An open letter to Alternative Medicine

Dear Alternative Medicine,

Please stop insisting I don’t understand. I get it. The conventional health-care system has problems.

Indeed, my experiences with conventional medicine have often been less than ideal. While I was in university, my mother’s physician ignored her health complaints for months and months. It was cancer. She died less than a year after an exasperating series of bungled medical decisions that included a horrific misdiagnosis of a ruptured bowel. A few years later, a close relative died from overtreatment caused by a diagnostic cascade (unnecessary testing leading to unnecessary interventions). Another relative ended up in the ICU from an iatrogenic injury (harm created by medical treatment). I could go on and on.

I’ve been given antibiotics for a viral infection (an error that is still far too common), been told that drinking water will lower my blood pressure (it won’t), and, despite evidence-based national guidelines to the contrary, that I need to get both regular PSA screening and “digital” prostate exams. Once, an injury that X-rays eventually revealed to be a shattered metatarsal (foot) bone was confidently identified to be merely a sprained ankle. “Feel free to keep running on it,” the doctor advised.

To be clear, I have no doubt that most of the health-care providers I have engaged with were doing their best. But there are systemic issues and pressures that often create an environment that isn’t conducive to the optimization of the patient experience. So, yes, I’ve been ignored, belittled, and made to wait (and wait). These are experiences encountered by many (especially, and to a far, far greater extent, by women and people of colour). This reality may have made an increasing number of people fans of alternative medicine. When research tells us that the average physician stops listening after 11 seconds, it is no wonder that 45 minutes of acupuncture, incense and mellow electronica seems appealing.

And yes, dear Alternative Medicine, I am fully aware of the justified concerns about the influence of Big Pharma (and the biomedical industry more broadly) on both research and clinical practice. In fact, in my academic life I have studied these issues, mapping the impact of commercialization pressure on biomedical research and the hyping of results. Not only do these conflict-of-interest issues twist the evidence base used to make clinical decisions, they erode public confidence in physicians and the health-care system.

In contrast, my experiences with you, Alternative Medicine, have almost always been positive, at least in the context of the one-on-one interaction. I’ve tried everything from naturopathy to cupping to crystal therapy to Reiki. And wow, Alternative Medicine, I’m impressed with how much time you spend with me! I very much appreciate how you listened patiently to all my concerns. And I gotta say, reflexology (basically, a fancy foot massage) feels darn good. Chills.

So I get that too. I get why people enjoy hanging with you, Alternative Medicine. But none of this makes you clinically effective. None of this makes your core tenets scientifically plausible – including the idea that there is a life force energy (as suggested by Reiki Masters and other energy healers), that water can hold the memory of a completely absent substance (how homeopathy is supposed to work), or that we need colonics and IV vitamin therapy to detoxify our bodies (common naturopathic procedures). As author and physician Ben Goldacre famously said: “Problems in medicine do not mean that homeopathic sugar pills work; just because there are problems with aircraft design, that doesn’t mean that magic carpets really fly.”

Yes, there is the placebo effect – the go-to, last-ditch justification for selling things that everyone agrees, even the proprietors, do not really work. But do we want a health-care system that embraces (unethical and possibly illegal) deception and magical thinking to induce a transient (and often greatly overstated) effect? In this era of misinformation, do we really want to encourage an approach that invites people to ignore the science and use less critical thinking? Is enabling a vast wellness industry built around placebo theatre a sustainable health-care policy?

In reality, it feels like you are often simply exploiting people, Alternative Medicine. You are leveraging significant, systemic health-care issues in order to sell unproven (and often potentially harmful) stuff to people who may be desperate for answers or comfort. Marketing misinformation is not a form of empowerment.

And you do not, as so often claimed, represent a virtuous path in the fight against corporate greed and patient neglect. On the contrary, you are part of a multi-trillion dollar wellness industry that is, like much of the health-care world, incentivized by profit. Conflicts of interest and industry interference are problems for both conventional and alternative providers. The alternative practitioners I saw charged for their services (obviously) and I was often upsold a host of potions and pills. I once left a naturopath’s office with $300 of useless herbs and homeopathy.

It is true that some of your offerings have intriguing historical beginnings. This can give them an exotic and intuitive appeal. And you often use this theme to silence advocates of a more science-based approach by suggesting we are insensitive or lack open-mindedness. But, in reality, most practices framed as alternative are relatively recent “Western” creations (homeopathy, naturopathy, chiropractic, detoxes, hydrotherapy, chelation, etc.). Others are presented as an ancient modality when, in reality, the culturally glamorous backstory is mostly or entirely marketing spin. (No, those jade vagina eggs were not used in ancient Chinese culture.) More importantly, just because a therapy is ancient, exotic or even popular does not mean it is effective. Heck, bloodletting is considered one of the oldest therapies! 

So, please, Alternative Medicine, stop using untrue assertions to discredit critics and justify your existence. Not only are your arguments disingenuous, they are conceptually incoherent. You can’t fix the problems of the conventional system with unproven therapies, misinformation and a lowering of the standards of evidence. What we need is good science and compassion everywhere, especially in the context of conventional care. We need health-care providers who have the time and resources to listen to patients, and the skills needed to adjust their practice in response to the best available evidence.  

Best,

Tim