published 12/05/06, updated 11/29/09

Alternative to What?

“Alternative” health care professionals need to decide what they are really the alternative to

by Paul Ingraham, Vancouver, Canada MORE
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Credentials and qualifications

I am a writer and retired Registered Massage Therapist (unusually well-trained for a massage therapist, a 3000-hour program). I’m almost done with a Bachelor of Health Sciences degree. I am a peer reviewer for The Natural Standard, and a copyeditor for Science-Based Medicine. My most important qualification is more than a decade of workaholic post-graduate study, clinical experience, and constant conversations with readers from around the world, including many experts who have provided countless suggestions and criticisms.

For more information, see: Who Am I to Say? More information about my qualifications, credentials and professional experiences for my readers and customers.

Modern health care consumers are faced with a hair-raising dilemma: the hard choice between medical care that is often impersonal and institutionalized care,1 or the so-called “alternative” options, most of which are unproven by definition, most of which would have long ago been adopted by doctors if they actually worked.2 It’s no choice at all.

I quit!

I am so concerned by some (not all) of what passes for health care in the alternative health care community that it is probably just a matter of time before I give up my credentials and move on to greener pastures. There is no realistic hope of redefining alternative health care as simply the “warm and friendly” alternative to big and institutionalized medicine. It’s a lovely idea, but it’s never going to happen. Alternative medicine is a massive industry now, and its substantially anti-scientific character is well-established.3

However, for the record, it didn’t have to turn out this way.

Alternative medicine could have grown-up to be something different and better than it is. And for individual ethical alternative health care professionals, it still doesn’t have to be that way. Being an alternative health professional can still be mainly about better bedside manners — spending more time with people, and offering a few of the more plausible and harmless treatment options, rather than pushing a bewildering array of dubious and unproven “miracle cures” on people.

Impersonal and institutionalized

Like many alternative health care professionals, I was originally inspired to pursue my career by the poor care I received from doctors. In spite of that, I am no doctor basher. I have since come to understand that a great deal of doctor bashing is deeply unfair, often rooted in patient’s fear and pain, and a more or less perfect ignorance of the no-win situations that doctor’s face every day.4 The training and clinical experience doctors obtain deserves respect, and — however unwise it may be — their infamous arrogance is justified in many ways. The good doctors I know are my role models.

And they would be the first to admit that health care systems are in trouble around the world. Consider the increasingly grim outlook for the National Health Service in the UK. Jonathon Tomlinson, a London GP, writes:

I believe that the corporatisation of healthcare is dehumanising. By this I mean that real, whole people living with their hopes and worries, ideas and expectations, are broken down by the process of corporatisation into biological parts not for diagnosis and treatment but so that they can be measured and converted into profits. We are far more than the sum of our biological parts; we also have relationships with our past and future, our family and friends, our work and environment, our country and our home. We are irrational and passionate as well as calculating and objective; we need kindness, affection and understanding as well as diagnoses and treatments. And healthcare is far more effective when this is taken into account.
Patients not Profits; the NHS and Corporate Healthcare, by Jonathon Tomlinson

People are frightened to go the hospital. Many people have real horror stories about hospital experiences.5 Statistics about illness and surgical damage caused by doctors and hospitals are like something from a third world country.6 Here in litigious North America, medical malpractice lawsuits are more an epidemic than any epidemic.7 Even while our economy groans under the weight of common problems like back pain, a few doctors have proven that the majority are incompetent at treating musculoskeletal conditions,8 and cannot offer nutritional advice.9 And the litany of problems with universal health insurance here in Canada, or with for-profit medical institutions in America, is overwhelming. Pharmaceutical companies are perpetrating some of the largest health care frauds in medical history.10

The good doctors I know are my role models.

The roots of all this evil are an impersonal, institutionalized approach to health care, and of course the profit motive.

Pseudoscience and anti-science

On the other hand, so-called alternative health care is dangerously anti-scientific — as a group, many of us are actually hostile to science. Sometimes we criticize doctors and medical care for some of the right reasons (see above), but more often for the wrong ones. We often seem to think that science is the enemy!

Alternative health professionals often seem to think that science is the enemy.

