harvard Medical School but did not complete an internship nor, as far as I can ascertain, ever take the medical boards in any state.
Apparently, he continued his herbal research during an extensive stay in South America.
Today, Weil mixes scientific medicine with Ayurvedic and other forms of quackery and calls this practice "integrative medicine." One of his main tenets is: "It is better to use natural, inexpensive, low-tech and less invasive interventions whenever possible." However, there is no scientific evidence for the claim that natural interventions are always superior to artificial ones. Millions of people use herbs and natural products for a variety of conditions, such as calcium, echinacea, ginseng, ginkgo biloba, glucosamine, saw palmetto, shark cartilage, and St. John's wort. All of these, when tested scientifically, have failed to support the traditional wisdom regarding their healing powers. Pharmaceuticals and other treatments are much superior to most herbal remedies. If a plant has been shown to be effective as a healing agent, the active ingredient has been extracted and tested scientifically and is part of conventional medicine. Otherwise, any beneficial effect following use of the herb or plant is probably best explained as due to the placebo effect, natural regression, the body's own natural healing processes, or to some other non-herbal factor. Why so many people—including many highly educated and medically trained people—believe in the efficacy of quack remedies is a complex issue. As Barry Beyerstein has pointed out in his most thorough analysis of this phenomenon, there are a "number of social, psychological, and cognitive factors that can convince honest, intelligent, and well-educated people that scientifically-discredited [or untested] treatments have merit" (Beyerstein 1999). The typical believer in untested or discredited medical treatments accepts uncritically the apparently clear messages of personal experience that such treatments are effective. To the uncritical thinker, many worthless or harmful treatments seem to "work" (the pragmatic fallacy). Such people are either unaware of or intentionally ignore the many perceptual and cognitive biases that deceive us into thinking there are causal relationships between quack treatments and feeling better or recovering from some illness or disease. They uncritically place "more faith in personal experience and intuition than on controlled, statistical studies" (Beyerstein 1999). Furthermore, the mass media is rarely critical of "alternative" healing and often presents non-conventional medicine in a very positive light. And critics of complementary and alternative medicine (CAM) are often stereotyped as lackeys for the AMA or the pharmaceutical firms. For example, when a recent double-blind study of 225 men with enlarged prostates [benign prostate hyperplasia or BPH] found no statistically significant difference between those who took saw palmetto and those who took a placebo twice a day for one year, a user of saw palmetto wrote a letter to the editor of the Sacramento Bee in which he claimed that the study was
Rather than accept the results of a scientific study, the letter writer—like many purveyors and proponents of quack treatments—trusts his interpretation of his personal experience, even though it is contradicted by a double-blind scientific experiment.* He also brings up a common claim among believers in quack remedies: the pharmaceutical industry has rigged the game so they can sell more drugs. The letter writer believes that the pharmaceutical industry has somehow manipulated the seven scientists who did this study, as well as the New England Journal of Medicine, which published their research. The letter writer is probably not the least bit interested in the fact that the National Institutes of Health, which spends millions of dollars each year trying to validate quack treatments, has funded a major new study of saw palmetto and another commonly-used herbal treatment for BPH.* The new study will involve several hundred patients at 11 centers nationwide. Such information is probably of no interest to this letter writer, since he already knows that "saw palmetto is a blessing." Of course, if the results of the new study support the claim that saw palmetto is an effective treatment for BPH, he may view the study with a more positive eye, as it will confirm his bias. In any case, the fact that someone has not had prostate problems since he started taking some herb is not very strong evidence that the herb has had anything to do with it. His prostate problems—whatever they may have been—may have subsided had he done nothing. It is possible that he stopped drinking caffeinated beverages at the same time he started taking the herb and that the entire positive effect he feels is due to not ingesting caffeine. Perhaps he began ejaculating several times a week after his problem emerged.* A scientific study can control for various factors that might be causing an outcome and isolate the most likely significant factor. Intuition is unable to do this. Many believers in integrative medicine are led to their uncritical evaluation of personal experience because of their deep commitment to metaphysical notions such as subtle energy or spiritual forces. They do not accept that the biological world is governed by mechanistic processes determined by laws of nature. Scientific or evidence-based medicine is rooted in a set of beliefs about reality that seem to contradict their beliefs in non-physical entities and forces that are at the core of their perception of reality. They don't necessarily reject science altogether, but they are as likely to put their faith in prayer, intuition, meditation, or visions induced by drugs, as they are in randomized, double-blind, controlled studies. Scientific medicine is not infallible, of course. And we should not draw strong conclusions from a single study. That goes for both skeptics and believers. The results of a scientific study should usually be taken to hold tentatively, until significant replication or other strong supportive evidence leads to a consensus. Even then, the door should never be closed to further