News at NCH
"Does Complementary & Alternative Medicine Really Work?" By Allen Weiss, MD, MBA, President and CEO

Dr. ALlen Weiss, MD, MBA, FACP, FACR

February 1, 2009 - According to American Demographics, approximately 70% of Americans have tried or are currently using alternative medicine—acupuncture/acupressure, prayer, herbal/vitamin therapy, chiropractic/message, aromatherapy, hypnosis, magnetic therapy, and reflexology—to cure their ills.

The question is: Do any of these complementary and alternative medicine (CAM) therapies have any efficacy?

The answer —although you'd never know it from all the people who have been persuaded by the unsubstantiated claims and high-octane sales pitches to try these treatments—is nobody really knows for sure.

There are indications that some of these therapies may be helpful. Acupuncture, for example, may provide a number of medical benefits, from reducing pain to helping with chemotherapy-induced nausea. But the fact is we lack any conclusive data about the effectiveness of any of these alternatives.

One thing we do know is that CAM therapies are expensive—very expensive. Estimates of the costs to Americans range $34 to $47 billion every year.

Consequently, the real question we ought to be asking ourselves is: Can we afford to continue spending precious healthcare dollars on therapies of questionable scientific value, particularly at a moment when we are trying to control healthcare costs in general to help the economy recover?

The National Center for Complementary and Alternative Medicine (http://nccam.nih.gov/health/) has been funded with close to a billion dollars of taxpayer revenue over the past decade or so to bring a scientific approach to CAM. The results, especially for devotees of alternative medicine, are not what they want to believe. For example:

  • Echinacea, a vitamin that reputedly fights infection, does not appear to prevent colds or other infections, based on most of the rigorous scientific studies.
  • St. John's Wort, touted to be a natural antidepressant, is similarly questionable. Two large scientifically-controlled studies showed that placebo and St. John's Wort were equally effective.
  • Anti-oxidants have been shown many times not to prevent cancer in large, well-controlled scientific studies.

If the benefits of these alternative medicines are so inconclusive, you might ask: Why are they so popular?

Well, for one thing, healthcare practitioners have known for centuries that just being kind and directing personal attention to people who are suffering and upset can make them feel better. This phenomenon is known as the “placebo effect.” When people think they are receiving a therapy they believe will be beneficial, there is a much greater chance that the therapy will be efficacious. This may explain why 70% of Americans report they have benefited from CAM therapies.

In this context, I must admit that I have tried elderberry to ameliorate the effects of an upper respiratory infection, no doubt due to a virus. I thought the once-a-day lozenges helped, but I can't be sure.

How do we find out whether these therapies really work? The answer is rather simple. We should study them.

Specifically, we should subject them to the same research as traditional medicine, with rigorous, double-blind, controlled studies to demonstrate benefit or not. Results of such testing should be widely shared, so that all would benefit either from using the medicine or moving on in a more promising therapeutic direction.

Medicine, after all, is based on science. And we, as an ethical society, must demand meticulous scientific study to protect unsuspecting, vulnerable, worried—yet hopeful—people from being taken advantage of by unproven and expensive therapies. Ironically, people will often get better, regardless of the medicine they take to cure their “illness.” The natural course of many diseases is that they are self-limited.

I am not contending that conventional therapies are perfect or without side effects. Nor am I saying, as in the case of acupuncture, that all CAM therapies are without some benefits. But what is irrefutable is that whether traditional or alternative, the efficacy of treatments must be substantiated through evidence-based medicine, scientifically supported by solid data. Only then will we know if they really “work.”

Such scientific testing is our best course as a nation, not only to more effectively marshal our precious healthcare dollars but, more importantly, improve the future of America's health.

 


 

Dr. Allen Weiss is CEO & President of the NCH Healthcare System. He is board certified in Internal Medicine, Rheumatology and Geriatrics, and was in private practice in Naples, Florida from 1977 - 2000. Dr. Weiss is active in a variety of professional organizations and boards, and has been published in numerous medical journals, including the American Journal of Medicine and the Journal of Clinical Investigation.