What is alternative medicine?

Broadly speaking medicine falls into two categories: Conventional and Alternative.

Conventional medicine consists of medicines and treatments which have been tested in clinical trials and have been proven to work. This is known as the scientific, evidence-based approach, to medicine.

Alternative medicine is defined as treatments that have not been verified through peer-reviewed, controlled studies, or which have failed to pass such studies. As such, they are not recognized by the medical community.

They are often traditional, culturally-based treatments and their efficacy is often believed to be due to metaphysical forces, which are incompatible with known science.

The metaphysical forces go under names such as: Qi, Yin and Yang, Innate Intelligence, Vital Energy, or their new-age counterpart Energies; none of which have ever been shown to exist.

Financial aspects of the industry.

Before discussing alternative medicine it is important to realise what a large profit-driven industry it is. The consumer pays for most alternative remedies or treatments used. It is a £1 billion plus industry so there is plenty of financial clout there to promote it. The market has been doubling in size every four years.

Many claims are made for the benefits of alternative remedies and services, but this has to be contrasted with the fact that providing such remedies is a very lucrative business in many cases. There are many greatly exaggerated claims made for alternative remedies. Opponents of conventional medicine often accuse "big pharma" of chasing profit. This is probably true, all businesses seek profits; however, the alternative medicine industry is no different.

It should also be made clear that many, mainly herbal, alternative remedies are sold as foodstuffs and not as medicine, which is why they can avoid a lot of expensive testing for their real usefulness.

Empirical evidence.

Drugs and medicines have empirical evidence to back up the claims that they are effective. They undergo rigorous testing and have to be scientifically proven to work, and that they are also safe to use. Any side effects that they cause are documented and understood and will be taken into consideration by the doctor prescribing the treatment.

Alternative treatments do not go through these procedures. Many have mystical thinking or perceived ancient wisdom behind them, but no strong scientific evidence to prove that they really work. Most evidence cited is individual anecdotal evidence, and where proper controlled studies have been done the results show that alternative treatments get the same results as the placebo control group.

Some treatments, such as herbal remedies, may have biologically active compounds (i.e. drugs) in them but as they are not usually thoroughly tested it is not known what they are or what their side effects may be. Many are known to interfere with conventional treatments, St John's wort for example.

Disease and Illness

When considering cures for illness it is important to realise that there is more than one classification of Illness.

The main categories are:

Chronic illness

This is defined as any disease that develops slowly and/or lasts a long time. Examples of common chronic illnesses are diabetes, arthritis, congestive heart failure, Alzheimer's disease, Parkinson's disease, and stroke. They often are never cured but are not necessarily debilitating.

Acute illness

This is defined as an illness that starts suddenly and is short lived. Two common examples are colds and the flu. Most will clear up of their own accord (known as self-limiting disease); some will clear up quicker by responding to antibiotics or other medical treatment.

Subjective illness

This includes such things as 'feeling under the weather', aches and pains, symptoms of chronic illnesses and psychosomatic illnesses (where a person displays physical symptoms due to psychological conflicts caused by stress, anxiety, worry etc). The level of discomfort or pain experienced depends on the sufferer's state of mind, beliefs, and expectations.

How do alternative treatments appear to work?

Alternative treatments tend to be used for self-limiting illnesses as cures and for chronic illnesses as treatments, although some of the more mystical and extreme alternative practitioners are not shy in claiming miracle cures for all sorts of chronic disease, especially cancer.

This is an age in which we are very aware of health and health issues. A group of people labeled the "worried well" have sprung up. These are people who will self-(mis)diagnose ailments at the slightest cough or ache, and often treat themselves with various remedies which they will swear have cured them.

Most people who use alternative treatments buy them over the counter for self-limiting acute conditions, coughs, colds and such like, or subjective conditions such as aches and pains. Self-limiting illnesses will clear up as the body fights them off naturally; this can give the illusion that the "remedy" has effected the cure when in fact it made no real difference. This is known as the post hoc fallacy.

Chronic conditions improve after hitting a low point: the point when you're most likely to take medication. (see: regressive fallacy).

The major reason that ineffective remedies appear to work however, is the placebo effect.

For an analysis of the many reasons inefficacious treatments appear to work follow this link: How ineffective treatments appear to work

If treatments appear to work, what's the harm?

Fortunately, for most people, most of the time, there will not be a problem. The safety record of alternative practitioners is generally good; however, this does not mean that alternative treatments are risk-free. Some treatments, such as acupuncture, are invasive, and some manipulation therapies, such as chiropractic, carry a small risk of serious injury.

