Alternative Medicine: Quacks or Cures
by: Mark Schloneger
Submitted for: Biology Senior Seminar
Professor: Stan Grove
Date Posted: November 25, 1996
I. Introduction
II. What is Alternative or Complementary medicine?
III. Description of alternative medical systems (including a brief history
and background)
IV. Does alternative medicine offer legitimate cures, or should it be discouraged
as quackery?
V. What place does alternative medicine have in modern medicine?
VI. Conclusion
Works Cited
Alternative Medicine: Quacks or Cures
Introduction:
Although "Alternative" or "Complementary" medicine has
been kept on the fringes of the medical sciences in the past, it is becoming
increasingly more popular, and more reputable. Alternative medicines are
those medical systems which are not taught to or practiced by most conventional
medical doctors. Alternative medicines seemingly have always existed, changing
and conforming to the current climate of society. There seems to be an almost
endless number of alternative medicines, each with their own method of gaining
perfect health. Often people who are dissatisfied with conventional medicine
turn to alternative medicine for their medical needs. Many similarities
link the diverse extremities of alternative medicine. These links define
alternative medicine, but also help explain why they remain so controversial.
They are characterized by a lack of unbiased, scientific testing, the belief
in a vital force that cannot be explained scientifically, and a lack of
strict regulation ensuring competency and consistency among practitioners.
Although these similarities exist a distinct separation must also be made
between two types of alternative medical systems. The first type includes
those that have "strong intellectual foundations and time tested methods
of maintaining health and curing diseases" (Micozzi A48). These have
established training and practice procedures and large numbers of practitioners
and patients. Micozzi includes homeopathy, herbal treatment, chiropractic
medicine, traditional osteopathy, and traditional Chinese medicine (acupuncture)
in this first type of alternative medical systems. These are contrasted
with what he refers to as "magic bullet" treatments which are
usually for a specific disease like cancer. They don't have scientific research
or a long tradition to support them. There are an endless number of this
second type of alternative medicines. The scientific community is much quicker
to label this second type as quacks, whereas the scientific community has
failed to gain a consensus on the legitimacy of the first type. Unfortunately,
both are encompassed by the term alternative medicine. This paper will focus
on the more controversial alternative medicines described in the first group.
By examining some of the most popular, enduring alternative medical systems,
one can begin to see some general trends of the systems, understand some
recurring flaws, and understand the attraction and usefulness of alternative
medicine in today's health care system. However, alternative medicine remains
controversial. Whether it can be supported scientifically or not, alternative
medicine may be useful to encourage both physical and mental well-being
via a placebo effect. For this reason, alternative medicine must be considered
by physicians as a complement to modern medicine.
Description of alternative medical systems (including a brief history
and background):
Chiropractic treatment:
Chiropractic is one of the most respected and most prominent of alternative
medicine practices. Although many people would only consider visiting a
chiropractor for the alleviation of pain caused by musculoskeletal problems,
chiropractic beliefs involve much more than just muscle manipulation. Just
over a century ago, Daniel David Palmer claimed to have cured both deafness
and heart trouble by manipulation of the spine, which released impinged
nerves and subsequently alleviated the symptoms (Magner 11). He felt that
if these two dissimilar diseases were caused by impinged nerves, it was
logical to think many other diseases were similarly caused. Thus, the science
(knowledge) and the art (adjusting) of chiropractic emerged.
Since the initial "discovery" of chiropractic medicine, chiropractic
has established itself as a popular health care option which emphasizes
"the inherent recuperative power of the body to heal itself without
the use of drugs or surgery" (The Association of Chiropractic Colleges).
The Association of Chiropractic Colleges state that the focus of chiropractic
is the "relationship between structure (primarily the spine) and function
(as coordinated by the nervous system) and how that relationship affects
the preservation and restoration of health." According to chiropractic
theory, a subluxation, a partial dislocation of the spine, impedes the flow
of "vital energy" or "Innate Intelligence" to the body's
tissues (Butler 63). Such subluxations are capable of effecting many bodily
functions, but these conditions can be favorably altered by chiropractic
adjustments.
