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Some Thoughts about "CAM" Beliefs

JeanneE Hand-Boniakowski, RN

The White House Commission on Complementary and Alternative Medicine Policy (WHCCAMP) issued its final report in March. It is a prayer of praise to CAM, which it never actually defined, despite two years of "study". Between the WHCCAMP and the NIH National Center for Complementary and Alternative Medicine (NCCAM), there have been, in 10 years, over one billion of our dollars spent, supposedly to research the efficacy, safety, and veracity of "Alternative Medicine." Results? We have -- according to these fine commissions -- debunked exactly nothing. Nothing has been either proven or disproven, according to these expert panels. This lack of any definitive answers to the questions these groups were charged to study does not seem to bother the leadership of either group, who say that it means more study is needed.

I was enthusiastic when the Office of Alternative Medicine, the body that evolved into the NCCAM, was formed at the NIH. As a user of several practices that fall under the vague term "alternative medicine," I was glad there would finally be rigorous testing, to separate the wheat from the chaff. NIH authority assured the likelihood of valid research. Or so I thought. I assert that, yes, we should study the few practices and theories in the hodgepodge of so-called CAM that have sound hypotheses amenable to testing. But we should also relegate the majority of CAM practices to the rubbish heap of nonsense where they belong. When a practice and/or its theoretical underpinnings conflict with scientifically verified facts, when it fails scientific testing or is so bizarre that it cannot be tested, it should be discarded from medical and nursing care. Allowing appropriate room for a patients to engage in their religious rituals is an ethical imperative. But granting such religious practices (homeopathy, qigong, therapeutic touch) the status of adjunct medical or nursing therapy is an ethical mistake. Those who continue to push for acceptance of such practices should be called by their proper names: variously cultists, crooks, or quacks.

CAM has no definition that the movement can agree upon, nor even that the NCCAM or WHCCAMP can provide. This ambiguity annoys some alt-med advocates, such as meditation teachers who wish they were not associated with the dental alchemists or the alien abductee shrinks. But most folks are happy with the loose coalition of CAM, where the few practices which have either proof or promise lend credibility to the rest, no matter how wacky. Just having a couple of official federal bodies (sort of) in on the fun, not to mention all those endowed CAM departments at prestigious universities, is enough for alternative healers of all varieties to feel validated. Having a department of alternative medicine in your medical college no more proves efficacy than having a theology department proves God, of course. The majority of CAM professors are advocates, rarely skeptics. They share a vague and unchallenged assumption that CAM must mean something. Again, the similarities to theology. Proponents capitalize on associations with major universities while ignoring the standards and conclusions of science...oh, excuse me, "Western Science," that stodgy animal that doesn't understand the quantum essentialism of the spirit-filled world, blah blah blah. This notion of different, culturally defined, distinct and equally valid versions of science is spreading. There is no such thing Western science, Eastern science, Islamic science, Creation science, Chinese science, et cetera. There is only science. These other things may be philosophy, delusion, religion, ideology. They are not science.

There is a smiling, even sweet, intellectual dishonesty among the CAM crowd, which they see as openmindedness and cultural sensitivity. This allows them to hold equal belief in an enormous array of nonsense. Going to wellness fairs, folk festivals, new age shops and other venues crawling with CAM practitioners has exposed perhaps the most insidious aspect of this loose movement. In a spirit of equality and inclusion, fairness and access, there is virtually no discrimination. It is a mutual admiration society, with oohs and aahs, hugs and healings for all. It is a sweet and kindly crowd, for the most part. Your personal experience is the highest standard of proof. And they are all recipients as well as providers of services. They accord equal respect for the varied "healing modalities" offered by each. Thus a wild crossbreeding of goofy ideas is fertilized in the permissive soil of uncritical enthusiasm. Allergies are diagnosed by applied kinesiology, and cured by waving laser pointers over acupuncture points, supplemented by Chinese herbal medicines and homeopathic preparations.

I have been told by a less activist skeptic that these people are not doing any harm, and maybe they stimulate enough placebo to do some good in spite of themselves. I am afraid this is the prevailing attitude among skeptics. I am not so sanguine. Many CAM consumers are fair-weather marks who have physically harmless CAM treatments (Reiki, Polarity, colorpuncture) to get and stay "in balance." This is entertainment and caring physical touch, for the worried well and the just swell. If they get sick, though, they will see a "real doctor" as one woman said to me. They are playing a game of make-believe and they almost acknowledge it. It is akin to belief in ghosts, I think. Something harmless, fun to believe, and not to be examined too closely lest it lose its charm.

The problem, of course, is knowing where to draw the line. Con artists and misguided crusaders alike can convince a fair-weather mark to have expensive and even dangerous treatments. Laetrile, chelation therapy for atherosclerosis, coffee enemas and chiropractic neck manipulation can be dangerous, and have not proven effective. Indeed, many treatments in medicine that are "standard of care" have not been proven in that most definitive of testing protocols, the double blind study; sometimes is not possible.* And a physician may treat outside the standard. But everything that is considered standard-of-care in medicine has been extensively studied and clinically and statistically analyzed, and, unlike vast areas of CAM, must be based on known facts and sound hypotheses. A sound hypothesis is grounded in theoretical reality as assumed based on plenty of experiment and observation. For example, the cause of a particular illness may be unknown, but knowledge should lead one to consider an infectious pathogen or chemical trauma, say, and to not consider a ruffled "human energy field." The HEF is popularly presumed, yet unmeasurable by any objective means, and lots of CAM theory depends on its existence. A house of cards built on a wishes, guesses, and dogma.

