Alternative and complementary medicine

August 14, 2012

Mark L. Friedman, MD, FACEP, FACP

Let me make my opinion clear from the outset. I am biased in favor of the scientific method:

1) Make an observation
2) Formulate a hypothesis
3) Make predictions based on the hypothesis
4) Test the predictions experimentally

Medical treatment based on science must conform to these basic principles. It matters not whether it is modern or ancient, Western or Eastern, conventional or unconventional. Veritas curat: The Truth Cures.

Modern medicine is willing to accept any hypothesis that has been suitably proven. Acceptance usually comes by consensus based on a preponderance of scientific evidence over a period of time. This is a continual process and is applicable to therapies that are commonly accepted as well as those that are not. One of my medical school professors once stated: "Half of what we are teaching you is wrong. We just don't know which half."

Over the years I have seen commonly accepted therapies thrown out after being discredited experimentally. I have also seen some pretty strange and unexpected ones that proved to be true. The point is that the medical community both welcomes and requires the truth. As a group we are skeptical of unproven treatments, especially those that make claims based on being "ancient, traditional, mystical, or persecuted by the medical community." If you wax nostalgic for the "good old days" (we are talking before 1900 here) of "traditional medicine," just remember that the average life expectancy in the U.S. in 1900 was 47. Today it's 78.5.

So we should be referring to it as "alternatives to medicine" rather than "alternative medicine." The main danger is that unsophisticated people (as well as intelligent ones facing life-threatening diseases) will opt for "alternatives" that may be useless when conventional treatments might be curative.

What about cases of "incurable" disease where medical science is powerless to intervene? What's the harm here? Unfortunately, despite all our medical advances, ultimate mortality is still 100 percent. The harm, in fact the crime, is that unscrupulous practitioners are preying on dying people, giving them false hope in order to pick their pockets. The purveyors of "snake oil" have always been with us and likely always will be.

How can the average person protect him or herself against the charlatans while remaining open to the latest true medical advances? Do your homework. What is the educational background of the person making the claim? Do they have a real degree from a recognized institution? Is their research available from Pub Med or is it published in the Journal of Irreproducible Results (or, more likely, not published at all)? What is their agenda? What does your doctor (or ours) think about it?

And what about "complementary" medicine and treatments? This is where doctors often talk of the "art" of medicine as opposed to the science. As long as we are pursuing the best course of treatment known to science, there is no harm, and in fact may be significant benefit, to such "complementary" strategies as support groups, prayer, interacting with pets, and a myriad of others. The key here is that these "therapies" should not interfere with conventional treatment and should not in any way exploit the patient. The placebo effect is real, as are other lesser-known mind / body interactions.

My bottom line: FSH will not sell snake oil. Nor will we be affiliated with anyone who does. We are not paid for referrals.

Originally published Aug 14, 2012 1:16:10 PM.