SkepticReport * Is Complementary & Alternative Medicine a UFO?

Medical Quackery

by Paul Lee, Physical Therapist

July, 2003
Definitions First

There are many definitions for CAM and EBM. Here are some ways of looking at it:

CAM is a combination of organized and unorganized companies and individuals, trained and untrained, who promote, sell, use, and/or treat with methods, products, and/or ideas, whose effectiveness is as yet unproven by objective, reproducible, scientifically accepted methods of research. They are usually promoted on the basis of speculative, subjective, and unproven anecdotes, which, even if they may be true, cannot be trusted, since they may point to idiosyncratic results, that may have no relevance to others. The individuals involved may be ordinary, innocent citizens, including authorized medical personnel, such as MDs. They can also be individuals and corporations who are into it for commercial reasons, and may also have less than noble motives, although motives are irrelevant to the question of the validity of the methods, products, and/or ideas.

The NCAHF uses this description:

"Complementary and alternative medicine" ("CAM") is an imprecise marketing term that is inherently misleading. "Alternative" methods are loosely described as practices outside of mainstream health care. They lack evidence of safety and effectiveness and are generally not covered by insurance plans. "Complementary medicine" is loosely described as a synthesis of standard and alternative methods that uses the best of both. In truth, there are no "alternatives" to objective evidence of effectiveness and safety."
NCAHF

They should not be confused with the allied health care professions and methods, such as diet, exercise, massage, physical therapy, etc..

EBM is the use of any methods and products that have been proven effective for their intended purpose by the best methods of research currently available. They are always subject to reevaluation, and their use may be revised or abandoned in keeping with newer evidence. EBM is not the same as modern medical practice, although modern medical practice should, as much as is practically possible, incorporate EBM methods in its practice.

What is CAM?

Complementary & Alternative Medicine (CAM) are methods for which efficacy and safety are unproven or disproven. They may or may not be effective and safe. These questions may or may not have been verified. Most of the methods have been disproven. If and when proven to be effective, they cease to be "alternative" and become EBM.

Evidence Based Methods (EBM) are methods which have been tested for efficacy and safety. Their degree of effectiveness and safety is known, and side effects are constantly being monitored.

To put it bluntly...

CAM is like a UFO - it is "un"proven, just as a UFO is "un"identified. That's the criteria for classifying both of them. Advocates of Complementary & Alternative Medicine (CAM) [now more accurately termed sCAM ], just like believers in Unidentified Flying Objects (UFOs), claim that their belief is true. It's a matter of the claim, not the fact, that determines whether something is classified as a CAM modality or not. If claims of effectiveness are proven to be true, then the method should not be categorized as CAM, but as Evidence Based Medicine (EBM), and that's how it works in practice. When scientists have proven true efficacy for a method, it is incorporated into EBM practice. It may take time, but it does happen.

Until proven otherwise, claims of effectiveness for CAM methods, just like claims of sightings of UFOs, should be approached with extreme caution. Skepticism is the correct initial approach to such phenomena. Extraordinary claims demand extraordinary evidence. Claims of effectiveness do not automatically justify acceptance, use, or funding, only a classification among other CAM methods. Only promising methods should receive funding.

Thus we can see that CAM and UFOs have something in common: once a CAM modality is proven effective, or a UFO is identified, they leave the realm of CAM and UFO. They cease to exist as such, and become something quite different. They become believable, because they become objective, verifiable, and usable. UFOs become Identified, and CAM becomes Evidence-Based.

A Defining Moment

Before we go further, let's get some definitions straight. There is a vast difference between methods that are unproven or promising, and then either proven or disproven. The order in which I have listed them represents the progression through which any method claimed to have efficacy must proceed in order to be considered evaluated properly.

Unproven methods are methods that have not been scientifically researched, even though they may have centuries of use and millions of positive anecdotes. Promising methods have some research that indicates possible usefulness and effectiveness. Proven methods have been thoroughly researched and shown to have good effect and usefulness. Disproven methods have been thoroughly researched and found to lack real effect.

