Alternative? Quackery? Experimental? BoingBoing!

On one of my favorite geek blogs, BoingBoing, Xeni Jardin recently posted about quack cancer cures. Xeni was diagnosed with breast cancer a while ago, and she’s been “talking about cancer, sharing the experience of… treatment” for a while now. She’s been getting lots of advice lately from “well-meaning friends” who have suggested some pretty outrageous so-called cures. I’d love it if you took the time to read her post, and some of the ones on other blogs she linked to, as she pointed out the difference between evidence-based medicine and anecdata. “What doctors like my rad-onc practice is constantly under scrutiny, and has endured the test of peer-reviewed science and empirical logic. It’s the best we have…. If I had fake cancer, I’d totally use fake cancer cures. But I have real cancer.”

Not eight hours later, another post appeared on BoingBoing.  Lindsay Stark wrote about the Ancestral Health Symposium, a place where “MDs and naturopaths” talked about “what has come to be known as the paleo diet.” Lindsay, “once a gangly nerd with weak and painful joints” from ankylosing spondylitis (AS), touted her experience with the “so-called caveman diet”: “I don’t hurt anymore; I’m thriving.”

So what’s the difference? Why is a “weird fad diet” OK to look at for treating AS (Lindsay), when “people who sell fake cancer cures are murderers” (Xeni)?

The two BoingBoing posts can actually fit together quite well; I just think the two authors, writing independently, left out a middle piece. Before I can fill that part in, I need to backtrack for a moment to one of the posts Xeni referenced.  Orac at scienceblogs gives some non-standard definitions:

“Conventional” medicine is based on scientific knowledge whereas alternative medicine is based on clinical or anecdotal evidence.

I’d point out that not nearly as much of “conventional” medicine as we might like is actually based on thorough scientific study, but I’ll agree that much of alternative medicine does not have rigorous scientific data to back it up.  Sometimes, that’s because the “alternative” is simply incorrect: no matter what you may hear from which celebrity, the vaccine for measles is not the cause of the dramatic increase in autism.  We know this because as we learn more about autism, we can now see signs of the condition in children months before the vaccine would be given.  Sometimes, it’s because tests are hard to conduct or difficult to fund.  Before the effect of acupuncture on knee arthritis could be studied, researchers needed to develop a way for patients to receive what they thought was acupuncture, but wasn’t: special not-needles that stayed in place even though they didn’t enter the skin.  And sometimes, what starts out as an unverified claim gathers enough evidence to make the jump from “alternative” to “conventional”.  A good example here would be the use of fish oil to prevent heart disease.

There’s another word used for treatments that haven’t become part of conventional medicine, but may make it there one day: “experimental.” Many people who wouldn’t dream of seeing an alternative healer, or who would be dubious of an MD who practices “integrative medicine” (another quote from Orac: “it’s just alternative medicine ‘integrated’ with real medicine, and you all know what happens when you ‘integrate’ cow pie with apple pie”) might consider enrolling in an experimental drug trial.

“Alternative” treatments often come from a different world-view than that used in conventional medicine. Maybe a particular remedy comes from a system that emphasizes balance among multiple traits (hot-cold, or yin-yang); maybe there’s discussion of life-force (ki, chi, prana…) that science hasn’t identified yet. But I would point to the pragmatic quality of science and suggest that if it repeatedly works, in multiple replicated experiments, it shouldn’t matter who thought of the idea: it still works.

So if you’re considering an unconventional treatment, look at some of the details.

  • Is it something that’s being actively studied, or are you just shown testimonials of patients who say it worked for them? Testimonials may be a place to start, but they’re not enough. It’s always possible to find someone who had improvement while trying a particular treatment. The question is, did the treatment cause the improvement?
  • Are the claims out-of-scale? If someone tells me that a certain kind of tree bark can reduce blood sugar in diabetics who take it every day, and that they have a few small-scale studies documenting this effect, I’ll have a look. (Maybe some day I’ll do a post about cinnamon.) If someone tells me about a rare fruit that can cure all cancers, I’ll walk away quickly.
  • Are there side-effects? Pretty much everything has side effects, especially if you are using multiple products or taking more than the recommended amount. Even water can be dangerous: drinking too much water during physical exertion, for example, can cause dangerous changes to the electrolyte levels in the body. If someone tells you a particular treatment avoids a side effect of a conventional treatment, you might be interested. If they tell you that it has no side effects of its own, be concerned.

The conference that Lindsay Stark went to was not just Paleo-proponents sitting around and talking about how well a particular diet worked for them, or selling cookbooks or memberships in grass-fed beef co-ops. To quote her post again: “Binghamton U biological anthropologist David Sloan Wilson called for the testing of the mismatch hypothesis in rigorous and controlled studies; and… Mat Lalonde laid out heaps of data showing… the foods recommended by the paleo diet win out in terms of nutrient density alone. In other words, evolution provides the hypotheses that we then can test. (emphasis added).

While anything based on diet or nutrition is sometimes called alternative, it’s that willingness to rigorously test the hypotheses, rather than just accumulate personal stories, that makes Lindsay’s post about the paleo diet a story about experimental medicine as well. Orac’s objections notwithstanding, there is an overlap between experimental, alternative, and conventional medicine: and in my definition, that mix is integrative medicine.

(Image: ‘Tug of War ‘  by Josh James;