David Freedman's masterfully written article presents a very flattering view of the world of alternative medicine. But what is the "triumph" of new age medicine that he's writing about?
Freedman points out right from the start that most of the methods he writes about so generously simply don't work. The triumph of new age medicine is really the triumph of marketing over science, of hype over reality. How does Freedman leave us with the impression that there might be something to this alternative medicine stuff after all?
One answer lies in the way Freedman lays out his argument. He accurately describes how conventional medicine often fails its patients by focusing too much on drugs and surgery, and how doctors don't always spend enough time listening to their patients. It's true that modern medicine has many failings, but alternative medicine is not the answer. We do need to find ways to fix what's wrong with the practice of medicine, but not by turning to fairy tales.
Freedman presents some compelling anecdotes about patients whose pain was relieved by alternative medicine. Before everyone rushes off to their new age healers, let me offer a couple of stories in response.
Kristi Bedenbaugh was a healthy 24-year-old medical office administrator and former beauty queen in South Carolina when, in 1993, she visited a chiropractor for her sinus headaches. During her second visit, she suffered a stroke immediately after the chiropractor manipulated her neck. She died three days later. An autopsy showed that the chiropracter's manipulation had split the inside walls of both of her vertebral arteries. The chiropractor later agreed to pay a $1000 fine and take 12 extra hours of continuing education credits.
In 1992, the same thing almost happened to Rebecca Carroll. "June 9, 1992, is the day I almost died," she wrote in a series of articles describing her experience. "It is the day after my neck was adjusted by a chiropractor, dissecting my vertebral artery and causing me to have a stroke." She was saved by an experimental clot-busting drug that has now become part of standard therapy.
Just anecdotes? Perhaps. But a 2003 study by Wade Smith, a neurologist at the University of California, San Francisco, found a dramatic link between strokes and recent chiropractic adjustments. A Facebook group is supporting legislation to warn the public of this risk.
What about acupuncture? In 2006, according to an article in Nature, a 64-year-old man visited an emergency room in Seoul, South Korea, for severe back pain. Three days earlier, he had visited an acupuncturist for treatment, and his pain had grown much worse since. The treatment had caused an E. coli infection deep in his spine. Although the infection was eventually controlled with antibiotics, the man was paralyzed, permanently. The journal's finding was stark: "Conclusion: Paraplegia might result from complications of an acupuncture therapy."
In 1995, a 40-year-old Norwegian woman visited an acupuncturist for relief from fibromyalgia. As reported in The Lancet, she died two hours later, and an autopsy revealed that the needle had punctured her left ventricle.
In an article in the British Medical Journal last year, scientists at the University of Hong Kong reported at least 50 cases of infections caused by acupuncturists and warned that this was the "tip of the iceberg." This isn't surprising in light of the fact that acupuncturists are not trained in infection control and don't practice proper sterile procedures.
David Freedman is right in pointing out that study after study shows alternative medicine to be no better than placebo. What he neglects to mention is the real possibility, however small, of serious harm. Perhaps the greatest "triumph" of alternative medicine is the multi-billion dollar industry that now flourishes around it, offering ineffective treatments at a handsome profit.
I should also point out the clever marketing ploy illustrated in the quote from Dr. Jay Perman of the University of Maryland. He says, "When it comes to alternative medicine, it's not clear what the mechanism is that can make it helpful to patients, but it may be that it helps create the right environment." Just by using the term as he does, Perman is - perhaps without even being aware of it - buying into the false notion that all the treatments lumped under the name "alternative" are equally valid. It's one thing to support massage or relaxation therapy - I'd support both of those myself. It's quite another to practice (and train medical students in) beliefs such as homeopathy that are wildly implausible and that violate well-established principles of physics, chemistry, and biology.
Finally, readers of Freedman's article might come away with the impression that I'm opposed to any treatment that hasn't gone through rigorous clinical trials. I've never said that, because it's not true. My position is quite different. I believe that when studies show that a treatment doesn't work, it's time to move on. Acupuncture, homeopathy, Reiki, Ayurveda, healing touch, and other "energy" therapies have all failed their scientific tests. Alternative medicine proponents like Brian Berman make excuses for these failures, claiming that the benefits of their so-called medicine somehow cannot be measured, and insisting on more studies.
Real science is all about admitting our mistakes and moving on. Alternative medicine isn't new - on the contrary, it consists almost entirely of old, long-disproven methods that have been re-packaged as "alternative" or "integrative" medicine, and whose proponents simply won't accept the evidence. It's time to move on.
The debate continues here.