Complementary and Alternative MedicineJoe Segen2017-11-18T23:23:36+00:00
Complementary and alternative medicine
Complementary and alternative medicine herbs and such
Also known as non-traditional or non-Western medicine, complementary and alternative medicine (CAM) doesn’t interface well with mainstream medicine. This reflects the widely disparate backgrounds and training of the practitioners of each.
At one end of the spectrum are physicians and scientists: we are duty bound to manage patients in the safest and most effective way possible, based on studies which may have included 10,000 or more patients, resulting in the most current data, which is often reduced to guidelines; this is known as evidence-based practice. The “creative” practice of medicine–e.g., off-label use of drugs, dismissing the impact of adverse effects, and ignoring contraindications increase the risk of poor outcomes, allegations of negligence and malpractice and lawsuits. Each of us who puts the letters MD (DO or equivalent in other countries) after our names, has invested a decade or more into medical school, residency and fellowship(s); practicing outside the lines set by our professional colleges risks losing what we’ve worked for.
At the other end of the spectrum* are often well-intentioned CAM practitioners with degrees (or life experience) in naturopathy, acupuncture, Ayurvedic care, chiropractic, traditional Chinese medicine, homeopathy, and other fields of alternative health, or those who have impressive-looking certificates from Internet U. Enthusiasm does not spell validity nor sincerity science.
*Somewhere between the two ends, one should place (1) physicians (MDs, DOs) who primarily practice mainstream medicine, but resort to CAM therapies, such as probiotics (e.g., fecal therapy) and acupuncture, when nothing else works for a particular patient with a certain condition, and (2) Quacks and charlatans who take advantage of desperate patients for whom conventional therapy, in particular, for Stage 4 cancer or very advanced AIDS has failed.
Alternative (heathy) food
Studies designed to verify or refute CAM methods and therapies have two key problems:
CostThe latest estimate (2014) of the cost of bringing a new drug entity to market is $2.6 billion. Whilst many of the herbs and natural products have been in use for hundreds of years and thus might be allowed to skirt some of the FDA requirements for trialing a natural agent, they would still need to be standardised and jump the same hoops (phase 1, phase 2, phase 3 and post-marketing/phase 4 studies) as required of new chemical (drug) entities seeking FDA approval for marketing. The funding for such research reflects the expectation that regulatory approval will be followed by a cash flow based on patent exclusivity, which natural products are unlikely to obtain.
Size of the cohort Phase 3 trials have 300 to 3,000 patients with highly specific inclusion criteria. It would be very difficult to find enough CAM providers capable of stringently selecting patients for such a study. My experience with CAM providers is that they’re too touchy-feely to be rigorous in their selection of patients to include or exclude in a clinical trial.
This is not to say that CAM providers are completely wrong; misguided, perhaps; Pollyanna-esque, certainly, but not without some reason. If we use the term CAM loosely and refer specifically to disease prevention through the adoption of a healthy lifestyle, Mediterranean or Asian diet, alcohol and fats in moderation, and regular exercise, then CAM is spot on. Harvard Medical School’s Heartbeat, an online publication gushingly asserts that regular vigorous exercise reduces the risk of hypertension, diabetes, stroke, some forms of cancer and the risk of heart disease, as effectively as medications.*
*On a personal note, I run 3 miles/4.8 km every other day at 6-7 miles/9.6-11 km/hour, do a few sit-up and a 50+ pushups. My serum glucose is normal, my blood pressure is 130/80 (I’m 65) and have a heart rate of 40 to 45; obviously I don’t know if I’ll get cancer or stroke out tomorrow, but as the Harvard e-zine suggests, I take no meds.
As long as one follows a healthy lifestyle and has no physical complaints, most CAM is harmless. But once a dread disease–by which most of us mean cancer or AIDS–is identified, none of the CAM modalities and therapies are more effective than mainstream medicine…most are worse. Miraculous cures have been described in the Catholic church. The medical name for this phenomenon is spontaneous regression of cancer, which occurs in 1:60,000 to 1:100,000 cancers. The few cases of “cures” brought about by CAM may correspond to this hen’s tooth rarity. Steve McQueen–the so-called King of Cool died of mesothelioma in 1980, after having multiple alternative (“quack”) therapies, which probably shortened his life. Steve Jobs, of Apple, chose to follow a fruit-based diet after his diagnosis of an endocrine tumour of the pancreas, delaying the definitive treatment, a Whipple procedure, by nearly a year, making the surgeries that followed, including a liver transplant, palliative rather than curative.