Proponents of various forms of alternative medicine regularly rally under the claim that medicine treats only the symptoms, while their favored modality “treats the whole person.” I’ve long known that this is wrong, and I could enumerate all the reasons why, but only now did it occur to me that there’s an even deeper level to this inaccurate claim that I haven’t seen addressed elsewhere – irony.
I’m not going to try to get into so much detail that it obscures the point (for a change) so I’ll stick to the examples that directly apply to my inspiration. Doctors and scientists who blog cover the overt falsehoods that are relative to their specialties with far greater specificity than I ever could. They can even tell you how each individual CAM treatment doesn’t work and why. I don’t think I need to do that, because I could never attain that level without the education, experience, and dedication that these science-based medicine bloggers have.
Instead, I’m going to draw from my own experience at a forum in which we discuss mental disorders – ADHD in particular, but also its other delightful companions and complications – where alternative treatments are accorded an undeserved level of respect and science-based medicine is treated with derision. In this place, since we are dealing with conditions that are complex in origin and difficult to reproduce and test in animal models, speculation is going to be a given. However, much of the speculation involves disregarding or even discarding the huge volume of information we already have from research.
There is absolutely no question that each condition being discussed is brain-based. There is absolutely no question that any effective treatment for these conditions is going to have to be a treatment of the brain. And there is absolutely no question that all the current approaches are aimed at relieving symptoms, whether through medication or other therapies, because research on the cause of symptoms yields results much more quickly than research looking at the most complex organ of the human body will yield information on causes. Science is churning away at brain research; new tools and knowledge are helping it to advance more quickly than it did in the past, and the findings from these are being used to develop even better tools and knowledge. Still, because there are practical and ethical limits on researching living human brains, results will not come as fast as they do for other diseases and conditions that involve other organs with simpler functions than the brain has.
Now that the introduction is out of the way. . .
The proponents of various alternative ideas on the origins and treatments of these disorders are quite aggressive in their attacks on the faults they perceive in current science-based hypotheses. The critique frequently seen elsewhere, “This doctor/medicine/therapy just treats the symptoms, while my preferred modality treats the whole patient!” is often seen here. As I explained above, treating the symptoms is pretty much all that’s available, because there can be no prevention or cure while the cause is still unknown. The insistence that doctors are not treating the whole patient is a flawed assumption, especially in the case of mental or neurological conditions; partly because these doctors are well aware of the complexity of these conditions, the overlap in symptoms among different conditions, the potential for disastrous results with incorrect medications, and the inherent inaccuracies in the Diagnostics and Statistical Manual as a stand-alone tool, it’s essential that they know the patient in great detail. A competent psychiatrist will not write a prescription for something that treats the symptoms until he knows as much as he can about the whole patient.
The CAM practitioner, however much time he spends getting to know “the whole patient,” knows nothing about the origins of the condition, either. Less, in fact, than the medical doctor. Nor does he know the origins of the symptoms, because the scientific knowledge places the treatment of these symptoms outside of his area of practice. The chiropractor, the acupuncturist, the homeopath, the practitioner of “energy medicine,” are all attempting to treat the symptoms.
Unlike the scientific researchers, though, these practitioners make the assumption that symptom relief, self-reported by the patients, indicates that they have discovered the cause for the problem. If manipulating the neck makes the patient feel better, then the problem is in the neck, therefore adjusting the neck changes the brain. If a needle in a particular spot makes the patient feel better, then that spot is directly connected to the brain, and putting needles in that spot will fix the brain. If water with “memory” makes the patient feel better, then the water’s “memory” is stronger than the brain, and can change it. If manipulating “energy fields” makes the patient feel better, then the problem is misaligned energy in the brain, and fixing the energy can fix the brain.
CAM practitioners and adherents miss this irony. Doctors and scientists know that symptoms can be a diagnostic tool, but that symptoms alone do not always provide a definitive diagnosis. Doctors and scientists know that symptom relief is not the same as a cure. CAM practitioners, in their efforts to fix symptoms, are using symptoms and symptomatic changes to reach a diagnosis – and the certainty with which they claim to have solved the problem is indicative that they are diagnosing using symptoms. They are doing the very thing of which they derisively accuse doctors of doing. After they’ve had enough patients tell them they feel better after having undergone whatever procedure it is they did, CAM practitioners waste no time announcing that they have found the cause of a condition and spreading the word on how their preferred modality can cure it.
Their criticism of the shortcomings of scientific medicine, as it turns out, is not only ironic but hypocritical.
Worse still is that the results are just a placebo. And contrary to their claims, the Placebo Effect does nothing to cure. In fact, all the Placebo Effect does is change a person’s perception of the subjective severity of a symptom temporarily. Sometimes that effect will last long enough (or be renewed by enough CAM treatments) for an illness to resolve itself. That is not an example of the curative powers of placebo. And placebo, again, addresses only symptoms!
Because placebo is subjective and of relatively short duration, a patient undergoing an alternative treatment will naturally need far more frequent visits to the alternative practitioner, sometimes over the course of many years, in order to re-up its effect. And each time the patient reports to the practitioner that he feels better, the more “evidence” the practitioner believes he has gathered that he is actually affecting a cure. In real medicine, though, a cure doesn’t need repeated treatments. In real medicine, a patient is cured when there is no longer any sign of disease, and no further treatment is needed. In real medicine, ongoing treatment requirements are indicative that a cure has not been reached. And, of course, in real medicine, symptomatic relief is not considered a cure.
So for all the brouhaha coming from the proponents of alternative medicine about medical doctors “just treating the symptoms,” it’s the alternative practitioners who are actually doing that – and doing it worse. Science-based medicine treats a wide range of symptoms, and often treats them quite well, preventing conditions for which we don’t yet have a cure from becoming worse or becoming conditions that can’t be treated at all. CAM treats only the symptoms that the patient can imagine getting better or worse, and does nothing for symptoms that are beyond the power of positive thinking to improve. That’s not “treating the whole patient,” but potentially dangerous chicanery.