Focus on Alternative and Complementary Therapies
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Focus Alternat Complement Ther©2005 Pharmaceutical Press
Focus Altern Complement Ther 2002; 7: 241–3
Michael Baum
The English language has a rich and beautiful vocabulary. My Shorter Oxford English Dictionary, which faces me in my study as I write this piece, weighs several kilograms and occupies a whole shelf on my bookcase. All these wonderful words have precise meaning and we tamper with them at our peril. I therefore worry about the use of the words alternative, complementary and holistic, when applied to the practice of medicine. As my contribution to this debate, I would like to sum up my own views on the meaning of these words when describing the practice of the healing arts.
I was forced to confront this question about 15 years ago when I was invited to take part in a series of colloquia chaired by His Royal Highness, The Prince of Wales, at the Royal Society of Medicine. The first question you have to ask is, alternative to what? Proponents of alternative medicine will describe the practice of doctors in the National Health Service both in primary and tertiary care as ‘Orthodox’, ‘Western’, ‘Reductionist’ and so on. However, as someone that has served the National Health Service for over 40 years, I view alternative medicine as a series of comprehensive health belief systems, superficially with little in common, yet sharing beliefs in metaphysical concepts of balance, energy fields and similarities which date back to galenic doctrine from the second century AD, or oriental mysticism some 2000 years older. A wonderful example of this mode of thinking was demonstrated to me when I was involved in a late-night radio phone-in programme in the company of a homoeopathic physician. We were talking about the treatment of cancer and he was recommending the prescription of Iscador (an anthroposophic mistletoe preparation). When I challenged him as to why he was advocating Iscador he explained to me, in tones suggesting that I was somewhat thick, that Iscador was an extract of mistletoe and mistletoe grew as a parasite on the branches of the oak tree; it grew in all directions sucking the lifeblood of the tree in a manner similar to that of a cancer developing within the human body. In other words, because of the belief in the magic of similarities, extract of mistletoe is said to be good for cancer. So, in this parallel universe of alternative medicine, treatments are based on metaphysical concepts, rather than physiology and biochemistry. The second major flaw in my perspective on alternative medicine is that the ‘proofs’ of efficacy are based on inductive logic with an epistemology that dates back to Aristotle. Essentially, this evidence of proof is based on anecdotal case histories, which ignore the placebo effects of treatment and the variable natural history of chronic or self-limiting diseases. I have no time for alternative medicine and I despair of the political correctitude or the softening of the brains of many of our young medical graduates who seem to embrace these antique belief systems with such avidity.
In contrast, I have a lot of time for complementary medicine and I like to think that I practise this approach most days of my working life. The Oxford English Dictionary defines the word as, ‘that which completes or makes perfect, or that which when added completes a whole’. In other words, while modern medical science struggles to make patients get better, complementary medicine aids patients in feeling better, and, who knows, by feeling better the act of healing itself may be complemented. It bothers me not at all if some complementary approaches are placebo; I am often guilty of using my portable ultrasound scanner as a placebo device for reinforcing my reassurance of frightened young women with painful lumpy breasts. It bothers me not at all if the touch of the healer or the hand of the therapeutic masseuse is guided by strange belief systems that are alien to me, provided that the intention is to support the clinician in their endeavours rather than compete in the relativistic market place of ideas. In fact, the very practice of complementary medicine exists at the highest level of the ideals of the holistic process.
Jan Smuts coined the word ‘holism’ in 1926, using it to describe the tendency in nature to produce wholes from the ordered grouping of units at different hierarchical levels, with the whole being greater than the sum of the subordinate units. Chamber’s Twentieth Century Dictionary describes holism in a precise and economic way as follows: ‘Complete and self-contained systems from the atom and the cell by evolution to the most complex forms of life and mind’. It can be perceived, then, that the concept of holism is complex and exquisite, and as an open system lends itself to study and experimentation. In my opinion, the highjacking of the word holistic by proponents of alternative medicine is another example of debasing the currency of our language in order to prop up primitive and closed belief systems. The holism described by alternative medicine is a purely metaphysical construct where the mind, body and spirit are bound together by vital forces or energy fields. The self is perceived as the platform on the three-legged stool of the mind, body and spirit, and if the glue that sticks one of the three legs to the platform softens, then the structure collapses. This glue, this vital force, these paranormal energy fields, are not open to the experimental method of study, and therefore have to be considered a surrogate for faith whose popularity increases in our fin de siecle society. As the twenty-first century opens, Western society appears to be in the grip of a group neurosis, which manifests itself in the expression of ‘New Age’ beliefs, with, for example, 60% of the American public believing in abduction by aliens and unidentified flying objects!
