My long article on alternative medicine came out a few days ago in The Atlantic. In a nutshell, I explain why more and more doctors are recognizing that alternative medicine does a better job in some ways with many patients than mainstream medicine does–even though the core physical treatments of alternative medicine seem to rely mostly or entirely on the placebo effect. In particular, I make the case that alternative practitioners tend to invest more time and effort in helping patients adopt healthier lifestyles and attitudes than do mainstream doctors, and these changes are likely to do more for most people’s health and wellness on average than mainstream treatments.
Not surprisingly, several prominent medical-science bloggers have gone ballistic at the suggestion that alternative medicine might have something going for it. Here’s a brief list of links to some of the notable, highly critical responses to the article:
I responded at modest length to each of these posts in the comment sections under the posts (except for Salzberg’s post to the Atlantic, where my response is on a separate page. Salzberg and Novella, both highly respected scientists (and Novella is a physician as well) known to be strongly opposed to alternative medicine, were interviewed by me at length for the article, and their viewpoints were, I think it’s fair to say, well-represented in the article. (Neither has suggested otherwise.) I didn’t interview Gorski, but mentioned him in passing in the piece. Gorski is a physician-scientist who must be among the angriest voices on the planet with regard to alternative medicine–he is the hardest-core of this group of hard-core anti-alternative-medicine warriors–and he went after me some months ago with regard to my Atlantic profile of John Ioannidis, the highly acclaimed physician-researcher who has found so many problems with published medical research. Herper is, I believe, a lowly journalist like myself.
I’d like to make some relatively broad comments about these mostly angry responses to my article. I’ll start off by pointing out that while these folks imply (they of course don’t come out and say so) that they are representing mainstream medicine and indeed all of science and perhaps all of Western thought, they are not. As my article makes clear, mainstream medicine has been slowly moving toward increasing acceptance of alternative medicine. Increasingly, Gorski and other hard-core opponents of alternative medicine are themselves gradually being pushed toward the fringes of medicine. (Gorski concedes as much in his post.) Whereas I found top physician-researchers happy to say good things about alternative medicine wherever I looked, including at some the most prestigious academic medical centers in the world–I wasn’t even able to fit them all into the article–I had to work a bit to line up two highly respected, articulate scientists who were intensely opposed to it so I could fairly present that point of view in the article.
Don’t take my word for it–go out and ask physicians you trust what they think of alternative medicine. Yes, many still object to it, and most have some concerns and hesitations about it (as do I), but I’ve found that most have come to accept to some extent the fact that some of their patients, for whatever reasons, seem to get some real benefits from it, and often with problems that seemed resistant to mainstream medicine. Why would a caring physician, or any scientist, find this fact so hard to take?
Some of the attacks on my article also attempt to paint me as an alternative-medicine “apologist.” But what does that even mean? Am I imagined to attend meetings of my fellow apologists where we come up with our arguments together? Apparently I’m being assigned to some terrible camp for which I’m supposed to be judged, rather than for my actual argument. Are my attackers mainstream-medicine apologists? Do any of us have to stoop to name-calling to make our points? For the record, I’ve never had anything to do with alternative medicine in my entire life until I took on this article, either as a patient or a journalist, and I did my best to come into it with an open mind, and with no skin in the game. If I’m an apologist for this field, I’m an incidental one.
There are two main claims that underlie all the attacks on my article. They are: 1) Because physicians could in principle provide the sort of health-improving attention to patients that alternative practitioners by most accounts are today much more likely to provide, and because it is so difficult to clearly prove that alternative practitioners do in fact do a better job in this regard, it’s wrong to say that alternative medicine offers any advantage in this regard. And, 2), because alternative medicine incorporates core treatments that don’t actually have the (implausible) direct physical effect claimed, but rather work by the placebo effect, alternative medicine is a fundamentally evil, anti-scientific entity (voodoo!), and therefore one must never suggest there is any aspect of alternative medicine that might be good.
I can only shrug at these notions. You’ll either buy them or you won’t. I don’t, and most physicians don’t, as far as I can tell.
Those two basic arguments underlie Gorski’s particularly rabid rant, too. But if you read it, you’ll quickly find yourself buried in a detailed, apparently point-by-point refutation of virtually everything I say in my article. He goes through the article paragraph by paragraph, sentence by sentence, finding in each the logical flaw, the fallacy, the error of argument. Do I compare A and B? Then I’m a fool because A and B are different! Do I contrast C and D? Then I’m a fool, because it’s a false dichotomy! Do I assert a point about science? What do I know about science, I’m a journalist, and therefore a fool! Do I quote a Nobel Laureate? Then I’m a fool, because I’m arguing from authority! Do I point out a problem with mainstream medicine? Then, fool that I am, I’m setting up a straw man! Do I cite a study? Then I’m a fool, because that study was trash, or I’ve misinterpreted it, or it doesn’t apply here! Do I say that randomized studies, the gold standard of medical science, can’t really settle the question of whether alternative medicine might ultimately do a better job in some ways? Then I’m a fool, because any question can be settled with randomized trials, and in fact the studies have been done!
