Confronting Mediocrity

The title should be “Trying to understand Complementary and Alternative Medicine” because I simply can’t understand it – at least the medical basis for it.

I’ve never really paid much attention to Complementary and Alternative Medicine (CAM) and just assumed it was just something of interest to a fringe element of society. After all, there really isn’t any scientific or medical basis for it to be anything more than that. The whole concept of remedies based on no quantifiable evidence of efficacy seemed more than a little preposterous to me. Quite frankly, it just seemed dumb.

I’ve been reading about CAM over the past few days and my opinion hasn’t changed – it is dumb. How’s that for an intellectual assessment? In my recent readings I was rather surprised to see how CAM has been able to successfully weave itself into society. Oprah Winfrey has provided us a CAM evangelist in the form of Dr. Oz, and Andrew Weil™ MD, LLC  has his own popular media presence. There are many others. I had never really paid much attention to Dr. Oz and only had vague name recognition of Andrew Weil. Much has been written about these two salesmen and those like them so I won’t offer any comment beyond putting a “Dr.” in front of your name doesn’t make what you’re selling legitimate or efficacious. There are several sites devoted to understanding CMA and its cousins one site such site is Science Based Medicine and is a great place to get up to speed on topical CAM related issues.

Even more perplexing and disconcerting than the evangelists is that the NIH has a section devoted to CAM, the National Center for Complementary and Alternative Medicine (NCCAM). It is one thing for the market to reward the Ozs and Weils by enabling them to cash in on meaningless therapies but it is quite another for the NIH to give credibility to CAM. The NIH should not be in the business of supporting the CAM industry by lending legitimacy to it.

The puzzling justification sometimes heard for legitimate instutution’s providing supporting for CAM is it is provided because people are interested and want it. This is wrong on so many levels but at the most fundamental level it reminds me of the child screaming at the checkout for a candy bar. Sometimes you don’t give them the candy bar just because they want it! There is a seminal difference between wanting something and needing something. For various reasons people may want a mystical answer in the form of CAM but is it really what they need? Unlikely.

The one thing that became obvious to me as I was reviewing CAM – much of its popularity seems to be directly related to sales or maybe sales reflect its popularity. Regardless of the order of the relationship, there is a relationship.  Anytime you have a $50B market there will inevitably be two component- sellers and buyers. Now that’s not an enlightening observation because no market exists without those two fundamental elements.

I’ve always seen the demand side of a market as more influential than the supply side, e.g. decreasing domestic demand for cocaine usage will have a greater impact than burning coca plants I Colombia. Fundamentally, as long as people believe in something there will be some to package, market and sell it. Hence, the commercial success of the Ozs and Weils.

The question I find interesting is what drives the demand and is it possible to reduce the demand.  I believe it is possible to speculate on the first point but on the second point I have less optimism. I think it safe to posit that the decision to seek an alternative therapy is one that is rooted in a belief system and not a system of logic. Unfortunately, decision making based on emotions and beliefs permeate society and there is no reason to believe CAM decisions are made with any different construct.

I can see the following beliefs contributing to appeal of CAM for some people:

• Can’t accept that medicine is complex so look for simple answers that are understandable.
• Can’t accept that is some cases there is no definitive answer.
• Are disappointed with the results of medicine.
• Want control of their environment. It is empowering to be in control.
• There is a distrust of established medicine.
• Most people are used to making decisions based on faith. They may have faith in an expert or faith in themselves. For some there isn’t much difference.
• Can’t understand subject enough to make logical decision so default to faith system.
• The power of anecdotal success in conjunction with CAM is extremely powerful.

There is an interesting survey along these lines on the American Medical Association website. Recent results are listed below. The percentages listed are the number of respondents who believe the statement is the reason so much is spent on CAM.

As has been observed through various public opinion polls there appears to be a knowledge baseline of 20%. To me this means that no matter what the issue one should not be surprised to see that 20% of the people will have opinions that are at odds with reality. As a corollary I would suggest that for the twenty percenters there is a vanishingly small likelihood that anything can be said or done to displace their belief or faith based approach to life with reason and logic. For that reason there will always be a market for the mystical including CAM.

The twenty percenters can’t be saved from themselves and there is little reason to try to persuade them with logical arguments when their decision construct is belief based. It simply won’t work and wastes time. George Bernard Shaw was right when he said “ I learned long ago, never to wrestle with a pig. You get dirty, and besides, the pig likes it.”

Where then should the anti-CAM effort be placed? I believe it is unambiguous that the fire line for the spread of CAM is at the university and government level. There is no justification for universities to support in any embodiment of CAM. It is fully contradictory to the nature of a university to support the mystical. Similarly, the government should get out of the business of endorsing CAM. Helping our elected representatives understand the CAM issues is a constructive first step to the issue. I know I will be contacting mine.