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Complementary &
Politically correct definition
Alternative Medicine
(CAM)
Boon or bogus?
Allopathic Medicine, despite its
undeniable benefits, has its limits.
There are a whole host of diseases
and disorders for which it can offer
no cure or respite. Patients are
unable to accept this situation and,
frequently, look for remedies in
other systems of Medicine,
collectively labeled as
Complementary and Alternative
Medicine (CAM).
Those seeking solutions in CAM
will have to contend with a
profusion of choices; the range on
offer appears chaotic. There is no
single point from which directions
can be obtained.
In an era where scientific validation
is the unnegotiable bar for usage in
clinical practice - evidence based
Medicine as it is referred to - the
vast majority of CAM treatments
on offer are unproven. What is
more, side effects and harm are
poorly documented. Many, if not
most, practitioners have not gone
through a formal process of
training and certification. Large
numbers are nothing more than
quacks.
The patient who seeks remedies in
CAM has to sail carefully through
essentially uncharted seas.
"But, it works"
No consensus
Scams and health fraud
The placebo effect
Much more at:
"Complementary and Alternative
Medicine (CAM) is a broad domain of
resources that encompasses health
systems, modalities, and practices and
their accompanying theories and
beliefs, other than those intrinsic to the
dominant health system of a particular
society or culture in a given historical
period. ... Boundaries within CAM and
between the CAM domain and the
domain of the dominant system are not
always sharp or fixed." (The Institute of
Medicine, 2005)
CAM - a plethora of choices
To make sense of the many therapies
available, it might help to look at them in the
broad categories that the National Institutes
of Health uses for classification.
Healing systems: complete sets of theories
and practices, not just a single practice or
remedy, that center on a philosophy.
Examples of complementary and alternative
medicine healing systems include:
* Ayurveda
* Homeopathy
* Naturopathy
* Ancient medicines: Chinese, Asian, Pacific
Islander, American Indian and Tibetan
practices.
Mind-body connections: techniques that
strengthen the communication between
mind and body. Examples include:
* Meditation
* Yoga
* Biofeedback
* Prayer
* Hypnosis
* Relaxation and art therapies, such as
poetry, music and dance.
Dietary supplements and herbal
remedies: treatments that use ingredients
found in nature. Examples include ginseng,
Making a choice of CAM to use for a specific condition is not an
easy task. For any given condition, there are dozens of
options.
© Dr Arjun Rajagopalan
29 November 2008
"There is only medicine that has been
adequately tested and medicine that has
not, medicine that works and medicine that
may or may not work. ... What most sets
alternative medicine apart, in our view, is
that it has not been scientifically tested and
its advocates largely deny the need for
such testing."
Angell M, Kassirer JP. N. Engl. J. Med.,
1998. 339 (12): 839–41.
ginkgo and echinacea, selenium, and
glucosamine sulfate. Herbs and
supplements can be taken as teas, oils,
syrups, powders, tablets or capsules.
Manipulation and touch: use of human
touch to move or manipulate a specific part
of your body. They include:
* Chiropractic and spinal manipulation
* Massage
* Other types of manipulation and touch
therapies, such as osteopathy, craniosacral
therapy and acupressure.
Energy therapies: those that believe an
invisible energy force flows through your
body, and when this energy flow is blocked
or unbalanced illness ocurs. Unblocking or
re-balancing the energy force is the goal of
these therapies. Proponents of
acupuncture, for instance, say that the
insertion of needles into points along
energy pathways (meridians) in the body
restores natural energy. Energy therapies
include:
* Acupuncture
* Therapeutic touch
* Reiki
* Magnet therapy
* Polarity therapy
* Light therapy.
29 November 2008