A brief aside about studies: There are hundreds of thousands of researchers whose careers depend on producing studies, so I’m not exaggerating when I say there is a study, and probably ten or 50 or 200 of them, for just about any reasonable question you could possibly think of, with results for each question pointing in every possible direction. And in medical science sooner or later someone manages to cobble together a version of study for each question that can be called a randomized study. When someone like Gorski sets out to prove a point, or (as is more often the case) trash someone else’s, he’ll point to one of these studies and cackle, QED! And when his opponent, if she is playing the same game, disses that study as junk and plunks down a different study that points in the opposite direction, Gorski will declare that study invalid in some way. And soon the two will be slapping studies down in front of each other and tearing them up like a violent game of crazy eights. I never go there. In fact, I would prefer to not quote studies at all in my articles for that reason, but editors strictly require it–I have never been able to win that argument. But I do so knowing the Gorskis out there will claim they can trump my study with their study, or howl at every point that isn’t backed up by a study.
At this point, if I were anything like Gorski, I’d fire back by taking on every single point of his rant, and show why each is flawed, and why every one of my points should stand. I won’t play that game, because it accomplishes nothing. (Well, I play it a little, but try to keep it short, and to assert a broader perspective.) There is no argument in the world that a Gorski can’t tear apart point by point, and (you’ll have to trust me on this) no tearing apart Gorski could produce that I couldn’t in turn rip to shreds. You can see these sorts of mind-numbing, often semi-childish back and forths in many of Gorski’s rants, since his targets do sometimes take the bait, and you can frequently see them play out in the comments underneath his posts, since he draws a crowd that loves playing this game.
The basic problem here is simply that of being unable to see the forest for the trees. Science by tradition endeavors to break down phenomena into their simplest component parts, and many scientists, and fans of science, become so enamored of this approach (which certainly has its benefits) that they are incapable of approaching anything any other way. I suspect this is why when Gorski enters an argument, he immediately atomizes. What he won’t, and perhaps can’t, do, is take a step back from the dueling studies and the logic errors and the flawed reasoning and the inappropriate comparisons, and instead look at the big picture objectively, and ask, What’s really going on here? What might I be missing? Is there another way of looking at this? Does there seem to be some important, underlying truth that’s being suggested here, a truth that may differ from the “truth” I’ve been clinging to, at least to some extent?
In the case of this subject, that shouldn’t be hard to do. My point is incredibly simple. Our healthcare system has left physicians unable to lavish the time on patients needed to make patients feel fully cared for, or to invest time and resources in getting patients to adopt the healthy behaviors and attitudes that are so effective in lowering the risk of our most serious diseases and in relieving the pain and discomforts of many, many disorders. (I’m not even really making a controversial point here–you can read much the same in the pages of the New England Journal of Medicine of the Journal of the American Medical Association.) Alternative medicine practitioners often focus on these approaches, and many patients indisputably report that they benefit from it. Why should we care at all about medical science if it isn’t dedicated to making us feel more well? But the enemies of alternative medicine are so blinded by their disdain for the “voodoo” element of alternative medicine–the fact that its core treatments depend on the placebo effect, and have no plausible mechanism–that they refuse to give an inch on any aspect of alternative medicine. Never mind that this placebo effect has been shown to accomplish wonders with regard to how patients feel, or that many and probably most of the drugs that physicians prescribe also don’t do much more than placebo for most patients, along with carrying a risk of horrific side effects. And again, you can look all that up in the medical journals.
What I’ve tried to do in my Atlantic article, and in most of my work these days, is raise questions in areas where people already think they know the answer, but may not. I try hard to resist the temptation to claim that everyone should simply embrace a different answer, but rather merely endeavor to show that there may be a different answer, or set of answers, that work, to some extent, in some situations, for some people. I want to provoke intelligent conversation on a subject where many or most people didn’t think there was anything to discuss. I want to open closed doors. But the Gorskis of the world treat intellectual doors as if it is their sworn duty to keep them tightly latched shut. They claim they’re defending science. I assure you they are not. Nothing more closely represents the spirit of science than open-mindedness and a determination to put biases aside and seek out the ways in which one might be wrong. Nothing is a bigger affront to the scientific spirit than to put all one’s might into trashing all arguments and evidence that threatens a preferred point of view. I estimate I’ve interviewed over a thousand scientists in my career, and the great majority of them were perfectly willing to confess their doubts, their hesitations, their concerns with being wrong, the questions that haunt their work and beliefs. The scientists who never give an inch when confronted with opposition to their claims and beliefs, who react with bile and disdain, who tear apart and take no prisoners, are as far as I can tell outliers, and are easily and best ignored. They can blog to their hearts’ content, and win a core of like-minded fans, but in the end they won’t do much harm. They’re noisy preachers to the choirs.
But here’s the biggest point I’d like to make about the alternative-medicine debate: Don’t take my word for it, don’t take the word of the Nobel Laureate or the top scientists I quote, don’t take the word of the alternative-medicine practitioners I quote, and please, please don’t take Gorski’s word for it. Go out and see for yourself. Talk to mainstream doctors, and alternative-medicine practitioners. Talk to people about their experiences with different types of treatments. Decide for yourself whether there isn’t something interesting going on with alternative medicine, something that seems to provide real help to some patients who were let down in some way by mainstream medicine. We don’t all have to agree on what exactly is going on here, or whether it is entirely a good thing. But I’ll bet you won’t end up thinking that, as Gorski and others assert, alternative medicine is a purely evil and harmful thing that must be crushed. But fair warning: You may end being called an alternative-medicine apologist. On the other hand, you’ll be in good company.