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Mar 13 2008

Airborne, and Medicine, and Why Skepticism of X Shouldn’t Equal Faith in Y

AirborneIn case you haven’t heard about this yet: The company who makes Airborne, the overpriced vitamin pill that supposedly prevents you from catching colds but that actually does bupkis, has settled a large class action suit against them, and will be refunding $23.3 million to customers who bought the stuff. (Good piece about it on Respectful Insolence).

I don’t so much want to talk about the story itself — although I do find it interesting. Especially since the laws about making health claims for “dietary supplements” are so weak and half-assed. It’s actually quite remarkable that this case succeeded. The Airborne people had an enormous amount of latitude in what kinds of claims they could make — and they still screwed up and overstepped their extremely generous boundaries.

But that’s not what I want to talk about.

There was a comment by Calli Arcale in the Respectful Insolence discussion about Airborne that really jumped out at me. I hadn’t thought if it in these terms before, and it shifted some stuff around in my brain.

Here’s the thought: Why should skepticism of conventional medicine translate into faith in alternative medicine?

SickoThere are good reasons to have a healthy skepticism of conventional medicine. It has horrors in its past; it’s often too focused on pharmaceuticals and procedures instead of lifestyle changes (although that’s changing a lot); and like all sciences, there’s a huge amount it doesn’t yet know. And in the United States, the conventional medical system is seriously broken. It’s too corporate, too tied in with money and profit — causing real harm to patients, and great frustration to the providers who genuinely want to give good health care. (In Europe it works a whole lot better… but that’s not much help if you’re living in the U.S.)

DoctorSo yes. It’s good to be skeptical of conventional medicine. Here, in my opinion, are some appropriate forms for that skepticism to take: Ask your doctor lots of questions. Do research on your health conditions and the treatments you’re getting for them. Don’t automatically take the first course of action your doctor recommends; find out what your options are. Periodically revisit your treatments and make sure they’re still appropriate and up-to-date. Eat a healthy diet, get regular vigorous exercise, and for the love of Loki, quit smoking if you smoke. (Okay, those last ones aren’t actually skeptical of conventional medicine — conventional medicine is constantly begging people to eat better, exercise more, and quit smoking — but it’s a good way to improve your health and reduce the amount of time you spend in the doctor’s office.)

HomeopathyBut here, in my opinion, is a bad form for that skepticism to take: Reject conventional medicine entirely. And replace it with alternative medicine…. which has all of the flaws of conventional medicine, and just about none of its advantages.

Which brings me back to the question: Why should skepticism of conventional medicine translate into faith in alternative medicine?

Polio_vaccine_posterYes, conventional medicine is flawed. But a fair amount of the time, it works. Our life expectancy is almost twice that of our ancestors, and that’s due in large part to conventional medicine. I could go on about it for days: from anti-depressants to heart surgery, from the elimination of huge numbers of deadly childhood diseases to the effective treatment of high blood pressure; from the eradication of smallpox to the fact that many people with AIDS can now have a pretty long and decent life.

Scientific_method_2_2And more to the point — in fact, the very reason for all these successes — conventional medicine has a system in place, the scientific method, for testing its treatments and making sure they actually, you know, work, and are reasonably safe. It’s not a perfect system — but it’s far, far better than no system at all.

Which brings me back to the big question, the question I asked over and over again the last time I brought this up and to which I never got a satisfactory answer: What does alternative medicine have to offer that conventional medicine doesn’t?

Gold_cureAlternative medicine has horrors and frauds in its past, every bit as much as conventional medicine. Read the history of the turn- of- the- century el-quacko health movement if you don’t believe me. Alternative medicine is every bit as focused on powders and potions and weird procedures as conventional medicine — they’re just different powders and potions and procedures. Alternative medicine is flying in the dark every bit as much as conventional medicine — in fact, far more so, since by definition conventional medicine is medicine that’s been subjected to rigorous testing, and by definition alternative medicine is medicine that hasn’t.

