Denialism

5 Alternative Medicine Treatments that Work?

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by

MarkH
in

CNN suggests there are 5 (count them 5) alternative medicine treatments that actually work! How pathetic is it for altie-meds that the article is presented this way. You know, 5 altie-med therapies that work versus, well, all real pharmaceuticals that actually have proven medical effects. As many have pointed out, if it works, it ceases to be “alternative” and then becomes evidence-based medicine. But let’s not take this for granted, let’s go over this list presented by altie-quack Andrew Weil.

1. Acupuncture for pain

Hands, down, this was the No. 1 recommendation from our panel of experts. They also recommended acupuncture for other problems, including nausea after surgery and chemotherapy.

Well, as Orac has pointed out, the evidence is that acupuncture – the ancient Chinese technique of using needles to beneficially re-direct qi – does not work. Sham acupuncture works as well as “real” acupuncture. So acupuncture doesn’t work, randomly sticking needles into people helps though.

2. Calcium, magnesium, and vitamin B6 for PMS

When pre-menstrual syndrome rears its ugly head, gynecologist Dr. Tracy Gaudet encourages her patients to take these dietary supplements. “They can have a huge impact on moodiness, bloating, and on heavy periods,” says Gaudet, who’s the executive director of Duke Integrative Medicine at Duke University Medical School.

Hmmm, again, I think the evidence for this is weak. The papers I found on B6 calcium etc. (1 2 3 4 5 6) did not show anything consistent or profound for B6 or Magnesium although Calcium has shown a small effect in the Nurses Health Study (abstract). But we must remember John Ioannidis’ work and remember this is a correlative result. A study such as the Nurses’ Health Study is likely to generate many false-positive significant effects simply because they study so many variables, and this needs to be confirmed with more direct studies of calcium supplementation. I think the statement that these supplements can have a “huge impact” is unwarranted and incorrect.

3. St. John’s Wort for depression

The studies are a bit mixed on this one, but our panel of experts agreed this herb — once thought to rid the body of evil spirits – is definitely promising. “It’s worth a try for mild to moderate depression,” says Weil, founder and director of the Program in Integrative Medicine at the University of Arizona. “Remember it will take six to eight weeks to see an effect.” Remember, too, that St. John’s wort can interfere with some medicines; the University of Maryland Medical Center has a list.

That St. John’s wort can “interfere” with some medicines sounds kind of benign – after all you’re not on any medication, just the pill right? Next month you find out your birth control didn’t take and you’ve got an extra reason to be depressed. A systematic review from Cochrane suggests there is some evidence for efficacy of St. John’s Wort for depression, but it’s pretty poor, varies greatly between studies, and is “not fully convincing”. Not the kind of results you try to hang your hat on when it comes to treating a dangerous illness when there are other drugs that do not have the same risks of drug interaction and are consistently more effective.

4. Guided imagery for pain and anxiety

“Go to your happy place” has become a cliché, but our experts say it really works. The technique, of course, is more complicated than that. “In guided imagery we invite you to relax and focus on breathing and transport you mentally to a different place,” says Mary Jo Kreitzer, Ph.D., R.N., founder and director of the Center for Spirituality and Healing at the University of Minnesota.

There is a great deal of evidence for the efficacy of guided imagery for a great number of problems from pain management to stress headaches. It’s silly to describe something that has been proven to work effectively as “alternative medicine”, this is evidence-based medicine.

5. Glucosamine for joint pain

“It’s safe, and it looks like it’s effective,” says Dr. Frederick Hecht, director of research at the University of San Francisco Osher Center for Integrative Medicine. “It may be the first thing that actually reverses cartilage loss in osteoarthritis.”

Fail. Real studies of glucosamine and glucosamine/Chondroitin as well as systematic reviews suggest little effect on pain and standard therapy with anti-inflammatory drugs are better. Long term studies show it might slow cartilage loss, however, it’s not clear it’s the glucosamine as much as the sulfate moiety as the substance is rapidly metabolized upon administration.

So, to summarize, we have 1 treatment which works but that should not really be considered “alternative” as it is widely recognized as efficacious evidenced based medicine. One which works, but has nothing to do with the mechanism the alties believe. The other 3 are the typical examples of medications with proof of efficacy in small, poorly-controlled studies that disappears with more thorough analysis. At best, they may have some modest effect, but for the most part, they are remarkable only for their mediocrity as treatments for any disease.

