Holistic Medicine: From Alternative to Mainstream?

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The sCAM Commitment
so-Called "Alternative" Medicine (sCAM)

--- As a promoter of scientific medicine, the scientific method, critical thinking, truth in
advertising, health care consumer protection, etc.,

--- And in recognition of the fact that misinformation about unproven and disproven healing
methods, philosophies and ideas is being spread by the use of deceptive and misleading
marketing terminology, especially terms like "alternative medicine", "Complementary
and Alternative Medicine", "CAM", etc.,

--- I commit myself to try, as often as possible, to expose the deceptiveness and inaccuracy
inherent in the popular jargon that is being used to describe and market unproven and
disproven healing methods.

--- One effective method I can use is to attempt to use expressions and words that are more
accurate, and which point out the deceptiveness and inaccuracy inherent in this popular
marketing jargon.

--- One proposed expression to use is:

so-Called "Alternative" Medicine (sCAM)

Other expressions that serve the intended purpose are of course welcome.

--- My hope is that others interested in the preservation of truth and the protection of
society, will join me in making a commitment to do the same.

Paul Lee, PT
Oct. 2002

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Effectiveness & Evidence are the Cornerstones of Modern Medicine, and are a Shibboleth worth fighting for. Claims that any form of
CAM is evidence-based seek to undermine this position.

"Evidence-Based CAM" is an oxymoron. If a method has become evidence-based, then it should no longer be considered or
classified as CAM. Period. Use of the term sCAM is an attempt to combat this misuse.

One of the important functions of the Healthfraud Discussion List is to combat misleading information, such as the confusing and
misleading use of the legitimate terms "evidence" and "evidence-based" by sCAM practitioners to describe their illegitimate methods.
This is one of the most common ways they attempt to deceive the public. While they rarely misuse the term EBM in this way, they
still claim their method or product is backed up by scientific evidence, when at best it is only poor studies they are quoting or
misquoting, and at worst it's a total lie.

My use of the expression so-Called "Alternative" Medicine (sCAM), is very deliberate. It is a very accurate description of the
practices, philosophies and ideas that parade under such misleading names as:

(1) Alternative Medicine
(2) Complementary and Alternative Medicine (CAM)
(3) Integrative Medicine (an attempt to marry CAM to modern medical practice, whether EBM or not)

These all stand in stark contrast to Evidence-Based Medicine (EBM), which is a goal of modern medical practice. While EBM is an attempt to lead modern medical practice away from its earlier, ignorant roots, sCAM is an attempt to revive the ideas and methods that have been proven to be wrong, or which have little or no evidence for them.

While sCAM makes a cute and often true acronym, it must be remembered that not all sCAM practitioners are guilty of conscious deception or of perpetrating real scams, in the illegal sense. So even if they aren't telling "lies", they are still telling "untruths". It's a question of motives.

(Therefore, to avoid legal difficulties and charges of making false accusations against those who UNWITTINGLY promote quackery, I use a small "s" and capitalize the rest of the word. This is also convenient, since CAM is the normal abbreviation for Complementary and Alternative Medicine, which is pretty much synonymous with sCAM!)

The need to avoid the use of the three misleading expressions above is vital. We should not be silent parties to the spread of this misinformation. The expressions, when used by skeptics, should at the least be placed in quotation marks, preferably with "so-called" placed before them. Hence the ideal expression: so-Called "Alternative" Medicine (sCAM)

These three misleading expressions deserve the scorn and skepticism that is implied in this acronym. There is no need to apologize for using it, but an explanation may often be appropriate. The strength inherent in the use of the expression sCAM, lies in the fact that it takes the very words that are misused, and uses them against its promoters. They get their own untruths thrown back in their faces, and in the process are not only ridiculed, but exposed as promoters of untruths. Thus both the false ideas and their promoters get dealt with in one blow.

David Ramey and Kurt Butler sum up my feelings very well:

"The "alternative" folks have had their way with the language. Treatments are "alternative" and "complementary" and "integrative" but the fact is that they're not a legitimate alternative if they don't do anything, they're not "complementary" if they don't add to anything but expense and they don't need to be "integrated" if they're just a waste of time and money." - David Ramey, DVM

"The word 'alternative' appears in quotation marks because the methods it characterizes are not true alternatives. A true alternative to an effective health-care method is another method that has been proven effective. The methods described herein are ineffective, unproven, or both." - Kurt Butler (1992) A Consumer's Guide to "Alternative Medicine." Buffalo: Prometheus Press.