Airborne_2And alternative medicine is every bit as driven by money and profit as conventional medicine. The Airborne thing is a great example. Alternative medicine is a huge industry, and a hugely profitable one. In fact, the two are overlapping more and more: CAM companies (complimentary and alternative medicine) are being bought up in increasing numbers by the big bad Big Pharma… for the simple reason that CAM brings in pots of money, without all that pesky and expensive double-blind, placebo-controlled, peer-reviewed testing. (Funny how you hear so much about Big Pharma, but you almost never hear about Big CAM…)

So what does alternative medicine bring to the table that conventional medicine doesn’t?

And once again, why should skepticism of conventional medicine translate into faith in alternative medicine?

Shiva_parvati_ganeshI’ve seen this kind of thinking a lot. Western religion is bad… therefore Eastern religion is good. Modern strip-mall monoculture is bad… therefore our bucolic rural past was good. Capitalism is bad… therefore Communism is good. (You don’t see this last one so much anymore, but it used to be very common indeed.) And in progressive lefty circles, there’s almost a knee-jerk belief that anything conventional is bad, and anything alternative is good.

But it doesn’t make sense. Being critical of something doesn’t mean you should automatically embrace its opposite.

ManusingmicroscopePut conventional and alternative medicine side by side. You get two systems of medicine, both with serious flaws. In fact, both with many of the same flaws. But conventional medicine offers something that alternative medicine doesn’t: a reasonable likelihood that any given treatment has been rigorously tested and found to be effective at least some of the time.

What does alternative medicine offer?

Homeopathy_2As far as I can tell, pretty much bupkis. From homeopathy to Reiki, aromatherapy to reflexology, careful, double-blind, placebo-controlled, peer-reviewed testing has shown almost every example of it to be useless at best. It has occasional hits — the use of meditation to relieve stress, for instance — but it has far, far fewer hits than conventional medicine. It’s a stopped clock that’s right twice a day. And it has no method in place for resetting the clock.

Pulvermachers_electric_beltsIf you’re going to be skeptical of conventional medicine — and I think you should — you need to be every bit as skeptical about alternative medicine. Unless you want to go back to the days of unregulated patent medicines — of Lydia Pinkham’s Herb Medicine and Pulvermacher’s Electric Belts, the Gold Cure for Neurasthenia and Simpson & Son’s Patented Revitalizing Tonic — you need to be just as skeptical about alternative medicine as you are about conventional medicine. And probably more so, since there’s no FDA or medical establishment whose job it is to be skeptical for you. It doesn’t make sense to be be skeptical of the one and credulous about the other.

13 comments

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  1. 1
    Indigo

    I’ve also noticed that a lot of proponents of alternative medicine seem to prefer it because unlike many forms of conventional medicine that can have drastic side effects, the worst most alternative therapies can do is not make you feel any worse. If you really believe that both are equally effective at curing your illness, which treatment would you rather get: someone massaging you and shining pretty coloured lights on your skin, or chemotherapy that makes your hair fall out and your appetite vanish?

  2. 2
    Nan

    Lets not forget the human element. Lots of alternative medicine has what can only be termed a beguiling bedside manner — very patient focused, a great deal of attention being paid to how you feel, and a general validation of the patient’s concerns — while encounters with traditional allopathic practitioners can be unpleasant. The asshole in the white coat comes in, does a cursory exam, lectures you, makes you feel stupid, and shoves a prescription in your face. Given a choice between listening to accurate bad news coupled with unpleasant advice and delivered by a jerk, and listening to a smooth-talking snakeoil salesman who makes you feel good about yourself and claims everything is going to be okay, it’s not surprising many people will opt for the snake oil.
    As for the natural treatments not being harmful, that’s not true. The historical record is loaded with examples of “natural” cures that were actually quite toxic. I’m blanking on specifics (it’s early, not enough caffeine yet) but I’ll try to track some down. Orac at Respectful Insolence no doubt has some recent examples stashed in his archive. Plus, of course, the longer a person is relying on woo while forgoing a known effective allopathic remedy the more likely it is they’ll die from delaying using what actually works for too long.