Naturopathic doctors in North America are trained well enough to know better, but still routinely sell products and services of questionable value, in league with a supplements and “natural” medicines industry that is nearly as profitable and just as corrupt as their “Big Pharma” counterpart. Homeopaths have failed to provide any scientific evidence that what they offer actually helps anyone, and they have recently suffered serious public relations damage from exposés like the 2006 BBC story about dangerous anti-malarial substitutes.11 For the last ten years, acupuncture has failed one fair scientific test after another,12 like the recent inability of acupuncturists to treat back pain in a recent German study13 — yet acupuncture persists as a profession if this research never happened. Doctors of traditional Chinese medicine, now popular in the west, continue to rely far too heavily on a variety of unproven folk remedies as if they were effective simply by virtue of being popular in China for a long time.14

In the physical therapies, the profession of chiropractic remains popular but the value of the profession’s services remain controversial. I avoid criticizing chiropractors directly on this website, due to legal concerns.15 Questioning chiropractic is better left to heavyweight experts and organizations.16 Training standards for massage therapy are all over the map; even here in BC, where massage therapists are trained better (and more scientifically) than anywhere else in the world,17 my own colleagues still routinely promote scientifically questionable ideas to patients.18 And a dizzying variety of superstitious sub-disciplines like craniosacral therapy, reflexology, and reiki — fringe therapies that have failed to prove their efficacy despite many fair tests.19

These practices constitute a clear and present danger to the health of patients, and to their pocketbooks. Journalist and chronic pain patient Paula Kamen brilliantly exposes them for what they are in “Mind-Wallet Connection,” a chapter of her brilliant book, All In My Head, where she describes an tragicomic series of failed attempts to cure her migraine with alternative therapies:

I was becoming turned off by what I saw as a lackadaisical attitude on the part of many healers. They had all the time in the world to follow “the mystical course of nature.” Just as no neurologist had ever admitted to me, “I don’t know,” none of them had said, “Well, you’ve given this enough of a try. You can stop these twice-weekly sixty-dollar visits.” If I didn’t stop these sessions, they would go on indefinitely, and we would grow old together.
All In My Head, by Paula Kamen, p191

The shame of medical care

Like community policing or town meetings, house calls and humane, personal, socially interactive medical care has nearly disappeared from civil society. Such qualities are more likely to be found in places we consider “primitive” or “underdeveloped” because they lack adequate facilities — yet they may well be “friendlier.” The voice of Dr. Patch Adams, the most prominent medical spokesman for a “nicer” kind of medical care,20 has been completely drowned out. The failure to transcend bureaucracy and to be more about people than machines and money is the true shame of modern medicine.

Alternative health care, therefore, should be all about spending time with patients, listening to them, being personal with them. Alternative health care should be to mainstream medicine what small-scale organic farming is to industrialized farming.

Alternative health care, therefore, should be all about spending time with patients, listening to them, being personal with them.

But it isn’t. Instead, alternative health care has firmly established itself as the alternative to scientific health care. The message our industry sends out to the public is: “We’ll sell you whatever the doctors disapprove of. We’ll tell you what you want to hear. We’ll sell you ideas and potions that you’ll enjoy believing in, and we won’t spoil the experience with any boring, depressing science.”

But science is not the enemy: arrogant, impersonal, institutionalized health care is the enemy. That is what we should be the alternative to.

Science is good!

Science is a pretty good system for slowly but surely revealing all that is true in nature. However strange or difficult to understand, whatever actually is can sooner or later be understood as a part of the natural world — there is no such thing as “paranormal,” for, if it exists, it is normal.

Being anti-science is like being anti-honesty. Science is not guilty by association.

I can appreciate the confusion, though, among alternative health care professionals and consumers alike. The “bad guys” try to use science all the time to defend ethically dubious practices. As long as tobacco companies and polluting industries continue to claim that “studies show” that they are innocent, it’s going to be hard to shake the impression that science is guilty by association. As long as technology continues to be used so disastrously to make war, it will be easy to see science and scientists as evil.

Being anti-science is like being anti-honesty.

And it’s not helping that politician’s now reflexively refer to “the science” without ever actually understanding it or properly referencing it. In fact, science tends to get co-opted by practically anyone who wants to seem legitimate for the duration of a sound bite: even the flakiest of flakes will greedily cite a scientific study that seems to support their ideas,21 only to turn around and ignore and attack science every other day of their lives. Talk about a fair weather friend!

Just because science and poor medical care often seem to be mentioned in the same breath does not mean that they are actually the same thing, or that the shame of medical care is also the shame of science. On the contrary, just as alternative health care professionals have a lot to answer for in their rejection of science, doctors are also guilty of abusing and ignoring relevant scientific evidence. The “soft” social sciences in particular, but also hard biochemistry, have produced reams of data about the medical importance of “subtleties” like the relationship between outcomes and time spent with patients, the effects of fear and anxiety, the need for better nutrition in hospital meals, the hazards of impersonal care, setting a good example in lifestyle habits,22 and so on and on and on.

