Some Bad CAM Outcomes

Outcomes research looks to the results of a therapy to see whether it works.

That's the basic underpinning without the larger scientific methodological explanation. At any rate, a neurology blog describes some very bad outcomes from use of CAM therapies.

In case 1, a nutritionist recommended to a client "a hydration detoxification program, which included drinking 4 pints of water per day and reducing salt intake ..." The patient followed the "advice until her sodium level dropped to unhealthy levels, causing a seizure. Details in the news reports are sketchy, but it seems that Page had permanent neurological symptoms following her misadventure with detox hydration therapy, and was recently awarded 800,000 pounds in a malpractice judgment."

In Case 2, a practitioner (acupuncturist, perhaps?) was doing cupping, rubbing alcohol on the patient when "it spontaneously burst into flames." The patient "has apparently suffered significant burns and will need treatment for about a month."

So far, so good - these are bad outcomes and (as the facts are reported to us, or rather the alleged behavior) would appear to fit the conclusion of negligence, incompetence, or perhaps criminal behavior.

But the reporter than jumps to conclusions and generalizes about CAM itself:

All interventions have their risks. No medical treatment that actually does something is completely without risk. That is why the standard method for evaluating a treatment is to assess the risk vs benefit ratio, as applied in an individual clinical situation. Risks are therefore justified if they are outweighed by the benefit. It is therefore not reasonable to cite instances of bad outcomes in order to impugn a treatment or a profession, without putting such outcomes into the proper context of the benefit of such treatments.

Of course - if there is no benefit to the treatment because it is based upon abject pseudoscience, then any risk is unacceptable. Here are two recent tales of risk without benefit - otherwise known as malpractice and incompetence, euphemistically referred to these days as complementary and alternative medicine.....

There is no such thing as legitimate "detoxification" treatment. Anyone claiming that a treatment detoxifies the body is a charlatan of one type or another. The concept has a psychological appeal - it is easy to imagine bad stuff being drawn out of or purged from our bodies. We evolved an emotion of disgust to help us avoid true toxins and harmful substances in our environment and food - so the detox scam is just playing off of this emotion. But there is no science behind it - so beware.

It is always interesting to see so much orthodox rigidity underlying claims of being 'scientific:' it is an either/or reality, us versus them -- or in the words of a major medical journal's editorial, there is no alternative medicine, only science and nonsense.

And this same approach reminds me of those who claim that alternative therapies are unregulated, or under-regulated. The first is simply inaccurate; the second, if true, can be corrected through sound legal, regulatory, and policy fixes. Legal rules such as licensure, malpractice liability, scope of practice boundaries, professional discipline, federal and state fraud rules, food and drug law, and even laws relating to third-party reimbursement and professional society guidelines and educational materials can help curb abuses in complementary - abuses that are no different from those experienced in medicine and the allied healing arts.

If we view healing as a spectrum of activities - from the physical to the nonphysical, from the biochemical and physiological to the psychological, spiritual and energetic, from the medical to those of the allied health professionals and those of the CAM providers, from the most modern, technological advances to the most ancient forms of addressing imbalance, from focusing on symptom management to dealing with the broader environment - then we can understand health and healing in its broadest form, and, unclouded by rhetoric sharpen our view of the toolbox to choose those therapies that work in the best interest of the patient.