Alternative medicine: under the microscope

Natural Health, Sept-Oct, 1998

Great numbers of Americans today pursue health care options that have not been put to the same rigorous scientific tests that a drug must weather before being marketed. Proponents of alternative therapies (sometimes referred to as complementary or integrative) argue that these methods, first of all, are much safer than drug-based medicine, and, second, have often been shown to help people, though sometimes not in medicine's gold-standard setting, the randomized, double-blind, controlled trial.

That some doctors prescribe these unproven treatments for their patients deeply disturbs doctors like Wallace Sampson, M.D., editor-in-chief of The Scientific Review of Alternative Medicine. Sampson thinks it is wrong for any health care practitioner to charge money for unproven treatments, and he believes that few things under the tent of alternative medicine have anything of value to offer either patient or physician.

Sampson is semiretired from medical practice; for 40 years he has specialized in hematology and oncology. Today he teaches at Santa Clara Valley Medical Center, a Stanford University teaching hospital. In 1979 he developed a course at Stanford on the scientific analysis of alternative medicine claims.

Lewis Mehl-Madrona, M.D., is a psychiatrist and the medical director of Shadyside Hospital's Center for Complementary Medicine at the University of Pittsburgh Medical Center. Mehl-Madrona is also the author of Coyote Medicine (Scribners, 1997) and other books on holistic health care.

Mehl-Madrona, a Native American, includes therapies in his practice that he or his patient believes will be helpful, even if they have not been validated scientifically. He claims that such therapies are often helpful, while scientifically-proven treatments many times are not. Mehl-Madrona believes that his patients often know what the right treatment is, and he sees himself as their guide, someone who is helping them make the right decision.

Sampson likens this approach to letting a passenger fly an airplane.

Natural Health invited the two doctors to square off and argue their positions. Dr. Sampson began.

Sampson: What we call alternative medicine is a conglomeration of unproved, disproved, dubious, investigational, theological, ideological types of treatment programs that are very difficult to describe as a group. We really should be talking about the individual methods. Nevertheless, as a group over the past 10 to 20 years, the evidence for most of them is conflicting at best, to minimal, to negative.

Mehl-Madrona: I would say there is a tremendous body of research on many of the techniques that we use in alternative medicine but that it is largely ignored by the allopathic medical community. Also, there is a problem in the politics of research. It's much easier to get money to study a pharmaceutical that will bring profit to a company than it is to study activities that are provided by human beings, in which there's no product. In spite of that, there's still a reasonably robust literature on these techniques.

The fact is that much of what doctors do in medicine has no scientific basis. We're faced in medicine every day with situations where we don't have good data and we don't have knowledge, with certainty, of how to proceed. So we have to invent treatments. We do that with pharmaceuticals, we do it in so-called alternative medicine, and we do it in psychotherapy. We try, above all, to do no harm, and oftentimes we help our patient.

But much of medicine remains mysterious. What we do in the room with patients in many ways remains a mysterious artistic endeavor in which we struggle to understand people's suffering and the nature of their lives. And we try to find ways for them to transform their lives so that they feel better.

Natural Health: Dr. Sampson, if a practitioner does not have scientific evidence that a therapy works, should he use that therapy if he believes it will help the patient?

Sampson: The short answer is that it should not be used if it's being charged for. But let me go back. There is evidence that at least 85 percent of procedures performed in hospitals are evidence-based, and for the balance a reasonable and logical case can be made for doing what was done. That's an old wive's tale about medical procedures not being scientifically proved, and there was no basis for that statement in the first place. The man who first made it admitted it was based on a very small study in the north of England in the early 1960s. And we've come a long way since that time.

There's plenty of evidence that what is done for cancer, infectious disease, various hereditary disorders, and so forth really works. Although they don't work for everyone, we know the percentages for whom these things work. There are a number of misinterpretations made in the alternative medicine community (which are, I think, rather self-serving) in order to equalize scientific biomedicine with unproved and dubious methods. And nothing of the sort can be done if one looks at the evidence.