I have spoken with practitioners who have not developed adequate referral relationships with the rest -- the real -- of medicine. Someone suspicious of medical doctors may depend upon a well-meaning CAM therapist who does not recognize ominous symptoms. If someone has a psychiatric crisis during a "shamanic journeying", will the healer/tour guide be able to, or even know to, get the patient help, or try to chant him back? One of the most lethal diseases in the US is major depression. A variety of admittedly imperfect drugs have literally saved lives, but CAM scammers are among the strongest critics of synthesized psychotropics.

Everytime I think folks cannot buy another, wilder form of snake oil, they buy the stuff by the case. Just last week, someone assured me that she saw silver fillings turn to gold and porcelain crowns turn to gold crowns. She is, she insists, "the biggest skeptic" but she "saw it with my own eyes." I asked her why I have not seen it in the dental journals, told her of many years of similar claims, that our "own eyes" are very easy to fool, and that the Indian fakirs/fakers beat the western hemisphere to most of these tricks by centuries. She said she had a different need for evidence than me, and said, "I saw it . . . you don't have to believe it." My response? "YOU don't have to believe it!" Preponderance of evidence, experimentation, data (not anecdote) mean that knowledge is not a matter of faith, that you don't have to "believe it." I should have asked why the "dental healer" did not just make new undamaged teeth. And what cement does God use under those miraculous gold crowns?

The dental healings were all the rage recently in charismatic christian churches, and seem to have been an import from Argentina, where the craze appeared in the 1970's. Along with gold crowns where they had never been before, and cross-shaped gold fillings, there is gold dust, glittering and appearing on folks clothes, hands, hair. Commonly this is accompanied by oil, usually appearing on people's hands. That is the way the reports go. The "gold dust" that has been tested is shown to be plastic glitter. A few American preachers have had to admit that the miraculous gold crowns God gave them were actually placed months or years before by their dentists.* Few folks will check their dental history to verify what they already are sure is a miracle. As for cross-shaped fillings, molar fillings on the chewing surface are usually this shape, as decay occurs in the anatomical pits and fissures between the cusps. In human molars and premolars that pattern of nooks and crannies is a cross. In dogs, who have the same number of teeth, but many more cusps on each molar, there is no cross. Fillings made of silver amalgam are shiny when first placed, though may darken with time, and grinding the teeth can continuously burnish these fillings. Shine an incandescent penlight in your mouth and your back teeth may shine with golden crosses, too, as the yellow light bounces off the silver surfaces. Of course, people will see what they desire and expect to see, and reinforce one another in delusion and illusion. It is these dependable aspects of human perception and psychology that honest magicians and unethical charlatans alike depend upon.

The "holy teeth" stories may seem a silly and absurd example, but these tales share in common with other healing anecdotes some important aspects that illustrate a determined lack of critical inquiry. If these stories were true, it would be easy to test the claims; yet believers show a curious lack of interest, and even hostility to, such independent investigation. It reminds me of the notable lack of concern that Freud's "hysterics" showed to their reported afflictions (blindness, paralysis), which led to the theory that the symptoms serve a purpose and the afflicted preferred the symptoms to the responsibilities of wellness.

Belief in miracles serves various purposes to believers, and I often encounter folks who don't care about scientific verification. Those rare tests designed by believers to test their beliefs are usually biased and inadequate, built upon common fallacies. These "researchers" do not consciously cheat (often), but neither are their lousy techniques challenged by "peers," because their peers do similarly silly work.

When I quiz CAM fans on the pseudoscience of their claims, they are almost always surprised. Although they like to claim victim status, oppressed by the mythic, monolithic "medical establishment," they are seldom challenged to their faces with simple friendly skepticism. And I am still surprised that they have not already asked themselves the questions I do. Chatting with an acupuncturist recently who sells a line of homeopathic "remedies," I gave him an aid to understanding the extent of dilution involved in a "30 C" homeopathic preparation. So, there is not even a molecule of the original substance in the final remedy. He agreed, then explained that water retains the "memory" of the substance originally chosen for "potentizing" (dilution). Well, I said, what of all the other substances that water in the remedy has encountered? If water molecules and the component atoms retain "cellular memory of water," what of the places it has been: sewers, other folks bodies, uranium mines, trees? He "never thought of that." I only know it the remedies work, he said, maybe the key is in the "succussion" (ritually hitting the bottom of the vial on you palm a specified number of times). I looked at him like he had just sprouted another head and his skin broken out in a plaid. When folks just get absurd, they may need someone to stop making nice-nice and call them on the nonsense. He finally said he did not know exactly HOW it worked but THAT it does work. Well, it is a start, but I hope he will examine his evidence THAT the remedies work. And how does he define "work"?

I will not defer to the supposed authority of homeopaths who can't talk sense about the field they are so educated in. Likewise psychics, theologians, physicists, or anyone else who makes claims about reality if they cannot back them up with reality. And out of that list, only physicists can do so in their field of expertise, but a physicist is not physics, and can believe in nonsense as religiously as the next guy.

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Mrs. Hand-Boniakowski is a registered nurse and registered dental assistant who works in a dental office in Manchester, Vermont. She and her husband Jozef maintain and publish a provocative monthly online newsletter for parents, students, teachers, educators, professionals, doctors, dentists, lawyers, other professionals, and working people, especially those who think non-traditionally

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This page was posted on July 24, 2002.