Nepali Times
Life Times
Alternative medicine

DHANVANTARI by BUDDHA BASNYAT, MD


If you are having a heart attack, it is probably not a good idea to seek immediate treatment with homeopathy, herbal medicine or acupuncture. In that setting, it is best to be treated with western (allopathic) medicine where available. However there are many illnesses where western medicine has its limitations: ranging from terminal cancer, certain neurological problems like amyotrophic lateral sclerosis (Lou Gehrig's disease) to common cold, where you can only treat the symptoms. There are also diseases like rheumatoid arthritis, diabetes mellitus, and hypertension where there is clearly effective control with modern medicine but no cure. Many people desire a cure and choose alternative medicine.

However, reports based on recently published findings show that 95 per cent of alternative or complementary medicine is not evidence-based and borders on quackery. This is big pill to swallow for practitioners of alternative medicine. Western medicine, as mentioned often in this column, is based on randomised controlled trials which try to show that a drug for a certain disease is better than a placebo (sugar pill). However, most alternative medicine therapies do not look better than a placebo.

Many alternative medicine researchers have reached a point where they do not want to carry out more trials because the trials show the ineffectiveness of their medicine and risk hurting the trade in the long run. Even meta-analysis (putting together small trials to see if the sum effect shows efficacy of the drug in question) of these alternative medicine drugs have increasingly shown negative results.

Rather than giving up, more rigorous trials of diseases using herbal and other complimentary drugs with adequate sample size of the population need to be carried out. There may be many useful herbs with an effective drug molecule that need to be tested to show benefits. Making use of the placebo effect for certain patients may also be a great idea.

But in reality, most people who have a clear-cut disease will want to know if there is proper evidence for use of that particular drug for them. There is also a myth that unlike western drugs, alternative medicines have no adverse effects. This needs to be dispelled.

What also needs to be shunned are statements by 'scientifically-challenged' celebrities and godmen who think that alternative medicine is outside the realm of scientific scrutiny. Time to separate science from superstition.



1. Rajeev Das Hada

Dr. Basnyat,

Your arguments are too general. Your arguments are correct in saying that immediate care and emergency cases need allopathic remedies. But to say that 95% of alternative medicine is not evidence based or is quackery is ridiculus. There are many types of alternative medicine. There are a lot of quacks out there, no doubt, and there are a lot of genuine ones out there too. To say chinese acupuncture, ayurveda, homeopathic medicine, etc , are all quacks, is stupidity. These medicinies work better than allopathic medicines in a lot of cases. It depends upon the genuinety of practioners.

What needs to be done is to standardize and categorize alternative medicine or regulate it just like modern medicine.Anyhing that is not allopathic medicine has been branded as alternative medicine. This broad categorizing needs to be removed. The word alternative medicine itself needs to be removed. When you say studies in alternative medicine have shown ....... blah, blah, blah, which approach  are you talking about? There is bound to be quackery when it is not standardized.

Also, most of the researches and studies are done by pharmaceutical companies. It is in their vested interest to downgrade alternative approaches to medicine. And, they have become very successful in doing so. Doctors, scientists, insurance companies and above all politicians are all in their pay rolls.  Thus the researches and studies that are produced and fed to the public are also all dubious. 



2. Bob
Herbal medicine is plant-based and plants have active healing powers. Many modern drugs are derived from observation of the practices of traditional herbalists. If one wants to foolishly deny that these herbs have active ingredients with the ability to affect the body's functioning, one must also deny the "adverse effects" complained of. Herbal medicine is occasionally poorly applied, leading to harm - but the vast majority of medical harm is inflicted by the monopoly of the pharmaceutical industry. All that many doctors know about the latest powerful drugs they prescribe is what the pharma salesman told them.


3. Anonymous
Surely, a big pill to swallow for practitioners of research with the author's seemingly "religion-like" faith in RCT. The hard core positivist approach to research methodology, that evidence validated through RCT is the only "scientific truth", is problematic even in medicine. The pure rationalist positivist paradigm has been challenged by qualitative (or constructivist) researchers in fields such as linguistics, social sciences, anthropology, history etc. (See an insightful dialogue between Naresh Neupane and Rabi Thapa in this issue of the Nepali Times!) "Ecological validity" has been an emerging concept of  research in many fields; one cannot deny the role of context and subjectivism in constructing reality.  Search for a "holistic" approach to healing, promotion of health, and prevention of disease has been a big challenge in medicine since the dawn of modern age of science and technology. Human beings are not guinea pigs after all, nor is a human body a mere "factory of enzymes". 'Chemical management' of illness, though practiced extensively in modern age, is philosophically reductionist at its very root; moreover, the practice is full of inherent paradox, e.g. iatrogenic effects (e.g. increasing nosocomial infections due to rampant use of antibiotics!); in other words, treatment leading to disease! Hence, human quest for "alternative" medicine will always be there; it is also an individual's freedom to have choices. I agree with the author that rigorousness must be maintained in research. Perhaps we need to develop an "integrated approach" to healing illness and promotion of health.


LATEST ISSUE
638
(11 JAN 2013 - 17 JAN 2013)


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