Edward Murray is likewise eloquent on the use of this very term:

One thing that is very important in "marketing" ideas like this is to control the vocabulary of the debate. For example, the alternative crowd has appropriated "alternative" which makes the listener see it as a "valid" alternative. Similarly, their mantra has appropriated "safe," "natural," "gentle" and so on.

To undo this, it is necessary to change the vocabulary, often by just consistently using terms, clever phrases and other things like this that allows control over the debate.

Yesterday, I saw for the first time in a post by Eric Hoy the use of the umbrella term SCAM to describe these folks. That is beautiful. It takes their words and uses them against while at the same plants firmly in the mind of those listening to the debate that this stuff is a scam. By repeating this enough and using it often, it may be possible to strip this crowd of the advantage they now have in the debate which makes their potions and therapies seem legitimate, merely "alternatives," "complements" to real medicine.

There are other less clever ways of doing this. Instead of accepting their terminology, "alternative," it can always be referred to as "so-called" alternative, driving home the point that there is medicine and something else that is not medicine.

That little phrase "there is medicine, and there is fraud" is another way of making this point.

Cathy threw out the beautiful line "Data" is not the plural of anecdote" in a message today.

What a great answer to their assertion that there are studies supporting these SCAMs.

Edward Murray
Aug. 25, 2002
HF List

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Here's the quote referred to above:

"IMHO, this is the core of the "effective" forms of Supplementary/Complementary/Alternative Medicine (SCAM). It doesn't take a lot of scientific training to look at the conditions that SCAM claims to cure, and realize that they have vague symptoms, vague diagnostic criteria, and no definitive pathology. Homeopathy, reflexology, iridology, chiropractic, and anything Hulda touts are most effective when treating imagined diseases, or invented conditions (like fluke infestations). As has been eloquently discussed here before, when a real medical condition like Anthrax appears, even the SCAM artists scramble for Ciporfloxacin."

Eric S. Hoy, Ph.D., SI(ASCP)
Aug. 24, 2002
HF List

***

Below are a number of definitions and quotes that can help to shed light on this matter:

Alternative has two possible meanings. Correctly employed, it refers to methods that have equal value for a particular purpose. (An example would be two antibiotics capable of killing a particular organism.) When applied to unproven methods, however, the term can be misleading because methods that are unsafe or ineffective are not reasonable alternatives to proven treatment. To emphasize this fact, we place the word "alternative" in quotation marks throughout this book whenever it is applied to methods that are not based on established scientific knowledge.

http://www.quackwatch.org/01QuackeryRelatedTopics/quackdef2.html

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Complementary and integrative are claimed to synthesize standard and alternative methods, using the best of both. However, no published data indicate the extent to which practitioners who use these labels actually use proven methods or the extent to which they burden patients with useless methods. Typically these practitioners employ a "heads-I-win, tails-you-lose" strategy in which they claim credit for any improvement experienced by the patient and blame standard treatments for any negative effects. The result may be to undermine the patient's confidence in standard care, reducing compliance or having the patient wish to abandon it altogether.

http://www.quackwatch.org/01QuackeryRelatedTopics/quackdef2.html

***

"Complementary and alternative medicine" ("CAM") is an imprecise marketing term that is inherently misleading. "Alternative" methods are loosely described as practices outside of mainstream health care. They lack evidence of safety and effectiveness and are generally not covered by insurance plans. "Complementary medicine" is loosely described as a synthesis of standard and alternative methods that uses the best of both. In truth, there are no "alternatives" to objective evidence of effectiveness and safety. As noted by editors of the top two American medical journals:

"There is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data or
unproven medicine, for which scientific evidence is lacking. Whether a therapeutic practice is 'Eastern' or 'Western,' is
unconventional or mainstream, or involves mind-body techniques or molecular genetics is largely irrelevant except for
historical purposes and cultural interest. . . . As believers in science and evidence, we must focus on fundamental issues-
namely, the patient, the target disease or condition, the proposed or practiced treatment, and the need for convincing data
on safety and therapeutic efficacy." - Fontanarosa P.B., and Lundberg G.D. "Alternative medicine meets science"
JAMA. 1998; 280: 1618-1619.

