Alternative Medicine and the Post-Hoc Rationalization

If you follow me on the Skeptoid blog you’ll find that I take a dim view of complementary and alternative medicine. My opinion is based primarily on a rational evaluation of the research. Complementary and alternative medicine (CAM), as a whole, is chock full of poor studies, index studies and weak correlational studies. There is a minority of well done positive research that subsequently fails to show any benefits and goes unreplicated. Alternative medicine as a whole has all the failings of an old west medicine show plagued by scam artists and ideologues. Scammers and ideologues use the freedom that discarding the scientific method offers to reinforce an emotional response. This summer, BioMed Central, a peer-reviewed open-access journal, published an overview of alternative medicine treatments and the benefit in getting injured or sick people back to work, undertaken by researchers at Columbia University. This study, titled “Complementary and alternative medicine use and absenteeism among individuals with chronic disease,” was a retrospective correlational review of data collected from the 2012 National Health Interview Survey data.

This research took a long, hard look at days out of work and alternative/complementary treatments. Researchers sought to answer a simple question: does CAM shorten your time out of work? The resounding answer was no. Worse, it showed that people who underwent complementary and alternative treatments were out of work for a longer period of time.

Acupuncture and “moxing.” Via Wikimedia.

Structurally this research was just about as rigorous as a correlational review can be. The methods are described, in part, like this:

CAM practices considered for inclusion were determined by the National Center for Complementary and Integrative Health’s (NCCIH) definition of “complementary health approaches” for mind and body practices and natural products. Natural products were included in our definition of CAM as these therapies are the most commonly used. CAM practices included acupuncture, massage, meditation, movement therapies (does not include general exercise), relaxation techniques, mind-body practices, vitamins (excluding multi-vitamins), minerals, and herbs. Participants reported not using any of the NCCIH-defined practices were considered non-users. CAM types of interest were categorized as either dietary supplements or mind-body practices. Mind-body practices included biofeedback, mantra meditation/mindfulness meditation/spiritual meditation/guided imagery/progressive relaxation, and yoga/tai-chi/qi-gong. Dietary supplements included use of non-multivitamins, non-vitamin supplements, minerals, and herbs.

There are, of course, limitations to any type of retrospective review, but the authors seemed to hit all of the most valid limitations without any glaring omissions. It was about as scientifically rigorous as you can get given the type of research.

It’s important to point out, though, that the findings are correlational and not causational. It’s not possible to say that CAM made them more sick, or sick longer. That conclusion is not supported by this study. Making a causation conclusions from a correlation study is a common failing. This study merely indicates that a large group of people missed work and the ones who used alternative and complementary treatments for recovery missed more work than the ones who didn’t. The reason for their prolonged absenteeism could be any number of other things correlated with CAM users. Nonetheless, this finding flies in the face of what most CAM proponents say, namely that natural and/or mind body therapies are more effective than conventional medicines.

So are results like these compelling to CAM providers and advocates? Are alternative and complementary practitioners expressing concern, changing practice, or demanding more research? No, not really. Instead, CAM proponents usually turn to classic post-hoc reasons why this kind of research is wrong, drawing unsupported conclusions to excuse the findings. They basically argue that a treatment didn’t work because the patient lacked the guidance of a proficient CAM practitioner. Unfortunately this is an all too common response to negative CAM research. “We know that CAM treatment X works, so if the research shows that it doesn’t, it must have been done improperly.” That is not a scientific response to an unexpected finding. A accurate response in science is, “The data seems to show no benefit. Let’s take a closer look at that.”

From essential oils to acupuncture, I see special pleadings claiming that there is some undefined element that can be used to dismiss any negative findings: “The essential oil must not be pure enough,” “that acupuncturist must be unlicensed,” “the cancer patient didn’t fight hard enough.” They must be using the CAM wrong!

Fire cupping. Via Wikimedia.

The Columbia researchers suggested that the cause might be that many subjects using CAM services were self-administering their non-traditional therapies. They may have misadministered a treatment, because they were practicing without the guidance of a licensed clinician or trained therapist, and inadvertently caused themselves more harm than good.

The only problem with that conclusion is that it is completely imaginary. The survey doesn’t match that type of data. They have no way of knowing any of that. It could be that everyone involved could have been going to the highest level of CAM practitioner. So you can conjure up an excuse without data, but I could just as easily suggest that the voodoo dolls prevented a quick recovery. Although their supposition sounds plausible it assumes that CAM works and that it was therefore done incorrectly. That is not science, it is not logical, and invokes some non-existent level of competence as the reason.

