The Running Battle For Alternative Medicine

Scepticism about Complementary and Alternative Medicine (CAM) and therapies is continuously increasing but evidence of its benefits is lacking, regardless of a mega budget for research.

Imagine you're going into hospital for an operation. It's not a particularly nice thought but think about the doctor telling you what the procedure is and how it will cure your ailment. That's all fine, but then, when the doctor is done describing how it will help you, he tells you that actually the operation hasn't in fact ever been officially proven to have helped people before but hey, here's hoping!

Probably wouldn't be keen on taking the procedure then, would you?

It seems like common sense. You'd tell the doctor where to stick his unproven procedure and find help with another doctor. Yet so many of us have absolutely no problem with alternative medicine, be it acupuncture, homeopathy or herbal supplements; treatment for an ailment that has largely not yet been proven positively effective.

In Western culture, the term 'alternative medicine refers to ways of healing “that does not fall within the realm of conventional medicine. In a more cynical sense, it could also be described as 'that which has not been shown consistently to be effective'. What classifies as CAM ranges from Chinese herbal medicines to homeopathy to dance therapy and chiropractory.

Possibly due to our current economic climate, the level at which we consume alternative treatments is rising. Also, one of the most common Google searches related to such a topic is 'alternative medicine for depression' (try it out; start typing 'alternative medicine' into Google's search bar and see what it suggests). It seems too obvious a link to be coincidental; bad economic climate leads to financial issues leads to depression leads to not being able to afford any necessary psychotherapy which leads to...

...alternative medicine.

Though this is only one possible explanation. The problem with this theory is that it has been shown that many people only resort to alternative treatments after prescription treatment has brought them no relief.

In Ireland, an independent study carried out by doctors at Rath Mhuire Health Centre in Swords, Co. Dublin, showed that 27% of 328 people had visited an alternative practitioner in 2010. The most common reason for attending was 'to treat an illness for which conventional medicine was already received'. 52% claimed that personal recommendation from a family member or friend was the biggest factor in their decision to visit.

41% had not admitted it to their GP. This, as we'll see in a moment, can actually prove to be very, very dangerous. Not all of us would think that though, would we?

In the US, usage of CAM has been steadily rising from 36% of adults (aged 18 and over) in 2004 to 38% in 2008 and is still on the up. On average, 12% of children have been noted to use or have used some form of CAM too.

It's quite surprising how popular CAM has become when one considers that, for instance, a dietary supplement manufacturer does not have to prove a product's safety and effectiveness before it is marketed especially when the World Health Organisation (WHO) claim they aim to “ensure the use of safe, effective and quality products and practices, based on available evidence” in their manifesto about alternative treatments.

In the United States, a manufacturer is permitted to say that a dietary supplement addresses a nutrient deficiency, supports health or is linked to a particular body function (e.g. the immune system) if there is research to support such a claim. If the product claims any of the above, they must include on that packaging that “this statement has not been evaluated by the U.S. Food and Drug Administration (FDA). This product is not intended to diagnose, treat, cure or prevent any disease.”

Surely this misleading and unproven tactic is an injustice?

“We are also interested in understanding and exploring the many components of the placebo effect; what role does expectation play?”

A lot of people who suffer from serious illnesses such as diabetes and cancer take CAM as well as prescriptions, hence the term 'complimentary'. They might do it to maximise their chances of good health (which let's face it we'd do anything for upon the news we were ill). The question here is whether or not any 'cure' or improvement isn't just due to the fact that they're still taking prescription drugs, scientifically proven to work, as well as the CAM. The effects of the prescription drugs are interpreted as the wonders of alternative medicine. What would happen if , for whatever reason, they stopped taking the prescription drug and solely relied on the CAM? Would there still be improvement or would they be denying themselves vital treatment? It is too often the case that the answer is the latter. This is where CAM becomes dangerous and deluded.

As I mentioned above, not telling your GP about your use of any CAM can be dangerous. For example, this was realized by Professor Alastair MacLennan of Adelaide University in Australia in 2000. When one of his patients almost bled to death on the operating table after she failed to to tell him beforehand that she had been taking herbal medicines in order to “build up her strength” before the operation, some of which had a powerful anticoagulant side-effect that almost resulted in her death.

But where is the irrefutable proof that CAM can be beneficial for those with illnesses? Studies have shown that some people, particularly those suffering long-term illness and take prescription medication, can improve their condition with alternative treatments. But, as I said, there's still a question of this being the prescription drug that's also being taken simultaneously. Chances are the CAM wouldn't be resulting in improvement alone.

There is also the argument that any positive results could be put down to the placebo factor. That is to say if you believe it will work, it will. We all know thinking positively can have unlimited effects and this could be a case of it, not a scientific or chemical reaction from the CAM. A strong and positive mental state can have physiological effects. According to critics, it's possible that CAM only works on the basis of the belief of its user.