In 1988, the American Chiropractic Association (ACA) placed advertisements
in Reader's Digest which advised families to consider their chiropractor
their family doctor and primary health advisor (Magner 2). Chiropractors
are licensed in all fifty states, which means that minimum requirements
of training and knowledge are regulated. Although scientific testing of
chiropractic techniques is rare, many chiropractors feel that since many
of their patients return and chiropractors remain busy, they must be effectively
treating their patients. Thus, chiropractic continues to surge forward capturing
their share of health care field.
William Jarvis, Ph.D. writes that most people rightly believe that
manipulative therapy is useful. However, in the next sentence he writes,
"Chiropractic has failed the most fundamental scientific requirements
that it define itself, determine its clinical usefulness and limitations,
and conduct basic research on its mechanism" (Magner ix). It should
be noted that manipulative therapy is used by doctors of osteopathy, a highly
regulated and researched field. Thus, it is not the manipulative therapy
which receives the main criticism, but the rest of the chiropractic philosophy.
Butler states three of the false tenets to which most chiropractors adhere
and believe. First, medical doctors treat only symptoms, but chiropractors
get to the root of health problems by finding and treating subluxations.
Secondly, chiropractors are uniquely qualified to prevent and treat practically
every health problem by regular spinal manipulations, which keep nerves
flowing and organs functioning normally. Thirdly, chiropractors should be
considered as primary-care family physicians who are as capable of dealing
with common health problems as medical doctors (65). However, chiropractors
are not on a equal playing field with medical doctors because chiropractic
schools lack the high standards, chiropractors are no longer judged by medical
standards when taking licensing examinations, and chiropractors fail to
learn proper diagnostic procedures. In fact, the main reason that chiropractors
are no longer required to take basic science boards, similar to the exams
osteopathic and medical doctors still take, is because most chiropractic
graduates were unable to pass the boards. Only 23% of chiropractors succeeded
in passing the boards, whereas 86% of medical students passed the exams
during the span in which they were administered (Magner 20). Thus, chiropractors
are not trained to act as a family physicians, but they continue to attempt
to establish themselves in this manner.
Oriental treatments (Acupuncture):
The theory of chiropractic that maintains that all bodily functions can
be affected by spinal adjustments, is similar to one of the oldest complementary
medicines, acupuncture, which claims that healing can arise from needling
acupuncture points. Another striking similarity is the chiropractic belief
in a Life Force or Innate Intelligence (mentioned previously), and the acupuncture
theory of Qi (also Chi, or Ki), which is the Life Force or "vital energy"
and its flow can be influenced and manipulated to induce healing (Butler
94). The basis behind the needling is the belief that the Qi flows though
the body in channels called meridians. Disease, from within this understanding,
is an imbalance of the Qi. Therefore, acupuncture is defined as "a
Chinese medical practice or procedure that treats illness or provides local
anesthesia by insertion of needles at specified sites of the body"
(Braun).
Acupuncture is thousands of years old which makes it distinctly different
than many of the alternative medicine theories. However, several of the
more recent theories are based on the same oriental systems of belief as
acupuncture. Over the years acupuncture has changed very little, except
that the number of acupuncture points that used to be thought to be 365
now number over two thousand (Butler 94). Acupuncture doctors believe there
are twelve different pulses in the body, each associated with a vital organ.
These superficial pulses help the acupuncturist to evaluate whether the
Yin or Yang has moved and which organs contain too much or too little Qi
(Braun). The improved energy and biochemical balance produced by acupuncture
stimulates the body's ability to heal itself, and therefore allows physical
and emotional health to be reclaimed (American Academy of Medical Acupuncture).
Similar to chiropractic, many people associate acupuncture simply with pain
control. However, the Medical Acupuncture Organization maintains that treatment
of a wide range of medical problems is possible including digestive disorders,
respiratory disorders, neurological and muscular disorders, and reproductive
problems. Acupuncture is used more in Asia and Europe than in the United
States. However estimates of the number of people who use acupuncture differ
vastly depending on the source. Regardless of the actual numbers, acupuncture
is slowly working its way into Western health care.
