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What is alternative medicine? Does alternative medicine work? The University of Toronto recently stirred up a bit of controversy by uncritically offering a class on "Alternative Medicine." When people looked at the coursework, which included many studies debunked by this channel, some people started to freak out. The issue highlights a much larger problem: No one is sure how best to teach that subject.

The dichotomy, however, between alternative and traditional medicine, or between Eastern and Western medicine, is a false one. We would be much better off if we could reframe the issue. That's the topic of this week's Healthcare Triage.

This episode was based on a post I wrote for the Upshot. Links to sources and more reading can be found there:

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The University of Toronto recently stirred up a bit of controversy by uncritically offering a class on alternative medicine. When people looked at the coursework, which included many studies debunked by this channel, some people started to freak out. A variety of bloggers and journalists brought up many valid concerns, but this whole debate highlights a much larger problem: no one is sure how best to teach this subject. The dichotomy between alternative and traditional medicine or between Eastern and Western medicine is a false one. We'd be much better off if we could reframe the issue, and that's the topic of this week's Healthcare Triage.


People often think of Eastern or alternative medicine as more 'natural'. They feel that Western medicine is built around technology and products produced in a lab. They're not entirely wrong. Many of the gains that have been made in traditional medicine have been the results of innovation in laboratories. But that doesn't mean that everything doctors are taught in medical school involves a drug or device. I talk to patients all the time about diet and exercise, and I don't do it because there's a company making money off of it. I do it because both of those things have been proven to be important for health.

Nor do all medications get cooked up in a lab. We recommend folic acid which is a B vitamin for pregnant women because research has shown that doing so reduces the risk of major birth defects in newborns. We all know that adequate intake of vitamin C prevents scurvy and vitamin D prevents rickets. None of these things are controversial to physicians. We recommend them all the time, and that's not because they were developed in the Western hemisphere. It's because they were subjected to the rigor of scientific investigation and found to have merit.

There are many other forms of non-technological medicine that have the weight of scrutiny behind them. In a meta-analysis published just a few years ago, researchers looked at all the accumulated randomised controlled trials examining how acupuncture fared in treating people with chronic pain. They found that not only did acupuncture work better than no acupuncture control groups, there were small but significant differences between acupuncture and sham acupuncture. This would suggest that not all of the benefits are placebo effects.

People have been treating many mental health issues with therapy for years. Full disclosure: I'm one of them. I've never taken any of the long-term psychotropic drugs, and many patients prefer not to if possible. Austin Frakt, my upshot co-contributor wrote recently about the evidence supporting cognitive behavioral therapy for insomnia as well as a host of other problems. Even mindfulness or meditation has been studied extensively and found to be pretty effective in treating anxiety and mood problems. I've been convinced enough by this evidence to attempt meditation myself.

I would argue that all the therapies I've mentioned here aren't considered complementary therapies. They're often just considered therapies. That's because they've been studied and they've been proven to work. Too often though, those who consider themselves supporters of alternative medicine disdain the idea that any of their treatments need to be studied. They make an appeal to the fact that their medicine is more natural and has been used for long periods of time or has the support of many people in other cultures. Of course not long ago, all therapies could be described in this way. The application of modern science allowed for us to design and conduct trials that could prove or disprove a treatment's efficacy or harm. Many of the drugs we use today had humble origins. Digitalis comes from foxglove, quinine from cinchona bark, penicillin from bread mold and aspirin from willow tree bark. Conventional medicine may have improved on our ability to purify these substances, but it acknowledges that many natural therapies hold value.

But science rejects many forms of complimentary medicine as ineffective. Just a few months ago, the National Health and Medical Research Council of Australia released a report in which they fully reviewed 225 studies of homeopathy; the practice of treating sick people with small amounts of substances that cause similar symptoms in healthy people. And after considering more than 1800 pages for inclusion, they published their findings. They found no well-designed studies that found it to outperform placebo or function as well as any conventionally approved therapies. And their conclusions echoed a previous report from Britain and those of Cochrane systematic reviews. My friends who believe in homeopathy don't really care.

Those who favor conventional medicine though can be just as blinded. Too often, when confronted with evidence that advanced technology might not be providing any benefits, the medical community refuses to change its behavior. Healthcare Triage episodes are littered with examples of this. From potentially too widespread screening mammography, to advanced life support, to many surgical procedures. Supporters of Western medicine are often blind to their own prejudices too.

Butterbur, a plant extract that has been found in medical studies to be as effective as antihistamines in treating allergic rhinitis without the sedating side effects conventional drugs often have. Horse chestnut seed extract appears to be safe and effective in the short-term treatment of chronic venous insufficiency. Peppermint oil can be used to relive the symptoms of irritable bowel syndrome. I know a few physicians who promote these therapies as often as they do prescription or over-the-counter drugs. Granted, that could be because it's potentially harder to be sure of what you're buying when you purchase supplements, but there are ways to overcome those issues.

In 1998, the Journal of the American Medical Association published a theme issue on alternative medicine for common chronic medical conditions. The randomised controlled trials within it offered evidence that spinal manipulation did not improve tension-type headaches, that acupuncture and acupressure did not reduce pain caused by HIV-related peripheral neuropathy, and that the supplement Garcinia cambogia did not help with weight loss. However, the same issue contained studies that showed that yoga-based interventions improved carpal tunnel syndrome more than wrist splinting, that the Chinese practice of moxibustion significantly increased foetal activity and fixed breech presentations before delivery, and that Chinese herbal medicine appeared to improve symptoms in some patients with irritable bowel syndrome. Although some of this research has been contained, to my knowledge, neither side of medicine has changed their practices or beliefs much based on this work.

In an accompanying editorial, Phil Fontanarosa and George Lundberg, two of JAMAs editors wrote, and I'm quoting: "There is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data or unproven medicine, for which scientific evidence is lacking". I'd only change this by adding in there is no conventional medicine.

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