Choosing Alternative Medicine

After a terribly painful and debilitating illness, Steve died.  He had been treated for Stage 2 Hodgkin’s Disease with a series of intense therapies including German enzymes, American antineoplastins, Mexican naturopathy and Chinese Herbs, complemented by focused meditation, innumerable vitamins, extreme diet modification and acupuncture for severe pain.  He fought the cancer with every ounce of his being, doing everything to survive, except the one thing that had an 85% chance of cure; chemotherapy.

I was struck this week by a comment on my website, which bemoaned the highly disorganized state of “alternative medicine” in this Country and in particular the “paltry sums” for alternative research funding by the National Institutes of Health (NIH). The writer suggested that not only could the quality of health be improved with alternative medicine studies, but would go a long way towards saving health care dollars.

It seems to me that the idea that we need more Complementary and Alternative Medicine (CAM) research goes right to the core of the confusion between so called “conventional medicine” and CAM.  There is a major difference between the medicine practiced by board certified, classically trained physicians and that of alternative practitioners.  That difference is research and data.

If an MD or DO is treating a cancer patient and that patient asks to see or understand the basic science and clinical studies which support the recommended therapy, that published data is readily available. Standard oncology treatment goes through 10-20 years of research, from the test tube, animal studies and through a series of supervised human multi-phase trials, until it is approved and offered to patients. Each step is refereed by competing and critical PhD and physician scientists and must be published in peer-edited journals for general review and criticism, all of which is public and transparent. Where it is not, and when people attempt to manipulate or falsify the system or data, massive blowback eventually occurs.

Alternative medicine, by its very definition, means that it is an alternative to this system of scientific analysis.  Essentially, anyone can come up with an idea and without any of the above research steps, provide it to patients.  If I decide that sunshine enhanced lemon juice can kill cancer because it is acidic and cancer hates acid, then I can start selling it in pill form tomorrow.  If you look at a long list of CAM therapies, that is what they have in common … the shortcut from idea to bedside.

CAM treatments may have long respected histories. Some, like Chinese Traditional Medicine, Ayurvedic Medicine of India, American Homeopathy or Acupuncture, are hundreds or even thousands of years old and have millions of adherents who believe it has helped or even cured them.  Often the most vocal support comes from individual patients regarding their own experience with an alternative treatment. Scientists believe that individual case reports are poor substitutes for the objective analysis of hundreds of patients in experimental trials.  All CAM therapies have limited or no published research to explain the science of these therapies or to prove they work any better than placebo.

When proper research is performed, certain alternative treatments are found to have value.  Vitamin D (with calcium) seems to improve bone density.  Acupuncture can treat migraines and prevent chemotherapy-induced nausea.  Chiropractic is more likely than orthopedic surgery to return patients with routine back pain to employment.  Exercise helps depression and decreases the likelihood that breast cancer will relapse. On the other hand, randomized trials have shown that laetrile (amygdalin) has no anticancer activity and that Vitamin C does not prevent or blunt upper respiratory infections any better than sugar pills.

A key question is that just because the research supporting CAM therapies is limited, does that make them bad?  Not necessarily, but it does mean that when choosing such a method of care, patients need to understand they are making the decision based not on a step-by-step scientific process, but on unproven theory.  It comes down to trust in the CAM practitioner, because no one, not the person providing the treatment, the patient’s primary physician, nor the patient, has any objective evidence to show that the therapy may help or hurt.

Patients have many reasons to choose alternative treatment instead of or in addition to conventional medical care. The most obvious is the powerful desire to do everything possible to fight the disease, to leave no stone unturned.  The need to control one’s destiny, especially if confronted by doctors or a medical system, which seems impersonal, cold and uncaring, drives many patients to seek a different path.  Many patients distrust conventional medical care, and most Americans believe conventionally trained doctors either deliberately or by ignorance fail to offer reasonable alternative therapies. For some there is deep mistrust in the objectivity of the “physician-medical school-pharmaceutical-government complex.”  Traditional religious, superstitious and pseudoscientific reasoning support the CAM decisions of many patients.

Like most physicians, I have seen many patients hurt by CAM therapies. Some by obvious side effects, such as the woman whose breast fell off after receiving a poultice or the man who had such severe nerve damage that he never walked again.  Others delayed life saving therapy with horrible result.  Many spent their last dollars without benefit.  Finally, other patients undoubtedly experienced side effects and perhaps increased cancer growth because we simply do not have the data on alternative therapies to understand what to expect.

CAM therapies are an alternative to conventional medicine.  As we do research on each concept, it will not longer be alternative medicine, but proven or not will fall under studied medical science.  I absolutely agree with the comment on my blog that we need to do more experimentation on any therapeutic concept for which there is a reasonable scientific base.  Every hypothesis, every dream, every hope must be considered. Nevertheless, until ideas are subjected to the light of scientific scrutiny, each patient and family must understand that by alternative we do not mean a therapy which is proven, but out of the mainstream; by alternative we simply mean unknown.