"There cannot be two kinds of medicine -- conventional and alternative. There is only medicine that has been adequately
tested and medicine that has not, medicine that works and medicine that may or may not work. Once a treatment has been
tested rigorously, it no longer matters whether it was considered alternative at the outset. If it is found to be reasonably
safe and effective, it will be accepted. But assertions, speculation, and testimonials do not substitute for evidence." - Angell
M, Kassirer JP, "Alternative medicine--the risks of untested and unregulated remedies." N Engl J Med 1998;339:839.

Only a small minority of licensed medical practitioners use "CAM" methods. No published data indicate the extent to which "CAM" practitioners use proven therapies or the extent to which they burden patients with medically useless methods. However, there is good reason to believe that most provide substandard care and seek to undermine their patients' confidence in standard care.

http://www.ncahf.org/pp/whcpp.html

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Throughout the report, the Commission implies that "CAM" is a well-defined medical discipline rather than a marketing term used to promote unproven methods. It fails to acknowledge that science-based medicine is already a highly "integrative" process and that all it requires of any therapy is objective scientific evidence that it works. There are no "alternatives" to objective evidence of effectiveness and safety. If such evidence does not exist for a given therapy, scientific medicine does not embrace it. The Commission falsely assumes that "CAM" research is cost-effective and that "CAM" methods have been sufficiently developed to integrate into every aspect of our educational and health-care delivery systems. Its report does not identify a single "CAM" practice that should be considered improper. Moreover, the Commission did not even propose criteria for evaluating "CAM" practices for safety or effectiveness -- a major flaw in their work.

Given limited resources to improve health care in our society, diversion of federal spending to study illogical and ill-conceived ideas makes no sense. Many CAM practices and methods are illogical, unsafe, and never likely to be effective, a point made in the dissent by Commissioners Fins and Low Dog. The pathway for funding research has always been based on testing viable hypotheses, not all hypotheses, whether viable or not.

http://www.ncahf.org/pp/whcpp.html

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> It is apparent to me that the simply black and white view of
> alt-med (AM)/evidence-based-med (EBM) is dysfunctional and
> often leads to quack busters and skeptics looking silly.

"Recently we on the list have begun to use the term evidence-based medicine instead of "traditional" medicine. Of course, the opposite of evidence-based medicine is not "alternative medicine," but "unproven medicine." Dr. Dean Edell was the first person I heard divide medicine in this manner: what is known to work, what is known not to work, and what is still unsatisfactorily investigated.

"Now, can you honestly say that if you were a physician, you could, in good conscience, recommend that a patient take a substance or undergo a procedure which was either known to be ineffective or the efficacy (and dangers) of which were unknown?"

Lauren Eve Pomerantz
HF List

***

Evidence-based methods are effective, and effective methods should be evidence-based. If a method appears to be effective, then it should be possible to prove it. If the research has not been done yet, it should be. We must remember that 'Absence of proof is not the same as the absence of fact; it simply demonstrates the lack of adequate research.' - Robert Sydenham. 'Lack of evidence in the literature is not evidence of lack of effectiveness.'

Paul Lee, PT

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Definition of complementary medicine adopted by Cochrane Collaboration:

"Complementary and alternative medicine (CAM) is a broad domain of healing resources that encompasses all health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the politically dominant health system of a particular society or culture in a given historical period. CAM includes all such practices and ideas self-defined by their users as preventing or treating illness or promoting health and well-being. Boundaries within CAM and between the CAM domain and that of the dominant system are not always sharp or fixed."

http://www.cochrane.org/

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Alternative medicine is "...an investment in romanticism about health...".

Dr. Sally Satel

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There is no such thing as "alternative or complementary" medicine.

There is medicine which is tested for safety and efficacy. It is based on sound principals of science and regulated by responsible government bodies. It is administered by people with years of education and training. The opposite of this is fraud, not medicine.

If any of the products or therapies put forward as "alternative and complementary" medicine could be proved to be safe and effective, and were manufactured in a way to guarantee that what is on the label is in the bottle, they would not be "alternative or complementary." They would be medicine.