The idea that CAM is better when administered by a licensed or trained practitioner is in itself flawed. If you are licensed or certified in wizardry from Hogwarts it doesn’t mean you can then do magic. CAM has no scientific standards of safety or effectiveness. All a CAM certification represents is proficiency in nonsense. Since CAM treatments with proven efficacy become conventional treatments — such as prescription fish oil — treatments that remain alternative are limited by insufficient or poor evidence. In the absence of a reasonable standard of effectiveness for a practice, providing an internal standard is useless. CAM practitioners get around the lack of evidence by promoting anecdote and belief as superior to facts. Even if you firmly believe that it’s OK to have no standards, and that anecdotes are compelling, there’s still the problem of how information about a treatment is stratified. Using nonsense ideas like the naturalistic fallacy or mysticism as a foundation can mean that literally anything goes, without restriction. How can anyone turn around point and say that there is a standard and treatments fail only for a lack of believing (wishing) hard enough? What does that even mean?

Honest researchers would point out that the data in this study questions the use of CAM for chronic pain. Further, it offers evidence that CAM does not offer superior treatment to conventional therapies, and that more rigorous research is required. Honest researchers ask the real questions and do not try to prop up a unsupported conclusions.

Real medicine doesn’t work that way. For example: it was common practice to recommend inpatient rehabilitation for post-operative reconstructive knee surgery. The medical community’s consensus was that daily physical therapy would be much better than three times a week. Patients don’t like to go the rehab; they want to be home after surgery. But, some new, good research was done: it demonstrated that people get the same results with home therapy that they do with inpatient, despite therapy being less frequent. Counterintuitive though it may be, it warranted a practice change. Home therapy is much less expensive than inpatient, and patients are happier. Although it was a monetary hit for doctors and facilities, it was best practice so we changed. We didn’t try to argue that the the therapists in the rehab facilities must have had substandard training.

Physical therapy technicians look on as Lt. Cmdr. Candace Cornett conducts a brief check-up on Cpl. Mathew O. Behm’s recovery from knee surgery prior to physical therapy at the Physical Therapy Department at Robert E. Bush Naval Hospital. via Wikimedia

That is CAM’s biggest failing. When something doesn’t work, they try to come up with reasons why they should keep doing it. Whenever evidence is presented showing that isn’t working, they offer nonsensical special pleadings as to why their magical treatment didn’t work today.

Ignoring evidence and developing an excuse as to why you should continue is not good medicine—it’s ideology. Medical treatments need an honest answer: does a treatment work or doesn’t it? Is it safe or not? That is all that matters. Hand-waiving mysticism, claims to natural fallacy, ancient wisdom notwithstanding, we need to stop pouring money down a CAM hole. Stop taking people’s money and handing back feel-good nonsense.

Whenever anyone objects to failed CAM treatments advocates quickly point out the wrongdoings of the “medical establishment” or “Big Pharma.” Which is just a nonsense argument. Let’s say that “Big Pharma” is costly and their products are safe and effective only 90% of the time. They are still 90% more effective than any CAM treatment, which isn’t free either. I’m not saying 90% is acceptable but that is a different argument. One argument is asking for higher standards. The other is asking you to ignore CAM’s low (or nonexistent) standards. As an analogy: imagine your child is smashing car windows with a bat. It’s hardly helpful to say, “Well, it doesn’t matter because other kids are stealing gum from the supermarket.” Deal with the problem. Don’t make comparative statements as attempt to distract from a failed practice. Just because there are problems in the medical industry doesn’t mean that CAM works.

There is no alternative medicine, there is only medicine that works and treatments that don’t. Treatments that do not work are neither an alternative, nor a complement; they are ideology, and special pleadings and anecdotes notwithstanding, ideology has no place in healing.

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Disclaimer: This post is my personal opinion, it is not a substitute for medical care. It is for informational purposes only. Information on the Skeptoid blog is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified healthcare professional regarding any medical questions or conditions. This post does not reflect the opinion of my partners, professional affiliates, or academic affiliations. I have no financial conflicts of interest to disclose.

About Stephen Propatier

Stephen Propatier is a board certified acute care nurse practitioner specializing in spine and sports medicine. He is a member of the Society for Science Based Medicine.
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20 Responses to Alternative Medicine and the Post-Hoc Rationalization

  1. Robert says:

    brilliant.

  2. mudguts says:

    you mean never waiting for the coconut oil to melt??

    Good stuff.. exhaustive for a post and covers w
    he position of the wobbity people.

