Clinical trials of integrative medicine: testing whether magic works? - I just thought that I’d take the editor’s (and, speaking for Steve, the founder’s) prerogative to promote our own efforts. Regular readers of SBM are famil...
6 hours ago
Do 4 in 10 of us use CAM?Sure, if you count vegetarians and PilatesFlipping through an old [university] magazine in a waiting room, I read [faculty member's] assertion that complimentary and alternative medicine (CAM) should be studied because over 30% of Americans use it. In the Wall Street Journal on 12/26/08, journalist Steve Salerno cited a recent report of 38% CAM usage, although he used the figure in a compelling argument against spending public dollars on non-scientific modalities. Salerno received a response in the 1/09/09 WSJ by a quartet of CAM's finest that used bizarre logic: any lifestyle change (e.g., diet, exercise, stress management) that prevents disease is CAM, lifestyle change is an inexpensive way to prevent chronic disease, therefore we need "serious government funding" of all CAM (including chi manipulation). Physician bloggers from Science Based Medicine call this tactic "the CAM bait-and-switch," and it involves the same conflation responsible for the claim that 4 in 10 Americans use CAM.Look at the data behind the "4 in 10" claim that Salerno cites. In a 2007 survey (raw data here) of 30,000 households, the most frequently reported use of CAM in the past year was of "nonvitamin, nonmineral, natural products" (17.7% of respondents), and the most common such product was "fish oil or omega 3 or DHA." The next highest rate was for "deep breathing exercises" (12.9%), and number three was meditation (9.6%). In fourth place was "chiropractic or osteopathic manipulation" (8.6%), the vast majority for back, neck, or joint pain. The next five most common responses were similarly unexciting: massage (8.3%, also mostly for back pain), yoga (6.1%), diets (3.6%, primarily vegetarian, Atkins, and South Beach), "progressive relaxation" (2.9%), and "guided imagery" (2.2%). Dude, where's my chi?Homeopathy made the top ten with 1.8% of respondents. Acupuncture tied with Pilates at 1.4%. Ayurveda, Qi Gong, and Reiki altogether made up less than 1%.The big CAM winners were the supplement industry, heavily marketed and poorly regulated thanks to its congressional lobbying, and manipulation/massage for musculoskeletal pain, which is not terribly "alternative." Disciples of CAM can claim a vast public mandate only by appropriating all nutrition, exercise, and relaxation techniques, which are thoroughly uncontroversial aspects of our curriculum. Although Deepak Chopra and Andrew Weil want us to believe that 4 in 10 Americans believe in CAM (incidentally, about the same fraction that denies human evolution), these data suggest a figure more like 4 in 100 for the really magical stuff.Of course, neither proof of efficacy nor need for research should be a popularity contest. What really matters for any potential therapy are evidence and plausibility, hurdles that cannot be sidestepped by surveys or rhetoric. Each independent CAM modality must stand or fall on its own merits; accepting all CAM because massage feels good and some herbs are efficacious is as intellectually dishonest as rejecting all CAM because Kevin Trudeau is a fraud.
a medical/graduate student's musings on medicine and science, with occasional rants about quackery