Many of the same criticisms arise for acupuncture that were raised for chiropractic.
The primary complaint is the lack of unbiased, controlled research studies.
In addition to the lack of scientific research, the inability to explain
some aspects scientifically, such as the Qi, and the lack of regulation
on practicing acupuncturists also raise criticism. Acupuncture does seem
to be better regulated in many states compared to chiropractic, because
many acupuncturists are either medical doctors or under the supervision
of a medical doctor. The risk of injury during treatment remains controversial.
The American Academy of Medical Acupuncture (AAMA) insists that there is
very little risk of injury or side effects. However, Butler writes that
students of traditional acupuncture are taught that misplacing a needle
slightly can result in greater damage than the original disease that the
needling was to cure. The misplaced needle could either move the Qi the
wrong way or damage blood vessels or nerves (101). Further, Butler points
out that China, the nation of acupuncture's origin, has rejected the practice
several times in their long history. He maintains that its resurrection
was the result of a vast shortage of doctors in China in the 1970's. Validating
acupuncture created an illusion of competent health care (95). Finally,
in 1981, the keynote speaker for a meeting of the American Association of
Acupuncture and Oriental Medicine "likened scientific medicine to death
and decay and acupuncture to full liberation" (97). Once again, alternative
medicine is portrayed as making extravagant claims, which suggest superiority
over conventional medicine.
Massage therapy and reflexology:
There are many types of alternative medicine which involve massage, many
based on the belief in meridian or pressure zones. Massage therapy, acupressure,
and Shiatsu are all forms of massage that are based on the understanding
that by massaging or putting pressure on specific areas, the body can be
affected and can increase circulation of the blood and the lymph, affect
muscles, enhance skin conditions, and affect internal organs (Agran). Reflexology
has similar methodology, except that the pressure points are all thought
to be specifically on the hands and feet. Reflexology and other types of
massage therapy are based on the same concepts and have similar historical
background as acupuncture, but the pressure is applied using fingers instead
of needles. The major benefit of the hands-on method is the stimulation
of the circulatory and lymph system (Greene). However, massage therapies
claim to be able to obtain many of the same results as acupuncture, and
are therefore subject to the same criticisms. Similar to chiropractic, many
people visit massage therapists for pain relief or just relaxation, often
unaware of the extravagant claims the alternative medical practitioners
may make, and lacking basic understanding of the beliefs of the practice.
Homeopathic treatment:
Homeopathy is the belief that a drug-induced disease will drive out a pre-existing
disease if and only if the two are similar. Homeopathy has a German origin,
which Samuel Hahnemann developed in 1810 "after many years of research
and experimentation" (Chauvin). He maintained that susceptibility to
disease is a personal phenomenon, which involves a disturbance of a "vital
force." Homeopathy attempts to stimulate the body to heal itself. Conventional
medicine treats and hides symptoms which signify an internal problem exists,
but also signify that an attempt is being made by the body to resolve the
problem. Conversely, homeopathy attempts to give a substance that will further
induce the symptoms, and therefore stimulate the restoration of health.
The homeopathic substance is created by diluting the disease causing substance
until little of the original remains. For example, it is not uncommon to
create a homeopathic remedy that is 1/millionth of the original disease
causing substance. In these infinitesimal amounts, homeopaths claims a greater
than placebo effect is reached (The National Center for Homeopathy). The
key to healing is that "like cures like."
Homeopathic medicines are regulated by the 1938 Food and Drug Administration
(FDA) law legalizing them. However, the regulation primarily exists to keep
dangerous medicine from being distributed, rather than regulating the effectiveness
and benefits of the remedies. Homeopathic medicines are treated similar
to over-the-counter medication. As with other alternative medical practices,
criticisms include the lack of unbiased, scientific research. According
to homeopaths the difference between homeopathic and conventional medicine
is that homeopaths' aim is toward a cure, which Dr. Samuel Hahnemann describes
as "the complete restoration of perfect health". Conventional
medical doctors are viewed as only being interested in the control of patient's
symptoms through the regular use of medical substances (The National Center
for Homeopathy). Homeopathic belief is based on the insinuation that conventional
medicine is less beneficial and has been failing to provide sufficient health
care.
