Tuesday, January 31, 2012

Alternative medicine and the lesser of two evils

A recent article at the conversation (an Australian news website) titled Alternative medicine can be scientific say besieged academics discusses the integration of Complementary and Alternative Medicine (CAM) into mainstream university health programs in Australia.  The article takes a present both sides of the issue stance and thus quote from those who want alternative medicine out of universities and those arguing for its inclusion.

Those trying to stop the integration of CAM into universities point out that allowing integration "give[s] such ideologies undeserved credibility."  And that such undeserved credibility could lead to greater problems:
"The great danger . . . [is] that people who have chronic health problems or who have been persuaded that doctors do not have the answers are delaying the 'proper investigation and treatment' of their illness by instead seeking help from therapists offering alternative medicine."
On the other side the article quotes a Dr. Wardle,("a NHMRC Research Fellow at the University of Queensland’s School of Population Health and co-director of the Network of Researchers in Public Health and Complementary and Alternative Medicine (NORPHCAM), an international group promoting clinical research in CAM").

Dr. Wardle's primary argument for integrating CAM into universities is that CAM practitioners who are university trained won't be quite as dangerous as the "fringe element" who lack university training.  Wardle himself admits that there is "a lot of crap" practiced in CAM.  However, Wardle ignores the underlying complaint of his opponents that Universities promoting CAM may cause the public to rely on these "crap" treatments because, as he argues, at least the treatments won't be quite as crappy.

Wardle tries to ignore his opponents legitimate criticism that teaching bad science is dangerous by using some rhetorical tricks.  I want to address two of his faulty arguments: 1) false dichotomy, and 2) a non-existing contradiction.

1.  False Dichotomy
Wardle's primary rhetorical trick to promote teaching CAM in universities is to set up a false dichotomy.  A false dichotomy is where a situation is set up as having only two possible options when in fact other potentially better solutions exist.  To set up his false dichotomy Wardle ignores the fact that the standards of care for CAM could be improved by proper regulation.  Instead, he argues that putting CAM into universities has "increased the standards, decreased the fringe element, and improved public safety."

This is an implied false dichotomy.  Wardle is trying to argue that we should allow CAM into universities because otherwise, CAM practitioners will be even more dangerous.  This ignores better solutions such as regulating the CAM practice.  This false dichotomy can be seen in Wardle's statement here:
"[the opponents of CAM are] actually not that interested in evidence, because the overwhelming evidence is that putting CAM into universities has increased the standards, decreased the fringe element, and improved public safety, so it definitely smacks of dogmatism . . . ."
Here Wardle has implied that if the opponents of CAM want to make it safer then they have to let it into universities.  This ignores the argument put forth by the opponents who point out that Universities create undeserved public confidence in CAM.  It also ignores the fact that the opponents of CAM are interested in evidence; they care about whether medical treatments are based on evidence or as Wardle describes it CAM "crap."

2. Non-Existent Contradiction
We can really split medicine into two categories: medicine supported by evidence and medicine not supported by evidence.  Wardle tries to confuse this issue with crafty use of the word "but."  Before I get into the problem with the use of this word lets look at the quote I want to address:
"[Opponents of CAM] love to say that there’s no such thing as complementary medicine and conventional medicine, there’s just evidence-based and non-evidence-based, but, for example, St John’s Wort for over a decade now has been shown to be equally as effective as any pharmaceutical indication for mild to moderate depression . . . ." (my emphasis)
When we read the word "but" we assume that what follows will contradict the preceding statement.  However, Wardle doesn't do this, he follows "but" with a consistent statement.  The reason he included the word "but" is to confuse the reader, he wants you to think that it contradicts.  I want you to reread the statement without the word but:
". . . there’s no such thing as complementary medicine and conventional medicine, there’s just evidence-based and non-evidence-based, . . . for example, St John’s Wort for over a decade now has been shown to be equally as effective as any pharmaceutical indication for mild to moderate depression . . . ."
When written this way the statement actually makes sense.  Opponents of CAM correctly point out that some alternative medicines are supported by evidence and those are the ones we should trust.  It doesn't matter whether a medicine is called alternative or just medicine, the real issue is the evidence.

So why does Wardle use the word "but"?  It appears he wants to undermine the fact that we should judge every medicine based on the evidence.  He is trying to get rid of these categories of evidence and non-evidence based medicines and stick to the traditional notions of alternative and modern medicine.  This is essential to his cause.

If we realize that some of alternative medicine is supported by evidence and some isn't then suddenly we can criticize universities for teaching those CAM practices not supported by evidence.  We can simply realize that all medicine should be based on evidence.  Wardle however wants all CAM to be taught in universities:
"The world of CAM is not a “homogenous entity”. . . . There is a lot of crap, but there’s good stuff, and treating it like it’s all the same thing is very, very fraught. Taking it out of universities runs a real risk of the fringe element getting a stronger voice in the profession.”
So remember, Wardle just tried to get rid of the categories of evidence vs. non-evidence based medicine and this quote shows why.  Under his category of CAM we either teach all of it or none of it and thus he says we must teach all alternative medicine to prevent the fringe from taking over.  Note what he is arguing: he is saying that we must teach these fringe treatments we know do not work in order to prevent these same fringe treatments from taking over the profession!  This is absolutely insane, teaching people to do something not supported by evidence is not likely to stop them from performing fringe treatments, its going to increase the use of fringe treatments!

If however we are willing to admit that some CAM is supported by evidence we don't need to teach all CAM.  Instead we can just teach the CAM that works which would actually help to reduce the use of fringe treatments.  This is exactly why Wardle doesn't like it when scientists try to point out that the real issue is whether medicine works and not whether it is called modern medicine or CAM.

Arguing that Universities should teach alternative medicine in order to increase the standard of care provided by CAM practitioners is absurd.  I fully agree that we should try to increase the standard of care to protect the general public.  However, there is a much better solution.

Medical doctors are currently held to a standard of care in their practice.  A doctor is liable for malpractice if they do not perform up to the standard level of competence provided by most doctors.  So why do we allow other people to practice so called "alternative medicine" without being held to this same level of care.  If people claim to be practicing medicine why do we not hold them to the same standard of malpractice as medical doctors.

The solution is easy, anyone claiming to provide medical treatment should be held to a single standard of care, the same standard that every medical doctor is held to.  When I walk into an alternative medical practice my body doesn't suddenly magically transform into a new body that is less harmed by alternative treatments.  So why does the standard of care magically transform between a physicians office and an acupuncture office?

No comments:

Post a Comment