Contrary to popular belief, there does not exist a parallel system of "effective" therapies, one consisting of CAM (safe, cheap, etc.), and the other of EBM (side-effects, expensive, etc.). The vital difference is that CAM uses methods that are "claimed" to be effective, while EBM uses methods that have been "proven" to be effective. To the trained scientific observer, observed "effectiveness" is considered uncertain until confounding factors are ruled out. It could just as well be the confounding factors that are the true explanation for any observed "effect". To the untrained mind, things are accepted at face value, often with unfortunate results, if not healthwise, at least for the development of a false belief system.

It is not the advocates of CAM that choose to have things this way. It is the believers in EBM - scientists and professionals in the established health care system - that hold unproven methods at arms length, while believers in alternative medicine embrace them, when the only proof they have is anecdotes.

That's why the scientific community defines EBM, and the alternative medicine industry has coined the misleading term CAM. Each side has different standards of evidence, proof and effectiveness. CAM methods are believed by their advocates to be effective, but they lack evidence acceptable to adherents of EBM.

Evidence-based methods are effective, and effective methods should be evidence-based. If a method appears to be effective, then it should be possible to prove it. If the research has not been done yet, it should be. We must remember that "Absence of proof is not the same as the absence of fact; it simply demonstrates the lack of adequate research. - Robert Sydenham. "Lack of evidence in the literature is not evidence of lack of effectiveness."

This is often misunderstood, since it contains two poorly understood elements. The first is that effectiveness exists, in and of itself, regardless of proof, or rather, "before" proof is provided by proper research. The second is that lack of proof doesn't justify the marketing of methods based solely on claims of effectiveness, which are hoped to be proven in the future.

It is one thing to say: "I believe it's effective, but have no proof as yet." It's quite another to say: "I believe it's effective, and my experience with it is enough proof for me and my customers."

The scientific community is well aware of the deceptiveness of human experience. This they have learned from the sometimes bitter experiences which misinterpretation of data have led to. Since many believers in CAM do not have this experience in conducting research, and often lack education in these matters, they glibly accept any positive anecdote as proof of efficacy.

EBM advocates understand the fallibility of blindly believing first impressions, and the following quotes reflect the wisdom of this position:

"Science is what we have learned about how to keep from fooling ourselves."
Physicist Richard Feynman
"A habit of basing convictions upon evidence, and of giving to them only that degree of certainty which the evidence warrants, would, if it became general, cure most of the ills from which this world is suffering."
Bertrand Russell
"The brightest flashes in the world of thought are incomplete until they have been proven to have their counterparts in the world of fact."
John Tyndall (1820-1893)
"Scientific thinking might be defined as learning to distinguish the exception from the rule. I'd have a hard time entrusting my health to someone who didn't know the difference."
Stan Polanski
"The most important quality of the scientific method is its capacity to eliminate bias. That's what randomisation, blinding, proper sampling and so on is about. That's where almost all non-scientific medicine breaks down."
Patrick Bramwell-Wesley
"Anecdotes are useless precisely because they may point to idiosyncratic responses."
Pediatric Allergy & Immunology, 1999, Nov;10(4) 226-234
"The plural of anecdote is not data."
Roger Brinner
"The last treatment before "cure" by natural causes (perhaps running it's course.) should not be considered cause and effect."
Charles Morrow, Ph.D.
"Of course, the best (worst) part of it is that the alt-med people are convinced that it is all plausible because they are looking for evidence to bolster their belief rather than build a belief based on evidence. Which is what makes them 'alternative.'"
Greg Hart

These quotes represent another world view and paradigm than is common in the world of alternative medicine. An understanding of their own fallibility seems to be lacking among believers in CAM. Their belief system seems to consist more of rationalization, circular reasoning, wishful thinking, and speculation, than of experimentation and critical observation. Therefore the term CAM is misleading and deceptive. It would be more correct to use the term COST (Competing, Opposed, and Supplementary Therapies) than CAM, [and even more accurate to call it sCAM ]

It is Competing with EBM.
It is Opposed to EBM.
It is Supplementary to EBM.
It is Therapies that are not EBM.

As such it is an unnecessary and additional expense (cost).

The Health Care system is not EBM

There is a common misunderstanding, which is unfairly used as a straw man argument by CAM advocates. It is that the established health care system is the same as EBM. It is not. While the existing health care system uses EBM, it has also inherited some methods for which there is poor documentation, often because of lack of research. Many of them have been used for ages, based on experience. These methods should not be trashed uncritically, but should be subjected to rigorous research, in common with new methods that clamor for acceptance. If they do not stand up to rigorous research, then they should be laid to rest, along with other disproven methods.

