Monday, February 27, 2006

Of Cam, CAM, and SHAM.

A SHAMblog newcomer, Cameron Burgess, has posted comments to an older page, "the hope and self-destiny of death," mounting an impassioned defense of complementary and alternative medicine (often referred to by the acronym CAM, which I figure is also what folks call our new friend Cameron, for short). Cam's points about CAM are sufficiently provocative that I thought I'd do an update here, addressing those points one by one. And the timing is good, given the recent series of studies showing that some of today's most popular alternative remedies offer no benefit. Notice also the headline from the piece to which I've linked above: Despite the tests, consumers continue to "swear by" their alternative therapies. Sound familiar? See why alt-med is such fertile terrain for SHAMpreneurs?

I've taken the liberty of splicing my responses in between Cameron's points, numbered below.

1. we are all going to die. Well...OK. But just because we're all going to die doesn't mean we should be cavalier about life and/or hasten the process by wasting money on foolish or dangerous treatments. Does it?

2. the western medical obsession with extending life has fueled a global trillion dollar pharmaceutical / medical industry that results in more deaths through incorrect prescription, elective surgery [including cosmetic surgery] and suicide [ever hear of someone overdosing on echinacea or mineral supplements?] than CAM has, or in all eventuality will, in thousands of years of application. This, again, is probably true, though it falls into the category of a canard, I think. First of all, CAM is almost totally unregulated, so there's no way of knowing just how many people it has helped or hurt. (CAM practitioners like to fly as low as possible under the radar, hoping to avoid being sued and/or prosecuted.) But remember, because in many cases CAM "therapy" has never shown itself to be more than a placebo--a sugar pill--the damage it causes may be mostly by omission, i.e., luring unsuspecting people away from proven treatments that could genuinely help them. Indeed, one of my greatest fears about CAM is that it promotes and celebrates the legitimacy of not just self-treatment, but self-diagnosis (see also point 4, below): "Hey, you don't really need a doctor to tell you what's wrong with you, do you? Your body is a miraculous, self-sufficient system; it will tell you what it needs." Do I need to say much more about the potential dangers there? With regard to many of the things that end up killing women in particular, early diagnosis is critical. Wasting months on self-treatment, channeling your untapped energy reserves or realigning your chakras--that is, till you're confronted with symptoms you can't ignore, like unexplained bleeding--can be fatal.

3. antibiotics alone have resulted in new streams of highly resistant bacterias and pathogens known collectively as 'super-bugs' capable of killing much faster - so the drugs get stronger and the bugs get stronger. This is one of Cam's strongest points--that traditional medicine is ironically laying the groundwork for its own ultimate defeat, farther down the line. However, in medicine's defense, (a) if nothing else, antibiotics, when properly prescribed, do what they were intended to do. So it's somewhat unfair to hold their developers and advocates culpable for damage that nobody saw coming; (b) I concede that the pharmaceutical industry, which my old editor-pal Greg Critser denounces as "Big Pharma" in his excellent book, Generation RX, hasn't always acted with the consumer's best interests at heart. But that's a separate argument from the one about medicine vs. CAM per se. In any setting, the profit motive can have a corrupting effect. You think the alt-med gurus aren't in this for the money?*; (c) the over-prescribing of drugs often stems from consumer demand itself: People with a cold (which, being a virus, is unresponsive to antibacterial agents) will expect to leave the doctor's office with a "scrip," and feel cheated if they don't get one. I'm not saying that means doctors should lie to patients or knowingly give them useless pills.... But that's what alt-med conmen do all the time! It's their basic business model.

