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Science… 1, Well-Meaning-but-WRONG-Parents… 0

February 12, 2009 Leave a comment

“Court Says Vaccine Not to Blame for Autism”
http://www.nytimes.com/aponline/2009/02/12/washington/AP-Autism-Ruling.html?_r=1&hp

This is something that the vast majority of doctors and scientists have contended for a long time, and it’s good to see that the judges were sensible in this case. There are technically two more major cases left that the anti-vaccine crowd are fighting to win, but maybe with this precedent it will be a losing battle for them. The only thing that has come about from the anti-vaccine crowd is irrational fear of vaccines, which has likely led some people to choose not to vaccinate their children. This would be a step back a couple centuries, and by choosing not to vaccinate one is really choosing to place everyone else at risk.

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Categories: Medicine, Science

CAM’s (Complementary and Alternative Medicine) Movement to "Mainstream"

January 16, 2009 Leave a comment

CAM has always been interesting to me, primarily a bystander at the scene of an accident sort of way – exciting because you don’t truly know what’s going on and can’t actually see if anyone has been hurt. I’ve had acquaintances that participate in some form of alternative medicine, whether it is acupuncture, meditation, or using herbal remedies to cure disease, but I don’t think I’ve ever quizzed them directly on their reasons to choosing it over western medicine. I even know one person that takes it as far as going to an alternative medicine therapist for her ailments.

More recently though, I’ve discovered just how widespread the CAM “movement” has become. More than a third of U.S. adults use a form of alternative medicine, and the alternative medicine industry is well into the multi-billion dollar scale. Our own government has a CAM department within the National Institutes of Health (NIH) that is funded by $250 million of taxpayer money annually, the roots of which are shady at best. My interest in the subject has grown further due to the medical community blogging about it (see the list to the right for one’s I read most often). A great post was made by “Orac”, a surgeon/scientist, here: The Three Musketeers of Woo Meet D’Artagnan to Fight for Woo. It’s a lengthy read, but it’s initially about an article in the WSJ that attempts to discredit CAM. The article is much shorter so please read it even if you don’t bother with Orac’s post.

Here is Orac’s opinion on the latest attempt by CAM supporters to make it more mainstream:

The seemingly never-ending quest of advocates of unscientific medicine, the so-called “complementary and alternative medicine” (CAM) movement is to convince policy makers, patients, and physicians that, really and truly, it no longer deserves the qualifier of “alternative,” that it is in fact mainstream and even “scientific.” That very search for respectability without accountability is the very reason why “alternative” medicine originally morphed into CAM in order to soften the “alternative” label a decade or two ago…Such a term conflicts with their desire to “go mainstream,” and they most definitely do want to go mainstream. However, they want to do it on their own terms, without all that pesky mucking about with science, evidence, and rigorous clinical trials that we in the science- and evidence-based medicine biz have to contend with. Consequently, they increasingly use a new term, a shiny term, a term free of that pesky (and oh-so-buzz-killing, albeit rebellious) “alternative” label. Now they want to “integrate” their unscientific placebo-based practice with real, scientific medicine. Thus was born the term “integrative” medicine (IM), and it’s becoming increasingly common and accepted.

Lately, the CAM movement has a new cause célèbre with the anti-vaccine crowd. It’s always been around, but people like Jim Carrey’s girlfriend, Jenny McCarthy, have given it new vigor by claiming that vaccines cause autism. Despite the total lack of scientific evidence supporting their claims, the media has given a voice to those who really should have none. It’s truly a public disservice for the media to give even the appearance of a scientific controversy over the relationship of vaccines to autism. There is no controversy in the scientific community about a link to autism from vaccinations, and there is no evidence of such either.

Let me be clear, I don’t have a problem with ALL alternative medicine. Mostly, this is because some of it is not technically “alternative”, even though it is practiced by alternative medicine therapists. For example, an alternative medicine therapist may preach diet and exercise, as if western medicine (evidence-based medicine) doesn’t already shout to the rooftops that this is important. There are also herbs with scientific evidence to show they have real health benefits. I do have a problem with the type of alternative medicine that advertises to treat disease without rigorous scientific evidence proving as such. So, by definition, “alternative medicine” is medicine without scientific evidence beyond placebo effect (examples include acupuncture, “qi”, homeopathy, magnet therapy, etc.). There is a horde of evidence to support the notion that alternative medicine can produce results that are equivalent to placebo, and while the placebo effect is important and valuable within medicine, it should not serve as the basis of treatment.