  3. 3
    christine

    This is a great topic, Greta. I have been on both sides of the fence and yet never stopped to consider *why* I was so willing to choose one side so readily over the other.
    Coincidentally, I am in the middle of reading a good book related to this topic: Snake Oil Science: The Truth about Complementary and Alternative Medicine. It is written by Barker Bausell, former research director of the U. Maryland’s Complementary Medicine Program. He presents thoughtful, and often funny, insights into alternative medicine from the perspective of the traditional scientist. So far, it’s been a good read.

  4. 4
    Nattie

    About conflating vitamins with alternative medicine (this turned out longer than I anticipated, I apologize):
    I’m somewhat perplexed that vitamins are being lumped in with “alternative medicine.” I realize that Airborne claimed to prevent colds and that it couldn’t prove to do so, which is a problem for any kind of medicine. I don’t think it’s alternative medicine, though.
    I think, here, that maybe my definition of alternative medicine is narrower than the one you’re using, or maybe that most people use. I’m honestly not sure. Airborne has some herbal stuff in it too, and I know a herbal remedies are often considered “alternative medicine.” Looking at Airborne’s ingredients, though, it seems to be primarily a vitamin supplement.
    I guess what bothers me is that the definition of “alternative medicine” seems to be so broad. It places vitamins and some herbs in the some class as, you know, healing yourself with crystals or some other ridiculous nonsense. Vitamins and some herbs really do have health benefits that are well-documented. It’s as scientific as any other medicine in that regard. Vitamins, for example, are crucial to the body’s functioning in multiple ways beyond the scope of this comment. If you have the vitamins available in your body when they’re needed, you’re less likely to become ill. They’re not a magic bullet, but people understate their importance and real contribution to health. Often people seem to think that as long as you’re not suffering a deficiency disease — i.e. the “minimum daily requirement” on nutritional labels, which really *is* a bare minimum — that you do not cannot benefit from more vitamins. Just because you’re taking enough vitamin C to ward off scurvy doesn’t mean you have enough vitamin C needed to maintain good health, for example. If you’re just a breath away from scurvy, you’re still unhealthy indeed.
    Today’s culture regards anything that isn’t reactionary medicine as “alternative medicine,” though, it seems. In other words, anything that isn’t designed by a human in a lab isn’t considered “real medicine” and that just boggles my mind. It’s considered somehow silly to take vitamins preventively, and instead one should wait until they’re sick and take “real medicine” for it; e.g. something like pseudoephedrine. Should I happen to get sick, I certainly take those things.
    However, generally speaking vitamins are either used for their purpose in the body, or the excess is flushed out with no ill effects. (Always research this, because there are exceptions. However, a lot of research on “vitamin overdose” is also poorly done. It’s best to err on the side of caution, though.) Vitamins enable your body to do things if it needs to. Most man-made medicines, however, act by inhibiting things in the body. Granted, they (usually) do this very well, but inhibiting things causes bigger side effects, and worse side effects (as compared to vitamins — some side effects are no big deal, of course). And, of course, evolution equipped our bodies to handle vitamins, whereas synthetic medicines are not as simple. Complications are more prone to arise.
    So I am always surprised that vitamins are thought to be so ineffective, or, on the opposite end of the spectrum, *dangerous* especially when the baseline for the comparison is reactionary, inhibitory medicine. It’s very difficult to overdose on something like Vitamin C, and you don’t feel significantly different when you take it. It’s much easier to induce a nasty reaction to cold medication, though — it’s more dangerous in smaller amounts, and even the standard dosage makes your average person feel rather wonky. Don’t get me wrong: I’m not one of those people who shies away from man-made medicine, nor do I want to overstate the effectiveness of vitamins. It’s just that comparatively, (most) vitamins are pretty harmless for the amount of good they can do.
    I think part of the reason vitamins are perceived as worthless is because people notice when they’re sick, but they tend not to “notice” when they’re healthy. When you’re sick, the effects of something like pseudoephedrine are clear. Vitamins can’t work the immediate miracles of man-made medicine because they can’t go in and shut down your pain receivers, or clear up your sinuses and all that. Without the obvious, outward difference in how one feels, it’s easy to forget that your body *is* doing something with the vitamins. It’s easy to feel like you’d get the same result by performing a ritual dance to preserve your health. It’s easy to feel that way, but it’s not true.
