In a recent post, we discussed the interplay between Slow Medicine and complementary and alternative approaches to clinical care. We concluded in our piece that these two approaches share important values, including an emphasis on simple lifestyle strategies for maintaining wellness and managing disease.
However, as Slow Medicine practitioners, we are more cautious about complementary and alternative therapies, some of which are costly and unproven, and increasingly have been linked to adverse effects. Our piece emphasized the need for greater rigor in evaluating the benefits and risks of complementary and alternative approaches.
In response, we received a number of thoughtful critiques from complementary and alternative medicine practitioners. One clinician noted: "I am living proof (as are many of my clients) of the effectiveness of alternative therapies for preventing, treating, and curing disease. This article sounds like the conventional 'naysayers' are running scared ... worried that their profits will be diminished?"
Another comment read: "Of course, small companies marketing unpatentable herbs cannot fund megatrials, but it's often perfectly reasonable for consumers to make choices based on inconclusive information, such as small trials and animal studies, and/or traditional knowledge."
We found ourselves sympathetic to some – but not all -- of the points our readers made, and decided to write this follow-up piece to help clarify our perspective. Specifically, we want to highlight that:
- We respect thoughtful complementary and alternative practitioners such as Dr. Andrew Weil. His recent book that we discussed in our previous article, Mind over Meds, is provocative, even if we don't agree with every point. In particular, we enjoyed reading his articulate indictment of our modern healthcare system, which highlights how the U.S. healthcare system provides costly, invasive therapies at the exclusion of simple, effective approaches.
- We agree that it would be absurd to require a rigorous and expensive randomized trial to evaluate each and every complementary and alternative therapy. Indeed, this would be a catastrophic waste of money! For patients who want to try chamomile tea to treat insomnia, an herb from their garden to manage allergies, or deep breathing exercises to control pain, we are ardently supportive. Where it gets dicey, however, is in more serious situations. We could not in good conscience condone herbs to manage cancer, nor natural approaches as primary therapy for life-threatening chronic conditions like diabetes for which there are standard evidence-based therapies.
- Although some natural compounds contain substances proven to improve health, the bottled versions we purchase in stores hardly resemble the compounds found in nature. So-called "natural medicine" has sadly become a booming, unregulated business that results in huge corporate profits from the sale of over-priced, refined, and bottled substitutes for organic products. Sadly, the supplement-industrial complex has become indistinguishable from "big pharma."
- Because of lenient regulations on the supplement industry, bottled supplements and botanicals frequently don't even contain what they claim to contain. Increasing evidence suggests that supplement products sold in retail stores surreptitiously contain dangerous synthetic compounds similar in structure to ephedrine, amphetamine, and even methamphetamine. In our view, there's nothing simple or natural about these products. Moreover, concentrations of the active ingredients may vary widely. As a case in point, although the natural substance red yeast rice contains pharmacologically active compounds similar to statins, the concentrations found in commercially available products are highly unpredictable. All else being equal, we'd rather that our patients know precisely what they are ingesting.
- While it certainly would be absurd to mandate randomized trials to evaluate each and every complementary and alternative therapy, we believe there is value in enhancing the rigor in this discipline. For one thing, rigorous supporting data could bolster the case for effective complementary and alternative therapies, promoting their more widespread adoption. Second, although chamomile tea and garden herbs might seem benign, some "natural" therapies might have unanticipated adverse effects. Similarly, alternative procedures such as acupuncture and spinal manipulation may be harmful when performed by inexperienced practitioners. While we are enthusiastic about simple, commonsense approaches, even if untested, we believe complementary and alternative practitioners would do their field a service by putting their strategies up for thoughtful, methodical, and independent evaluation.
Overall, we find important areas of overlap between Slow Medicine and complementary and alternative practitioners, though we worry that some members of the complementary and alternative therapy community may be too "fast" at times to embrace approaches with limited efficacy and unproven safety. We would, however, underscore the strong evidence base for healthy lifestyle interventions, which Slow Medicine and complementary and alternative practitioners alike promote.
"Updates in Slow Medicine" applies the latest medical research to support a thoughtful approach to clinical care. It is produced by , of Harvard Medical School, and , of the Keck School of Medicine at the University of Southern California. To learn more, .