Jan 25 2010
One of the claims most frequently made by “alternative medicine” advocates regarding why alt-med is supposedly superior (or at least equal) to “conventional” medicine and should not be dismissed, regardless of how scientifically improbable any individual alt-med modality may be, is that the treatments are, if you believe many of the practitioners touting them, highly “individualized.” In other words, the “entire patient” is taken into account with what is frequently referred to as a “holistic approach” that looks at “every aspect” of the patient, with the result that every patient requires a different treatment, sometimes even for the exact same disease of very close to the same severity. Indeed, as I have described before, a variant of this claim, often laden with meaningless pseudoscientific babble about “emergent systems,” is sometimes used to claim that the standard methods of science- and evidence-based medicine are not appropriate to studying the efficacy of alternative medicine. Of course, this is, in nearly all cases, simply an excuse to dismiss scientific studies that fail to find efficacy for various “alt-med” modalities, but, even so, it is a claim that irritates me to no end, because it is so clearly nonsense. As Harriet Hall pointed out, alt-med “practitioners” frequently ascribe One True Cause to All Disease, which is about as far from “individualization” as you can get, when you come right down to it. More on that later.
A couple of years ago, before I became involved with this blog, I was surprised to learn that even some advocates of alt-med have their doubts that “individualization” is such a great strength. I had never realized that this might be the case until I came across a post by naturopath Travis Elliott, who runs a pro-alt-med blog, Dr. Travis Elliott and the Two-Sided Coin, entitled The Single Most Frustrating Thing About (Most) Alternative Medicine. In this article, Elliott referred to a case written up by a fellow naturopath, who used an anecdote about the evaluation and treatment plan by a naturopath of a pregnant woman with nausea to show what is supposedly the “unique power of our medicine.” Unexpectedly (to me at least at the time), Elliott did not quite see it that way:
The physician who wrote the article is a chiropractor and naturopath whose practice is nearly 100% musculoskeletal issues. He said that he nearly always refers patients out for other issues, but this case was a woman who requested that he treat her pregnancy-related nausea.
This physician tried, in a series of appointments: ginger root, raspberry tea, pre-natal vitamins, a blood-type diet, acupuncture, acupressure, and spinal manipulation. None of these treatments worked, but the patient persevered.
Finally, the physician reached further in to his toolbox and prescribed a homeopathic remedy that cured her on the spot. The physician noted, “we are so fortunate as naturopathic physicians to be trained in many modalities. … This case reminded me that [we can treat on a much more personalized level] when we are equipped with so many different tools.”
This particular aspect of alt-med reminded me of a disparaging parody of the various nonsense to which many alt-med practitioners subscribe, namely:
If you try bazillions of cures until symptoms go away, then declare the last one to be a cure, you might be an alt-med believer or practitioner.
Which is most likely what happened in the case described, particularly since the last “remedy” tried was homeopathy, arguably the most utterly ridiculous and scientifically implausibly risible “treatment” ever conceived by a human mind. Most likely, what happened is that this patient’s symptoms either regressed to the mean or resolved on their own through the natural course of the condition, and this improvement just so happened to correspond with the trial of a homeopathic remedy. Be that as it may, however, Elliott brought up an interesting point, one that I’ve never heard an alt-med practitioner or promoter bring up before:
This case can certainly be hailed as a success, since the patient was healed and no harm was done by the initial treatments that didn’t work. But I can’t help but feel badly for the woman for having to go through so much trial and error to get results. I mean, it probably cost a significant amount of money to keep returning to this physician for his next guess.
This is exactly the kind of situation that frustrated me when I practiced naturopathic medicine. How did I know what would work for a patient? (I didn’t.) And just like this physician, I didn’t think that there was any way to know, either. I could try and learn from each patient and apply that knowledge to the next one with similar symptoms, but each patient was so unique that what cured one person might have no effect on the next.
Meanwhile, patients are forced to try treatment after treatment, doctor after doctor in search of a solution that works.
Of course, I can’t help but marvel at the irony here. Indeed, the above passage fried my irony meter until nothing was left but a smoldering, smoking, quivering blob of metal and rubber crying out feebly, “¡No mas, no mas!” If such a patient went to a conventional doctor (or to multiple conventional doctors) with a complaint of nausea, and various remedies were tried and didn’t work, just imagine the reaction of various defenders of alt-med to that! This same case, if it had been handled by “conventional medicine” would be cited by alternative medicine aficionados as “evidence” of how ineffective “conventional medicine” is or how it can’t deal with common problems! Indeed, how many times have you heard “testimonials” that begin with a patient describing a trek from doctor to doctor, all of whom were unable to diagnose the problem or find an adequate treatment to relieve the patient’s symptoms? I can just hear it now: The sarcastic commentary about how poorly conventional medicine does with problems such as nausea in pregnancy and how superior “alternative medicine” is in dealing with such complaints. Yet, here we have a case being presented by a naturopath in which the hapless patient was forced to try remedy after remedy, none of which worked until the end, in which it is not clear whether the “homeopathic” remedy actually did anything (chances are, for obvious reasons, that it did not) or the nausea simply resolved on its own thanks to the tincture of time, as nearly all nausea and vomiting during early pregnancy does. Indeed, this problem will resolve in 90% of women by the 20th week of gestation. (How many weeks did this woman try naturopathic remedy after naturopathic remedy?) And this case is presented as a success! Now that I think about it, hanging around the alt-med Usenet newsgroups years ago, I heard similar stories time and time again. If you lurk on the CureZone message boards, you’ll find hardcore alt-med believers discussing trying various remedy after remedy, touting some and dismissing others contemptuously, all on the basis of little or no evidence.