    Vitamins very much work when it comes to the job they do. It’s smart to take them rather than wait until you get sick and rely on reactionary medicine. And it’s just as biologically sound and testable as any other medicine.
    I’m also always dismayed by the idea that vitamins are in the same class woo because people often take medicine with serious side effects to address a symptom of a vitamin deficiency. Imagine, for example, the “depression” symptom of scurvy. You would be silly to take an antidepressant for it instead of some vitamin C. (We don’t often get scurvy, but it illustrates the general idea well. This is more common for symptoms of B vitamin deficiencies.) Why? Because people think vitamins are worthless in a similar vein to how they think Reiki is worthless. I don’t mean to give the impression that all or even most symptoms of illness are related to vitamin deficiency; I would doubt that. But it does often happen that people end up taking goofy medications when all they needed was some vitamins.
    I agree with the spirit of your post, that people shouldn’t turn to superstitious remedies because they see some problems with conventional medicine. All the same though, I don’t think Airborne belongs in the same class as Reiki by merit of being a weak supplement. (500mg of C is its largest component, and that’s almost nothing when it comes to C.) All medicines — alternative or conventional — claim to work at some point, and they don’t all become “alternative” medicine when it’s revealed they’re ineffective. They’re simply ineffective.
    Also, I don’t think Airborne qualifies as alternative medicine simply because I don’t see what it’s an alternative *for* in conventional medicine. I have never come across a pill that claims to prevent colds unless it’s a vitamin or herbal supplement. (If there is such a thing, please correct me.) I don’t see what conventional medicine someone is rejecting if they take a supplement to prevent colds.
    Now, if someone gets something like cancer and decides to just take vitamins for it, that’s a problem. But I think that’s a problem of ignorance, not alternative medicine. If someone decided to take Sudafed for their herpes, we would not label Sudafed “alternative medicine.” We would just wonder what the hell they were thinking.
    If someone gets Reiki for, well, anything, then I think it’s helpful to have the label of “alternative medicine” for that. I just don’t think it’s helpful to apply it to vitamins and scientifically-tested herbs, because it gives the impression that there is no good scientific research showing that it is effective. It leads one to believe that if they take vitamins, they may as well be acting on faith or something.
    Which brings me to one last point: it’s absolutely true that most *blends* of vitamins and herbs usually don’t have “careful, double-blind, placebo-controlled, peer-reviewed testing” and that’s unfortunate. It costs money to do that stuff, and though I wish more companies would, there’s a reason they don’t: the individual components of the blend often have been tested in that manner, and that’s enough to get people to buy it. Indeed, those very studies are what prompts companies to put a certain vitamin or herb in their blends. The problem with most blends is that they don’t have *enough* of each component to be effective. Imagine if a Nyquil tablet contained 1/5 of what it ought to; of course it would hardly do anything. This is Airborne’s problem as far as I can tell; its ingredients in much larger amounts ought to be effective, but it contains hardly enough of anything to make a difference.
    So, for example, you hear things like green tea has been proven to show weight loss… if you have something like 700mg of its EGCG a day. (I forget the exact number, but it’s around there.) So out of ignorance or deceit, companies manufacture blends with, say, a mere 25mg of it, and of course those are complete crap. People see “green tea” on the label, so they buy it. And since so many people are ignorant about vitamins, there is no shortage of companies looking to hoodwink them. Consequently, any consumer must read studies and compare them to the quantities in a blend before they buy anything. But some dishonest companies shouldn’t color the entire vitamin/herb supplement business as ineffective or as alternative medicine. The science is still there, it just gets trampled on by the opportunistic.

  5. 5
    Dave Haaz-Baroque

    I wrote about this exact same thing in my journal last week! It wasn’t as well-written as your post, of course.
    http://shadowcircus.livejournal.com/242066.html
    The other thing that’s always confused me about Airborne is the marketing; “Invented by a school teacher!”
    Um… and a school teacher should be trusted to practice medicine on what basis?

