Alternative medicine

Slow medicine: one more thing about alternative medicine

In a recent article, we discussed the interplay between slow medicine and complementary and alternative approaches to clinical care. We concluded in our article that these two approaches share important values, including a focus on simple lifestyle strategies to maintain wellness and manage disease.

However, as slow medicine practitioners, we are more cautious of complementary and alternative therapies, some of which are expensive and unproven, and increasingly associated with adverse effects. Our article has highlighted the need for greater rigor in assessing the benefits and risks of complementary and alternative approaches.

In response, we received a number of thoughtful reviews from complementary and alternative medicine practitioners. One clinician noted, “I am living proof (like many of my clients) of the effectiveness of alternative therapies to prevent, treat and cure disease. will profits be diminished?”

Another comment read: “Of course, small companies marketing non-patentable herbs cannot fund mega-trials, but it is often perfectly reasonable for consumers to make choices based on inconclusive information, such as small animal testing and studies, and/or traditional knowledge.”

We found ourselves sympathetic to some – but not all – of the points raised by our readers, and decided to write this follow-up article to help clarify our point of view. Specifically, we want to point out that:

  1. We respect thoughtful complementary and alternative practitioners such as Dr. Andrew Weil. His recent book that we talked about in our previous article, Beware of medication, is provocative, even if we do not agree on all points. In particular, we enjoyed reading his articulate indictment against our modern healthcare system, which highlights how the American healthcare system provides expensive and invasive therapies to the exclusion of simple and effective approaches.
  2. We agree that it would be absurd to require a rigorous and expensive randomized trial to evaluate every complementary and alternative therapy. Indeed, that would be a catastrophic waste of money! For patients who want to try chamomile tea to treat insomnia, an herb from their garden to manage allergies, or deep breathing exercises to control pain, we strongly support. Where it gets risky, however, is in more serious situations. We could not in good conscience tolerate herbs to manage cancer, nor natural approaches as primary therapy for life-threatening chronic diseases like diabetes for which there are standard, evidence-based therapies.
  3. Although some natural compounds contain substances proven to improve health, the bottled versions we buy in stores bear little resemblance to the compounds found in nature. So-called “natural medicine” has unfortunately become a booming, unregulated business that generates huge corporate profits through the sale of overpriced, refined, bottled substitutes for organic products. Unfortunately, the supplement industry complex has become indistinguishable from “big pharma”.
  4. Due to lenient supplement industry regulations, bottled supplements and herbs often don’t even contain what they claim to contain. Mounting evidence suggests that supplements sold in retail stores surreptitiously contain dangerous synthetic compounds similar in structure to ephedrine, amphetamine, and even methamphetamine. In our opinion, there is nothing simple or natural about these products. In addition, the concentrations of the active ingredients can vary considerably. For example, although the natural substance of red yeast rice contains pharmacologically active compounds similar to statins, the concentrations found in commercially available products are highly unpredictable. All other things being equal, we prefer that our patients know precisely what they are ingesting.
  5. While it would certainly be absurd to require randomized trials to evaluate every complementary and alternative therapy, we believe there is value in improving rigor in this discipline. On the one hand, rigorous supporting data could strengthen the case for effective complementary and alternative therapies, promoting their more widespread adoption. Second, although chamomile tea and garden herbs may seem benign, some “natural” therapies can have unintended side effects. Likewise, alternative procedures such as acupuncture and spinal manipulation can be harmful when performed by inexperienced practitioners. While we are enthusiastic about simple, common-sense approaches, even if untested, we believe that complementary and alternative practitioners would be doing their field a favor by subjecting their strategies to thoughtful, methodical, and independent evaluation.

Overall, we find significant areas of overlap between slow medicine and complementary and alternative practitioners, although we are concerned that some members of the complementary and alternative therapy community are sometimes too “fast-paced” to take approaches to limited efficacy and unproven harmlessness. We would, however, like to highlight the strong evidence base for healthy lifestyle interventions that slow medicine and complementary and alternative practitioners promote.

Updates in Slow Medicine applies the latest medical research to support a thoughtful approach to clinical care. It is produced by Pieter Cohen, MDfrom Harvard Medical School, and Michael Hochman, MD, MPH, from the Keck School of Medicine at the University of Southern California. To learn more, visit their website.