The best part might be the final advice though, it’s hysterical.

All our experts warn that since alternative medicine is financially lucrative, a lot of charlatans have gotten into the business. They have these tips for being a savvy shopper:

A lot of charlatans? How do they tell the difference between one quack pushing unproven therapy and another? They’re either charlatans pushing unproven treatments, or they’re using real medicine that isn’t alternative. It’s pretty simple.

What continues to astonish me is that the altie-med types are able to pass their nonsense off as some anti-corporate, power to the people campaign, when these supplements and herbs are just as much big business as the pharmaceutical companies. So I have to ask, who is the more evil corporation. The one that may undersell dangers and pushes its product onto people who might not need it – but the drug works – or the one that does the same only the drugs demonstrably lack or have no proven efficacy?

Comments

  1. scienceteacherinexile

    South Africa has a world class med system, and some of the best training and doctors in the world (first heart transplant was performed in Cape Town). But the thing that still gets me is how the educated sector here swear by their homeopathic remedies. The pharmacies have huge homeopathic sections.
    And then there are the “traditional healers” who are tribesmen usually with no formal education. Kids die because these guys perform circumcision rituals as part of their tradition. Kids die sometimes from bleeding, from infection, or some contract HIV.
    Finally there is the Minister of Health for the country who has stated that traditional treatment (effectively olive oil and garlic) is an effective treatment for HIV/AIDS. Of course this is the same person who was fired in Zimbabwe early in her career for theft and went on drinking binges when in hospital which may be why she recently had a liver transplant although her doctor denies this.
    This country has some good potential, but we must crush these disturbing problems.
    Jacob Zuma is up for the ANC nomination for president (effectively the presidency as the ANC is firmly in control). He testified in his rape trial last year that after the deed, he showered to protect against HIV.
    If this guy wins the nomination, I will pack up my family and move back to the US because this place will be doomed..

    Reply
  2. Infophile

    You know, I was kind of surprised not to see Chiropractic on this list. It’s one of those alternative treatments that’s gained quite a bit of support and respect (almost all of it unfounded). Then again, maybe that’s the problem: They don’t consider it “alternative” anymore… *shudder*.

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  3. Plutarch

    “Practitioners” of “alternative medicine” depend on the placebo effect, and they can get away with it because they’re not licensed by anyone or liable for any wrongdoing when the “treatment” doesn’t work.

    On the other hand, if a real doctor were ever to prescribe a placebo for a patient, and the patient found out, the doctor would lose his license. Real doctors have accountability; alt. med. quacks can get away with whatever.

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  4. Pierce R. Butler

    It seems MarkH’s definition for “alternative medicine” is “anything which doesn’t work”, which is conveniently flexible in supporting the claim that, hey, alternative medicine doesn’t work.

    For years, my dog has ingested a daily tablet of glucosamine, and his hip movements stiffen noticeably whenever I’ve run out of tablets for even a couple of days. I doubt this is due to the power of suggestion, as he doesn’t believe in psychosomatic influences.

    Likewise, I’ve repeatedly observed the accelerated healing effect of aloe vera tissue on cuts, bruises, and burns. By my definition, that counts as “alternative” medicine, in that it is not recommended (or even mentioned, sfaik) in lay or professional medical literature (if you exclude herbalism from that category).

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  5. Plutarch

    Pierce,

    Anecdotal evidence does not provide support for the efficacy of any of these treatments because it might be nothing more than your perception, or the placebo effect, the observer effect, experimenter’s bias, or any number of other methodological errors.

    The beauty of the double blind study is that it eliminates all other explanations except for the treatment being studied, and that’s why those sorts of trials are considered valid while the argument that “it helped my mom/dad/sister/dog so it must work” is not accepted.

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  6. Kagehi

    Well, Chiropractic hasn’t really been an altie medicine for the most part anyway. Now, its a) overused, b) mis-proscribed and c) often given “as” an altie medicine by people desperate to drum up business for what they suddenly realize, after years going to school for it, would, if used properly and appropriately, net them less than probably 20% of the patients they currently treat with it.

    And that is a huge problem imho. You can’t practice it without having very specific skills, so you don’t cause damage, instead of helping, **but** if you only treated people that really truly needed it, you would have to sideline in some other specialty as well, which may not be practical, or will lose you shirt. Its, unfortunately, easier for them to play the same stupid game that Acupuncturists do, or even to (worse) branch out into some of that sort of true altie medicine, as a supplement to their business. Its just too specific, too limited, and too little needed for when its “actually” needed.

