A: Scientific medicine is a body of knowledge about the human body, its maladies, and their treatment, acquired by the application of scientific methods of study. These methods were developed for science in general and medicine in particular after it was discovered in how many often non-obvious ways subtle biases influence the outcome of a study. One of the best known of these ways is the "placebo effect". Many patients given a placebo (a pill with no active ingredients) will experience benefit, sometimes dramatic, simply because they expect to. An initial study of the use of a liver extract and vitamins in chronic fatigue syndrome reported dramatic improvement in all patients. When the same researchers followed this up with a randomized, controlled, double-blind study (RCDBS), they found the treatment to be no better than placebo. In a RCDBS, patients are divided into two groups, one of which gets the treatment being studied and the other a placebo or sometimes another known-effective treatment to which the first is to be compared. The assignment is done in such a way that neither the patients nor the physician evaluating the patients' responses knows who is getting which. At the end of the study, the codes are broken and the results tallied and analyzed.
Q: What is alternative medicine?
A. "Alternative medicine" is a name given to several schools of folk (non-scientific) medicine whose treatments are typically derived from tradition rather than from scientific study. The ideas often come from a single founder and are then passed along with little change to successive generations of students as in the case of chiropractic or homeopathy. New treatments may sometimes be added by others but the core theories are not challenged.
Alternative medical treatments are often promoted through the use of anecdotal evidence and testimonials. Anecdotal evidence consists of stories of how a treatment worked in individual cases. Testimonials are statements from alleged satisfied customers. They may be fabricated or contributed by people with a financial interest in the product. Even when they are genuine they are often misleading. Typically only the best testimonials are selected out to present. Under the very best of circumstances they are still subject to the same sources of unintentional bias that plagued the trial of liver extract and vitamins mentioned above. Historically, the large majority of treatments for which there has existed only anecdotal evidence have been eventually discarded as useless. There is no reason to believe that currently popular folk treatments will be any better. Many who have dabbled in "alternative" medicines admit when pressed that the majority of the things they have tried haven't worked, or worked for a time but then lost effectiveness.
Q: Why should I take the word of scientists over alternative medical practitioners. Isn't is just one group's opinions against another's?
A: Opinions in science matter little. What matters is hard data, arrived at in the most reliable way possible. Scientific medical methods have been developed to eliminate potential sources of bias like the placebo effect and are the only reliable way to prove efficacy of a medication. Anecdotal evidence is inadequate, as the liver extract and vitamin studies mentioned above and many others like them prove. It doesn't matter where the treatment in question came from. Much of scientific medicine is derived from folk medicine ideas which have held up under scientific scrutiny.
Q: How can they make these claims if they are not true?
A: There used to be some consumer protection for "dietary supplements", those vitamins, minerals, enzymes, and herbs sold as alternative medicines, but in 1994, Congress exempted dietary supplements from Food and Drug Administration regulation. This was done at the urging of the supplements and pharmaceutical industries in response to an FDA proposal to increase consumer protection because of misleading labeling and unsubstantiated claims. Instead of shoring up consumer protections, they were scuttled. There is now no requirement for any proof of safety or efficacy before marketing these supplements, nor any requirement that they be of a certain purity. In several studies of dietary supplements, many of the manufacturers' products were found to contain none of the advertised ingredient.
Q: If someone says some alternative treatment helped them, what harm is there in trying it?
A: In the case of homeopathic medicines, magnets, or crystals, none except for any injury that may occur as a result of delaying effective treatment and the money wasted. Homeopathic medications are nothing but water, the active ingredient having been diluted out until it is unlikely that there will be even a single molecule in a dose. Sometimes medications sold as homeopathic ones illegally contain active medications such as steroids. These adulterants can cause serious harm if taken by the wrong patient.
Herbs may not be safe either. Some commonly used ones have been found to cause cancer, miscarriages or other problems. Even vitamins can cause problems. Vitamin A has recently been shown to increase the risk of fetal malformations in doses only a little above the recommended daily intake. The amount contained in two glasses of carrot juice a day is enough in some patients to cause chronic headaches and loss of vision from increased intracranial pressure. The trouble is that the vast majority of alternative treatments have never been studied the way FDA-approved drugs have to uncover possible serious side effects before marketing. Studies of interactions between herbs and other herbs or medications are even rarer. An herb might cause cancer or heart disease in one in ten users yet easily escape detection for years without scientific study. In contrast to FDA-approved medications, there is no requirement for proof of safety or efficacy before an herb or other "natural" medicinal product can be marketed.
Q: Why aren't researchers interested in studying alternative medicines to prove whether or not they work? Why won't the government fund studies of alternative medicine?
A: The NIH has a branch actively looking into alternative medical claims in a scientific manner. So far they haven't come up with much. Drug companies are very interested in investigating alternative medicines. They have researchers combing the rain forests, talking to native folk medicine practitioners to find new herbs to investigate, so you can be sure that they have looked at all of the commonly available "alternative" medicines (it's a lot cheaper to go to a health food store than to the rain forest) and discarded them as unpromising. The results of these pilot studies unfortunately go unpublished to avoid aiding competitors. It is sometimes alleged that drug companies studying herbs fail to find them effective because they isolate compounds which only work in the natural state. In fact, drug companies almost always start testing with the whole herb. Only if it shows benefit do they then go looking for the beneficial compound. If alternative practitioners want their treatments to be taken seriously, they might consider doing their own research. Controlled double blind pilot studies are quite inexpensive to do. I suspect a bigger problem is that most folk practitioners are not anxious to have the cold light of science shone on their lucrative practices. Scientific evidence that a folk medicine treatment doesn't work rarely deters its promoters.
David A. Nye MD - Luther-Midelfort, Mayo Health System, Eau Claire, WI
2:38:18 PM 