  • Chris Olivier
    After reading "Bad Pharma" by Ben Goldacre, I question whether the little evidence available on CAM is any worse than the biased evidence published (or not published in the case of negative tests)!
    • James Salwitz, MD
      Excellent point. The influence of pharma and other factors (political, financial...) which can result in biased medical research is a real problem and needs to be addressed. I would propose that the answer is to force high ethical standards and objective data analysis on health science, not to give up the idea of disciplined academic study and simply "guess" the best therapy. Thanks for the comment, jcs
      • Steve ransom
        Magical Mystery Tour Free book online You'll never look at alternative medicine in the same way again! Please go to and download the free 126 page PDF. Twenty tears in the research and writing, the reviews on the main page tell you just how good this book is. Enjoy. But be warned. You'll never look at medicine and particularly alternative medicine in the same way again! Steve Ransom
  • Thanks for this thoughtful post. Alternative therapy ought to be held to the same ethical standard as conventional: first do no harm, including keeping a person from receiving beneficial conventional treatment. I would add that one of the wickedest impacts of a few predatory practitioners of alternative therapy is to bankrupt the patient and their family by taking advantage of their desperation. I've seen families empty their retirement and childrens' college funds and take second mortgages out in pursuit of treatments that have been, in fact, proven to have no benefit. I advise patients that one certain sign of a cancer treatment charlatan is when they ask for $xxxxx up front before they will even see you for a consultation. That said, my impression is that the alternative predators are few and far between. Most sincerely believe they are helping people, and some responsibly guide patients back to conventional medicine. My version of Steve, a college age woman with stage 2 Hodgkin's that she tried to treat with everything but conventional therapy was sent to me by the naturopath she consulted (after 2 years of trying everything on her own) when she was short of breath, febrile and wasting with now stage 4 HD. In retrospect (7 years out) the woman now in her 30s says that naturopath saved her life. I think the real potential benefit of alternative/complementary therapy is when it is part of the panoply of therapy, conventional and otherwise. Use whatever works -- and that's the key, what works, as you have described in your post. Some effects are surely less "measurable" -- and those we just might have to call "healing" effects, and can be seen with the application of all kinds of therapy -- even just being present and listening.
    • James Salwitz, MD
      In my experience most alternative and complementary practitioners are not "predators" but believe deeply in serving their patients and communities. They, like the patients for whom they care, have accepted the concept that giving treatments that seem to "make sense" even if they are not proven, is reasonable. In addition, I would agree fully that many CAM providers are highly compassionate and communicate well, something conventional physicians often lack. Thanks for your comment, jcs
  • Dr. Salwitz, In re: your comment <> This is the classic "straw man" tactic to debunk your version of "alternative" medicine. Somehow in your view "alternative" medicine has no evidence, and if it does have evidence, it is no longer "alternative", having been blessed at the alter of RCTs, systematic reviews and EBM. I agree with the other posters. Goldacre's case is relentless in its pursuit of bias in "scientific" medicine.
    • James Salwitz, MD
      Interesting thought ... how would you define "alternative medicine?" jcs
      • <> I wrote a discussion of this for a chapter in Bonica's Management of Pain. Happy to send it to you...doesn't look like there is opportunity to attach to this comment.
        • James Salwitz, MD
          If you send to my email (JIMSAL@MSN.COM) I can try and attach. jcs
  • "Individual case reports are poor substitutes for the objective analysis of hundreds of patients in experimental trials", but don't think we can discount CAM altogether. I'm wondering if others have the same unsettling thoughts I have? Namely, the fact that the financial backing of said trials is supported by the prospect of huge monetary gain in the form of inflated pricing of a resulting marketed product by the participating drug company and is therefore subject to unscrupulous measures fueled by greed; and that despite the objective analysis of experimental trials, history continues to record large numbers losing their battles with disease along with too many even experiencing harm rather than help done them. Perhaps the understandable, plain and simple lack of confidence in existing results or mistrust of 'Big Pharma' motives leads some to distance themselves from a particular conventional treatment therapy in favor of CAM therapies with success confirmed by individual case reports. Would that we should all tend to shrink from any form of exploitation whether it originate within conventional medicine or CAM.
    • James Salwitz, MD
      I could not agree more ... you are 100% correct. This is why I believe we must demand in creating health care policy and medical decisions that we strive to build a base of objective research. This should apply as much to the FDA, pharma, individual lab researchers, practicing doctors and CAM providers. That, more than anything, is the point of my blog, that it seems to me that in much of alternative medicine we have abandoned even the attempt at scientific trial and objectivity. As a physician who 15 years ago stopped allowing any pharma representitives into our offices, I would be the last to be an apologist for the motives of drug manufacturers. jcs
  • May be in a few decades "alternative" will mean the exact opposite as today...
  • @Acupuntura - YES THIS!!
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  • Most modern medicines are from alternative medicines however it's been put aside because of the new develop medication. We do have another way to get cured as what I read from we can get off medication. We have few option to be better than taking a medication that is not yet tested.

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