Science tends to get co-opted by practically anyone who wants to seem legitimate for the duration of a sound bite.

Do we blame science for being ignored by doctors? Wouldn’t it make more sense to blame the doctors? Or, better yet, shouldn’t alternative health care professionals be the champions of neglected science? If we want to really be professional — if we want to help people — we would do well to embrace science.

Let’s get to work offering desperately needed compassionate, personal, rational service to our patients. Let’s get back to basics. Let’s do what doctors seem to have forgotten how to do: let’s spend time with our patients, listen to them, lay our hands on them, hug them, laugh and cry with them. There is a much, much greater need for this in the world today than there is for any amount of reiki.

Notes

More specific criticism of medical care will be provided below. However, for some good general criticism of medical care and just a generally interesting read, see Jerome Groopman's excellent book, How Doctors Think. Return to text.
Again, more specific evidence will be provided below. As a general source, see: QuackWatch (http://www.QuackWatch.org/) Quackwatch fights health-related frauds, myths, fads, fallacies, and misconduct. Its primary focus is on health consumer information that is difficult or impossible to get elsewhere. Dr. Stephen Barrett, the founder of QuackWatch and author of most of the articles, is one of the great figures of anti-quackery activism. For many years now, I’ve been watching his work and the controversies and legal battles that swirl around QuackWatch, and I have been consistently impressed by Dr. Barrett’s integrity and intelligence — and unimpressed by the tactics and quality of his critics. He is also providing a vital service and a sorely neglected perspective on health care.. Return to text.
As Dr. Steven Novella has written: “Fifty years ago what passes today as CAM was snake oil, fraud, folk medicine, and quackery. The promoters of dubious health claims were charlatans, quacks, and con artists. Somehow they managed to pull off the greatest con of all - a culture change in which fraud became a legitimate alternative to scientific medicine, the line between science and pseudoscience was deliberate blurred, regulations designed to protect the public from quackery were weakened or eliminated, and it became politically incorrect to defend scientific standards in medicine.” Return to text.
A classic example: honesty has a public relations problem. Patients don’t want to hear that there is no cure. They become irritated with doctors who can’t help, or who “just” prescribe a pill. But many conditions truly cannot be helped, by anyone. Unfortunately, the humility and honesty of doctors who admit that they can’t help looks bad when compared to the many “alternatives” offered by chiropractors, naturopaths and others. People accuse doctors of being arrogant, but in fact it turns out that they have a bigger problem with their humility, concluding that medical care was “useless” instead of humble. Patients often tell me, with disdain, how much more I’ve helped them than their doctor ever did. I try to encourage them to be more gracious about it: do they really expect their doctor to offer massage? Return to text.
Like my friend, after a motorcycle accident, who was refused a spinal X-ray by emergency room doctors at Royal Jubilee Hospital in Victoria, BC, only to discover the next day that his vertebrae were indeed broken. Like my own story: an battle royale to prevent a determined nurse from dragging me off for a chest X-ray, even though my arm was in a sling because of the elbow injury that had brought me there. Or one told by a client recently, about having to advocate for himself while drugged, to convince a surgeon that he was in the hospital for a foot problem, and did not need abdominal surgery. Return to text.
The American Iatrogenic Association website (http://www.iatrogenic.org) The American Iatrogenic Association is devoted to the study and reporting of medical errors that lead to disease and death. In 2000, a presidential task force labelled medical errors a “national problem of epidemic proportions.” More plainly stated, this website presents a lot of hair-raising details about just how dangerous medicine can be. Return to text.
In Hospital Deaths from Medical Errors at 195,000 per Year USA. MedicalNewsToday.com. 2004. This article focusses on a major American study of medical error, summarizes the results of other similar studies, and paraphrases their conclusions: “medical errors caused up to 98,000 deaths annually and should be considered a national epidemic.” Return to text.
Most doctors are well aware that there are serious shortcomings in the medical management of most musculoskeletal problems, especially chronic pain cases. Dr. Jonathon Tomlinson, an instructor at St. Leonards Hospital in Hoxton, explains that “undergraduate training is focused on hospital orthopedics (broken bones and anything else that’s amenable to surgery) or rheumatology (nasty inflammatory diseases) which comprise a minority of the aches/pains/strains and injuries that people actually suffer from.”