    Hypochondria gets you nowhere.. I know you dont like me writing that Stephen, but seeing the behaviors are encouraged by the altie set ( dial up a non existent disease), I think it holds now in this community

  3. ask412 says:

    “…it was a monetary hit for doctors and facilities, it was best practice so we changed. We didn’t try to argue that the…therapists in the rehab facilities must have had substandard training” Stephen Propatier

    I enjoyed your article, particularly highlighting social responsibility is crucial to the credibility of the medical professional. I could not agree more, Stephen.

    Credibility to those needing health care or the health system of medical professionals knowledge as goes to the core of all ethics in modern medicine , doesn’t it?

    • ask412 says:

      Still, where the line of logic comes apart, credibility I mean, is the alignment with corporations who use power and wealth to leverage legislation is written in their favor, so that laws support their profit premise before corporate social responsibility | CSR exists in state after state and federally; where such overt manipulative behaviour is clearly poor CSR.

      Case in point, is the well-known EpiPen price gouging disaster and all its global implications, still, there are many others that we both know we could use and cite here aren’t there?

      While corporations are given carte blanche in law to use little if any corporate social responsibility*, Complimentary Alternative Medicine-CAM will always have a foothold. Both groups of businesses need effective Federal regulating, where testing without a clear line of vested interest is done. However, we all know the regulators have had their teeth pulled out legally, legitimately by legislation written, reducing staff, changing the course and direction of regulation, till they are little better than rubber stamps for the most powerful multinational corporate entities and their profit premise before CSR*.

      A good place to start would be to restrict advertising of both these groups, pulling all the media by making it illegal, through digital data transmission, free to air broadcast on all frequencies, printed magazine, and newspaper advertising, reverting the discovery about medication or treatment regimen too, reguCAM, or otherwise to qualified medical professionals like yourself.

      Is this feasible, doable, acceptable?

      No, not to the those with vested interests in profiting before their application of their primary driver exponential profit year in year out, most definitely no, it isn’t?

      The apex of our economic system is no longer framed as a fair system, even though we are told over and over its proof of how freedom and capitalism works, but is it really?

      Nevertheless, regardless, how can we complain about the ineffective and clearly, questionable CAM practitioners, their products and treatment regimes; while being hypocritical about the biggest problem in this eras healthcare, profit put before CSR*?

      Meaning, Potemkin Social Responsibility or CSR* of health care, or next to none, in health systems and their products, tested or not by vested or nonvested interests, used while endorsed by medical professionals in every single field of human healthcare.^

      Please, anyone, tell me where my lines of logic are flawed. Nonetheless, do be mindful what social responsibility & CSR* means, and naturally, don’t insult people’s intelligence quoting the failed economics arguments based on government austerity that never worked in all of human history. Or use any capitalist branding of what amounts to corporate welfare, as we all know the weasel words, old and new selling those stories for decades.
      ________________

      • @ask412
        Your logic falls apart in trying to link the effectiveness of CAM with corporate malfeasance. There is no question of the benefits of proven health treatments. No one is trying to say that the epi pen is a sham treatment, rather a example of corporate gouging. Trying to say that we should use nonsense because corporations do bad things is where your logic falls apart. The questions that need to be answered are effectiveness and safety. If CAM has any effect it has not been demonstrably shown in anyway close to level of proven medical treatments. The practitioners and proponents CAM therapies avoid evidence, continue despite mountains of poor dat,a deny and avoid any exploration of safety. CAM is a multi-billion dollar business that does just as many bad things as “Big Pharma”. CAM is a industry that uses its money and influence to prevent anyone from holding them accountable for their claims, both with legislative and litigation actions. How does that significantly differ from what the makers of epipens has done? Well there is one difference that I can see….. The Epipen can actually save a life. This is not speculation this is not claims of fanciful ancient remedies, or claims to nature, it is simply mountains of good data. Do individual doctors do wrong-sure, are their episodes of corporate shenanigans, absolutely, does what they offer for treatment work-Yes. Do naturopaths, acupuncturists, and homeopathic practitioners do wrong-sure, are there corporate shenanigans in the supplement industry- absolutely, does what they offer for treatment work as far as we can tell? TO date nothing.
        We can all appreciate that industry needs standards and healthcare is something that needs monitoring. We just have agree that what we need to assure first is effectiveness and safety. Sorting out the bad business practices needs to happen, part of solving that problem is by getting rid of the business that sell snake oil.