Provided that the complementary physician concentrates on making the patient feel better and spiritually at ease, then their position is secure into the new millennium. I would also urge proponents of complementary medicine to appreciate that the scientific method is an open system that encourages experimentation. Much research is urgently required to investigate the psychosomatic aspects of disease, and the spiritual dimension to healing. Complementary therapists, therefore, should resist complacency and join forces with clinical scientists to explore the domain between the mind and the neuroendocrine levels of the human organism.
Stephen M Sagar
‘… a consistency proof for [any] system … can be carried out only by means of modes of inference that are not formalized in the system … itself.’
Kurt Gödel
Why do cancer patients use CAM? The evidence suggests that most individuals who use CAM do so because of congruence with their own values, beliefs and philosophical orientations towards health.1 In North America, the Flexner report in 1910 reduced the art of medicine to scientism,2 with the consequence that objectivity, positivism and distancing from the emotional and spiritual components of being human, became the norm. Complementary and alternative medicine has forced the provider to refocus on humanistic and patient-centred medicine, including a rapprochement of exiled topics, such as nutrition, spiritual counselling, touch, and psychosomatic medicine.3 Some individuals may use CAM as a coping philosophy that may reflect their feelings of a reduced locus of control leading to depression.4
What do these patients have in common? I believe that they wish to become empowered during their existential crisis of receiving a cancer diagnosis, at a time when their ability to control outcome appears to have been taken away. Most conventional medical interventions force patients into a passive partnership with their healthcare provider. Empowerment improves health outcome, reduces symptoms and encourages adherence to a programme of treatment.5–8 The use of CAM by many patients is a reaction to their impression of forced passivity. When initiated by the patient’s own belief system, and supported by a practitioner that helps the patient make wise choices and monitors safety, CAM may be a useful adjunctive coping strategy.
Although the resurgence of CAM may initially have been a cultural fad, the recent encouragement of clinical trials has now demonstrated that many CAM interventions can reduce the side-effects of conventional interventions (surgery, radiotherapy and chemotherapy). These benefits are beyond just being a placebo effect.9 Many herbal products are being proven in the laboratory to be biological response modifiers and are entering clinical trials. If CAM advocates had not brought the potential benefits of some alternative interventions to our attention, then we would not have discovered some new biological products that are active antineoplastic agents. Many scientific discoveries have been the result of serendipity.10 The extraction of taxanes from the Pacific Yew is a rather clichéd example, but there are many others, such as Chinese destagnation herbs being used as radiosensitisers, which can improve the local control and survival from nasopharyngeal cancer.11 Sometimes, a whole new field of science is derived from an alternative approach; for example, immunotherapy was initiated from the controversial use of Coley toxins.12 When acupuncture was initially introduced from China, scepticism limited its use. However, we now know that acupuncture is a powerful modulator of neurological activity.13 Numerous studies have demonstrated its efficacy for controlling nausea and vomiting. Acupuncture is now proven in randomised controlled trials to improve the efficacy of conventional antiemetics, with the added bonus of reducing pain.14,15 It is now ridiculous to suggest that the efficacy of acupuncture is simply due to a placebo effect. In common with all drugs, belief may add to its somatic effectiveness, but many studies are showing that the electro-physiological stimulation of specific neurological pathways is the primary source of its usefulness. Since acupuncture was considered to be outside of the domain of conventional medicine, this is a clear illustration that alternative patterns of practice can complement the accepted norm of biomedicine.
The concept of CAM should be seen as a socio-cultural phenomenon. It is the antithesis of scientific structure and categorisation. It is the opposite pole of scientism. As such, the current wave of public preoccupation with CAM is a sign of discontent with the dehumanising influence of science. It has led to a quasi-religious division between the extremes of CAM proponents and the so-called ‘quack-busters’ of scientific nepotism. From an archetypal perspective, it is teaching us about the human condition, its shadow, and societal memes. Complementary and alternative medicine has become the thorn of conventional science. However, sometimes a thorn-prick may draw attention to the deficiencies of a self-serving paradigm that refuses self-reflection.
In conclusion, the use of CAM by cancer patients should be seen as an opportunity to research the efficacy of novel interventions, to provide a bridge between hardcore objective science and the subjectivity of the human condition, and to provide the challenge of researching whether science has the courage to be self-reflective and put itself under the same cultural microscope that it imposes on CAM.
