I recently attended an international conference where I was treated to an enlightening presentation on complementary and alternative medicine (CAM) given by some of the world's foremost authorities.
The conference was the Fourth World Skeptics' Conference titled "Prospects for Skepticism - The Next Twenty-Five Years." The session I attended was called "Medical Claims," and the "authorities" presenting at this session included some of the most vocal critics of CAM, including acupuncture.
Moderating this session was Wallace Sampson, MD, clinical professor of medicine at Stanford University School of Medicine and editor of the Scientific Review of Alternative Medicine. Presenters included Marcia Angell, MD, FACP, former editor-in-chief of the New England Journal of Medicine and senior lecturer at the Department of Social Medicine at Harvard Medical School; Stephen Barrett, MD, vice-president of the National Council Against Health Fraud who also manages several consumer-oriented websites including Quackwatch.com; Willem Betz, MD, Chair and Director of the Academic Centre for Training of General Practitioners at the University of Brussels; and Steve Novella, MD, MS, BA, assistant professor of neurology at Yale University and president of the New England Skeptical Society.
It was quite an experience to sit in a room of some 150 like-minded people and listen to these highly articulate professionals lament the sorry state of affairs the growing popularity of CAM represents. My ears must have been burning - a "quack" among skeptics. I learned a lot of really neat stuff, though. The good news for our side is that all of us involved in CAM are getting filthy rich. Apparently, the American public, gullible as lemmings, are falling all over themselves to fork over big bucks to all of us who dispense placebos and are willing to spend more time listening to them whine than the average medical doctor does. I also learned that the mainstream American media is hopelessly biased - slanting their stories in favor of CAM and not paying attention to the scientific evidence that disproves all the pseudo-scientific claims the slick and well-funded CAM PR machinery spews forth. I must have missed a meeting. I didn't know any of this stuff.
There was some bad news, however. It seems all of us involved in this field are either unethical or foolish. How else could we take people's money? We're either uncaring of the obvious - that our therapies are at best no better than placebo and at worst a danger to public health and the future of sound science - or we are so dumb as to actually believe our own baloney. If forced to choose, I guess I must be one of the dumb ones, as my ignorance of all the good news above proves. The other bad news I learned is that our day in the sun is coming to an end. Despite the terrible job the National Center for Complementary and Alternative Medicine has done fulfilling its mandate to study CAM, in the future, studies showing how ineffective this field really is will slowly but surely begin to turn the tide back to sound science.
The superior logic of these skeptical authorities forced me to take a long, hard look at my chosen vocation. Should I get out of this field before the CAM bubble bursts? Maybe I could become a real doctor and have sound science on my side for a change. What confidence I would feel knowing the therapies I use had undergone the gold standard of testing. Take, for example, the hormone replacement therapy (HRT) study that was recently completed only 70 years after synthetic hormones were invented and after they were prescribed to tens of millions of women. The sound science people can now calculate just how many cases of blood clots, strokes, heart attacks and breast cancers HRT may have caused over these decades. We can't do that in CAM. As Dr. Maida Taylor, associate clinical professor at UC San Francisco and senior clinical research physician for Eli Lilly & Co. so succinctly put it in a recent Los Angeles Times article, "As dire as the [hormone study] data may sound, at least we have data, whereas there are no substantive data regarding any alternatives."1 I feel so foolish. All these years I thought I had the right idea helping my patients successfully control their menopausal symptoms with acupuncture and Chinese herbs when, all the while, I didn't have substantive data.
Maybe if I were one of those clever, unethical quacks, I would know enough to get out of this field while the getting is good. Alas, it seems I'm one of the foolish ones who truly believe that acupuncture and the rest of Oriental medicine offers a safe and effective form of natural healing. I guess the best I can hope for is that the control we have over the media will allow us to keep the soon-to-come damning data about CAM's ineffectiveness out of the public spotlight for as long as possible. In the meantime, I'll have to find some measure of solace in the gratitude I receive from my gullible patients - that and my considerable fortune, of course.
All kidding aside, there are strengths and weaknesses in aspects of both conventional and CAM approaches. We will never be able to rid ourselves of the zealots at both ends of the spectrum who rail against the other, as though these issues were matters of religious dogma. That's all the more reason the moderate, open-minded people among us need to work together to bring the best of both approaches to the public.
Menopause relief minus hormones. Women: Pros and cons of natural therapies get renewed attention, after report on risks of traditional therapy. Los Angeles Times, July 15, 2002.
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