What's Eating the Small, Loud Band of Alt-Med Critics?

This post is part of our forum on David H. Freedman's July/August story, "The Triumph of New Age Medicine." Follow the debate here.

I give credit to the enthusiasm and passion of the small band of deeply anti-alternative-medicine warriors who have voiced their displeasure with my article. And let's be clear, this is a very small band. As I think was made plain in my article, most mainstream physicians and physician researchers pretty much agree with my basic argument. When I set out to interview mainstream experts, I expected to get a range of reactions to alternative medicine, but almost to a person they felt it was just fine, as long as patients seemed to benefit. On the other hand, I had to purposely hunt down the three articulate and respected critics I quote in the article. (I only quote one phrase from David Gorski, but he's made up for it and more since the article came out.)

Now, with Colquhoun (who's a respected researcher, but not a physician) weighing in, we've got almost all the usual suspects in the world of full-out, well-credentialed alternative-medicine haters rounded up to express their displeasure. Were we to get most of the prominent physicians and physician-researchers who are open-minded about alternative medicine for this debate, on the other hand, we'd need several years and new servers.

Anyway, just because they're in a tiny minority doesn't mean they're wrong. And honestly, I wish these folks would give me more to sweat over -- I love a good argument. But, disappointingly, Colquhoun sticks to the same tired, limp story to try to discredit the article, as do most of the others who have complained.

The story is this: I am an apologist for pseudoscience. Alternative-medicine treatments don't work, and these sleazy huckster homeopaths and acupuncturists and chiropractors pretend that they do in order to snare helpless patients who could have their ailments effectively treated by mainstream medicine. What could be more nefarious than preying on sick people with fake cures? And here I am, with the weight of The Atlantic behind me, defending this despicable practice, and helping these villains fool even more people with my tricky journalistic techniques. Oh, the shame of it.

I'd hate myself, if it weren't for the fact that I don't do any of this in the article. Rather, I point out high up in the piece, and with no bones about it, that science has pretty clearly shown that the core treatments of alternative medicine don't provide the direct physical effects that they are claimed to provide by practitioners. They work via the placebo effect. Now could someone please explain to me how it is that I could be defending pseudoscience in an article in which I so clearly say it's pseudoscience, and that it doesn't provide the claimed benefits? I do suggest there's a placebo benefit -- but so do my critics. We're in perfect agreement.

Given that I'm completely on his side with regard to the central issue that he and his fellow alt-med detestors spend all their time arguing with others about, what is Colquhoun so unhappy about? Well, I do document in the article some of the failings of mainstream medicine. But this doesn't seem to much bother him. I claim that mainstream medicine also relies on the placebo effect, but he doesn't quibble with that. I note that having practitioners spend time and energy getting patients to adopt healthier behaviors and attitudes can have an enormous impact on health and quality of life, lowering the risk of serious disease, and I observe that mainstream practitioners are on average less likely to do so than alternative practitioners. But he doesn't seem to take issue with that, either. And, well, that's just about it for the claims in my article. If you buy all that, you buy everything I've got to say.

OK, so what's really eating him? Why does he go through all this trouble to make it sound like I'm defending pseudoscience and backing the claims for these treatments when I so clearly do not, and when my entire argument is based on rather uncontroversial points that are ripped from the pages of mainstream medicine, and that are explicitly backed by a pretty impressive cast of mainstream characters?

Well, I can't read his mind, but I think I have a pretty good guess. The basic problem is that in the end, I leave the reader with the impression that there are aspects of alternative medicine that are actually pretty helpful, and that even compare favorably with mainstream medicine. I think the fact that I reach this conclusion based on individual points that are more in less in line with what Colquhoun and others critics say themselves in other contexts is irrelevant to them. The issue to them is that I reach it at all. It's an unacceptable conclusion. To them, alternative medicine isn't merely ineffective -- it's evil. They've invested a good chunk of their careers and reputations on attacking the claims for its treatments, and they're not about to stand around and let some journalist say something kind of nice about the purveyors of these treatments, no matter how reasonable are the points around which he builds his case.

Of course, the only weapon they really have to wield against alternative medicine is that its core treatments don't work as advertised. That, I believe, is why they keep pounding on this point in their critiques, and acting as if it justifies their accusing me of a shameful pandering to fairly tales, voodoo and pseudoscience. They are apparently hoping that readers will forget that their dismissal of the treatments' mechanisms only backs up what I say myself in the article.

Well, if you'd forgotten, hopefully you remember now, and we can all let this handful of never-say-die voodoo-killers move on to arguing with someone who actually disagrees with the one valid point they have to make. It would be kind of nice if they'd admit I was right about the rest of it, too. But I guess their enthusiasm and passion just don't seem to make room for it.

The debate continues here.