CAMLAW: Complementary and Alternative Medicine Law Blog

New York Times Tackles Complementary Therapies

In today's article, the Times took a crack at trying to define the CAM phenomenon.

The 2/3/06 story, "When Trust in Doctors Erodes, Other Treatments Fill the Void," made page 1, which means that complementary and alternative medical therapies, however, we define them, have truly moved, to borrow the title of a book by my colleague and Kennedy School of Government Professor/Harvard sociologist Mary Ruggie, from Marginal to Mainstream.

The story will receive endless commentary, so I'll confine mine to a few selective remarks on points that jump out to my quirky awareness.

Some of the story's assumptions deserve critique--for example: that most patients "do not appear to care that there is little, if any, evidence that many of the therapies work. Nor do they seem to mind that alternative therapy practitioners have a fraction of the training mainstream doctors do or that vitamin and herb makers are as profit-driven as drug makers." Well, we could correct that given time and energy...let's just say that it's easy to over-generalize and jump to conclusions, and much harder to be precise about what the evidence shows. There's also an "all P's are not Q's" problem: we could easily reverse the sentence to make the opposite point: "many patients care that there is a lot of evidence for selected therapies recommended by caregivers that work." (Consider, for example, acupuncture to contorl chemotherapy-induced nausea.) As to patients' supposed indifference to medical evidence, the story cites no empirical evidence. Certainly the legal and ethical principle of informed consent is relevant here as it governs the physician-patient conversation regarding risks, benefits, and the evidence.

As to a "fraction of the training," there is different training; the hard work would be to dig through the reports by respected panels (including mainstream docs) on the White House Commission for Complementary and Alternative Medicine (2002) and on the Institute of Medicine Committee on Use of Complementary and Alternative Medicine by the American Public (2005), and actually review the different kinds of training available to the various conventional and CAM practitioners. "Fraction" reduces a complex set of variables and implies measurement of a specified amount from a homogenous set of educational experiences.

"This straying from conventional medicine is often rooted in a sense of disappointment, even betrayal, many patients and experts say. When patients see conventional medicine's inadequacies up close -- a misdiagnosis, an intolerable drug, failed surgery, even a dismissive doctor -- many find the experience profoundly disillusioning, or at least eye-opening." OK, score a point for the other side, depending on how you read this. There's an ethical value of autonomy here undergirding patient's choices, and it's hard to tell whether the article is being respectful or snooty (paternalistic).

Next: "Consumers generally know that quackery is widespread in alternative practices, that there is virtually no government oversight of so-called natural remedies..." Not exactly. Read the books If there was no oversight, I'd have nothing to write about! (Except a few editorials in the New England Journal of Medicine repeating the same negative mantras about "no regulation," "no proof," "implausible," "doesn't work," plus "danger," danger," "danger," with a few salient examples of current abuses (which, by the way, are the subject of regulation, particularly in healing at the borderland of medicine and religion)). As to "quackery" being "widespread"....well, there's nothing like an epithet or insult to raise the blood pressure. I'm sure the licensed acupuncturists, naturopathic physicians, MD-acupuncturists, licensed masage therapists, and others will have plenty to say about that characterization. In any event, it's time to practice the relaxation response.

"Soon, intuition and the personal experience of friends and family may seem as trustworthy as advice from a doctor in diagnosing an illness or judging a treatment." What's wrong with trusting intuition and personal experience? Perhaps this is the standard dismissal of patient experience as "anecdotal" (i.e., unscientific and therefore irrelevant). Of course, the black-and-white dichotomy of medical diagnosis from a competent MD versus an armchair assessment by a friend makes clear who you'd rather go to, but that's the proverbial 'sraw man' argument. Let's not disparage intuition, particularly when it comes to taking care of one's own body. The article does quote a patient who remarks: "listen to your own body."

There's lots more to say here about the autonomy value....And in Beyond Complementary Medicine, I wrote of "subjectivity, intuition, and mystery in equipose to science and law" so that "the field of knowing may be broadened and enriched."

Everything the New York Times story says makes sense...if you're on one bandwidth of consciousness. In Future Medicine, I described this as emphasizing one regulatory goal (fraud control) to the exclusion of others on the "hierarchy of regulatory values." Analogizing to Maslow's hierarchy of needs, a society that stays at the first rung is neurotic and otherwise unhealthy. As one compensating positive, to the article's credit, the top rung (self-actualization, corresponding to the regulatory goal of facilitating transformation) is acknowledged somewhat in the discussion of spirituality in care.

"From here [listening to one's own body] it is a small step to begin doubting medical science." It wouldn't be the first time! At any rate, isn't "doubt" a religious term? I think of In re Guess, the 1990 case in which the North Carolina medical board sanctioned Guess by taking away his license to practice medicine (even though there was no evidence he had injured any patient), but offered to reinstate his licensure if he renounced homeopathy. Unlike Gallileo, Guess never recanted.

"Whatever the benefits and risks of its many concoctions and methods, alternative medicine offers them at least the promise of affectionate care, unhurried service, freedom from prescription drug side effects and the potential for feeling not just better but also spiritually recharged." Not always. There's a dark side to human nature that can manifest in CAM as well as conventional healers. Call it the Shadow, or read Howard Brody's The Healer's Power. It's there. And credentialing CAM providers so as to integrate them into conventional medical settings also carries a "dark side" of possibly negating the same qualities touted above. Again, beware of false dichotomies. Not to mention the label, "concoctions."

Overall, the story is a nice piece around the editors' chosen theme of CAM being of interst to patients "when trust in doctors erodes." But that is not the only reason for the persistence of medical pluralism and the struggles between the marginalized and the mainstream in any given society. Some powerful misconceptions, largely the legacy of historical battles between medical sects in the late-nineteenth century, still pervade the telling of the story. And to go beyond may require rooting out distorted versions, otherwise we're just glimpsing the old shadows on the cave wall.

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Michael H. Cohen, Esq.; 468 North Camden Dr. | Beverly Hills, California 90210 | 310-844-3173