Published in The Skeptic, 2005
The common view of ‘alternative’ medicines among skeptics seems to be that they are merely useless; junk produced and marketed by ruthless profiteers to take advantage of sick and anxious people. Ten years ago I shared that view whole-heartedly; but the experiences of parenthood and middle age have softened my views somewhat. I believe now that alternative medicine has a legitimate place.
By ‘alternative medicine’, I am not referring to systems like homeopathy, which are inherently irrational, or to treatments like massage and reiki, where a practitioner is directly involved: I refer chiefly to the kinds of tablets and capsules that can be bought off the shelf at pharmacists and supermarkets.
Rather than dismissing these treatments out of hand I believe we should take up an attitude of experimentation and establishing consensus. Here are my reasons why, and some of the experiences that shaped them.
1. The placebo effect
Even if we assume for a moment that all non-pharmaceutical preparations are totally inactive, there would still be a place for them, because of the placebo effect. Sceptics have a lot of trouble coming to terms with the placebo effect – I know I did – because it just seems so wrong: how can a rational person be made to feel better by something that has no biochemical impact? But once we recognize that there are a lot of things which irrationally make us feel better – a smile from a passer-by, having a hurt finger kissed, nearly getting the right lottery ticket number – placebos don’t seem so outrageous. I think of them as drugs for the unconscious mind – and since the mind is the organ which contributes most to how we feel, placebos can be very potent indeed.
Of course, it has to be the right placebo. The unconscious mind is simple; it’s not stupid. Tell it that cheap sugar pills will cure your impotence and it will laugh at you. But find a placebo with the right price (cost = potency), the right name (‘horny goat weed’) and impressive antecedents (‘used by Latvian shepherds to promote lambing in their flocks’) and the subconscious mind can be tricked into doing its stuff. And why not? I’ve had several battles with my subconscious mind. I’ve found it a powerful ally and a dangerous enemy. If it takes trickery to get it on my side, I’m all for it.
2. People are different
My family has a genetic sensitivity to peanuts, which varies from person to person. If I eat fifty peanuts, I suffer a mild discomfort. If my daughter eats one, it could be lethal. It’s transparently clear to me now that people have different biochemistries.
So if we react differently to peanuts, why not to echinacea, or St. John’s Wort? The fact that it didn’t work for you, or for your sister, or for ten people in a medical study, is suggestive, but not conclusive. Perhaps your genes are different.
The results of medical testing, in fact, often look like this: ‘Of fifty patients who trialled Treatment X, five reported a worsening condition, five reported an improvement, and forty reported no change. This was the same as in the control group, so Treatment X was considered to have no effect.’ Fair enough, if you’re a doctor. But if I was one of the five in the group who showed improvement, I’d want to know where I could get more of the stuff – wouldn’t you?
3. Self-experimentation
A few years back I caught the ‘flu and decided to try echinacea. Did it work? No, so I stopped taking it. Did I expect it to work? Not really. But I thought that it might. And for half the price of a box of pharmacist’s cold tablets, it was worth a try.
Generally speaking, people aren’t stupid. If they try something and it doesn’t work, they’ll give it up. If the condition continues to annoy them, they’ll try something else, and go on until they’ve exhausted the options or found something that works. If conventional medicine offers options, they’ll probably explore those too. But for the multitude of conditions that conventional medicine can’t yet help, why not experiment? After all, it’s exactly what doctors in pharmaceutical laboratories are doing. They have larger sample sizes and more stringent controls, but I have one big advantage: I only have to find something that works for me.
Right now I am trialling a treatment called ‘Macu-vision for eye health’, to see if it clears floaters in the eyes. My tentative conclusion is that it doesn’t, but just like paid researchers I have to allow for confounding conditions: new glasses, a stiff neck and a case of the ‘flu. I’ve trialled charcoal tablets for irritable bowel syndrome (conclusion: works like magic!) and gingko biloba for tinnitus (probably no effect). If I can get one in ten treatments to work I will be delighted; even one in a hundred would still make it worthwhile. And any clues I can get to help me are gratefully received…
4. Communication and consensus
Among the earliest communities on the Internet – and still among the busiest – are support groups for medical conditions. And much of the traffic back and forth is to do with remedies for these. Conditions that a typical GP would see once every few years are explained, discussed and debated on a daily basis. New treatments are described and reviewed. Web sites go up and are linked to. Knowledge is shared.
I had a dramatic demonstration of the power of the Internet when I began seeking medical help for tinnitus (ringing in the ears). To my doctor, tinnitus was synonymous with hearing loss; she sent me to an otolaryngologist, who cleaned out my ears and sent me on to an audiologist, who told me I had perfect hearing. That was the end of the line for conventional medicine.
Luckily I was equipped to do some of my own research, and I found material on the Internet indicating that tinnitus might result from a crooked jaw. I went to a physiotherapist for some exercises and to a dentist for a plate to hold my jaw straight at nights. The tinnitus reduced by about eighty per cent. Not ‘alternative’ medicine, to be sure, but an unconventional approach that I might never have thought of without help.
Conclusion
So what should a sceptical approach to alternative medicine look like? It could begin by distinguishing between treatments that could in principle have some effect and those that can only ever be placebos. It could acknowledge the role of the unconscious in responding to treatments and practitioners and recognize its importance in well-being. It could recognize that people differ biochemically in their responses to treatments, and that a treatment which works for one person in a hundred is still a treatment which works. It could acknowledge that, as well as a minority of gullible people who need to be protected, alternative medicine is used by people who are rational, well-informed and capable of making intelligent decisions. It could acknowledge the experimental way in which many users are testing these treatments, and the generally clear and unbiased reports they make to others around the world. Most importantly, it could recognize that while alternative treatments are a gamble, for most people they are a relatively cheap gamble that could pay off in a big way.
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