        • Larry Goldfarb says:

          They are embarking on some studies to see if meditation can be used to reduce the use of pain killers after back surgery. so at least they are starting to look at some of these scientifically. So in a couple of years we shall see.

          http://www.wsj.com/articles/can-meditation-help-pain-after-surgery-1474299114

          • ask412 says:

            ’embarking on some studies to see if meditation can be used to reduce the use of pain killers’ Larry Goldfarb

            They will need a whole lot more than ‘some studies’ to prove CAM therapies. All anyone could recommend is becoming familiar with google scholar rather than advertorial blogs like WSJ.

            Nonetheless, there is no doubt you are free to choose if you need back surgery, and can find a willing surgeon. There is always a medical professional willing to do anything for the for the money.^ After all, it is a for-profit system in America, so it should be little trouble.

            _______________
            ^ https://youtu.be/UfiZ4fidqvk

          • mudguts says:

            Oh wow.. a new one!!

            same conspiracism..

            May as well be the old one..

          • Meditation like all relaxation techniques works to some extent. The problem in ascribing magical effects. Pain is a sense that is evolved to be dismissed when necessary and possible. Like all relaxation techniques and exercise. Reducing psychological stress has a positive effect on reported pain. Best with chronic pain, poor with acute severe pain. Meditation is no different from exercise and massage or even prayer. It helps but like all acute pain probably not enough to deal with any type of major surgery. It would never pass IRB to do the research without some type of proven technique to prevent severe patient pain. Therefore you will be dependent on a persons subjective anecdote since you can’t possibly have sham meditation. So like other subjective techniques will invariably be a positive study that will tell us little of how effective it really is.

          • mudguts says:

            i.e. go for a swim.. it worked for Krishna right?

        • ask412 says:

          ‘…[@ask412 your]…logic falls apart in trying to link the effectiveness of CAM with corporate malfeasance’ Stephen Propatier

          That may well be your opinion, nonetheless, in law, both business models can demand to be treated equally, given enough financial equilibrium there would be a fair outcome between the two in a court. Still, as wealthy as these CAM medicine corporations are they have a small portion of the mainstream corporate wealth of pharmaceuticals companies.^

          You may not like reading and believe that people don’t trust pharmaceuticals or medical health systems, suppliers and their legal entities, still, it happens to be the reality, right or wrong.

          Unless both complementary alternative medicine-CAM and mainstream corporate medicine aren’t held accountable using the same rules; it is highly improbable there ever will be a fair outcome in people’s perception, despite what you and I feel about CAM.

          Bing mindful when modern medicine diverted from ‘herbal remedies’, it was the surgery and the development of hospitals for surgeons that diverged ‘for profit’ that differentiated the two streams of health care. The efficiencies afforded the surgeons in hospitals in those early and later years led to greater leverage using capital wealth gained and this power to influence legislation was written favouring their health system we all now deal with.

          No sane individual would argue that the America health system model has been egalitarian providing the absolute best care for every patient rich or poor. It has been purely based on a meritocracy, where only the wealthy get the best health care. But a good start would be treating these corporate money making entities equally, holding both systems to account on corporate social responsibility-CSR. Particularly as the perception is distrust of the ‘for profit motive’

          As for the psychopaths selling snake oil, the test needs to apply to both systems, where peer reviewed publications of long-term studies and efficacy are tested giving proof of concept where safety comes before profit. Since I have yet to read in verified scientific publications, after peer review that radiation hormesis is more than a hypothesis or homeopathic medicine works any differently, or that herbal remidies can replace some drugs, even if they just provide a placebo effect;
          how can applying due diligence on medicine, CAM or mainstream be that difficult?

          However, we both know the system is flawed, and profit is indeed put before CSR. Unless both are held to the same strict standard, CAM will flourish, based on distrust of modern medicines profit before CSR primary premise.

          It’s simple, apply the same standards to both in law, if one fails, it is economically, since the whole economic system is based on a ‘for profit model’, what is the problem?

          What better place to start than cutting the advertising out from under both. Demanding medical professionals are directly briefed about drugs, or CAM without incentives, but with appropriately supervised medical training in educational institutions along with other postgraduate students.

