Monday, January 19, 2009

Lies, Damned Lies, and CAM Statistics

My latest submission to the campus newspaper: 

Do 4 in 10 of us use CAM?
Sure, if you count vegetarians and Pilates

Flipping 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. 

Proud to say I reached my conclusions on the survey before reading the thorough SBM analysis, though that blog pointed me to the CAM response.  I was primed to be suspicious of such statistics thanks to a great podcast by Mark Crislip on a similar, older survey. 


Rogue Medic said...

I started reading the WSJ piece by the 4 doctors. When I came to the part where they claimed that alternative medicine could prevent 90% of all heart disease, I gave up.

The INTERHEART study, published in September 2004 in The Lancet, followed 30,000 men and women on six continents and found that changing lifestyle could prevent at least 90% of all heart disease.

Imagine if a doctor could prevent 90% of heart disease. What would be the first thing the doctor would do. Study it! There is no reason to have the press conference until there is real evidence to show. These quacks have no science to support their fraud.

What does the Lancet study, that they cited, actually say? The relation of smoking, history of hypertension or diabetes, waist/hip ratio, dietary patterns, physical activity, consumption of alcohol, blood apolipoproteins (Apo), and psychosocial factors to myocardial infarction are reported here.

Too bad no conventional medicine practitioners have caught on to these radical alternative treatments. Sorry about the sarcasm, but they did not find that sarcasm contributed to heart disease. :-)

All of these recommendations are currently part of conventional medicine. Why is the WSJ so gullible as to allow these frauds to print their lies?

They will divert sick people, people with treatable illnesses, away from real medicine to their non-medicine. how many people will they kill?

Heart disease prevention is best accomplished by staying away from medical frauds, such a Weil, Chopra, Ornish, and Roy.

Call me Paul said...

This kind of thing makes me crazy. I am a member of the Angus Reid Forum, and participate in monthly surveys for them on a variety of topics. On the most recent survey, they asked the question: have you taken any alternative supplements or medications within...a)the last seven days, b)the last month, c) the last three months, etc. In the question, they specifically included daily multi-vitamins. So, Homeopaths and Accupuncturists can point to the results of this survey and say, "look, six out of tem people use alternative therapies on a weekly basis." Stupid.

grene said...

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