While so-called "alternative and complementary" medicines and therapies are touted as being natural, gentle and designed to do no harm, this is far from true.

Arsenic is "natural." There are potent substances in many so-called "supplements." A large part of real medicine is in fact based upon purified forms of the active ingredients found in nature, made available in carefully controlled doses without deleterious contaminants. As has been shown many times, there are things that can do great harm in some of these so-called "natural" products because the manufacturers do not exercise responsible control over contaminants and the products simply have never been tested for safety.

Many so-called "alternative and complementary" products and therapies are touted as "gentle" and without side effects. They are also without real effects, or these could be found through testing.

And most often these products and therapies that "do no harm" in fact do nothing at all, positive or negative. But they do real harm to people in need of care because they keep them from getting it and deprive them of money that could be used more wisely for their health or even enjoyment.

Scientifically based medicine is forward-looking. and ever-improving. We stand today on the cusp of a revolution in medical science based on our growing knowledge of the human genome and truly enormous breakthroughs in our technology for determining what happens in our bodies when things go wrong.

So-called "alternative and complementary" medicine which purports to be, but rarely truly is, based on ancient medicine is backward-looking to a time when medicine and medical care gave us lives half as long as those we now enjoy.

The science and art of medicine has unquestionably improved and extended our lives in ways which simply could not have been imagined 100 years ago. We will continue this progress and conquer more of the frontiers of disease by staying with the scientific process that has brought us to where we are today, not by allowing quacks, scam artists, and charlatans to run around claiming to have "alternative and complimentary" solutions. True medicine is medicine based on sound scientific principles, not the idea that there is a sucker born every minute.

Edward Murray
Aug. 23, 2002
HF List

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> Catherine Creel wrote:

> That's a delusion. The majority of medicine, as practiced today,
> is not evidence-based. The lack of efficacy in medicine is what has
> more people seeking alternatives. There would be no need for "alt
> med" if medicine,and pharmaceutical drugs in particular, delivered
> what it promised.

Catherine,

It's not a delusion, it's an elevator pitch :>)

I think you are certainly correct that "the lack of efficacy in medicine is what has more people seeking alternatives."

The elevator response is that:

Modern medicine is an on-going process based on science. It certainly does not have all the answers today. What it does have is a process based on scientific methods which has a far greater chance of finding answers than a system of medicine based on unproved claims with no process in place to test either the safety or efficacy of the product or therapy.

You say that "there would be no need for "alt med" if medicine, and pharmaceutical drugs in particular, delivered what it promised."

The elevator response is that:

We certainly do not know the answers to all medical problems, but we are far more likely to find answers with a process that requires that claims be tested scientifically than with a system in which completely unsubstantiated claims can be made and there is no process in place to test them.

All FDA-approved drugs are tested for efficacy for the indications for which approval is sought. They are not approved unless they can be proven to be more efficacious than a placebo or a drug(s) that is commonly used for this indication. While this process is no guarantee that a drug will work for every individual, at least it is medicine based on a sound process far more likely to find solutions for more and more people over time than a system which can simply make a claim with no process in place to test that claim or guarantee the safety of the product.

Edward Murray
Aug. 23, 2002
HF List

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Propaganda and Language Distortion

We now see a new use of an ancient tool used by experts at manipulation of the public mind. Even the words "holistic," "alternative," "complementary," "unconventional," and "unorthodox" are invented euphemisms intended to mislead. They are benign terms covering a vast array of practices -- most of them unproved, dubious, disproved, absurd, and fraudulent. Any politician knows one must find an enemy, even a straw one, to win elections. The term, "slash, burn, and poison' was invented by laetrile advocates to demean ethical cancer medicine, and it worked and it stuck.

In a strange twist of the braid, constructivist sociologist-historians of medicine in an "alternative medicine" journal have already turned the tables on our analysis of language distortion and accused rationalist scientists' use of realistic terms like quackery, misrepresentation, and fraud of being merely prejudicial and biased. They call for more neutral terms to describe absurd methods like homeopathy. Thus the strings of constructivism and propaganda complement each other in the braid.

Wallace I. Sampson, MD, FACP

http://www.quackwatch.org/01QuackeryRelatedTopics/altbraid.html

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6 ft tall poz bear in Philadelphia

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