Naturopathic treatment:
Finally, naturopathy is a natural approach to health care that attempts
treatment using "stimulation, enhancement, and support of the inherent
healing capacity of the person (body)" (Bubis). Naturopathy asserts
that sickness is the result of an accumulation of toxins in the body, and
that natural means can be used to rid the body of these toxic substances
(Butler 137). Naturopathic medicine follows six basic principles in the
attempt to create wellness. These distinguishing principles are the healing
power of nature, the identification and treatment of the cause, the concept
of first doing no harm, the treatment of the whole person, the physician
acting as a teacher, and the best care is prevention (Bubis). These principles
are used to work in cooperation with the patient's "vital force."
Naturopathy incorporates many of the other alternative medicine practices
previously discussed. Dr. William Eidelman M.D. lists several emphases of
natural medicine. First is the use of natural substances, from foods and
herbs, as medicines. Secondly, because the body is considered to be electromagnetic
in nature, vibrations and other electromagnetic sources are used to gain
therapeutic effects. Thirdly, naturopathy acknowledges the consciousness
as a valuable tool by which healing can be achieved (Eidelman). In other
words, naturopathy takes advantage of the human psyche, using approaches
with the intent to gain a psychological, placebo effect.
Naturopathy uses very wholistic means to create wellness. Many people are
attracted by an approach that emphasizes treatment of the whole person,
rather than just the specific ailment or disease. This aspect is more similar
to the way medicine used to be practiced. It addresses the common complaint
that conventional medicine is too technologically sophisticated and impersonal.
Besides the wholistic treatment, it emphasizes the popular opinion that
nature is "perfect" and healthy. This is consistent with some
people's understanding of religion and the perfect creation of God. Naturopathy
seems to combine conventional medicine and alternative medicine. Naturopathic
doctors receive a very respectable background in the sciences, similar to
conventional medical schools, while receiving training in many forms of
alternative medicine at the same time.
However, critics are quick to point out some flaws in naturopathy. Because
naturopathy encompasses many of the previously mentioned alternative medical
practices, the criticisms of these alternative medicine in general reflect
on naturopathy. In addition, crititcs question whether the medicines given
should be considered natural when given in unnatural doses and when the
ailment and disease seem unrelated. Some naturopathic treatments used are
"enemas, starvation, doses of vitamin C equivalent to a hundred oranges
a day, doses of vitamin A equivalent to fifty carrots a day, foul-tasting
and toxic herbal teas, and raw beef gland pills" (Butler 138). Further,
many people refute the belief that nature is necessarily good and that God's
creations are perfect. We are God's creations as well, and our imperfections
are considered the cause of sickness. Studies show that "natural"
substances given at inappropriate doses are not healthy, but are actually
carcinogenic and potentially fatal. Thus, naturopathy appeals to the needs
and desires of some people who are dissatisfied with conventional medicine,
but are also the subject of much criticism.
Healing, achieved through superficial adjustment of the body to achieve
maintenance and balance of the Life Force, is the basis of each of the alternative
medical systems explored. The reason that they are considered alternative
medicine helps explain why they remain so controversial. In the midst of
this controversy, the traditional health care system needs to learn how
to deal with alternative medical practices. What attempts at research are
being made? Should alternative medicine be encouraged if it only results
in a placebo or psychological effect? As a supporter of wholistic medicine,
I think that the medical field must do what will most benefit the patient.
Thus, it is necessary to consider any type of treatment that gives results,
including alternative medicines.
Does alternative medicine offer legitimate cures, or should it be
discouraged as quackery?
Research:
One of the overwhelming problems with alternative medicine is the
lack of good, supporting scientific research. In 1993, Congress set up the
Office of Alternative Medicine (OAM) under the National Institute of Health
(NIH). Since then the OAM has used its resources to set up two alternative
medical research centers, and awarded 42 grants of thirty thousand dollars
each for research projects. The majority of the research is being done on
two areas of medicine, the treatment of HIV/AIDS by alternative medicine
and the effects of alternative medicine on the treatment of addictions and
related disorders (Marwick 1808). The NIH has also awarded grant money to
38 projects dealing with the mind/body interactions of alternative medicine,
as well as many other studies on the effects of alternative medicine that
precede the origin of the OAM (1810). Therefore, an attempt is being made
to begin doing scientific, reliable research. However, extensive research
on many types of alternative medicine will not be available for many years
because of the lack of research centers and lack of funding.