Herbal remedies are probably the biggest cause for concern. They are sold largely unregulated, and most are untested and poorly understood. This includes their potential side effects. Qualifications are not required to sell such remedies and even the so-called experts in the field don't really know what they are dealing with.

Some herbal remedies do contain physiologically active compounds that do have an effect on the body. As they have not undergone clinical trials and scientific testing, those effects and potential side effects have not been thoroughly evaluated.

Just because something is 'natural' does not mean that it is necessarily harmless. Nature has evolved many ways for plant (and animal) species to defend themselves. Manufacturing toxins is one such method.

Many herbal remedies are known to interfere with prescribed drugs. This can negate any benefit derived from prescribed drugs and put your health at risk.

See:

The danger of using herbal remedies with prescribed drugs

Chinese medicine caused kidney failure

A further potential danger with alternative remedies is when a person develops a serious illness and decides to turn to alternative treatments rather than see a doctor.

Conditions such as cancer need to be detected as early as possible. If someone wastes several weeks or months on ineffective treatments before eventually going for a proper diagnosis, it may just have tipped the balance from a curable condition to an incurable one.

An important point about the placebo effect

When tested, alternative remedies show no difference in efficacy to a placebo. In other words any benefit a patient feels from an alternative treatment is due to the placebo effect and not from any real effect of the treatment.

It is important to understand that placebo responses, such as feeling less pain or more energy, do not affect the actual course of the disease. Thus placebo responses can obscure the symptoms of real disease, which can lead to delay in obtaining appropriate diagnosis or treatment.

This could mask the real symptoms of a serious disease just long enough to tip the balance from it being treatable to incurable.

Are there any benefits to alternative treatments?

Alternative therapies do get results, although they seem to be attributable mainly to the placebo effect. The main area where alternative therapies are far better than conventional treatments is the doctor/patient relationship.

Alternative practitioners claim to take a 'holistic' approach to healing. Whilst this gets into the area of mysticism involving a mind or soul that is separate from the body, the fact is that a healer will spend a lot of time asking questions and listening to the patient's concerns in their life and not just focusing on the illness alone.

This is known as a patient-centred approach, and it is believed to enhance the placebo effect. Scientific research is currently under way to evaluate how much difference this personal approach makes to a patient with a view of encompassing it within conventional medicine. GP's often have no more than five minutes to devote to a patient, through no fault of their own, and this may leave many patients feel that not enough is being done for them.

Qualifications and regulation

Doctors undergo rigorous training and they are highly qualified; usually training for six years before qualification. They are registered with the General Medical Council and cannot practise without being registered. Doctors can be struck off the register if they practise their trade below acceptable standards.

Surprisingly anyone can set themselves up as an alternative practitioner. Qualifications are not needed and the entire industry is largely unregulated. There are moves under way to introduce some standards. Chiropractic, for example, is regulated - but this just means that practitioners have been accepted to practise chiropractic it doesn't mean that it really works. The distinction has to be made between being registered or "qualified" and the treatment being offered actually working.

This also raises the question: How can you be "qualified" in a treatment that cannot be proven to work?

Safety

Many alternative therapies are believed to be relatively benign in their pure form. However, as the industry is mostly unregulated and qualifications are not required then it is an ideal environment for charlatans. Trusting people could be placing their healthcare in the hands of untrustworthy or incompetent practitioners.

Remedies, especially herbal ones bought from overseas, can be adulterated with various drugs and compounds.

The perceived inherent safety of alternative remedies may be boosted by the fact that many people using them don't have anything wrong with them. People with nothing wrong with them taking remedies that don't do anything shouldn't cause too many problems. The danger lies when they stick with alternative remedies when something does go wrong.

Conclusion

Alternative treatments are usually based on pseudoscientific or mystical principles which have no basis in reality. The treatments show no real curative value; they appear to work mainly by the placebo effect.

From a scientific point of view alternative treatments are nonsense, they often don't have an explainable mechanism, they don't stand up to scrutiny, don't pass controlled studies and many could actually be quite dangerous.

However, they have shown that the placebo effect is powerful, and that a patient-centred approach to treatment is of great benefit to the patient.

There are certainly some lessons to be learned from alternative medicine, but with a complete lack of scientific rigour and an almost complete lack of regulation, alternative medicine is firmly embedded in the world of irrational thinking.

Perhaps it's time for the government to introduce, at the very least, regulation for the alternative medicine industry and some protection from the self-appointed professionals who make money from our media-induced obsession with health.

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