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  7. jre

    I wish that, when MarkH wrote

    It’s silly to describe something that has been proven to work effectively as “alternative medicine”, this is evidence-based medicine.

    he had expanded a bit on what “proven” means in this context.

    To say only that a treatment with convincing evidence of efficacy is automatically evidence-based (not alternative) medicine, and stop there, is to invite the criticism that the definition is circular. In fact, it’s not, since there are well-accepted standards for “proven” and “convincing” — but there are many reasonable and intelligent people out there who are unfamiliar with those standards. It is with those people you need to communicate.

    Pierce Butler is a perfect example. His informal glucosamine study is, as he points out, certainly blinded from the dog’s side. But it’s not blinded from Pierce’s side, unless he has enlisted a friend to assign a placebo during randomly selected periods. If he did that, and his dog was doing better with treatment than placebo to a high level of significance, then I would say, yeah, the glucosamine is probably helping. At that point, glucosamine would move from the “alternative” to the “evidence-based column” — but, and here’s the problem, it would have been an effective treatment even when we had only Pierce’s anecdotal evidence for it. To define “alternative medicine” so narrowly places even the goofiest therapies into the “not yet proven” category.

    I prefer the definition of Complementary and Alternative Medicine (CAM) offered by Steven Piantadosi in Clinical Trials: a Methodological Perspective (p. 83):

    [CAM is] a treatment whose mechanism of action is poorly defined or incompatible with established biology.

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  8. DRK

    As far as aloe vera, it is frequently mentioned in the literature. Just go to Google Scholar and type in aloe vera. There have been many medical and pharmaceutical studies about it, most favorable, it seems, as far as its anti inflammatory effects go.

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  9. sailor

    DRK, Interesting you get 10400 thousand hits for aloe vera and only 1870 for aloe barbadensis, which happens to be it real name!
    Either way I would guess this is one of life’s more useful medical plants. It is also used in the pharmaceutical industry, eg: aloe-emodin as anti-cancer. So it has gone from woo to mainstream.

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  10. Ryan Miller

    I happened to catch this yesterday while tuning into CNN. They had a 5 minute spot with some pretty faced woman hitting the key points you have included in your post. The most disturbing aspect of it was the caption on the bottom of screen which read, “Alternative Medicine Backed By Solid Science.”

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  11. Pierce R. Butler

    Plutarch:

    “Anecdotal evidence” multiplied by numerous reports may not approach the level of independently confirmed lab data, but it’s more than rumor.

    As a practical matter, I consider my own and numerous friends’ reports on this sort of thing more convincing than I would accounts of “scientific studies” from some glucosamine vendor. Everyone pushing a nostrum seems to have a list of “research” backing their claims; lacking the time and training to evaluate such assertions in depth (but having seen prescribed, gov’t-approved remedies fail), I find some “alternative” approaches worth a try – and those which show some success worth continuing.

    The above applies just to my use of glucosamine (and MarkH’s info about the sulfate content of same does put that in a new light). My experience with aloe vera, extending over three decades of a somewhat abrasive life, leaves me viewing its healing properties as conclusively proven.

    At the risk of sounding like a stereotypical pharmaconspiracist: just who could be expected to put up the funding to put a “folk” herbal salve such as raw aloe through FDA-quality testing?

    PS: Apologies for the tardiness in replying: I ran out of sacrificial goats, so just as I was about to post the great and mighty Thor smote my DSL connection, and much else.

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  12. Pierce R. Butler

    Having now caught up on later comments:

    Thanks to ire & DRK for your clarifications!

    I would quibble with the ire/Piantadosi definition of “complementary/alternative” medicines, in that this seems to classify those as quackery without exception. We’re dealing with several concepts here, which off the top of my head I’d align along two dimensions: how well a given approach has been researched, and how well it works. It’s quite possible that a single substance or therapy could simultaneously be at the minimum on one scale and the maximum on the other.

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  13. Ex-drone

    Quackwatch.org continues to be a good critical resource to check CAM claims.

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  14. Harald Korneliussen

    “…these supplements and herbs are just as much big business as the pharmaceutical companies.”

    Not only that, often they are the same companies.

    So there are disappointments in store, for both anti-establishment alties and scientific medicine proponents who were naïve enough to believe that the pharmaceutical companies were on “their” side.

    Reply

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