Opinion

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

25 Comments
  • Laura Combden says:

    Not everything that is true can be proven, and the gaps in the medical system get bigger everyday. Those that fall in those gaps are the under-represented. Basically anyone that isn’t a white male, and has not had the opportunity to have been represented in a large-scale study. I’m all for science, but when you keep touting science as all-knowing, while refusing to acknowledge the errors its made along the way, and refusing to admit that science does not always equal truth. Science is evolving too. The arrogance to believe you know everything, means you know nothing about nature. Not everything that is true can be proven, math sits on the shoulders of assumptions.

    This gap in the mainstream system is allowing too many to fall through, so please don’t harass a system that was created specifically to fill the gap of knowledge, when all the patients want is someone to help them after they’ve been rejected from the traditional healthcare system.

  • Dr. Yogesh Bele says:

    Namaste Tim,
    At the outset, I express my heartfelt sympathies towards all that you’ve been through, courtesy the various pathies.
    By now, I am sure, you must have learnt that even the human body doesn’t keep all it’s eggs in one basket when it comes to it’s neuro- physiological functions or any of it’s functions for that matter. Remember! sympathetic, parasympathetic, etc? Taking aleaf from this, having had enough of pathies that brought you nothing more than more sympathies, of which you must be fed up by now, it’s time you turn to the para( sym) pathies. Para here implies to – besides, beyond and apart from.
    So besides pathies, beyond pathies,and apart from pathies is the domain you have to look up at. Medicine, wedded to economics, conventional or otherwise, has served as nothing but a wound on the body of life. Also true is that, the wound is the exact point where the ” light of life” enters the wounded.
    As you heed towards the -besides the pathies, beyond the pathies and apart from the pathies, a plethora of mystic healings shall convey you.
    You shall realize the revelation of Shri Voltaire that “the art of medicine consists in amusing the patient while nature cures the disease” and that for not in the Oblivion has some of our brothers stated- ” Life is beautiful if you know the alternative ( here medicine)”.

    Prayers!

  • Mahesh Sabade says:

    Very well penned article. I have mixed thoughts/emotions.
    I represent Ayurveda as a practitioner, teacher, researcher and speaker. I can proudly say Ayurveda is effective in many areas/clinical conditions/incurable stages of diseases etc.
    There are numerous research papers related to such clinical work in the field of Ayurveda.
    Thank You!

  • Gail says:

    Very well said. There is room for both in today’s society but there are pros and cons to both.

  • Zsolt says:

    Great article, great approach!

    Nutritional science has to be one of the most confusing topic on planet Earth today.
    “The Experts” don’t even agree on what causes obesity. What sort of objectivity is that? At least real science like biology nor physics agree on the basics.

    People are waking up to the fact that in reality no drug, diet or a doc heals you because the human body is a self healing organism.

    Creating a right environment for the body to heal itself is very different to the Rockefellers mantra which has been ruling Western medical science in the last 100 years: a pill for an ill

    So my honest question is what’s the doctor role: to help patients so they can heal themselves or to create a long term customer?

  • Esther Konigsberg says:

    Dear Mr. Caulfield,

    I note with interest that despite all your impressive qualifications, you have no degrees in science. Although you continue to cite science in your dissertations, it is scientifically implausible to brush multiple “alternatives” with one broad stroke. Similarly, it is egregious to characterize a wide range of practitioners as using unproven therapies to the disadvantage of their patients.

    I could speak to my own experience, as you do, as a family physician that practiced for 23 years realizing very early on that what I had to offer my patients was severely limited. Don’t get me wrong, conventional medicine is a wonderful tool when used appropriately in the right circumstances. However, the old adage, if all you have is a hammer, everything looks like a nail applies to conventional medicine. We all realize that pharmaceuticals are over prescribed with unfortunate consequences. (The opiod crisis being one of the most obvious fall out of conventional medicine.)

    As a physician, frustrated by my limited tools and patient outcomes, I had to look outside the paradigm and did a fellowship in Integrative Medicine from 2001-2003. Counter to your unscientific contentions, I learned that there is a plethora of evidence for much of what you claim to be useless. The research is ongoing and the field is exploding. Before you claim to say that I don’t understand science, I was in Medical School at McMaster when Dave Sackett, the father of evidence based medicine was there. As a young physician I was ingrained with the tenets of evidence based medicine and live and breathe them to this day. I understand critical appraisal of the literature, I understand hierarchy of evidence and I apply it to my practice of Integrative Medicine ongoingly.

    I am not alone. My many colleagues who have completed fellowships recognized by the American Board of Integrative Medicine do the same. We see outcomes with our patients who cannot find satisfactory resolutions through conventional medicine alone. We receive many, many referrals from our conventional colleagues as well. And yes, I agree, that gratitude and life purpose is important, but when patients are sick, they have just enough energy to survive. We bring them back to being able to engage with life and fulfill their purpose as engaged contributors to society.