The CAM methods used by the alternative medicine industry also need to be subjected to the same rigorous research as other methods, since CAM methods have poor or no documentation, and rely on anecdotes for support. Many of these methods have been disproven and should be abandoned. Others that seem promising should be researched, and that research should be done by scientists.

It is problematic that while the established health care system is actively trying to weed out ineffective methods, the CAM system is searching through the garbage heap of discarded and disproven methods, in an attempt to revive and invent methods for which proof is not only lacking, but for which there is often adequate proof of lack of effect.

Not much proof in CAM

So, by definition, CAM methods are mostly unproven methods, even if they have millions of positive anecdotes and several thousands years of use. Neither age nor popularity can make truth error, or error truth. They have nothing to do with it. Precisely because anecdotes often point to idiosyncratic responses, they cannot be trusted to represent the truth of a claim. Anecdotes have interest only as a motivation to perform research for the purpose of confirming whether the claims of effectiveness are true or not.

Because CAM methods are, by their very definition, unproven, they are also untrustworthy, and many of their most prominent advocates are therefore judged to be fanatics, quacks, visionaries, and sometimes just plain crazy. And so far, in 99,5% of the cases, the judgment is usually true.

But sometimes the transition from CAM to EBM does occur. There is found to be a natural explanation for the seemingly unnatural and inexplicable. Sometimes, in spite of inferior knowledge and defective conclusions about active mechanisms, even true believers happen to stumble onto something that turns out to have value. Serendipity does happen. But it's rare and doesn't justify them in their wildly inaccurate claims for cures, nor in their exploitation of unproven "remedies".

Somehow these people have an idea, that with time, all CAM methods will be proven to be effective and useful. Unfortunately, that is not the case, and is far from realistic. There may be a minute portion of existing CAM methods that will be proven to have some usefulness, but when that happens, they will cease to be CAM, and will become EBM.

A criminal waste of resources

Most of the methods now classified as CAM have already been researched, often by those who believe in them. Maybe not enough, and maybe not entirely accurately, but usually enough to justify a skeptical approach to them. Further research of the promising ones may be warranted. But further research of the most unlikely ones, such as homeopathy, reflexology, and Applied Kinesiology, is a criminal waste of resources. At some point, the repeated negative results must be accepted, and the methods must be rejected. Those who continue to use them will be the charlatans and quacks, and those true believers that have been deceived by them.

These quacks and true believers often use conspiracy theories to justify them in their beliefs. They claim that pharmaceutical companies and doctors are actively engaged in an attempt to keep effective, cheap, simple, and safe methods and cures from being used by the public.

These claims are not only logically suspect, they are often used as a deliberate tactical part of criminal activities and anti-medical propaganda in the practice and promotion of quackery on unsuspecting victims. The so-called "health freedom" movement is especially guilty of exploiting this tactic in its attempts to ensure that some of the worst quacks can continue to practice their deceptions on unsuspecting victims. Though they disguise their efforts as an attempt to ensure that consumers retain their freedom to choose health products and services, regardless of the lack of evidence for their effectiveness or safety, it is done in such a way as to neglect to protect these same consumers from harmful and deceptive practices and practitioners.

No motive. No possibility. No conspiracy.

These claims lack credibility for several reasons. While pharmaceutical companies do have commercial motives, which have often led to unethical and illegal practices, they are still interested in finding and marketing new, effective products. They continually research CAM methods. When they find an herb or medicament that can be used, they develop it and market it. They care not where the method comes from. If it can be proven to be effective and relatively safe, they'll find a way to make money off of it, and it will be used. They have a direct interest in marketing effective methods, not in burying them.

Doctors are also falsely accused. But doctors and their families also get cancer and other tragic and deadly diseases. They are just as interested as anyone in finding and using effective, cheap, simple, and safe methods and cures. They have no interest in stopping such research. History is replete with examples of how new methods have eliminated the need for certain branches of medicine. That did not lead to the method being buried.