          ^ CAM
          $US9 billion per year:
          https://goo.gl/325Z3m

          ^ Mainstream pharmaceuticals
          $US337 billion per year:
          https://goo.gl/KbgfTI

          • Like everything you have listed here it is either untrue or unrelated. the supplement industry alone in 2012 made 37 billion. That completely excludes every other type of CAM Homeopathy, acupuncture, chiropractic, spa treatments. It has tons of political cash and influence.
            For profit medical models have to have standards its not selling widgets. People selling widgets can afford to sell you useless junk cheaply because people lives aren’t at stake.
            How much money is made is irrelevant. 337 billion a year for effective treatment is a much better bargain than 40 billion wasted on sham or harmful treatments. Throwing rocks at Proven Medicine flaws is hardly justifying the effectiveness of CAM.
            Medicine has flaws there is no way to avoid it. CAM’s flaws are so deep they refuse to even acknowledge that they even have flaws. It is a belief system not a system of scientific medical treatment. If you want to wish yourself better go to church.
            “I should get to sell my junk because you cost more money than me” is a wasteful and irrelevant to the problems of healthcare.

            One thing we both can agree on is the direct advertising of pharmaceuticals. It needs to stop. The perceived informational benefits is underwhelming in my opinion compared to the costs of advertising we all incur when we take medications.

  4. Macky says:

    Whatever the “science-based vs alternative medicine” debates reveal, there is never going to be total confidence in the mainstream medical system until it has been seen to have cleaned up its own act re inappropriate pushing of drugs and the back-pocketing of GP’s for side-income.

    Many have turned to alternatives because of a few good results in methods such as acupuncture where conventional medicine failed, for example. And the fear that abounds in some quarters of what is exactly in the latest vaccine that the authorities want to pump directly into your bloodstream is heightened by horrendous stories of children as well as adults being made ill by said vaccines, and still getting the illness that the vaccine was supposed to prevent.

    It is still noted to be a direct conflict of interest when drug companies perform their tests on their own drugs and government departments in other countries accept those tests without doing any of their own before passing said drugs on for distribution.
    In addition, there is the question of dirty drugs as well, manufacturing standards not being kept up.

    Western medicine is a triumph of research methods that continue to improve and adapt in the spirit of progress. Surgery especially.

    All that has been tainted by the criminal behavior of drug companies, many of them household names, and the resulting convictions and fines, plus doctors prescribing dangerous drugs where not appropriate for the patient’s condition, for kickbacks, a blatant betrayal of medical ethics.

    • mudguts says:

      Sorry.. no good results at all..

      Its sort of like saying ” only partly antivax”.

      Conspiracism gets nobody anywhere.

      • Macky says:

        I’ve asked you several times van der Ghaast to name one single conspiracy or conspiracy theory I’ve ever promoted on here or the old Skeptoid, and you’ve never been able to, but you keep up your tired old “conspiracism” assertion.

        You, like the other status quo supporters on Skeptoid blog simply keep on ignoring blatant evidence that support what I post on here, i.e. that despite the undoubted triumphs of modern scientific medicine, there are many who are suspicious of vaccines and other drugs because of the outright criminal behaviour of drug companies and doctors in their pockets.

        Here’s a sample I’ve posted before by way of solid proof of what I say, something you are simply unable to refute https://en.wikipedia.org/wiki/List_of_largest_pharmaceutical_settlements

        Note that’s only the top 20 since the early 90’s. Alternative medicines should well come under the same laws and restrictions as mainstream health care, but can you blame those who don’t know any better when they see something like the above ? Not everybody is a scientist, retired or otherwise.

  5. Swampwitch7 says:

    EARTH TO CONSPIRACY THEORISTS: were any of you aware that modern medicine derives from witchcraft and herbal medicine? If it worked, somebody took the opportunity to market it and make a business out of it. If it didn’t work, they didn’t.

    Does this suggest anything to anybody? Like, the good stuff has already been co-opted and the less so is left for the scavengers to quarrel over?

    Just sayin’.

    • Mudguts says:

      Modern medicine is derived from the science of the past 150years. You’d be in all sorts of trouble amongst the bleeders,poisoners and water torturers.

      If thats the sort of medicine you want… fine.. but dont woob, woob, woob swampwitch.

  6. Macky says:

    Yes but let’s not forget what I’ve posted above, that modern 150 year-old scientific medicine has been grossly debased by the greed of Big Money and Power.

    There’s no conspiricism, only courtroom historical fact, as the link I posted in an above post demonstrates.

    Why should anyone that knows the above facts of criminal misbehaviour by drug companies have much confidence in modern medicine given their disgraceful record of off-label promotion and doctor kick-backs ?

    Btw, that’s not an attack on science, but simply an observation on human behaviour distorting applied science. The bristling scientists can calm down and breath through their nose.

  7. Mathiasalexander says:

    Have people stopped conspiring yet?

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