Josephine P. Briggs, M.D.
The Continuing Debate
In the July issue of the Atlantic there is an article by David Freedman along with a series of online commentaries on the controversies surrounding the study and practice of complementary and alternative medicine. This type of dialogue is important, and we were pleased to be among those asked to offer perspectives on the topic.
Debate about complementary and alternative therapies has often been polarized, with advocates squaring off against critics and no common ground emerging. There are, in fact, some causes for concern. Many excessive claims are being made for alternative health practices, many therapies are lacking in plausibility, and some are being found to be potentially dangerous. But the field of complementary and alternative medicine is not monolithic. Some therapies—indeed some of those most widely used—are sensible and deserve our attention as we look for methods to help with problems not well managed by conventional medicine.
The most common health problem for which people turn to complementary and alternative approaches is chronic pain. Pharmacological management of chronic pain, while important, has hazards. Evidence is showing, based on carefully controlled studies, that there is promise in certain complementary treatments as adjuncts to conventional pain management. For example, the pain of osteoarthritis may be relieved by acupuncture; tai chi has been found to be helpful in reducing the pain of fibromyalgia; and massage and manipulative therapies can contribute to the relief of chronic back pain.
Some critics dismiss the benefits from these interventions as placebo effects, but I agree with Freedman’s Atlantic commentary that the term ‘placebo’ can distract us from more important issues. As Freedman notes, the time, attention, and reassurance given by alternative medicine practitioners almost certainly contributes to any benefit from the therapy. The research supports this. With acupuncture, for example, a number of studies have shown clear benefit for pain management when compared to conventional care, but only marginal benefit when the control group receives equal attention from a health care provider and a sham intervention that looks and feels like acupuncture. Should we dismiss this as a ‘placebo’ or acknowledge this source of benefit for patients? A difficult question for which there will not be a single answer.
The goal of NCCAM’s research is to ensure the development of a strong, objective evidence base that offers patients, providers, and health policymakers with the information they need to make informed decisions. This knowledge is vital, given the widespread and frequent self-care use of complementary and alternative medicine.
As Freedman describes, the benefits being observed with complementary and alternative therapies may yield important lessons for our health care system: the time, attention, and reassuring touch traditionally provided by caring health care providers is in short supply and is a highly important commodity.