The Hippocratic Oath has been one of the guiding principles of the medical profession for well over 2,000 years; a version is still administered to new physicians today. One aspect of the Oath has always struck me as a bit curious, however. It’s the part that reminds doctors to never do harm to anyone (often expressed as “first, do no harm,” although these words do not literally appear within the Oath itself). I’ve always wondered why it was deemed necessary to remind doctors not to harm their patients. Isn’t this sentiment pretty self-evident, akin to asking a fireman to swear “first, start no fires”? I suspect it may at least in part be a reflection of the fact that stretching as far back as the days of Hippocrates, many patients do not always entirely trust the people who treat them.
Today, that mistrust seems to be a driving force behind the ongoing interest in medications and techniques that collectively are known as alternative medicine. The term itself is rather ambiguous and open to interpretation. I suppose you could define it as non-mainstream medicine, but then we’d have the equally challenging chore of explaining exactly what “mainstream” means. It’s also unclear what to classify under the alternative umbrella. Most people would probably include such things as homeopathy, acupuncture, and therapeutic touch. Others might also add chiropractic, naturopathy, and massage therapy, treatments that are probably considered somewhat more generally accepted by the medical profession. If there’s a general unifying theme within alternative medicine, it may be that these options tend to fall outside the medical establishment, where treatments are based primarily on antibiotics, drugs, surgery, and other “Western” methods.
Treatments categorized as alternative medicine are many and varied. At least some appear to show sufficient efficacy and promise that they may eventually become more incorporated into the established suite of medical practices and lose the “alternative” label. Others appear more outside widely accepted scientific understanding. And some can only be classified as bizarre. Among these are such disciplines as ear candling, trepanning, and urine therapy (which is exactly what you think it is, a fact that you may not want to contemplate too deeply if you’ve just eaten breakfast).
In general, alternative medicines and practices have not been subjected to the same rigorous regulatory testing as mainstream options. This has lead to some unsubstantiated claims on the part of promoters of these treatments. Among the most exaggerated are those put forth by Kevin Trudeau, author of the book “Natural Cures ‘They’ Don't Want You to Know About.” Some of Trudeau’s claims are so questionable and irresponsible (such as insisting coral calcium can cure cancer) that lives may have literally been lost following his advice.
Other more benign (if no less shaky) claims can be seen routinely in TV advertisements touting such things as weight-loss pills and “natural male enhancement.” If you have very sharp eyes and speed reading skills, you may see the following statement flash on the screen just as many of these commercials end: “These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.” Taken literally, this would seem to imply that the treatment just described is absolutely worthless. Others with whom I have discussed this have dismissed this statement by explaining “Oh, that’s just something the government makes the manufacturer put on the label because it hasn’t been FDA tested yet.” Of course, such testing isn’t just a bureaucratic nuisance; it’s also designed to help identify possible health dangers to consumers. Bear in mind that many side effects only reveal themselves after repeated, long-term use. Others only show up when the product is used in conjunction with other medications. Manufacturers may not have the resources (or frankly the motivation) to thoroughly test every new medication in as many ways as possible. Therefore, whenever I see the “not been evaluated” warning, I usually proceed very cautiously before deciding whether or not to use that particular product.
The more open, less regulated nature of alternative medicine also appears to have fostered several myths. For instance, I’ve seen it claimed that alternative medicines are safer than other treatments. In fact, not long ago I read an article in the Reformer in which practitioners of one school of therapy claimed it produced no side effects at all! On the face of it, this is welcome news to those of us frightened by the laundry list of possible risks we often see listed in association with certain drugs. Of course, virtually all effective medications carry with them some risk or another; the only ones with no side effects likely offer no effects of any kind, positive or negative. To state that one medicine is safer than another is meaningless unless both deliver more or less the same level of efficacy. Distilled water no doubt produces far fewer unpleasant symptoms than chemotherapy, but I suspect few would consider it the “safer” option for cancer patients. Personally, I have seen little evidence that any alternative medicine is both safer and as effective as its mainstream counterpart.
Another possible myth – one that Kevin Trudeau has made a career of exploiting – is that many safe, effective, and inexpensive cures are being kept from the public by “big pharm” and a stodgy, closed-minded medical establishment too wedded to tired old dogma to recommend anything innovative. It’s probably true that physicians in general tend to stick to tried and true techniques – and well they should; few patients would feel comfortable with a doctor subjecting them to some unproven treatment when a clinically confirmed one is available. And the idea that pharmaceutical companies would deliberately suppress a potentially successful product is just plain silly. If a treatment works, the pharmaceutical companies will be all over themselves offering their own versions. If there’s a buck to be made, someone will make these products and someone else will stock them on shelves. In the world of business, greed trumps tradition every time.
Overall, the topic of alternative medicine is probably far too broad for me to cover in a single article. In upcoming articles, I’ll be looking at a few of the most popular treatments, discussing the pros and cons of each. But based on fairly extensive study and reading I’ve given the subject over the years, I would recommend avoiding any treatment that its supporters claim cannot be tested in double-blinded studies, or that is based on belief in the supernatural. I would further caution that “natural” doesn’t necessarily mean “better.” After all, arsenic and hemlock are both perfectly natural. And even though I’m a firm believer in “the proof is in the pudding” and that the ultimate test of any treatment is whether or not it actually prevents or cures what it claims to, I turn a skeptical eye to any medication that cannot provide an observable, understandable, and logical explanation for how it works.
The motivation for seeking alternative medical options is of course very understandable. Health is perhaps the most critical component to one’s quality of life, and many mainstream drugs recommended by physicians are downright scary. But in the end, a medication or treatment needs more that simply to do no harm. It also needs to prove – in an open, unambiguous, consistent, and replicatable way – that it can actually do some good.
Dick McCarrick
dmccarrick@vermontel.net