Introduction
This is a question I'm sure comes up
often. What is the best way to treat an illness? We hear a lot about
how science and modern medicine have made astounding breakthroughs in
curing potentially fatal disease. We also hear about all these great
things about Alternative Medicine, how it's “All natural”, how
it's “Ancient Chinese Medicine”, or how it's so much safer than
modern medicine. With so much information around on both of these it
might seem like an enormous task to figure what will work the best.
Hopefully in this article I can simplify things and hopefully make
the choice seem a little bit easier.
The Placebo Effect
While I'm sure most of the people
reading this have heard of the placebo effect, this is an important
issue to understand in making choices for treatment. The placebo
effect was discovered in the 18th century and is
essentially a pill or procedure that does nothing, but tricks your
mind into relieving the symptoms of a disease or illness. The most
common form of a placebo used is a sugar pill, which is just a pill
made of sugar. While modern science still doesn't understand a lot
about how it works, they have discovered a lot about the effect.
Research shows that 2 sugar pills are more effective than 1, and that
an injection is more effective than a pill. The more invasive a
procedure the more of a placebo effect it has. There are other
things, such as blue sugar pills work better as a sleeping pill
placebo than red sugar pills. Or a doctor in a lab coat gives out
more effective sugar pills than a doctor in jeans and a T-shirt.
So why is understanding the placebo
effect important in making medical decisions? It's because sometimes,
a treatment can seem like it's working even though all it's doing is
creating this placebo effect.
Modern Medicine
Modern Medicine, or western medicine as
it's sometimes called is more properly known as Evidence Based
Medicine. This is the medicine your doctor practices. Any drug your
doctor prescribes, or recommends has been tested against a placebo
and shown to work better. A lot of procedures and treatments come
from a good understanding of human physiology. All of the treatments
and procedures are based on scientifically sound evidence. A doctor
should be able to tell you the benefits and risks of a particular
treatment and what options are available.
So how is medicine tested? A good test
to see if a particular treatment is better than a placebo begins with
a double blinded, randomized, placebo controlled trial. So what does
all that mean? In a properly conducted trial, both the patients and
the doctors are blinded, that means that the doctors giving out the
medication, and the patients receiving the medication have no idea
whether it's real or a placebo. The patients should be randomized
using a computer algorithm or some other blinded method. A researcher
selecting patients for the groups could unconsciously bias the trail
in one direction. So during the trial, no one knows who is getting a
placebo, and who is getting real medication, this should even extend
to the statisticians doing the final tally on the numbers. Only at
the end of the trial, after all the results are in should the
blinding be taken off, and which group is which be revealed. In a
well conducted trial, with lots of participants, we get a really
good idea of the effectiveness of a treatment.
Alternative Medicine
If modern medicine is evidence based,
where does that leave alternative medicine? Well, alternative
medicine is either unproven, or dis proven So either it hasn't been
tested, or is difficult to test properly, or it has been tested and
shown to work no better than a placebo. There are a lot of
alternative therapies out there that have been tested and shown no
better results than a placebo. I realize at this point my view of
alternative medicine is looking pretty grim, as I am making the claim
that none of it has passed a test and shown to be effective. So what
happened to the alternative medicine that was tested and shown to
work? Modern medicine, being evidence based, adopts any treatment
shown to work, and as it's adopted, it becomes mainstream, and no
longer “Alternative”.
I'm not going to get into a description
of every alternative medicine out there. That might be a topic for a
later post. However be wary of any medical claims that rely on an
abundance of anecdotal evidence. If I haven't made it clear yet,
anecdotal evidence is completely worthless. How can you be sure that
the anecdotal evidence in these claims, is simply not the placebo
effect? The other effect that dis proven medicine relies on is called
“Return to the mean”. This effect is best shown by your bodies
natural ability to heal itself. How do you know if the anecdotal
claims for these alternative therapies are not just the person
getting better on their own? Truth is, we can't know, that is why we
have such controlled and rigorous testing, to control for variables
like this.
One of the other claims of alternative
medicine followers I hear quite often is “Big Pharma doesn't want
you to know, because it's not profitable”. This claim is simply
wrong. “Big Pharma” is mandated and regulated to prove that their
drugs work better than a placebo, in order to bring them to market.
The other part of this is that the alternative medicine industry is
now making over 100 billion dollars a year. I don't know about you,
but last time I checked, that seemed like a decent profit. Please
don't take this paragraph as my endorsement of the pharmaceutical
companies, they are definitely guilty of some shady practices for
profit. Dr. Ben Goldacre is working hard to bring this shady
practices to light and stop them.
Conclusion
While there are several topics I didn't
discuss in this article like the ethics of selling a placebo, or
particular alternative treatments, I hope there was enough
information to help you make a better decision. My thoughts are this,
why would you spend your hard earned money on a treatment that is
either dis proven or unproven when we have a good system of evidence
based medicine available. For further reading if you're interested I
recommend Trick or Treatment by Edzard Ernst and Simon Singh and also
Bad Science by Ben Goldacre.
Nice blog :)
ReplyDeleteI practice mindfulness meditation. Borne from eastern religious traditions, this practice has been scientifically demonstrated to be effective for enhancing people's ability to concentrate and focus their minds, and as a treatment for depression and anxiety. It has been embraced by Western/Scientific Med.
I personally am willing to lower my scientific standards somewhat for some alt/herb meds. There is very often less profit to be made from, say, yoga, herbs, and other nonpatentables. As such, there will be less drive to fund expensive double-blinded randomized control trials. However, there's a limit to how much I'm willing to ease up. I'll make an allowance for decreased scientific rigor on economic grounds. But a credible case still needs to be made. If, like homeopathy, the scientific evidence is pathetic and, on top of that, the whole enterprise runs in stark contrast to well-established scientific findings, I'm probably not going to be very impressed. I guess I'm just not that "open-minded"...