I’ll also concede that using CAM to supplement, rather than supplant, is rarely dangerous from a medical standpoint (from a psychological standpoint, I still may chuckle at you). CAM therapists want to make money, and a dead customer won’t do them well, so they stay fairly cautious. For example, homeopathic therapists often give treatments so dilute it is difficult to trace the original compound in them. The real danger shows up when people forgo evidence-based medicine (EBM) for CAM, especially with serious diseases such as cancer. And, there are people that do this and there are alternative medicine therapists that will try to convince you to stay away from conventional medicine. Trust me, you don’t want your chiropractor managing your type II diabetes. Chiropractors are really just not to be trusted in general.

What I really want to know is, with the abundance of scientific evidence refuting real benefits of CAM, why do people continue to utilize CAM? Specifically, why as much 38% of adults? This is no longer a minority that can be passed off as “hippies” in the 60’s, or just plain nutty. Everyday people, smart people, are choosing to use alternative medicine despite that there is virtually no scientific evidence to say it is effective. And, why would any sane person stop traditional medical treatment completely and put full trust in CAM to manage their disease? As Orac, and other bloggers have pointed out, this is very dangerous to the traditional medical establishment of evidence-based medicine (despite the obvious danger to patients). It gives the impression that, no longer is hard science required to be legitimate medicine. Renowned hospitals are now actually incorporating CAM into their business model and finding ways to bill insurers for their activities. No doubt this is due to the massive profits to be had, and NOT because all the MD’s/DO’s of the hospital are clamoring to invite their alternative “colleagues” to play doctor with them.

So, again, for what reasons is CAM becoming so popular? I have a few ideas.

  1. Desperation. Plenty of people have grown frustrated with their traditional medical care. There are some sub-types of this demographic. There is the legit person, who has been truly wronged by their doctors, have been failed to be properly diagnosed over and over, etc. Rare, but it does happen. Then there is the type of person that believes they have a medical condition, which may or may not actually exist. They may be simple drug-seekers, hypochondriacs, attention seekers, or people with chronic fatigue syndrome. As a whole, they are tired of their doctors telling them nothing is wrong with them (or the wrong thing is wrong with them, was that a “Rumsfeldism”?), and want someone that will give them another solution (I’d say usually either narcotics or a feel good attitude). Basically, both sub-types are desperate in their own ways and will do anything to find a solution that will “work for them”. These people often believe their body physiology is dramatically different than the rest of the population.
  2. Tradition. I’m less worried, in general, about this category. Plenty of people grow up in households that have traditional (cultural/religious) remedies for various ailments. These usually limit themselves to the sore throat, cold, headache, nausea, etc. Generally things that will go away all by themselves anyways, and most doctors will simply suggest symptomatic relief measures. I really don’t care if someone drinks tea to help their cold, gargles salt-water for their sore throat, or eats yogurt for their problematic bowels, and this certainly isn’t what doctors are worried about either. If tradition starts getting to the level of believing you can treat cancer by aromatherapy or your high cholesterol by acupuncture, then this becomes a problem.
  3. Trendiness. Doesn’t really need to be said that people do things they perceive to be cool. CAM is definitely “hip”, just look at all the celebrities that use CAM or overtly support the practice. There are crazies, like Jim Carrey’s wife, that want to set us back over 200 years (smallpox vaccination was discovered in the 18th century) because they believe vaccinations cause autism. Young people (and old) are attracted to the cause by the celebrities that support alternative medicine. One type of somewhat trendy, yet ancient, form of alternative medicine is acupuncture. However, not one good study has shown a benefit beyond placebo and people routinely pay $50/hour or more to get long needles stuck into them.

In order to combat the further propagation of treatment that is truly the antonym of the word, the scientific and medical community needs to make themselves heard in the media and with patients. The public needs to be further educated that alternative medicine has no scientific backing and at most should be used as an “add-on” to traditional medicine. It should be viewed kind of like using GPS in your own neighborhood – it’s cool when you first got it, but you still make a right-turn onto your street even if the GPS claims you’re currently driving in the Pacific Ocean. And, the media needs to be dissuaded from giving a platform to wackos and quacks. Stop making the public think anyone believes them but themselves. Finally, the government really needs to stop giving financial support to CAM. As Orac pointed out recently, we should defund NCCAM (National Center for CAM) and stick to agencies that are based in science, not trying to pretend.

Categories: Medicine, Science