4. the ultimate test for all medication should be a test of your own intelligence - the CAM practitioner may well have been negligent - however, the 'patient' was also clearly an idiot. This refers, I assume, to the specific patients I mention in my post of February 5. And it's where I seriously part company with Cam. Saddling the consumer with the burden of "knowing enough" about medicine to protect himself against fraud seems ill-advised and unfair. Though yes, I think consumers should arm themselves with as much information as possible, I don't think trust is something we want to discourage entirely...not if it's properly placed (for example, in people who have actual medical degrees from schools that don't contain words like "Maharishi" or "ayurvedic" in their names). Nor do we want consumers dabbling in health care in a dilettante sort of way, where they have just enough knowledge to do real damage to themselves and others. Besides, tell me why the consumer who puts his faith in "distant healing," "therapeutic touch" or "aromatherapy" is any less of an idiot than was Ruth Conrad for believing in her naturopath's caustic salves? At least the salves involved a tangible product; in many CAM settings, you're putting your faith in thin air. I'd also ask Cameron: Do you own a car? Do you know as much about your car as your mechanic does? Or do you basically trust him/her to diagnose and fix what needs fixing? Or: If you were arrested by mistake and charged with some serious criminal offense, would you act as your own attorney (figuring that you're supposed to be "smart enough" to know your way around a courtroom and a jury) or would you hire a good lawyer to represent you? This notion, that we are all "empowered" with the same know-how as the people we would ordinarily retain to help us in various settings**, is one of the core philosophies underlying almost all of SHAM, and is both precarious and fundamentally silly at the same time. It negates the very idea of expertise and specialized training.

5. regardless of misapplication of 'herbal goop' what has happened to our memory of thalydomide? you cannot blame CAM for that. No, I can't. And I'd be the last one to argue that conventional medicine never makes mistakes. But the logic here--that because medicine sometimes makes mistakes, it's "the same as" (or God help us, worse than) alternative medicine.... Let me say again: To propose an analogy between the harm done by conventional medicine--which at least rests on a body of clinically tested data--and the harm done by alternative medicine--which rests, usually, on nothing--is absurd. If your neighbor down the street who, say, runs a donut shop and has no background in finance tells you that the average Wall Street broker is clueless, therefore you should take whatever sums you've accumulated in your life and let him manage it for you...would you do it? Would you even consider it? And keep in mind: Even if you did give your neighbor control of your finances and he screwed it all up, it's not likely going to kill you.

Please, people. Let's get real. I know we're all very frustrated with modern health-care delivery and today's doctors, too many of whom act as if they're annoyed that the office staff left the door open, thus allowing actual patients in.*** That doesn't mean we can simply invent a Plan B and act as if it's just what the doctor ordered, so to speak. Finally: Here's a link to a short but valuable checklist of things to evaluate when confronted with an unfamiliar form of medicine (or so-called medicine). It's worth referring to next time a friend tells you about some Amazing New Treatment!

* see, for instance, the story of James Gary Davidson, SHAM page 211.
** except for the SHAM gurus themselves, of course. Them we need, or so they tell us...
*** I'm paraphrasing Dave Barry's classic riff on the indifference of salesclerks in haughty department stores.

3 comments:

acd said...

I most definitely agree with Steve here. Cameron is completely dismissing the benefits of medicine because of a few mistakes. By this same logic, she should just as easily reject the notion of CAM because it too has had documented mishaps, regardless of whether it has any potential benefits.

Most technological or medical advances come with a few drawbacks, but these do not outweigh the countless advantages of innovation. Should we boycott automobiles because of the deaths caused from car accidents? Or, to remain on the topic of medicine, should the FDA ban the use of all prescription drugs to avoid misuse? Of course not. It's simply a matter of weighing both the benefits and the risks. And when you compare authentic medicine to CAM, they both have risks, but conventional medicine has undeniable proven efficacy that CAM cannot live up to.

acd said...

I most definitely agree with Steve here. Cameron is completely dismissing the benefits of medicine because of a few mistakes. By this same logic, Cameron should just as easily reject the notion of CAM because it too has had documented mishaps, regardless of whether it has any potential benefits.

Most technological or medical advances come with a few drawbacks, but these do not outweigh the countless advantages of innovation. Should we boycott automobiles because of the deaths caused from car accidents? Or, to remain on the topic of medicine, should the FDA ban the use of all prescription drugs to avoid misuse? Of course not. It's simply a matter of weighing both the benefits and the risks. And when you compare authentic medicine to CAM, they both have risks, but conventional medicine has undeniable proven efficacy that CAM cannot live up to.

Anonymous said...

As a Reiki master, I must speak up here. Would I recommend to someone who'd been diagnosed with cancer that they choose Reiki (a form of healing touch) instead of conventional treatment? Absolutely not. Would I recommend to that person that they use Reiki to lessen the nausea and other unpleasant side effects of radiation treatment and chemotherapy, a use proven effective in hospitals? Absolutely. The two need not be mutually exclusive; instead, when both are used responsibly, they can have synergistic effects. The key, always, is to make sure you're well informed and use the good sense God (hopefully!) gave you.