Inside Medicine: Alternative medical therapies deserve to be studied further

Humans are not wired to be particularly objective. Once we have a small amount of information about something or someone, our minds begin to construct pretty strong beliefs.

As a simple example, my wife and I often argue over the quality of a haircut. She's convinced the more she pays, the better the cut. Personally, I see no demonstrable difference to support this observation.

The same is true with wine. Once you shell out $30 for a bottle of wine you're going to like the flavor even if it tastes (in blind taste tests) no better than an $8 bottle.

This week, in a very public discussion with Dr. Andrew Weil, the vitamin and integrative medicine entrepreneur, he and I got to talking about people's belief systems. While we disagree about a good number of things, including the value of his heavily promoted products, we do agree that both Western medicine and alternative medicine benefit enormously from the placebo effect (or, as he describes it, the body's ability to heal itself).

Neither conventional medicine nor alternative medicine seems to hold a corner on ineffective treatment.

A substantial number of products that are available over the counter at the pharmacy, are prescribed by a doctor or are offered by an alternative provider simply don't work. In fact, 46 percent of treatments used in primary care offices aren't proven effective, and 5 percent are harmful but are still used. Sure, the throat spray may tickle our throat and drive attention from the pain, the cough syrup may taste awful and make us think it is a powerful medicine, and the echinacea may lead us to think we are developing fewer colds. But careful studies have shown that these agents do not work as advertised.

In contrast, another group of alternative therapies seems to be more than just placebos. For some illnesses, benefits have been found with touch therapy, herbs, vitamins and alternative approaches to illness including traditional Chinese medicine, chiropractic and Ayurvedic medicine. Californians love complementary and alternative medicine; more than a third of us use some type of it, spending over $2 billion a year.

Chances are you won't see these effective treatments offered in a typical American hospital, but I am not sure why. A study in this week's Archives of Surgery looks at the impact of massage on pain after major surgery. Researchers found that patients who received a 20 minute massage felt better for long periods. For many conditions, acupuncture is very effective and is far safer than typical pain medicines.

Despite a growing body of research, these treatments remain "alternative" and are available only outside of mainstream medicine. We have hospital departments of anesthesiology whose experts use all sorts of complicated, dangerous and expensive procedures to treat pain, but no one in the departments know acupuncture? Unlike most alternative therapy, acupuncture has been subject to more clinical research than many orthodox medical treatments, but it still is rarely used.

Medical schools don't include the content or the skills in their curriculum, so the next generation of doctors will probably be no wiser than the preceding one.

Worse yet, people don't talk to their doctors about their experiences with alternative therapy – perhaps because they think the doctor won't be supportive. They may be right. Patients are often embarrassed to let their doctor know what they have tried, or they worry they might be scolded. Patients have told me they worry that I might see their use of alternative medicine as a betrayal of their trust in me.

Doctors should encourage patients to openly discuss any interest in alternative therapies. I applaud patients' attempts to find relief for their suffering, and we need to recognize the limitations of conventional approaches. In fact, doctors often need to know about these treatments so we don't prescribe medicines that have harmful interactions.

Other treatments that Weil discusses – different breathing techniques for sinus infections, and vitamin combinations to slow the aging process – need to be subjected to careful, impartial clinical study. I am skeptical of their effectiveness, but once the studies are done, the results need to be believed and widely disseminated.

About the writer:

• Michael Wilkes, M.D., is a professor of medicine at the University of California, Davis. Identifying characteristics of patients mentioned in his column are changed to protect their confidentiality. Reach him at drwilkes@sacbee.com.