In America, the organisation responsible ad key to this research is the National Centre for Complementary and Alternative Medicine (NCCAM). A US government agency, the NCCAM's aim is to explore alternative healing practices in the context of rigorous science, training 'CAM researchers' and spreading authoritative information about the results to the public and to professionals.

In 2010, NCCAM's budget for research and activity was $128.8 million but there is widespread criticism that they have little or nothing to show for it.

Steven Salzberg, a genome researcher and computational biologist at the University of Maryland said in 2009; “With a new administration and President Obama's stated goal of moving science to the forefront, now is the time for scientists to start speaking up about issues that concern us. One of our concerns is that the National Institute of Health (NIH) is funding pseudo-science.”

To find out more about this budget and the placebo effect of CAM, I spoke to Katy Danielson M.D., Head Media Specialist at NCCAM.

Firstly, she admits that the centre's studies have returned “unnerving” results as well as positive; “scientific evidence has found that the herb St. John's Wort may be useful for short-term treatment of mild or moderate depression (one of the most common ailments that CAM is sought for). However, St. John's Wort has also been found to interact with prescription medications in ways that can interfere with their intended effects, including antidepressants, birth control pills and anticoagulants.”

Maybe this was the detrimental factor in the case of our unfortunate Australian?

Danielson defends criticism of any supposed insignificant or inefficient research on the NCCAM's behalf by pointing out; “Our staff here, the researchers we fund and NCCAM's Advisory Council all come from a variety of backgrounds and disciplines. In fact, the NCCAM's director, DR. Josephine Briggs, is an M.D. And nephrologist by training.”

When asked whether the staff and researchers are of a scientific background or just have a knowledge of biology, plants or a subjective opinion on CAM, Danielson asserts that “there is a lot of real-world interest in these types of modalities and our research priorities have evolved as we learn more about the reasons Americans give for turning to CAM.”

Through the interview, it becomes noticeable that Ms. Danielson may be avoiding going into detail about whether or not the researchers have extensive medical backgrounds as she quickly reverts to talking about the organisations aims.

Referring to the significance of the placebo effect, Danielson reveals; “we are interested in understanding and exploring the many components of the placebo effect, like what role does expectation play, how important is the patient-provider interaction in health and also what is the mind-body connection and how can it be harnessed to promote health and well being. These are questions and examples of the challenges facing the NCCAM and the researchers we fund develop methodologies to study complex CAM interventions while upholding the rigorous standards of modern research.”

When I enquire if there's any particular ailment or condition they take into consideration in their research, she replies; “we focus on the role of CAM in symptom management. Current NCCAM-funded studies continue to examine the effect of specific therapies – such as acupuncture, yoga and spinal manipulation – on lower back pain. This is an area where our research is having an impact on practice. For example, the American College of Physicians and the American Pain Society include CAM treatments in their guidelines as options for treating lower back pain.”

OK, so lower back pain is a focus. But she still didn't point out any irrefutable examples.

I asked Danielson if, from a chemical point of view (for example, looking at their ingredients), herbal treatments such as Echinacea really harbour abilities to cure or at least relieve certain ailments. She says; “NCCAM works in collaboration with the National Institute of Health (NIH) and other institutes and centres to support the Botanical Research Centres (BRC) Program. The purpose of this the BRC program is to promote collaborative, integrated, interdisciplinary study of botanicals, particularly those found as ingredients in dietary supplements and to conduct research of high potential for being translated into practical benefits for human health.”

Regardless of her claims, there's still very little proof of similarities between prescription medicine and CAM that could actually help. This is particularly dispiriting when one considers the researchers' very large budget to carry out such study (if you missed it above, it's worth saying again; $128.8 million).

“Now is the time for scientists to start speaking up about issues that concern us. One of our concerns is that the National Institute of Health (NIH) is funding pseudo-science.”

- Steven Salzberg, University of Maryland

A further example of lacking evidence are the studies carried out by the Cochrane Library in Denmark. They undertook one of the most extensive sets of studies on the effects of CAM on a large range of conditions, from kidney problems to Cystic Fibrosis. Most remarkably, the heavily detailed study shows little or inconclusive evidence of CAM that is notably beneficial. The results for the majority of cases (and there are hundreds) are cited as placebo effects or that 'significant' results could not be found.

For example, when the researchers looked at the side effects of herbal medicine on women receiving chemotherapy, it was concluded that “evidence for their use on women with breast cancer has not been ascertained.”

In a similar case, Cochrane point out that although the review shows “some herbal medicines lower blood sugar and relieving symptoms in patients with diabetes, the methodological quality of the clinical trials evaluating these herbs is generally poor.”

No doubt our curiosity about alternative therapies will continue to push the level of CAM usage up but the issue still stands that we are being sold products claiming to have a certain effect when it hasn't actually been scientifically proven to do so. The supposed effect is merely described on the packaging.

Here lies injustice in the sale and marketing of CAM and further justification for its skeptics and critics.

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