    I suppose you would ask for proof. Of course, I cannot address every intervention that my colleagues and I do but there are a couple of noteworthy examples to cite (They are U.S. centric, but still applicable):

    1) In response to the risks of pharmacological treatments for both acute and chronic pain, and more specifically to the ongoing opioid crisis, nonpharmacologic pain approaches are recommended as a first line of care by the Centers for Disease Control and Prevention (CDC) and the U.S. Food and Drug Administration (FDA), the Army Surgeon General Pain Task Force,16 the American College of Physicians (ACP), and as part of comprehensive pain care by the U.S Agency for Health Care Research and Quality (AHRQ), National Institutes of Health (NIH), the National Academy of Medicine (NAM, formerly the Institute of Medicine IOM) and the Joint Commission (TJC).
    Interventions that improved function and/or pain for ≥1 month:
    Low back pain: Exercise, psychological therapy, spinal manipulation, low-level laser therapy, massage, mindfulness-based stress reduction, yoga, acupuncture, multidisciplinary rehabilitation (MDR).
    Neck pain: Exercise, low-level laser, mind-body practices, massage, acupuncture.
    Knee osteoarthritis: Exercise, cognitive behavioral therapy (CBT).
    Hip osteoarthritis: Exercise, manual therapies.
    Fibromyalgia: Exercise, CBT, myofascial release massage, mindfulness practices, tai chi, qigong, acupuncture, MDR.
    Tension headache: Spinal manipulation.
    Serious harms were not observed with the interventions.

    2) Whole Health System of Care Evaluation – A Progress Report on Outcomes of the WHS Pilot at 18 Flagship Sites. This is an out come based report from Veterans Affairs, that studied patients using co-ordinated Integrative Health Services, called Whole Health. There was a significant reduction in opiod use, pharmaceutical costs, better engagement in life with improvements in mission, aspiration, purpose and overall well-being. There was an improvement in employee health care workers job satisfaction with a reduction in burnout.

    I would be happy to discuss this with you further.

    Dr. Esther Konigsberg M.D. CCFP
    Assistant Clinical Professor McMaster University
    Assistant Clinical Professor University of Arizona
    Institutional Representative Academic Consortium of Integrative Medicine and Health
    Chair of the Fellowship Recognition Committee for the American Board of Integrative Medicine
    Upcoming Chair of the Ontario Medical Association Complementary and Integrative Medical Interest Group

    • Christine Houghton PhD.,R.Nutr. says:

      Thank you so much for your well-considered reply. It annoys me, as it must do you, to see articles like this one written by authors who have really no idea what the practices of Integrative/Complementary/Nutritional Medicine entail.

      I too have practised and continue to teach evidence-based Integrative/Nutritional Medicine/ Nutrigenomics. Patients who seek us out are looking for clinical results, not a reassuring placebo-style ‘pat on the head’ as the author so patronisingly describes what such clinicians provide.

      You have described the situation far more eloquently than I; thank you.

  • Rebecca says:

    Bravo! As a cancer survivor I cannot tell you the number of idiotic suggestions people made to me to treat my cancer. Surgery and radiation was all that I needed, and was quite effective. Hope I never hear another exhortation to “eat clean“ whatever though F that means!

  • Shay J. says:

    After learning of your close relationships with front groups and well documented shills it became clearer why you’d use your time to go after Integrative Medicine as much as you do. Time will not be kind to you as your bigotry and stereotyping against Integrative Medicine will be seen for exactly what it is.

    • Rebecca says:

      Medicine will be seen for exactly what it is, which is evidence-based, often highly effective, and considerably more accessible than the nonsense that is overpriced woo.

    • warren t says:

      Hi Shay, can i get a list of the front groups and the well documented shills please. cheers

  • Denise Thomson says:

    Well said
    This goes for pets as well in my exspierience.

  • tracey says:

    Well said Tim
    If only alternative medicine had no side effects. Since I have seen many the idea that there is none ……the approach is harmless is not true. The side effects and dangers are just undocumented. Conventional style medicine can’t address all things. If doesn’t pretend to do so. It attempts to link those illnesses we have known scientific treatments for with people with the illness. Sometimes this is a process and it takes time. Sometimes there are errors especially in a stressed system. Mostly it is not designed to make you happy with your life or give you fulfillment ( accept for true clinical psychiatric dx it can help)….that is your job. Perhaps if we all focus on what gives a sense of deep purpose, hope and gratitude to fill our lives with joy and focus less on the negative in ourselves, others and systems working hard maybe we would enjoy life and this amazing world we live in. Like most things using conventional medicine appropriately and conventional medicine and other fields working together to address their areas of strength so that the patients needs are met is likely ideal. I am not sure why anyone needs to be on a pedestal how about if we are respectful of each other.