Medical researchers have done many studies showing that most doctors do not understand aches and pains or heed expert recommendations. A good recent example is a paper in the Archives of Internal Medicine showing that family doctors frequently ignore guidelines for the care of low back pain — see Williams et al.

More generally, the Journal of Bone and Joint Surgery, and the Journal of the American Osteopathic Association, have both published papers recently showing that physicians simply do not have an adequate understanding of musculoskeletal medicine. In 2002, Freedman et al felt that “It is ... reasonable to conclude that medical school preparation in musculoskeletal medicine is inadequate.” Then again in 2005 in JBJS, Matzkin et al concluded that “training in musculoskeletal medicine is inadequate in both medical school and non-orthopaedic residency training programs.” Most recently, in 2006, Stockard et al wrote “82% of allopathic graduates ... failed to demonstrate basic competency in musculoskeletal medicine.”
Return to text.
See Matzkin, Freedman, and Stockard. Return to text.
I am referring generally to the case of anti-depressants, which are not “medicine” and specifically to well-documented cases of companies like Ely Lilly trying to buy American juries in order to set favourable precedents for other cases involving SSRI anti-depressants like Prozac. See SSRI Antidepressants Are Not Medicine. Return to text.
Malaria advice ‘risks lives’: Some high street homeopaths claim they can prevent malaria, a Newsnight investigation has found. Jones. 2006. Secret filming revealed homeopaths were claiming their preparations could be used instead of anti-malarial drugs to protect travellers in high risk areas such as sub-saharan Africa. Return to text.
See my review of some recent evidence in Does Acupuncture Work for Pain?. Return to text.
See Haake and a detailed discussion that paper in Tantalizing Research About Acupuncture For Low Back Pain. Return to text.
Hopefully it’s obvious that a billion Chinese can be wrong. Return to text.
Consider the case of science journalists like Simon Singh, who is in the news lately because he is being sued for libel by the British Chiropractic Association for comments he wrote in a column in The Guardian in 2005, in connection with his book, Trick or Treatment: The Undeniable Facts About Alternative Medicine. Singh can use all the public support he can get: please join the Facebook group For Simon Singh and Free Speech — Against the BCA Libel Claim. Return to text.
For more about this cautious approach to evaluating chiropractic, see Does Chiropractic Work? Return to text.
See Massage Therapy In British Columbia (Canada). Return to text.
Common pseudoscience from massage therapiests includes: generally excessive claims of efficacy, excessive faith in therapy despite negative reactions (“no pain no gain”, “healing crisis”), numerous variations on the claim that massage can “detoxify,” scientifically ignorant obsession with all kinds of biomechanical theories that have been disproven. I know all of this all too well from extensive personal experience and the reports of clients. I know an RMT who believes he can “cure all pain problems” by treating just the feet, one who believes that hand pain can be cured by talking to a psychic in Toronto by telephone, and another one who believes that 24 hours of vomitting and dizzyness after treatment is a normal reaction to therapy. Return to text.
Many of my readers may find that last statement too harsh. Perhaps a clarification will help, however: I do not attack the reputation of such practices because I have any doubt that “The universe is not only queerer than we suppose, but queerer than we can suppose.” (Haldane), but rather because of it. I do not doubt that the universe is a fascinating and bizarre place and that there are many wonderful things yet to learn about it. What I do doubt is that my fellow alternative health care practitioners are able to comprehend it well enough, without benefit of rigorous study and insights into biology the likes of which no serious scientist enjoys, in order to offer patients therapeutic benefits by completely unproven methods. In other words, I question their competence. If they were ethical, they would be more honest and humble about the limitations of their knowledge and skill — a quality conspicuously lacking from a group of people so fond of referring to themselves as “healers” and “masters.” Return to text.
Gesundheit! Institute (http://www.patchadams.org/home.htm) Return to text.
Flamm. Skeptical Inquirer. 2004. A Columbia University paper published in a peer-reviewed scientific journal claimed clear evidence of the efficacy of remote prayer, and was reported with great enthusiasm by the American media in the aftermath of post-9/11, and continues to be widely cited routinely in support of similar claims. Yet the first-named author “doesn’t respond to inquires,” the “lead author said he didn’t learn of the study until months after it was completed,” and then the third author, “indicted by a federal grand jury, has pleaded guilty to conspiracy to commit fraud” — not with regards to the study, but several other charges of fraud. Return to text.
Many doctors do not “practice what they preach.” While this is defensible — doctors are human too, and should not have to paragons of virtue in order to practice medicine — it is a neglected issue. Return to text.