After praising some sort of alternative medicine diagnostic modality called the BodyTalk system, which, supposedly greatly decreases this extensive “trial and error” approach, Elliott concluded:
Two years ago, I would have wholeheartedly agreed this case of nausea was a great success. But now that I know better, I see it as another sign of how far alternative medicine needs to go.
Yes, “individualization” of treatments is touted as the greatest strength of alternative medicine. Who can argue that this is a wonderful thing?
I can, at least to a point.
Here’s the problem with “individualized” treatments. Taken to an extreme, as many alternative medicine practitioners do, “individualization” becomes in essence an excuse to do whatever the heck the practitioner feels like and not to have to list diagnostic criteria or show actual efficacy of their treatments in a way that others can replicate. Look at Dr. Elliott’s statement: “Each patient was so unique that what cured one person might have no effect on the next.” Certainly, organisms such as humans can and do show considerable variability in their biology and response to treatment, but rarely so much that what “cures” one person will have no effect on the next. Such extreme emphasis of “individualization” is virtually custom-designed to lead to exactly the sort of marathon trial-and-error treatment histories he described.
Let’s compare and contrast. In “alternative medicine,” it is very frequent that consultations by different practitioners for the same patient with the same symptoms will result in completely different diagnoses and courses of treatment. In contrast, although there can certainly be disagreement among conventional doctors about the diagnosis and/or treatment for an individual, at least in cases that are atypical or represent uncommon diseases or conditions, such disagreements tend to occur within a much narrower range of possibilities. That is because science-based practitioners will have more standardized diagnostic criteria based on scientific evidence, rather than the individual idiosyncrasies and beliefs of different practitioners. In essence, science-based medicine, through clinical trials and research, has done a lot of the trial-and-error work already, so that individual practitioners don’t have to. The result is protocols that work for a majority of patients. Even when those protocols do not produce the desired results, the choices for “individualization” of therapy are much narrower and based on science and evidence gleaned from clinical trials of large numbers of patients. True, one danger is that this can devolve into “cookbook medicine,” but in reality, as long as the protocols are not too rigid, the good of such protocol-based medicine very likely outweighs the bad. In alt-med, however, what is tried first depends almost entirely on the individual practitioner, as does what is tried next — and next and next and next. There is no standardization and no scientific basis on which to choose treatments.
This emphasis on “individualization” in alternative medicine is particularly ironic when we consider certain specific alternative medicine practitioners, in whose practice disease causation all too often devolves into ludicrous commonalities in which there is claimed to be a single cause for many diseases. For example, the late Hulda Clark used to claim that “all cancer” is caused by intestinal flukes and that “the cure for all cancers” is in essence the same for everyone, a degree of standardization that even the most dogmatic practitioners of evidence-based medicine would find hard to swallow. (It should also be noted that, in an amazing bit of irony, Hulda Clark died of multiple myeloma; i.e., cancer.) After all, no practitioner of science-based medicine who actually knows something about cancer would ever claim that “all cancer” has a single cause. Similarly, Clark claimed to have the cure for AIDS based on similar principles, even though the causes of AIDS and various cancers are clearly different. Meanwhile reiki therapy, acupuncture, and a wide variety of other alternative medicine modalities claim that all disease is due to an “imbalance” in your life energy (qi) or a blockage in the flow of qi that needs to be eliminated; the only way that they differ is in the methods that they use to alter the flow of qi in order to cure. Or consider the case of the frequent alt-med claim that some therapy or other “boosts the immune system,” as if that were always a good thing and there were no such things as autoimmune disorders due to the excessive or in appropriate activation of the immune system. Truly, Harriet was right on target when she lampooned the tendency of different “disciplines” of alt-med to ascribe One True Cause to all disease.
Indeed, one of the most hilariously over-the-top example of this is “Dr.” Robert O. Young, a man I mentioned at my talk during the SBM conference at TAM7 last year, a man for whom acid is the disease and baking soda (in essence) is the cure for all disease. I’ve been meaning to write about him; he has some amazing gems, such as when he claims that cancer is a acid. So are viruses. And acid is the cause of all disease. I’ll add Young to the queue of topics I want to blog about. In the meantime, for your edification here is the slide in which I featured him at TAM7:
And Young is just one example of an “alt-med” practitioner who ascribes all disease to in essence a single cause.
In the end, this fetish for “individualization” in alternative medicine is a sham. It’s invoked when it is convenient to do so, particularly in the cases of “treatments” like homeopathy, in which any therapeutic effect perceived is due to the placebo effect. However, if you think about it, many alternative medicine modalities are far more rigid than conventional medicine in ascribing a specific cause to disease. When you come right down to it, the emphasis of alt-med on “individualization” and “treating the whole person” consists of little more than marketing buzzwords. There’s no evidence that alt-med does any better at treating the “whole patient” than conventional medicine and considerable evidence that, by lumping many diseases of unrelated pathophysiology together and using the same treatments for them, alternative medicine’s claim of “individualization” means the freedom to keep trying stuff until the patient’s symptoms get better on their own.
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