  6. 6
    Greta Christina

    Quick answer to Nattie’s very long comment:
    Vitamins as a nutritional supplement are not alternative medicine. (Although there is beginning to be some doubt as to whether vitamin supplements — as opposed to vitamins acquired by, you know, eating food — do much good. But I won’t argue that point right now.)
    And vitamins used to prevent illnesses — such as scurvy — that they’ve been shown by rigorous testing to actually prevent — are not alternative medicine, either.
    But vitamins sold as a preventative or cure for specific illnesses that we don’t have any reason to think can be prevented or cured by those vitamins — such as Airborne — *are* alternative medicine. It makes a very specific health claim, without backing that claim up with rigorously gathered evidence.
    The problem with Airborne isn’t that vitamins are bad or worthless. The problem with Airborne is that it repackaged vitamins and a few herbs, jacked the price enormously, and made claims about its ability to prevent and treat colds that vitamins simply don’t live up to.
    And to this:
    “anything that isn’t designed by a human in a lab isn’t considered ‘real medicine’”
    That’s just simply, flat-out not true. Current conventional medicine is *obsessed* with exercise, diet, and quitting smoking. I was told by a doctor that the best thing I could do for my digestive problems was to drink more water. And Nurse Ingrid could tell you about oodles more non- lab- invented treatments that conventional medicine is all over.
    I’d like to point you to an earlier piece I wrote on this. “Untested by Definition: A Rant on Alternative Medicine”:
    http://gretachristina.typepad.com/greta_christinas_weblog/2007/12/untested-by-def.html
    The point of that piece: Conventional medicine is, *by definition,* medicine that’s been rigorously tested and shown to be effective using the scientific method. Alternative medicine is, *by definition,* medicine that is outside that system of rigorous testing.
    That includes taking treatments shown to be effective for A and using them for B, even though there’s no reason to think it’ll be effective for B. And it absolutely includes treatments for conditions that conventional medicine doesn’t claim to be able to treat. The fact that alt medicine makes wild claims about everything from the common cold to criminal activity doesn’t make it *less* alternative…
    Finally, I want to answer this, since it cuts to the heart of my point:
    “Now, if someone gets something like cancer and decides to just take vitamins for it, that’s a problem. But I think that’s a problem of ignorance, not alternative medicine. If someone decided to take Sudafed for their herpes, we would not label Sudafed “alternative medicine.” We would just wonder what the hell they were thinking.”
    People don’t just decide on their own to take vitamins for cancer. They are advised to do so by people working under a false cloak of authority and knowledge. If someone “decided” to take Sudafed for their herpes, we would indeed wonder what they were thinking. But if they were advised to take Sudafed for their herpes by an alt medicine practitioner, then that would, indeed, be alt medicine. And in my opinion, that practitioner should be prosecuted for practicing medicine without a license.

  7. 7
    Greta Christina

    “Um… and a school teacher should be trusted to practice medicine on what basis?”
    You read my mind, Dave. That’s the subject of today’s post.
    http://gretachristina.typepad.com/greta_christinas_weblog/2008/03/created-by-a–1.html

  8. 8
    G Felis

    You know, I think this general phenomenon you refer to has even wider implications than you address – which I blogged about when I saw this. To quote my own blog (without the link back here, which would be redundant and annoy typepad):

    I’m dubious about X, therefore Y ?!?

    The ever-provocative and brilliant Greta Christina asks a very interesting question: “Why should skepticism of conventional medicine translate into faith in alternative medicine?”
    She lists a whole bunch of other examples where people commonly go from skepticism about one thing – often legitimate skepticism, at least to some degree – to completely uncritical and unreflective embrace of some alternative. In academia, I think that pretty much ENTIRELY explains the popularity of the more extreme forms of postmodern thought. Recognize that the search for truth is dicey and full of assumptions and power games? Clearly postmodernism is the way to go! Which, of course, completely ignores the power games and assumptions of postmodernists themselves – much more transparent power games (jargon-mongering twaddle) and more absurd and less plausible assumptions than the traditional forms of inquiry postmodernism purports to criticize and question.
    Are we looking at another of those inherent, knee-jerk, hindbrain kinds of human mental patterns that are so hard to spot, let alone break? Quite possibly, methinks…

