Alternative medicine: under the microscope

Natural Health, Sept-Oct, 1998

Mehl-Madrona: So you would say that the readers of Natural Health fit into those categories?

Sampson: Yes, I think a number of the readers do fit into those categories, but a number of readers are simply curious. But there is a population of people disaffected from science and disaffected from the system, who will be reading this journal. I'm very well aware of that and, as I told Mr. Thomson [Bill Thomson, editor], I had some concerns about doing this debate because I'm certainly not preaching to my choir. I am putting myself out in front for the disaffected people to point fingers at and I recognize that.

Mehl-Madrona: I don't notice that my patients are so disaffected. Many of them are scientists, university faculty, and corporate executives. And I find that they thoughtfully considered the studies on the issues that they're seeking treatment for...

Sampson: Remember, they're passengers on an airplane.

Mehl-Madrona: ... and I think that alternative medicine would not be popular if conventional medicine were entirely successful. If conventional medicine successfully treated 80 percent of patients, then you wouldn't see alternative medicine practitioners having more visits than all primary care practitioners combined in this country. What I see is that the so-called conventional therapies, which I think are no more scientific than the alternative medicine therapies, are not helping a very large number of people.

Moreover, I feel that there are studies to support a number of alternative treatments, Such as acupuncture.

Sampson: The majority of well-done studies of acupuncture show that it works no better than sham acupuncture or any other sham procedure.

Mehl-Madrona: That's absolutely contrary to my review of the literature.

Sampson: Yes, it probably is. But I'm talking about well-done studies. The best studies show acupuncture to be no better than whatever it's compared to, and the worst studies show that acupuncture is more effective than what it's compared to.

You have to evaluate the studies. Our journal is doing that. Our job is to take a look in a much harder fashion at the studies that have been done to try to see what really is going on here, and if there is a kernel of truth in some of these things, to tease it out. But to strip away the chaff, which unfortunately now is being interpreted as the kernel.

Mehl-Madrona: What comes to my mind is a study done at Penn State, in which the reviewers at several medical journals were studied. It was found that 98 percent of the time reviewers chose to accept papers that agreed with their bias, regardless of the quality of the methods. This is the politics of publishing articles on anything, actually. Typically it's much harder to publish a paper on an alternative medicine procedure, let's say in a big journal like The New England Journal of Medicine, than it is to publish a paper on a drug, because the bias is against it.

The consequence of this is that you find some people publishing in lesser known journals and other people saying, "This must not have been a good study because it wasn't published in the biggest name journal." I think that there's tremendous politics to the publishing of studies on alternative medicine. And I would welcome the opportunity to sit down at length with you and agree on one practice or therapy to compare papers on. Then we could look at the methodologies and argue simply on a scientific basis. Obviously, we're not going to do that in this discussion, but I certainly would welcome it.