Micozzi says that "clinical observations increasingly indicate
that some types of alternative medicine do seem to cure or improve some
chronic medical problems" that mainstream medicine can't help (A48).
However, he also admits that "we have no widely accepted scientific
explanation for how such treatments work" (A48). Langone agrees that
most of the studies rely on personal observation and anecdotal testimonies
(40). The problem with this type of "research" is best explained
by Food and Drugs enforcement officer Walter Campbell "our experience
of more than thirty years...has demonstrated that testimonials may be obtained
for practically any article labeled as a treatment for practically any disease"
(Young 4).
Many of the research studies that claim to be randomized, double-blind placebo-controlled
trials actually are scientifically useless because they contain major flaws.
For example, a study that attempted to test the effectiveness of hypnosis
in thirty-five cardiac surgery patients was not a good study for two distinct
reasons. First, candidates were chosen based on their desire to undergo
hypnosis, thereby failing to be random. Secondly the study wasn't double
blind because candidates knew whether or not they were undergoing hypnosis
treatments (Columbia-Presbyterian Medical Center). Studies that are not
truly blind or random do not provide usable data about the medical system.
However, it may show that the psychological effects or placebo effects of
procedures are beneficial. Mary McCaul notes that even if it's a placebo
effect, placebos are a powerful thing" (Langone 41). In fact, the placebo
effect has been estimated to be able to produce results of up to 30-40%
improvements (Miller).
Marwick explains that another major problem is that within the alternative
medical community there are many people who "are unwilling to subject
their therapies to a validation process that would make them acceptable
to physicians in general" (1808). It seems unnecessary to risk studies
which may invalidate their treatments, when they are able to attract a full
clientele without the scientific support.
Placebo affect:
Many people assert that even if a treatment simply produces a psychological
or placebo effect, it should be administered to obtain this result. Many
things besides germs and viruses affect wellness including environment,
lifestyle, and mind-body interactions. Ulcers and heart diseases are both
known to be closely linked to stress. Marc Micozzi notes that the importance
seems to lie in the fact that the patient believes in the healing power
of the treatment (A48). Nevertheless, there are dangerous aspects to the
use of alternative medicine as a placebo. First, the placebo effect does
not return a person to full health, but simply decreases their sickness.
Therefore, it seems that a combination of an alternative medicine with conventional
medicine would be an effective way to accumulate the benefits of conventional
medicine with the benefits of the placebo effect. In fact, the psychological
adjustment may allow the conventional medicine to work quicker and better.
However, this raises a second question of whether the use of alternative
medicine could create a slippery slope effect, in which an effective practice
could be abused. This could arise if a person began to believe that the
alternative medicine was creating the beneficial results and would therefore
choose to halt conventional medical practices. Similarly, persons may hear
that alternative medicine was used to gain the desired results, and be convinced
to use only the alternative medicine. It is necessary to consider these
possibilities when advocating the use of a placebo effect. Do the benefits
gained by one person outweigh the danger it could cause others? Finally,
not all alternative medicines should be considered placebos, because some
involve the risk of harm. This risk must also be considered before advising
the use of a treatment to gain a placebo effect.
What place does alternative medicine have in modern medicine?
The American Medical Association's official position is that a "patient's
improvement or recovery after alternative medicine treatment might just
as well be incidental to the action taken" (Langone 41). For example,
critics maintain that homeopathic treatments are water at worst and placebos
at best. However, Dr. Jennifer Jacobs, an advocate of alternative approaches,
say "perhaps the pendulum has swung too far toward technology and pharmaceuticals
and not enough toward some of the early healing methods that have a track
record in many cultures" (Langone 43).
What can we learn from alternative medical systems?