  9. 9
    Joreth

    I’ve been saying this about Airborne since I first saw the commercial. It said “created by a schoolteacher!” and I said (yes, out loud and back to the TV) “and what does a school teacher know about medicine? I’ve known some pretty imbicilic school teachers, and because of the teacher shortage, the standards to become a teacher aren’t all that impressive, particularly if her grade level is only second grade!”
    So, she deals with kids a lot and those kinds of professions get you sick often. I used to be a child photographer, I got every damn sniffle I came in contact with. That gave me absolutely no authority to “invent” anything. I took my vitamin C and echinacea (which did nothing and I learned later that testing proved it did nothing), I even came up with ways of mixing them together because I hate swallowing pills.
    That doesn’t mean that ANYONE should listen to me when I extole the virtues of my homemade vitamin-and-echanacea-milkshakes. Until someone does a double-blind study and gets the ingredients under a microscope and has some sort of *proof* that the ingredients actually fought off viruses and bacteria (as opposed to: I just simply didn’t get sick this month by coincidence), the only thing I can say about my milkshakes is that you can’t taste the vitamin C and it probably won’t kill you.
    And *I* think they taste pretty good :-)
    “Joreth”
    http://www.theinnbetween.net
    http://joreth.livejournal.com

  10. 10
    Inquisitive Raven

    As far as the body dumping excess vitamins goes, while this may be true of the water soluble vitamins, e.g. C, B complex, it is not true of the fat soluble vitamins (A, D) which are far more likely to cause overdose problems. With vitamin A, how much leeway you have depends on whether you’re getting it as retinol or beta carotene (which is actually a vitamin A precursor). You have much more leeway with beta carotene.

  11. 11
    Paul

    I know this is an old post, but hey – I read it, maybe other people will?
    My addition to your arguments above is that much of the treatment also depends on two (more) things:
    * The person being treated and…
    * what records are being kept.
    If the person is using both conventional and alternative medicine, it’s great if it helps. Unfortunately, it’d also be hard to sort out what helped the most, which combination of treatments worked, and how it could be repeated later on. The beauty of conventional medicine is it’s ability to work on a huge audience of sick/injured people – not just the one. A family member of mine who’d received homeopathic remedies for his various aliments got genuine help from what treatments his doctor prescribed, but the solution was tailored to him as an individual and likely would not be applicable to others even if they had identical problems.
    His argument was this: conventional medicine has the deductive approach. You start with all the common problems and possible solutions, and starting with the most generalized groups (gender, age, region, “race”, etc.) and work your way down until something works. Antibiotics don’t need to be tailor made for an individual, but the strengths of each increase with how resistant the bacteria is.
    Conventional medicine also focuses on stopping the symptoms first, then curing the underlying cause. Recently there’s been more effort being stressed on preventative measures like exercise, meditation, etc.
    Homeopathic medicine, in his experiences, is focused on the individual and what works for them. This means that treatments will be customized for each patient and will generally take longer to have a real affect. The idea is that once discovered, the ailment will be actually “cured” as opposed to possibly put into remission or having it crop up as something different but related.
    It certainly doesn’t mean it’s useless, but it’s far from being reliable. Like you’d mentioned, conventional medicine has both method and results to back it up. Alternative medicine needs that to make it more useful, and maybe someday it will. Hopefully soon, as we’d all like more tools in the toolkit when it comes to health.
    Records are another stumbling block, as far as I’m seeing, for medicine. Like all maintenance in the world (car, computer, water heaters, etc.), huge benefits are made by the documentation of repairs and changes made. If my doctor didn’t know I had acupuncture done on my shoulder, something could go horribly wrong when I went into physical therapy. Sure, both types of medicine suffer from this, but how much documentation sharing do you think goes on between hospitals and alternative medicine practitioners?

  12. 12
    Generic Cialis

    Great post. Very informative and helpful for women who really wont care their health.

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