  • Harriet Harris says:

    The best solution is to read and do what is best for you. However, putting anyone on a pedestal, whether it be a politician or physician is just wrong. There is no way that I will take a medicine without researching it. If I
    had to choose, and if the situation allowed me to, I would go the natural path instead of pharmaceutical drugs with side effects leading to more meds. It just makes sense.

    • Rebecca says:

      “Natural“ substances have side effects too. They’re just not studied or documented. There are many natural remedies that can kill you.

  • Mike Fraumeni says:

    Excellent read! It would be interesting to know what types of psychotherapy might be included in alternative medicine. For example, see link below to Pubmed (National Library of Medicine’s bibliographic indexing system database) to the medical subject heading for psychotherapy. Included for example is art therapy. Would art therapy be considered as well a form of alternative medicine? I don’t know. Or play therapy which is also included under psychotherapy. And perhaps art therapy could be considered mainstream as a therapy for seniors health but not to use it for cancer patients as part of their rehabilitation?

    Psychotherapy MeSH heading
    https://www.ncbi.nlm.nih.gov/mesh/68011613

  • MD says:

    Tim,

    I doubt you had a “shattered” metatarsal. A little histrionic, no?

    The rest of the article was a sane read and worthy of a chuckle. Or chortle.

    Keep up the good work. And sorry you, family, and friends have had some awful experiences. The standard isn’t perfection but collectively we can strive to do better.

    And of course, Lyme disease has made it into the comments [already].

    Regards,
    M. DiStefano, MD

  • Harold Pupko M.D. says:

    Dear Tim,
    You wrote: “…do we really want to encourage an approach that invites people to ignore the science and use less critical thinking?”
    Science is being ignored in the COVID-19 vaccine rollout to the possible detriment of the public health.
    We are getting a panic-based public relations campaign instead of a scientifically validated public immunization strategy.
    I hope that you will publicly be at the forefront in supporting Canada’s chief science advisor’s concerns about the dosing intervals being offered to our citizens: https://www.ctvnews.ca/health/coronavirus/research-doesn-t-back-vaccine-dose-delay-for-seniors-canada-s-chief-science-adviser-says-1.5358075 .
    Unless of course, you only support “science” that fits your political agenda.

    • R Bind says:

      This article is quite inaccurate making wide sweeping comments like “But none of this makes you clinically effective” as though every form of alternative medicine is the same. It’s laughable making comments like that.

      With regards to vaccinations…I totally agree with you. In Ireland, Dr Gerard Waters was struck off because he did not think it was safe in his professional judgment to give vaccinations to his patients and he refused to do so. However, they still had the choice to go elsewhere to receive them if they wished. He stated that the new type of vaccinations had not been studied long enough.
      The expression of the spectrum of differing opinions on this subject is being thwarted and healthy debate is being eroded. That will not improve matters as scrutiny and lively debate with questioning is necessary in all aspects of life. With this virus, we are seeing the dumbing down of debate and really looking at the evidence clinically and making proportional effective decisions. So medicine still has serious issues to address in terms of clinical effectiveness and being based on sound evidence.

  • Graham W S Scott says:

    Thank you for the continuing flow of accurate and helpful advice. I liked the way you put this letter together. Well done as always.

  • Wendy says:

    Thank you!!!

  • Cindy Andrew says:

    Thanks for the nothing Alternative Medicine. #GoScience

  • Dr. Rob Murray says:

    You will find Steven Phillips, MD and Dana Parish, HMH 2020 have addressed this topic very well in Chronic – The Hidden Cause of the Autoimmune Disease… Science is provisional, a way of knowing. Dr. Phillips has treated over 100 physicians for Lyme+ disease and over 20,000 for complex diseases.

    Evidenced based medicine is fine except in many cases it is edited and pruned of everything that doesn’t agree with dogma. It is evidenced biased medicine. “The greater the ignorance the greater the dogma” -Osler. Randomized double blind controlled trials are great except they 1.) take too long, 2.) are too expensive and 3.) don’t apply to most people. Who gets to say what is evidence anyway?

    Historically infection has always been seen to be the root cause of inflammation. Antibiotics have been shown to improve the situation for rheumatoid arthritis and MS patients but this has been ignored. The modern paradigm of medicine is to name it and treat it. There are 4 types of MS but neurologists still don’t know the cause. We are told not to worry because they are coming out with new treatments all the time. The treatments are estimated to reach a value of $66Bn in 2025. Why would anyone want to look for a cure? How many suffer from CFS/ ME/FM or an underlying infection of bartonellosis need to have their immune system dampened?

