I read another very interesting article recently on the Medscape website, which is a physician-oriented website. This is another interview, this one with Paul Offit, M.D., who is Professor of Pediatrics at the University of Pennsylvania School of Medicine, Children’s Hospital of Philadelphia and Chief of the Division of Infectious Diseases there as well. Paul A. Offit, MD, is also the coinventor of the RotaTeq® vaccine, for which he receives no financial remuneration for sales of the vaccine. Lastly, Dr. Offit is the author of a book entitled “Do You Believe in Magic? The Sense and Nonsense of Alternative Medicine”.
But this article is not about the vaccine, and it is not strictly about cancer and the power of the placebo effect, either, although that is the title of the article. Instead, the article is a report of Dr. Offit’s thoughts on the differences between complementary medicine and alternative medicine. Complementary medicine, as described here, is medicinal therapy given to a patient to relieve symptoms or improve physical or mental well-being in addition to tradition medical treatment. An example might be massage as a way to decrease stress levels in a cancer patient undergoing chemotherapy. Alternative medicine, as described here, is therapy given in place of traditional medical treatment.
Dr. Offit makes a point of defining the difference between science and religion here. He points out that medical treatment is based on science “which is what separates facts from ignorance” and he feels it is important these days to find a way to make that science compelling enough to overcome the general idea that facts do not matter. He says, “Medicine and science are evidence-based systems. They aren’t belief systems. How do you get someone away from a religious way of thinking to a more evidence-based way of thinking? That is the challenge.”
And Dr. Offit is talking about strictly about religion here, but also about the ways that people tend to think that “natural” ingredients or “organic” elements are just across-the-board more effective and/or less harmful. There are many pharmaceutical medicines which are based on “natural” ingredients. And he also points out that the polio or ebola viruses are also “natural”. Conversely, so-called natural elements, such as garlic, can be harmful if ingested incorrectly. Garlic, in his example, can cause stomach bleeding if taken in too concentrated a form. He says that in today’s world, we are not only combating illiteracy, where people do not read so they are not informed about science. But we are also combating “denialism”, where people are just not willing to accept the truth. He says there has been so much effort expended to give patients “a say” in their treatments, and take their thoughts into account, that the net result has been to place the patient’s ideas on the same level as the doctor’s ideas… even if the “ideas” of the doctor are backed up by evidence-based science, and the patient has no evidence or science behind their ideas.
Dr. Offit goes on to address the placebo effect. He says that it is unfortunate that we call it that, as placebo can be seen as a limiting, and somewhat dismissive concept. Instead, we should look at how we are able to marshal the body’s own immune system or chemical-release system and learn how to do that on a more predictable basis. If undergoing acupuncture sessions has a way of releasing our own body’s endorphins, for example, then perhaps we can continue to investigate ways to release our own endorphins. There are definitely effects of certain alternative treatments, but they are not always from the treatment itself. That doesn’t make the effect any less important, and does open up the possibility of applying science to these modalities to find more predictable pathways for delivery of the intended result.
As the doctor says, he decries ‘magical thinking’. “I worry that these therapies evoke a kind of magical thinking, prompting proponents to explain their effectiveness by saying, “There are just some things we can’t understand.” Although this is true in the realm of religion, it isn’t true in medicine. We may not understand it yet, but it can be analyzed.” There are things we still have to learn, but in his opinion, we should still apply scientific rigor to our investigation.
The story of Steve Jobs comes up more than once in this interview, as an example of someone who believed in alternative medicine so much that he resisted scientifically-proven medical therapies. In the end, as we know, he died. Dr. Offit does not go as far as saying that Mr. Jobs might have lived longer if he had made different choices, but he certainly implies that.
Probably the most useful section of this interview (and perhaps of his book) is the four ways he describes that treatment can cross the line from “placebo” into “quackery”. He outlines the four ways as choosing an alternative in place of something that works, taking something you think cannot hurt you which actually can hurt you, promises about results in treatment of diseases that the medical establishment has no sure cures for currently (such as autism or certain aggressive cancers), and lastly, catering to magical thinking (he gives “meridians” and “astrology” as two examples here).
In the end, the doctor admits that there are alternative therapies and people that believe in them everywhere you look, even in his own household. But he says that when something is wrong with him and he sees a specialist, he expects that that specialist, who has made this his life’s work, should have the best answer to solve the problem. And he trusts him to do that.
Apparently, even his own wife sometimes will indulge in alternative therapies. He agrees that the body has its own ways of releasing chemicals, creating or recreating health. What he argues with is the lack of evidence-based science to back up some of the beliefs that people have about those mysterious ways.