Regardless of the direction in which alternative medicine is going, we can
learn several important points from them. The conventional medical community
must look at the success of alternative medicine, and reevaluate itself.
Micozzi points out that alternative medicine is gaining popularity because
it is less invasive, lower-tech, less expensive, more gentle, and more natural
than mainstream medicine. Alternative medicine emphasize the partnership
between the doctor and patient (A48). Many people feel that the hands-off
approach of medicine fails to be the wholistic treatment they desire. The
traditional medical practitioners need to learn from alternative medical
care-givers and attempt to better meet the needs of people. They need to
regain the trust and respect of the people who have become dissatisfied,
by turning to more wholistic medicine that is more cost-effective and more
personable.
Conclusion: How should we use alternative medicine?
Thus, the questions remains, what role alternative medicine should have
in modern health care and what can we learn from alternative medical systems.
If alternative medicine is able to produce good scientific support, alternative
medicine will need to be incorporated into conventional medical practices.
However, if alternative medicine's effectiveness is disproven or unable
to proven, or if the effects are found to be solely placebo effects, then
alternative medicine must be used sparingly and only under close physician
supervision. Further, the use of alternative medicine for psychological
benefits should normally be used only in combination with conventional medical
practices, not as a primary treatment. Alternative medicine does have its
place in health care, but it's appropriate role will not be known until
accurate research can be produced.
Works Cited
Agran, Jason. (1996, Oct. 23). Benefits of Massage Therapy [Online].
Available: http//www.agranenterprises.com/massage.html
American Academy of Medical Acupuncture. (No date). All About Acupunture
[Online]. Available: http://www.MedicalAcupuncture.org/aboutacu.html [1996,
Nov. 16].
The Association of Chiropractic Colleges. (1996, July). Issues in Chiropractic:
Position Paper #1 [Online]. Available: http://www.mbnet.mb.ca/~jwiens/acc.html
[1996, Nov. 16].
Braun, Paul. (No date). Acupuncture [Online]. Available: http:/198.150.8.9/acupuncture.html
[1996, Nov. 16].
Bubis, Eugene. (No date). What is Naturopathic Medicine? [Online].
Available: http://www.pandamedicine.com/natmed.html [1996, Nov. 16].
Butler, Kurt. A Consumer's Guide to "Alternative Medicine."
Prometheus Books. Buffalo, New York: 1992.
Chauvin, Claude. (1996, June 12). The Science and Art [Online]. Available:
http://www.homeo.com/a_art.html [1996, Nov. 16].
Columbia-Presbyterian Medical Center. (1995, Fall). Leap of Faith in Cardiac
Care. Bio Medical Frontiers [Online], 3 pages. Available: http://cpmcnet.columbia.edu/news/frontiers/biof0015.html
[1996, Nov. 17].
Eidelman, William S. M.D. (No date). Nutritional Preventive Medicine
[Online]. Available: http://www.maui.net/drbill/hompagnm.html [1996, Nov.
17].
Greene, Elliot. (No date). Therapeutic Massage for Health and Fitness
[Online]. Available: http//www.doubleclickd.com/theramessage.html [1996,
Nov. 16].
Langone, John. "Challenging the Mainstream." Time. 148.14,
40-44, Fall, 1996.
Magner, George. Chiropractic: The Victim's Perspective. Prometheus Books.
Amhearst, New York: 1995.
Marwick, Charles. "Time for New Head, New Approach at OAM." JAMA.
272.23, 1806-8, Dec 21, 1994.
Micozzi, Marc S. "The need to Teach Alternative Medicine." The
Chronicle of Higher Education. 42.9, A48, Aug. 16, 1996.
Miller, James. "Critical Thinking of the Treating of Diseases: How
to Avoid Quackery." Lecture Notes.
The National Center for Homeopathy. (No date). Homeopathy: Natural Medicine
for the 21st Century [Online]. Available: http://www.healthy.net/pan/pa/homepathic/natcenhom/
[1996, Nov. 16].
Young, James Harvey. American Health Quackery. Princeton University
Press. Princeton, New Jersey: 1992.