Wednesday, December 18, 2013

Why alternative treatments are not accepted by science

It is public knowledge that alternative treatments such as homeopathy and acupuncture (and many others) are not accepted by the scientific community as having effectiveness distinguishable from placebo. It is said that these treatments do not fulfill the criteria for medicine - which is often along the lines of double-blind clinical trials (or other trials of similar level of rigor).

This is easy to say - you just check what the dictionary says about science and check what kind of results previous research has yielded, and hope that the scientific method had worked and researchers and peer reviewers haven't been too dishonest.

But what kind of explanations and ideas do practitioners of alternative treatments have about this? After all, they think their treatments work - their customers' experiences usually support this - and many would like to have their discipline recognized better, even as part of the contemporary medicine, taught at universities.
Fourteen meridians in a Chinese acupuncture chart from the 1340s (source: Wikipedia)

Can the effectiveness be confirmed?

From books, interviews and generally on the Internet I have heard and read many opinions about the position of acupuncture and homeopathy in regards to what they call "school medicine". I'm sharing some of them here.

"Can be confirmed" / "Has been confirmed"

These are based on the idea, that the treatment "works" in the traditional sense and its effect can be confirmed and the treatment could probably be part of contemporary medicine.
  1. Effectiveness could be confirmed, but global conspiracy of Big Pharma corporations is controlling the industry and will not allow alternative practitioners to compete with their lucrative business. They are twisting and possibly sabotaging results of academic studies.
  2. Effectiveness could be confirmed, but due to the bad reputation  and "unscientific" background of the treatments, serious researchers will not attempt it, fearing that they lose their reputation.
  3. Effectiveness could be confirmed, but due to so many hoaxers and unreliable practitioners, it is next to impossible to produce reliable studies on the treatments.
  4. Effectiveness could be confirmed, but the process of doing so is very long and difficult, and it will take time before we can have conclusive results.
  5. Effectiveness has already been confirmed, but the scientific community (or Big Pharma) maintains the illusion that it has not.
  6. Effectiveness has already been confirmed: the placebo effect is the real effect, it has just been misunderstood.

"Cannot be confirmed"

Explanations in this category are based on the idea that for some reason, alternative treatments are fundamentally incompatible with what is usually called contemporary medicine or empirical science.
  1. Cannot be confirmed, because they are based on unknown interactions and laws of nature.
  2. Cannot be confirmed, because they are not based on laws of nature but a spiritual and/or unphysical connection of some kind, and by definition that is outside the reach of science.
  3. Cannot be confirmed, because they treat causes of conditions, not symptoms, and are thus outside the scope of contemporary medicine (which only deals with symptoms).
  4. Cannot be confirmed, because they are tailored for each person, and treatments of different people cannot be compared in a study.
  5. Cannot be confirmed, because they do not have a common methodology which could be evaluated.
  6. Cannot be confirmed, because they are only effective in a delicate, deep practitioner-patient relationship, which makes usual double blind and randomized controlled trials impossible.
  7. Cannot be confirmed, because medicine has distanced itself from natural treatment and spirituality so much that it is simply unable to detect the effectiveness.

"Confirmation is irrelevant"

There are some who abandon the whole idea of a treatment having an effect in the traditional sense.
  1. It is irrelevant whether it can be confirmed, because customers' (patients') own assessment of their own condition is the only possible criteria of effectiveness.
Regardless of the actual effectiveness of acupuncture, homeopathy and others, I think it would be constructive to think about these explanations instead. Some of them are actually not that implausible.

It is my understanding that patients of alternative treatments practitioners are generally (very) happy with their care. They have appointments with a private practitioner who has plenty of time to discuss with the customer, ask about background of the condition, and propose different options, unlike your usual doctor at the health center who will spend the 20 minutes by picking a diagnosis from the ICD-10 manual (or ICD-9 if you are American, I'm sorry) and write a prescription of antibiotics. Thus, general happiness about the experience should not be seen as any kind of evidence about effectiveness of the treatment, even if the harsh public health experience might act as a "nocebo" - making the drug's effect lesser.

Alternative or not?

Assuming that some alternative treatments actually work - and it is apparent that most do not - it would be incredibly useful to find out which ones have potential to be studied more and possibly be introduced to the realm of contemporary medicine. However, it has been noted that there are many ways of doing acupuncture, some of them not using needles at all, so studying one practitioner might not give any insight into how others do it. Homeopathy, on the other hand, is manifested by diluted "drugs" that have consistently been shown to contain no active ingredients (which is not in contrary to the principles of homeopathy), and would be easier to study, however in homeopathy as well it has been stressed that the treatment cannot be distanced from the delicate practitioner-patient dynamic.

Meanwhile, some ordinary health products have been misleadingly labelled as homeopathic to make them more attractive to consumers - these may be a case of products that can be shown to be effective, but as they are not true homeopathic products, they do not add to the knowledge of alternative treatments.

Homeopathy has been studied at various universities (including my alma mater, University of Michigan, which even had a dedicated department for it). Many trained physicians still allege that homeopathy is about medicine in traditional sense, and can be empirically studied and its effectiveness confirmed, thus making it a "non-alternative treatment". At the same time, explanations for how homeopathy might function have been proposed (memory of water), but even if homeopathy was effective (which I doubt), its underlying mechanism would still be unknown. Some also claim that the effectiveness of homeopathy has already been confirmed many times over, but for some reason the credible results are not taken seriously.

Supporters of alternative treatments do not always seem to grasp the breadth of ideas - among the practitioners and supporters - about what the real problem is. For some, whether acupuncture of homeopathy works is just a matter of empirical science. For others, it is a spiritual matter. Thus, homeopathy, acupuncture and others thus present themselves as ambiguous, fuzzy ooze around certain misguided concepts, which explains much of the trouble they have with contemporary medicine.

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