Complementary and alternative medicine Medicine Politics Quackery

“Complementary and alternative medicine”: Not just one thing

I’ve been on a bit of a tear criticizing the National Center for Complementary and Alternative Medicine (CAM). One of the reasons is because, as I’ve said time and time again, there is no logical organizational or scientific reason why the potpourri of disparate, often unrelated, and often mutually contradictory therapies that fall under the rubric of CAM should have its own Center at the National Institutes of Health.

Yesterday, blog bud Abel Pharmboy posted a very good explanation on why. Money quote:

CAM is a terrible term. It is NOT medicine. Modalities proven to work are medicine. Modalities that don’t work are not medicine. There is no complement to medicine. Medicine is medicine. There is no integrative medicine, either. Medicine already takes advantage of all modalities: surgical, pharmacological, radiological, physical, psychological, nutritional – if a clear benefit can be offered to a patient that outweighs the risk.

So-called integrative medicine gurus have adopted proven, preventive medicine techniques – diet, exercise, meditation, yoga – and have used them 1) to justify that “CAM” works and 2) that the efficacy of these approaches justifies study and implementation of approaches that have absolutely no scientific basis.

Exactly what I’ve been saying all along.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

10 replies on ““Complementary and alternative medicine”: Not just one thing”

Very well put.

It takes the focus off of claims of fairness. As if it is fair to patients to mistreat them just to give these ineffective treatments equal time, or some other unfair abuse of patients.

It takes the focus of of the charisma of the pusher proponent of this holistic pseudo-medicine. A proponent, who focuses on using that charisma to put a hole in the patient’s wallet.

It takes the focus off of claims of being misunderstood geniuses. As if a true genius, such as Galileo, would have to wait for money from NCCAM to rigorously test his ideas.

I consider the key to be: “. . . a clear benefit can be offered to a patient that outweighs the risk. ”

A Clear benefit that outweighs the risk.
I couldn’t say it enough.
Every so-called “Alternative therapy” either has no clear benefit (no positive effect above that of the placebo) or is not worth the risk. All too often Alternative therapy is the alternative to getting well.


The problem with ethical medicine is that is loses some potential placebo effect. You can’t lie. But if you can come along and “supplement” real medicine and, um, also supplement the truth with a harmless placebo, and – to get the full effect – lie and say “this placeb- ahem, err, this new treatment is tremendously effective in many cases as a complement to your existing therapy, though does nothing without the mainline treatment” – well, you would expect patients to have better outcomes, right? You can’t lie about active treatments because they require informed consent – they can have serious side effects – but properly researched CAM (that is, researched to prove it does NOTHING at all), and most of all properly branded CAM, could be useful, surely? You can lie because the lie itself is the fully researched and effective treatment. Anything that gives legitimacy to the truly ineffectual treatments also improves its benefit, right?

Shorter: “…if a clear benefit can be offered to a patient that outweighs the risk.” Lying satisfies this criteria. Maximum placebo, minimal side effects.

Not that I think these bozos should get actual MONEY, and “alternative” therapies should be bloody banned, but… I’m torn over the “complimentary”. If my boy was in hospital with something potentially fatal, I would honestly prefer the docs to lie to him and me, even if it garners only a tiny fractional increase in his chances. And we know that complicated impressive bulshytt works better than simple bulshytt with no Centre to call its own.

So maybe this is all some vast experiment to upgun the placebo effect…

/only half joking: of course confidence in the medical profession is the best placebo of all. Lying could damage that – unless you had some kind of government body whose job it was to obscure the science…


Magpie, I don’t think you have that right.

All medicine has placebo. You can not give medicine without inflicting placebo on people. When you give a drug or try a procedure, you are giving placebo.

The good part of EBM whether it be a pill or a procedure is that it gives placebo and added benefit.

The only thing that EBM could benefit from is they way that healthcare is delivered. I don’t know what to do about it, but I think the average time a doctor spends with a patient is like 7 minutes… a reiki practitioner or homeopath is like an hour.

The talking, the comfortable quiet setting and empathy is something that would benefit all those people who seek CAM, but would allow them to get treated with EBM.

I have no idea, with our current system, how doctors can make money that way…. but i’m just sayin… you don’t need to give a magic sugar pill with every prescription to get placebo action.

Hang on a minute – yoga is a “proven, preventive medicine technique” ?

Sure. Low-impact exercise with an emphasis on stretching and range of motion? Forty years of that and a lot of the aches and pains I’ve acquired over the years would be seriously reduced.

Yoga: Anecdotally, I got lots of leg cramps overnight related to my bicycle commute home from work. After six weeks of weekly yoga sessions last year, I have had hardly any (and cant remember any) since.

Of course ‘these positions release toxins’ was rubbish, but the exercise, stretching, and relaxation was real, and the exercise and stretching were measurable.

Earlier recomended techniques – a couple of supplements – didn’t do much, if anything.

The lymph system removes ‘toxins’.

Yoga gives the lymph a good ‘push’

Ujayyi breath creates heat, making sweat which is also purifying in it’s own way.

FACT: Yogis can stop and restart their own hearts at will.

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