    Why is the medical community complacently treating patients with inflammatory autoimmune disease with immunosuppressives when these drugs only treat symptoms-not root cause-and put patients a greater risk for developing potentially life-threatening opportunistic infections and cancers? To do this is contradictory to the principles of precision medicine which is based upon the notion that development of effective therapeutic interventions requires an understanding of the processes underlying the pathogenesis of the disease. How can we expect to cure autoimmune disease when we don’t know what we are treating?

    The art of medicine is gone and its medicine that has lost its way. 50 years ago everything was diagnosed clinically. Now days they have tests for just about everything and everything that they don’t have a test for gets thrown on the compost pile of psychiatric diseases. Because what they’re sick with, what they’re struggling with is absolutely valid. And if science can’t yet measure it, if our diagnostics aren’t there, that doesn’t mean it’s not happening. It means we need better diagnostics. The psychiatrist such as Dr. Robert Bransfield are left to tell the patient “of course you’re sick, you’re brain is infected.

    Botanicals have been used for over 5,000 years and seldom cause problems and don’t create antibiotic resistance. Using them in combination with antibiotics can mean using less antibiotics. Sick patients just want to get well yet they are caught in a turf war.

    e.g. Identification of Essential Oils with Strong Activity against Stationary Phase Borrelia burgdorferi, Feng J, Miklossy J, Zhang Y, et al, Antibiotics 7[4], 89; 19-10-16: 89 DOI: 10.3390/antibiotics7040089
    https://www.ncbi.nlm.nih.gov/pubmed/30332754

    Evaluation of Natural and Botanical Medicines for Activity Against Growing and Non-growing Forms of B. burgdorferi, Feng J, Zhang Y, et al., Front Med 20-02-21: https://doi.org/10.3389/fmed.2020.00006 https://www.frontiersin.org/articles/10.3389/fmed.2020.00006/full

    Botanical Medicines Cryptolepis sanguinolenta, Artemisia annua, Scutellaria baicalensis, Polygonum cuspidatum, and Alchornea cordifolia Demonstrate Inhibitory Activity Against Babesia duncani, Zhan Y et al., Front Cell infect Microbiol 21-03-08: https://doi.org/10.3389/fcimb.2021.624745 | https://www.frontiersin.org/articles/10.3389/fcimb.2021.624745/full

    Obsolete inaccurate blood tests still bring in big money for the patent holders, so why would they want to improve them? Why not just control the conversation, keep saying that they work fine?

    Pharmaceutical industries sell few cures but lots of bandages – very expensive bandages that require lifelong refills. No pharmaceutical company is interested in finding the cause of autoimmune disease and eradicating it. That wouldn’t be profitable.

    This is a medical system divided against itself. Adherents to the dominant
    medical opinion on Lyme and tick-borne diseases [TBD’s] are willing for various ideological reasons to let people perish. The defining characteristic of corruption in modern medicine is the abandonment of the patient’s interest. Patients are often road-kill on the highway to profit for the insurance industry.

    Dr. Rob Murray [DDS ret’d], Lunenburg, NS, Canada
    Board member Canadian Lyme Disease Foundation [www.CanLyme.org]

    Reference: Goldman Sachs asks in biotech research report: ‘Is curing patients a sustainable business model?’ Kim T, CNBC 18-04-11: https://www.cnbc.com/2018/04/11/goldman-asks-is-curing-patients-a-sustainable-business-model.html

    • Adam Mercy says:

      Brilliantly said Dr. Murray.

      The problems are far deeper and more existential than we know. Profound lies are the norm. Fluoride is a neurotoxin. Thr editors of the JAMA journal which published the data on fluoride and iq acknowledged that they were surprised but had to publish the data. CDC has admitted in court they have no evidence to claim it is safe. On their website they still call it one of the top 10 all time public health successes ever.

      Puff pieces are all on the net saying ya but correlation isn’t caution blah blah blah. People don’t realize that the deeply dangerous industries sponsor a slew of content that causes confusion in the public. One Forbes piece even wrote this:”Certainly, excessive levels of anything, even avocado toast, can be harmful.”

      I assure you that fluoride is not a chemical we need toxicology work done on. There are mechanisms. It is one of the most harmful chemicals known to mankind.

      Let focus on the now.
      Now just think .in the rush to vaccinate….what if the spike protein itself is a pathogen? Magro published this in Nov 2020 – brain pathology work that is strong. No viral replication in the brain. Pathology from viral proteins.

      The chemical industries literally have cornered the market in ideas and yet represents an imminent threat to civilization.

      I could talk about how many of the things you poo poo in this article have strong evidence for them – like energy medicine – but maybe in their infancy in practice. But when you are imminent danger that is not the place to focus.

      Adam Mercy
      Scientist

    • Dena says:

      Spot on

Author

Timothy Caulfield

Contributor

Timothy Caulfield is a Canada Research Chair in Health Law and Policy at the University of Alberta and author of the book Relax Dammit! A User’s Guide to the Age of Anxiety (Penguin Random House, 2020).

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