Alternative Medicine 1

1. Alternative Medicine 1 a.k.a. Complementary, Holistic, Unconventional, New, Planet, New Age, … Medicine/Health/Therapy/Healing, …

2. Alternative to What??? • alternative to scientific medicine • based largely on experimental research (often incl. double-blind clinical trials) • conventional medicine depends significantly on pharmaceuticals and surgery (but not enough on prevention!) • compare progress of both (as well as popularity) • consider credentialing and accreditation • evidence-based medicine

3. relaxation techniques chiropractic massage imagery spiritul healing weight-loss programs macrobiotics & other such diets herbal medicine megavitamins self-help groups energy healing biofeedback hypnosis homeopathy acupuncture folk remedies etc. Popular Areas of A.M. David Eisenberg et al., NEJM 1/28/93, p. 246

4. back problems anxiety headache sprains and strains insomnia depression arthritis allergies Typical Problems for Which Patients See Alternative Providers

5. Scope of Alternative Medicine • Most of world’s population depends on it much more than on scientific medicine—which is often unavailable or too expensive. • $20 billion industry in U.S. • 75% paid out of pocket • few % of total U.S. healthcare bill • more visits to alternative providers than to primary care physicians • NIH “National Center for Complementary and Alternative Medicine” • nccam.nih.gov • $50 M budget • (was $2 M in 1992 for OAM)

6. David Eisenberg* surveys (’90, ’97) NEJM JAMA • 629 million visits • $21.2 B ($12.2 B not covered by insurance) • 83 million Americans (25% since 1990 ) • 47% visits & 45% spending (since 1990) *Center for Alternative Medicine Research, Beth Israel Deaconess Medical Center, Boston

7. Alternative Care in U.S. (1997)

8. Aspects of Alternative Medicine • “ancient wisdom” • religious undercurrent • New Age spiritualism • faith healing • empiricism (experientialism) • substitute personal experience for scientific knowledge • mysticism (& extreme skepticism) • mind/body dualism • often anti-science • “energy” & “vibrations” (~red flag)

9. “Vital Force” • nonmaterial, divine, or personal form of “energy” (or “vibrations”) • little or no relation to physics usage • Qi (chi); chakras; “innate intelligence”; psychic energy; etc. • acupuncture —Qi and body interact through elaborate system of channels (nonexistent) • “energy” undetectable by instruments or objective tests • only subjective

10. Main Approaches • Mind/Body • biofeedback, relaxation, hypnosis, … • stress and emotions are known to play a role in physical health • neuroimmunology — new field • Alternative drugs • cancer treatments (shark cartilage!??) • other herbal remedies • Treatments at odds with Western medicine (and science) • chiropractic, acupuncture, homeopathy, …

11. Considerations • Most ailments (~80%) are self limiting! • Many are psychogenic. • Placebo effect is strong! (double blind?) • Are A.M. treatments safe and effective? • There are dangers in avoiding (or deferring) mainstream medical care for serious organic ailments. • How does one determine which treatments work, and which do not? What is the evidence? — and how solid is it? • Beware quackery and con artists ($$$).

12. Placebo Effect & Clinical Trials • Placebo • sugar (glucose) pill, saline injection, sham treatment • surprisingly effective (typically 30-40%!!) • used as control in clinical trials • Double-blind trials • patient & practitioner unaware of whether patient receives actual drug or placebo • randomization & encoded labeling • statistical analysis (large studies preferred) • expensive • ~ “gold standard” — but not always possible

13. Clinical Trial Phases (new drugs or treatments) • Phase I: safety, safe dosage range, side effects (~ 50 subjects) • Phase II: effectiveness — and more on safety (~200 subjects) • Phase III: confirm effectiveness, monitor side effects, compare other drugs or treatments, plan safe usage (~2,000 subjects) • Phase IV: continued study after it has gone to market (incl. long-term side effects)

14. Major Themes of A.M. • spiritual healing • yoga & ayurveda • natural healing • naturopathy & homeopathy • hands-on healing • acupressure, reflexology • therapeutic touch (mostly hands off !!)

15. Homeopathy Samuel Hahnemann 1755-1843 • Law of Similars • “like cures like” • Law of Infinitesimals • “infinite” dilution • unaware of Avogadro’s number! • Considered pseudoscience today • but remains popular & commercially successful • ~ placebo effect • Note: Sen. Royal Copeland, MD, sponsor of Food, Drug, and Cosmetic Act (1938; FDA), saw to it that homeopathic medicines were not included (re: safety & effectiveness) — Copeland was a homeopath

16. Therapeutic Touch • Emily Rosa • fourth-grade science fair project: • Could therapeutic touch practitioners actually detect a “human energy field”? • Results: No! • published in JAMA • JAMA 279:1005-1010 (April 1, 1998)

17. Conclusions(Rosa et al., 1998) “Twenty-one experienced TT practitioners were unable to detect the investigator's ‘energy field.’ Their failure to substantiate TT's most fundamental claim is unrefuted evidence that the claims of TT are groundless and that further professional use is unjustified.”