Doctor Ponders Popularity of Alternative Medicine

SAN FRANCISCO—Patients’ use of alternative (or complementary) medicine poses real difficulty for many physicians today. Patients often query their doctors about alternative medicine, asking for evaluations of different therapies, such as acupuncture.

“The problem is that it’s very difficult to be truthful and factual while at the same time honoring the patients’ feelings and beliefs,” said Robert Buckman, MD, medical oncologist at the University of Toronto. Dr. Buckman spoke at a seminar on alternative medicine at the Society of Gynecologic Oncologists meeting.

Most alternative therapies are not based on scientific hypotheses or even collected data, but on anecdotal observation, Dr. Buckman said. And only a few have been proven to be even mildly effective in scientific studies. But that does not mean that conventional medicine might not embrace some of these therapies in the future—if they are studied in a scientific manner.

Conventional medicine like alternative medicine is an ever-changing field, Dr. Buckman said. But unlike alternative medicine, conventional medicine operates on clear didactic principles. “We try to test hypotheses in conventional medicine by disproving them. But alternative medicine adherents have used no scientific methods. They just claim that their treatments cure cancer, for instance.”

Yet if alternative medicine is unproven, why is it so popular? Dr. Buckman said that a 1998 JAMA study offers some clues. In this study, the most common reason people gave for seeking out alternative medicine is that they think they get relief from their symptoms. Other patients believe that alternative medicine is better for their health than conventional treatments. Some also said they like alternative medicine because it promotes health rather than focusing on illness.

Any scientist evaluating alternative medicine, however, has to conclude that most of these therapies are not effective, Dr. Buckman said. In his view, only four such treatments have been proven in double-blind, placebo-controlled studies. These include traditional Chinese medicinal tea for childhood eczema, chiropractic therapy for low back pain, acupuncture for analgesia, and St. John’s wort for mild to moderate depression.

The problem is that factual information about alternative therapies has not filtered down to the public at large, he said. “The reason that so many people believe in alternative medicine is suspension of disbelief. There’s no way to prove that these therapies do or don’t work because no one collects data, there’s insufficient follow-up, concurrent use of conventional therapy, and misinterpretation of information.”

He pointed out that many consumers of alternative medicine say they “feel better” rather than that they are “getting better” through alternative medicine use. “And there’s an enormous difference between these two judgments,” he said.

Dr. Buckman believes that alternative medicine practitioners should stop telling “lies”—saying that their therapies cure cancer, for instance. “These claims can have devastating consequences,” he said.

Yet conventional physicians can learn from alternative practitioners. Many patients, for instance, say they go to alternative practitioners because they get more attention and care than from conventional physicians.

“We need to develop the skills of person-doctoring to the same level as our skills of disease-doctoring,” Dr. Buckman said. “We need to put more emphasis on magic—not just medicine. We need to give the same kind of support that’s contained in mother’s chicken soup. It’s a matter of giving our patients more emotional support.”