How safe, effective are alternative treatments?
BY DR. PATRICK NEUSTATTER
Joyce, an 81-year-old retiree living in Woodstock, is ready to branch out. She has high blood pressure and her doctor put her on HCTZ—a fluid pill.
But she and conventional allopathic medicines don’t seem to get along too well, she said. When she was having problems with aspirin in the past, a pharmacist told her she is a “very reactive” person.
She did, however, have a good experience with acupuncture, which cured her sciatica. So this has got her wondering: Is there some alternative medicine that might treat her blood pressure?
Like so many others, though, she is worried about venturing into the world of complementary and alternative medicine, or CAM. In an email to me, she asked “How can a person begin to sort out quack stuff from realistic, reliable alternatives since there can be side effects from so-called ‘natural’ supplements?”
I decided this was a good question to try to answer this month.
THE WORLD OF CAM
CAM is a whole slew of treatments—stuff you take like herbs, supplements and homeopathic remedies; manipulations like chiropractic, acupuncture and massage; and mind–body stuff like yoga, meditation and biofeedback.
It’s a growing industry, with $50 billion spent on these treatments annually, and you may have inadvertently participated yourself by using aloe on a burn or taking omega-3 fish oil, for example.
“Complementary” or “integrative” is where this treatment is used in conjunction with conventional medicine. “Alternative” is in place of.
ARE THEY SAFE?
Most CAM treatments have less potential to do harm than allopathic medicines. But they are by no means completely benign.
Even physical treatments like manipulation can be harmful—neck manipulations have been known to very occasionally damage arteries in the neck, for example. And, as Joyce points out “natural” is not the same as safe—ask any mycologist about the poisonous nature of some mushrooms!
As another example, people have died from taking the pill form of ephedrine for weight loss, and something as benign-sounding as ma huang tea contains this same dangerous ingredient.
Also, a lot of remedies interact with blood thinners. So, it’s very important to tell your doctor if you’re using an herbal remedy or other CAM treatment—though it is reported that only one in five patients do.
Another reason to be cautious: A recent article in The Free Lance–Star reported FDA inspections finding violations in half of all supplement production sites. The FDA discovered a vitamin preparation with 200 times as much selenium as it should have—so everyone’s hair fell out after taking it.
Supplements are treated by the FDA as foodstuffs, and not subject to the same strict standards of safety and efficacy as medicines. But buying only products with the USP (United States Pharmacopoeia) logo will provide some assurance of purity and uniformity.
ARE THEY EFFECTIVE?
This is where the real clash of philosophies comes in.
Conventional allopaths with their rigid, left-brain scientific thinking insist evidence-based medicine and clinical trials are the only thing to validate treatments.
Many CAM treatments have not been put to clinical trials. Or trials were faulty. Or the therapies didn’t stand up. Any efficacy of CAM is deemed placebo effect, and therefore “fake,” by the establishment.
But it’s mad to claim anything that’s not been proven by a clinical trial is snake oil, object the CAM proponents. It’s a whole different science, they say—you can’t standardize and individualize the treatments. And you can’t just single out one ingredient; you have to consider the whole package including the interaction with the therapist and any alterations in lifestyle and diet.
Not to mention: How do you come up with a placebo for acupuncture or manipulation? And no one can afford to do a clinical trial if you are not going to finish up with a Viagra or Lipitor, which you make billions of dollars selling.
Many of these complementary and alternative treatments have been around for millennia. The Greeks used spinal massage. Five thousand-year-old Otzi, the “Iceman,” was found with herbal medicines.
But most allopathic doctors’ objection to alternative medicines is based on their almost religious insistence on evidence-based medicine. And if they’re like me, they’re really hideously ignorant of CAM. The teaching in medical school is strictly allopathic—or was, though this is changing, and medical schools such as Georgetown’s are beginning to incorporate CAM.
This hostility to CAM is presumably why so few patients tell their doctors when they try CAM treatments.
WORTH TRYING IF IT HELPS
But there’s a lot to appreciate about CAM.
Many people especially like that CAM therapists have a much slower, more caring, attentive, holistic approach to the whole person—their environment and circumstance; their mind and body connection; working in partnership with the patient. All of which is in keeping with the new breed of assertive, self-reliant patient who wants more control.
This is likely what leads to the increasing popularity of CAM, even in the face of not fulfilling the criteria of evidence-based medicine.
It is not feasible to review the pros and cons of each individual treatment here, but I hope the resources mentioned in the sidebar below are adequate to allow you to glean the information you need for yourself.
My take is, CAM is worth a try if it is not hurting you—and I include hurt to your pocket book—but seems to be helping.
Even if the benefit stems from the placebo effect—which is likely to be enhanced by the greater ritual of the treatments and attentiveness of the therapist—don’t worry too much about whether some people consider it “quack stuff.”
DO SOME HOMEWORK
Starting from scratch can be a little overwhelming when you’re trying to research complementary and alternative treatments. Here’s some advice that may help.
You can look things up online in a search engine such as Google by:
- Starting with what you want to treat—i.e., “What will help my blood pressure?”
- Looking up a specific treatment—for example, “What are the benefits of omega-3 fish oils?” This approach is less helpful for getting advice on treating a particular problem, but it will tell you what the therapy is good for.
- Seeing if a specific modality has been tried for your particular problem—“Will tai chi help my arthritis?” But, as is so often is the case, finding the answer to a specific question on the Internet can be difficult.
The best source of information, in my opinion, is the National Institute of Health’s wonderful National Center for Complementary and Alternative Medicine website, at nccam.nih.gov.
This site covers the whole subject from soup to nuts: Is CAM right for you? What are all the different types? How can you know if it works? How do you know if it’s safe? How do you find a practitioner? It answers those questions and more—all in a far more comprehensive way than I can include here.
To see what clinical trials have been done, The Cochrane Library and the Cochrane Review are generally considered the definitive source for any kind of medicine. Online, visit cochrane.org/cochrane-reviews. (There is also specifically the Cochrane Collaboration Complementary Medicine Reviews.)
Two books that might be helpful:
- The slightly goofy “You: The Smart Patient—an Insider’s Handbook for Getting the Best Treatment,” by Dr. Michael Roizen of the Cleveland Clinic and Dr. Mehmet Oz the “Dr Oz Show” fame. Read the “Considering the Alternatives” section.
- “Trick or Treatment,” by Simon Singh, a science journalist, and Dr. Ezard Ernst, “the world’s first professor of alternative medicine” at the University of Exeter in England. Note that this well-informed book is biased toward the evidence-based-medicine camp.
A good sources of information about supplements and the like is fda.gov/food/dietarysupplements/consumerinformation.
Dr. Patrick Neustatter, a longtime family practitioner, is the medical director at the Lloyd F. Moss Free Clinic in Fredericksburg. He can be reached at firstname.lastname@example.org.