investigation, should new data arise that warrants it. The tendency of most of us, however, is to be uncritical and accepting of a study if it seems to support our beliefs. A skeptic might hail the Bent et al. study that found no significant benefit of saw palmetto, while a believer might reject the study because of a perceived fault. One need not speculate about drug company conspiracies to find a reason to reject a scientific study. No study is perfect. It is not difficult to find fault with nearly every scientific study ever done. The study did not go on long enough. The dosage was too small or too large or was given too frequently or not frequently enough. The placebo wasn't masked well enough. The sample was too small. The randomization process wasn't perfect. And so on. Furthermore, each human being is a unique and extremely complex biological organism. The same chemicals may affect different people in significantly different ways. They may even affect the same person differently at different times. It is not uncommon for a well-designed double-blind study to contradict earlier studies (as was the case with the Bent et al. study). It should not be a shock to anyone if the next saw palmetto study finds that it significantly improves BPH, but if it does that should not be the end of such studies. Eventually, a consensus should be reached about the effectiveness of this smelly herb to heal the prostate. But even when that consensus is reached, there will still be a few contrarians who will continue to prescribe and sell saw palmetto to patients concerned about prostate problems. Some of these will base their contrary belief on their intuitions but others will say that further studies need to be done because, after all, there have been some studies that have indicated it is effective and there are still many men who swear by it. It is always possible that the next study will prove beyond a reasonable doubt that it is effective. And if it doesn't? Well, there is always the next study and the one after that. Randomized double-blind studies are not perfect, but they are much more reliable than anecdotes and personal experience because they allow us the opportunity to control our observations in such a way as to minimize the effect of the many perceptual and cognitive biases that affect us all and are great sources of error. We are prone to wishful thinking, "a willingness to endorse comforting beliefs and to accept, uncritically, information that reinforces our core attitudes and self-esteem" (Beyerstein 1999). We often see patterns that aren't really there and find significance in coincidental occurrences.
The appeal of Weil's integrative medicine is that he mixes sound scientific knowledge and advice with illogical hearsay. For example, on his Men's Health Internet page, he provides scientific information regarding men with prostate problems. He offers common sense advice such as don't ingest caffeine and alcohol if you are having trouble with frequent urination, since these substances will increase the need to urinate. But he also advises men to eat more soy because: "Asian men have a lower risk of BPH and some researchers believe it is related to their intake of soy foods." As Sally Fallon and Mary G. Enig note, however: "the same logic requires us to blame high rates of cancers of the esophagus, stomach, thyroid, pancreas and liver in Asian countries on consumption of soy" (Soy Alert! 2001). Weil also states that saw palmetto "may help" BPH because: "There is clinical evidence that saw palmetto can help shrink the size of the prostate, and it may help promote healthy prostate function." Now we know there is clinical evidence that saw palmetto doesn't help shrink the size of the prostrate. On the positive side, Weil notifies the reader: "You should inform your health care practitioner you are using this product." Your physician needs to know what supplements you are taking because what he or she prescribes to you may interact adversely with the herbs you are taking. For those who want to study alternatives to scientific medicine, the University of Arizona seems like the hot spot. It not only supports the work of Gary Schwartz and the Center for Frontier Medicine in Biofield Science, Andrew Weil heads its integrative medicine program. Why would a major university risk its reputation by supporting such programs? Because these programs are very popular with the masses, the media, many medical schools and physicians, and politicians. Furthermore, there is significant grant money available to such programs through agencies like the NIH and the university gets a significant cut of whatever money the grantees take in. Someday we may look back at this period in our history and see the "alternative" science movement as a well-engineered social movement that created a very popular mass delusion on par with the tulip mania of 17th century Holland. See also alternative medicine, complementary medicine, energy, frontier medicine, hidden persuaders, holistic medicine, and vitamin supplements. * Ray Hyman provides an example of a chiropractor who agreed to a double-blind controlled test of applied kinesiology (AK). After AK had failed the test, the chiropractor said: "You see, that is why we never do double-blind testing anymore. It never works!" further listening
further reading
Hall, Harriet. (2006). "Andrew Weil: Harvard Hatched a Gullible Guru." Skeptical Inquirer. Volume 30, No. 1. This is a review of Weil's Natural Health, Natural Medicine. Mackay, Charles. Extraordinary Popular Delusions & the Madness of Crowds (Crown Publishing, 1995). Park, Robert L. Voodoo Science: The Road from Foolishness to Fraud (Oxford U. Press, 2000). Randi, James. The Faith Healers (Amherst, N.Y.: Prometheus Books, 1989). Raso, Jack. "Alternative" Healthcare: A Comprehensive Guide (Amherst, NY: Prometheus Books, 1994). Raso, Jack. "Mystical Medical Alternativism," Skeptical Inquirer, Sept/Oct 1995. Stenger, Victor J. "Quantum Quackery," Skeptical Inquirer. January/February 1997.
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©copyright 2006 Robert Todd Carroll |
Last updated 03/03/08 | ||
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