From: turpin@cs.utexas.edu (Russell Turpin)
Newsgroups: sci.med,sci.med.nutrition
Subject: What's wrong with "alternative" medicine?  (was: Homeopathy)
Date: 8 Oct 1992 13:44:37 -0500
Organization: U Texas Dept of Computer Sciences, Austin TX
NNTP-Posting-Host: cs.utexas.edu
Summary: A failure to weigh the costs and benefits.

-*----
I wrote:
>> If there is one thing that we do know from medical science, it
>> is that virtually *any* treatment (that does not have too severe
>> side effects) will yield positive results for *most* medical
>> problems *much* of the time.  Homeopathy works.  Chiropracty
>> works. ...

A careless reader might have taken the above as support for
"alternative" medicine.  After all, if all these treatments work
(to some extent, for many people, when applied to most medical
problems), why *not* use them?  For example, Robert Greenstein,
in article <1992Oct7.153856.2148@island.COM>, writes:

> ... Maybe that's the lure of alternative medicine. If people
> are going to get better anyway, they might as well do it
> without the side-effects ...

Robert Greenstein makes the assumption that "alternative"
medicine has no harmful side-effects.  This is false.  Many
people have died and many more have suffered permanent harm,
prolonged pain, and depleted financial resources from various
"alternative" treatments. 

Of course, that a treatment is risky is not, by itself, a
condemnation of it.  Indeed, people suffering AIDS and other
terminal illnesses have rightly criticized the FDA for its
unwillingness to let them take greater risks in their choice of
treatments. 

How, then, should one decide what treatments are appropriate for
a given problem?  The answer is that one should compare the
*relative* benefits and *relative* risks of various treatments. 

  o  Give preference to the *more* effective treatment.  Note
     that less effective treatments can be deadly even if they 
     have no overt side effects.  A patient can die from a 
     disease for which there is an almost certain cure, which 
     cure was bypassed because the patient put faith in stump
     water or homeopathic solutions.  It will be little comfort 
     to the family of the deceased that *most* people survive
     on the less effective treatment.  The difference between 
     an 80% survival rate and a 99.9% survival rate is great if
     you are one of the 19.9% who died needlessly.  (To look
     at this statistic differently, one has 200 times as much
     risk of dying using the less effective treatment.)

  o  Give preference to the *safer* treatment.  Chiropracty 
     does not carry much risk, but some people have suffered 
     permanent spinal injury from it.  Unfortunately, it is
     often applied to problems for which stump water is just 
     as effective.  Stump water is safer, and much cheaper
     to boot.

It is very difficult to determine the relative benefits and risks
of various treatments.  Doing so often requires complicated
studies involving the careful diagnosis of many patients, double-
or triple-blind treatment, longitudinal followup, statistical
analysis, and studious review of the alternatives.  The
unfortunate fact of the matter is that we cannot know fully know
the risks and benefits for various kinds of treatment.  Witness,
for example, the controversy that has surrounded coronary bypass
surgery, and the issue of which patients benefit from it.  (It is
important to keep in mind that the criticism of coronary bypass
surgery, and its refinement and more appropriate targeting, is an
instance of conventional medicine.  "Alternative" medicine did
not contribute informatively to this criticism, though, as usual,
various "alternative" medicine proponents try to turn internal
criticism of a treatment into a criticism of conventional
medicine!)

The hallmark of conventional medicine is that it painstakingly
works toward a knowledge of the relative risks and benefits of
various treatments, and it pragmatically incorporates treatments
as this knowledge changes.  The hallmark of what gets labelled as
"alternative" medicine is that its proponents either ignore
issues of relative efficacy and safety, or lack the depth to
discuss these issues.  (It is wrong to infer from this that 
(a) conventional physicians always provide the best treatment, or
that (b) none of the alternative treatments are worthwhile.)

Before closing, it is worth noting that less effective treatments
can also carry social and ecological costs.  There was an article
in the New York Times a few weeks ago describing how one species
of tiger is nearing extinction from poaching, because traditional
Chinese medicine uses pieces of it as remedies for joint pain and
other problems.  (The rhino has suffered similarly because
traditional Chinese medicine uses its horn to make cures for
impotence.)  Needless to say, there is no reason to think that
any of these treatments are any more effective than stump water.
(It does not take a genius anthropologist to hazard a guess that
these traditions, which have been "tested" for millenia, stem
from past beliefs in sympathetic magic.)

By the way, Mr Greenstein, we still await your scientific 
discussion of qi.

Russell
Newsgroups: sci.med