Alternative medicine: under the microscope

Natural Health, Sept-Oct, 1998

Natural Health: Dr. Mehl-Madrona, do the treatments you use with your patients lack the scientific evidence that Dr. Sampson is talking about?

Mehl-Madrona: First, Dr. Sampson and I disagree on how much evidence exists to support what medicine is currently doing. He feels that over 85 percent of the time what doctors do is supported; I feel that this evidence is woefully inadequate.

But to answer your question, some treatments I use do have the kind of evidence that he's talking about. For instance, I have a list of 3,000 studies of homeopathy, 300 of Which were randomized trials, and 70 percent of those support homeopathy. And many studies have also shown that acupuncture is helpful in conditions as far apart as asthma, low back pain, and neuralgia. Many studies support various treatments that I do.

But I also use treatments that I don't have evidence for--yet. I feel they work; they certainly don't harm the patient.

But whatever I use, I'm very clear with patients about what's known. I'll give you an example. A man came in with diabetes, with numbness and tingling in his feet, some pain in his arm, and high cholesterol. I told him there are some things that have been well studied that we can do. "For instance," I said, "exercise will help your diabetes." And I pulled out studies to show how that works. And I told him that garlic and a number of herbs and foods can help lower his cholesterol. For his pain, I said there is literature on the use of acupuncture. It's not as robust as exercise for glucose control in non-insulin-dependent diabetics, but it exists, I told him.

If I consider psychotherapy with this patient, it turns out that most studies show that the quality of the relationship with the patient is more important than what you actually do with the patient. So here it gets a little harder to talk about the kinds of scientific evidence that I think Dr. Sampson is looking for.

Natural Health: What if a patient doesn't want standard drug treatments or other protocols a doctor might normally use, but wants alternative approaches? Shouldn't a physician be allowed, in fact encouraged, to work with a patient using those therapies, even though they may not be scientifically proved?

Sampson: For the most part these therapies were developed in different cultures, for different reasons, with little to no evaluation of effectiveness. They had no way of knowing, before the mid-20th century, whether something really worked or not. So these are, you might say, reinforced misinterpretations, for the most part. On occasion, they hit something that really worked. I think acupuncture, for example, "works," but for reasons other than the reasons people think. But all the others are simply misinterpretations of events.

So when you ask, "Doesn't someone have a right to seek these out?" and "Shouldn't a physician have a right or an obligation to do them?" my answer is that I think patients have a right to do anything they want in a free society. However, that's not a medical decision; it's a political and social decision.