No, both the motive and the possibility are missing. It wouldn't even be possible to keep an effective method hidden from other scientists. After all, scientists gain their reputation by discovering or proving something. Conspiracy theories and stories of cover-ups are simply cheap ploys by greedy promoters of quack cures. They pander to the paranoia which they find or create in their customers and patients.

Dreams, duties

Quite frankly, all skeptics, be they doctors, scientists, politicians, patient organizations, or laymen, would love nothing better than to have many of the alternative methods that claim to cure cancer cheaply, simply, and safely, be proven to be true. Why not? We all would be happier if it just were true. If only life were so simple! While it's not wrong to dream, our dreams should be realistic.

Doctors and scientists have a duty to the public. They have an interest in discovering the true facts about the universe and about effective methods for use in the health care system. They also have a duty to protect the public from erroneous ideas, which are not always innocently spread.

Truth in advertising

After reading the above, some CAM and health freedom advocates will be tempted to unfairly claim that I am interested in making all forms of CAM practices illegal. I am not. What I want to see is truth in advertising and no more false claims of proven effectivity. The public should understand what it is they are dealing with. False claims and the use of dangerous methods should be punished under fraud and quackery laws.

Unproven methods should be paid for by the customers themselves. Insurance companies should not cave in to the demands of subscribers, and Medicare should not pay a single cent for such methods. They should only pay for well-established methods that are practiced by authorized health care professionals, not those performed by alternative medicine practitioners. Even when well-established methods are performed by CAM practitioners, they should still be paid for by the customer themselves. If CAM practitioners would clean up their act, they should, in the name of freedom of choice, still be allowed to practice. There will always be people who wish to choose the types of methods that are practiced by CAM practitioners.

The lack of accountability and good ethics in the alternative medicine industry is so notorious a problem, that even some of the leaders in the industry recognize it. They often use this problem as a weighty argument for more research. But at the same time, they are often unwilling to admit that many of their methods have been disproven by existing research, and they will not accept the logical consequence of this fact. They should stop demanding more research of disproven and dubious methods, and publicly renounce all support for them and their practitioners.

Wrong names

The National Center for Complementary and Alternative Medicine (NCCAM) could accurately be dubbed, the NCPUDT: National Center for the Promotion of Unproven & Disproven Therapies. The National Center for the Promotion of Quackery (NCPQ) could just as easily be another name. As yet, the White House Commission for Complementary and Alternative Medicine Policy (WHCCAMP) and the NCCAM have yet to prove their legitimacy by renouncing one single disproven CAM method. Therefore these agencies should be eliminated, and their continued criminal waste of public resources stopped.

They are not trying to create a health care system with two parallel branches, one EBM and the other CAM. They are actually trying to incorporate CAM into the existing system. They want to blend unproven methods with proven methods. This will counteract all efforts to purify the system by making it evidence-based. They will create a system where quackery and metaphysical mumbo jumbo will be elevated to a tax subsidised part of health care. They would thus undo a whole century of hard won scientific and medical progress. Such nonsense must be stopped.

If the responsible politicians don't have the courage to stop them, then these agencies will continue to waste funds in an attempt to preserve the jobs and influence of their employees, and in a vain attempt to justify their existence by launching one wild goose chase after another. So far they've all ended in blind alleys. The more this happens, the more the motives of their leaders can legitimately be questioned. Science, after all, is more concerned with the establishment of facts, than it is in the preservation of cherished beliefs. That is the realm of religion.

Researching CAM in the way these leaders wish, is tantamount to trying to fill their bathtub with water, when they have removed the plug:

The funds run in, and the funds run out.
Do they know what science is all about?
If they really do, they don't much seem to care.
They've pulled the plug on scientific healthcare!
(The NCCAM Blues, to the tune of "The worms crawl in, . . .")

Who will let the watchdogs out?

Where are the watchdogs needed to keep an eye on these so-called leaders? Where are the politicians with courage enough to resist the massive pressure from patients, their organizations, alternative therapists, quacks, other politicians, and the producers of alternative medicine, in short, practically everyone? The pressure is on to get the public to foot the bill. Who will stand up for truth in advertising and reliable, trustworthy scientific endeavors? In short, who will act as consumer protection advocates? The public is about to be fed to the sharks by the united efforts of the WHCCAMP and the NCCAM.