In part 1 and 2 I gave some comments on two radio interviews regarding complementary medicine (CM) and how the National Institute of Complementary Medicine (NICM) misleads the public. To be fair to the NICM, the full transcripts should be read in order to understand the context of these interviews. I cannot claim that everything that is being said is wrong or misleading – there are indeed some truths or half-truths. In this article I will focus on the most interesting part from another radio interview, regarding the effectiveness of CMs according to the NICM, and just give a short comment on the statements that they make. This article deals with creating public trust that CMs really works.
“Norman Swan: We’ll cover safety next week, and whether the alternative medicine industry should be regulated. But let’s get back to whether the treatments are effective, because many of those who use them tell you they are. The common response from orthodox practitioners though is that it’s just the placebo effect, the result of taking a sham treatment which you believe is going to do you good.
That riles people like Alan Bensoussan, who runs the Traditional Chinese Medicine unit at the University of Western Sydney.
Alan Bensoussan: Look I’ve been involved in complementary medicine for some years, and I remember 20 years ago the first reaction to acupuncture coming to the West was, ‘Oh look, it’s just a placebo procedure.’ About ten years later gradually people started turning around and saying, ‘Actually we know now something about it, we know that endorphins are involved, we know that other neurotransmitters like serotonin are involved in the process as well.’ And so gradually medicos are taking on acupuncture, practising it themselves, and there’s an increased acceptance of it. Whereby now, we wouldn’t say it’s a placebo procedure totally.
The point is that all therapeutic practices, all therapeutic interactions have a placebo component. Some practitioners of course and some therapies, may be able to potentiate that placebo more so. There’s no evidence that I’ve seen to say that complementary medicine is any more of a placebo than something as dramatic as surgery. Surgery could well carry a very strong placebo effect. Our knowledge of what works is increasing very rapidly. The Cochrane Collaboration have been active in accumulating data and good clinical trials in complementary medicine.”
Acupuncture is not only called a placebo anymore but a “theatrical” placebo. Looking at the scientific basis of acupuncture, energy flowing through non-existing meridians, it cannot be anything other than a placebo. And this has been shown over and over.
But now the claim is made that CM is equally effective as surgery (or surgery is equally ineffective as CM). This is a very interesting comparison and it places CM on equal footing with surgery. Most people will agree that positive outcomes due to surgery cannot possibly be due to only a placebo effect (eg. removing your appendix, heart bypass operations, mending shattered bones etc). But most people will also be surprised to know that there are some surgical procedures that have been shown to be equally ineffective as sham surgery – in other words, the positive outcome was caused by only the placebo effect. Because of this a review of health care procedures are currently taking place, which will hopefully lead to the removal of ineffective treatments. And rightfully so. If something is shown not to work (or it only causes a placebo effect) it should be stopped. This most definitely does not mean that every medical procedure out there is nothing other than a placebo effect. Some might be, but the vast majority have a clear effect on top of any additional placebo effects.
The NICM now wants the public to believe that CM is equally effective as surgery. Their argument: yes there might be some CM’s (they never specify which ones) that only causes a placebo effect, but most CM’s are just as effective as surgery. In a previous article I wrote about how they compare the theory behind TCM with quantum physics, in order to make people believe that there is a massive body of scientific evidence supporting TCM. Now they compare, again in a very convincing way, something that is in general very effective (surgery) with something that has been shown to be ineffective (most CMs). This is done to create public trust in the effectiveness of CM.
The term CM is difficult to define and it includes every medical procedure or treatment out there that has no or very little scientific evidence. This does NOT mean that no or very little research has been done – it means that all results indicate that it is not effective. An important distinction to make is disproven vs unproven therapies. Homeopathy is a disproven therapy (huge amount of research shows that it does not work) vs some herbal medicines where no research has been done and hence its effectiveness is unproven. However, most CMs are placebos while some of them like Homeopathy and Chiropractic can also be quite dangerous. There is a very good way to distinguish between medicine and CM. As soon as there is good and reproducible scientific results supporting the effectiveness and safety of any medical intervention, that medicine or treatment enters the realm of evidence based medicine, even if it was originally regarded as being a CM. Whereas, due to a lack of scientific evidence it enters or it stays in the realm of CM even if it was once regarded as a “conventional” intervention.