Complementary and alternate explanations

It is hard to counter a person who
affirms that they have been witness to
"Did you hear the efficacy of CAM, either personally
how ..." or in someone closely known. We are
so conditioned by the adage that
seeing is believing that we refuse to
concede that anecdotal reports are not
scientific evidence. There are several
explanations for these episodes.
Many diseases are self-limiting:
The old saying is that a cold will go away in a week or in seven
days if you treat it. Determining whether an intervention has
made a difference is therefore difficult. Unless rigorous study
methods are applied, an apparent benefit cannot be ascribed to
the intervention or the natural course of the disease.
Many diseases are cyclical: Allergies, multiple sclerosis,
arthritis and gastrointestinal problems like irritable bowel
syndrome all have their ups and downs. Sufferers may seek
therapy on a down, so that when an up comes that has to be due
to the therapy, doesn't it. Again, only rigorous study design
combats this.
Placebo effect: Both the above contribute to what is called a
placebo effect. It can be seen as the natural course of things. For
instance, some people need no pain relief after surgery, making a
pre-emptive intervention which claims to reduce pain after
surgery a sure win. There will always be some people publicly to
declaim its value. Natural "placebo" rates depend on what the
problem is and what the benefit is. There will always be some
people who benefit without an intervention.
Bets are "hedged": "My auntie was under the doctor for six
months, but it was only when she started on homeopathy that
she got better". The fact that the poor infantry slaved away for
six months is forgotten in the glamour of magic.
Original diagnosis may be wrong: Bandolier has highlighted
the difficulty of diagnosis. If the diagnosis is wrong, then
miraculous cures are less miraculous.
Mood improvement or cure?: Alternative healers often have
much more time to spend with their patient than a harassed GP
loaded down with kilograms of guidelines and tight prescribing
budgets. Is it any wonder that alternative healers can make
patients feel better? That mood change is sometimes seen as the
cure.
Psychological investment in alternatives - self-fulfilling
prophesies: Alternative healing can be as simple as some
herbal remedy bought from a shop. Sometimes it can involve
huge amounts of time, massive involvement of the family, and
an intense psychological investment in believing that something
(anything) will work. It is not surprising, then, that many people
find some redeeming value in the treatment.
(From Bandolier -
http://www.jr2.ox.ac.uk/bandolier/band71/b71-2.html)
... when it comes to human motivation I am working blind.
I can only guess why most people seem to prefer the
unproven to the proven, the anecdotal to the rigorously
demonstrated, and the so-called natural to the scientific.
John Diamond, Snake Oil and other Preoccupations

The placebo effect

Navigating the minefield of the internet
Faced with the profusion of choices
and the lack of a single, reliable
point of entry to CAM, patients
most often turn to the internet to
find answers. Their searches will
throw up an even larger range of
possibilities, mostly quackery and
some outright frauds.
Opportunists abound on the
internet and often target people
who are overweight or who have
medical conditions for which there
is no cure: multiple sclerosis,
diabetes, Alzheimer's disease,
cancer, HIV/AIDS and arthritis.
Remember: if it sounds too good to
be true, it probably is.
The following warning signs could
tip you off to scams and fraudulent
sites:
Cure-alls: Claims that the product Placebos - "sugar pills" - can
can treat a wide range of provide relief from symptoms
symptoms, or cure or prevent a of illness more often than can
number of diseases. No single be explained on the basis of
product can do all this. chance or random
occurrence. Good science,
Anecdotal evidence: Testimonials therefore, demands that trials
are no substitute for solid scientific of drug effectiveness have to
documentation. be pitched against a placebo
and shown to be significantly more effective.
False accusations: The purveyor Placebo-controlled trials are the cornerstone of
of the product accuses the drug research.
government or a medical
profession of suppressing Research with tools to image the brain as it is
important information about their working (dynamic imaging) strengthens the
product's benefits. connection between the placebo effect and the
anticipation of reward. In simple words,
Source: MayoClinic.com external motives will enhance the benefit of
http://www.mayoclinic.com/health/altern placebos. It is intriguing to note that the
ative-medicine/SA00078 strength of the placebo response depended on
the intensity with which the person believed
that he or she would benefit.

Red flag words: Words such as The "nocebo" - placebo's dark twin
"satisfaction guaranteed," "miracle
cure" or "new discovery." Expecting to feel ill can bring illness on in
some instances, particularly when stress is
Pseudomedical jargon: Terms involved - the "nocebo effect". In one 1960s
such as "purify," "detoxify" and test, when hospital patients were given sugar
"energize" may sound impressive water and told it would make them vomit,
but are generally used to cover up 80% of them did. If you are inclined toward
a lack of scientific proof. health anxiety, reading up on your malady or
medication on the Internet can fuel your fears.

© Dr Arjun Rajagopalan