Australasian Science Magazine

By Marcello Costa

How can we compare the evidence base behind conventional and complementary medicine?

The health industry increasingly emphasises “personalised care” and the need for individuals to take control of their own health. Health administrators face the same choices as to how they allocate resources for health care, so can we distinguish between good health sciences and wacky ones?

It is often claimed that the dividing line between scientific and unscientific knowledge is blurred and the distinction unclear. While the “nature of reality” remains a serious philosophical issue for scientific thinkers, what constitutes “reality” in health care is much more down to earth. It helps to distinguish between alternative and complementary procedures, which are often bundled together.

You can argue that there really are no “alternative” medicines. People wanting proper medical prevention and treatment go to a legally qualified medical practitioner.

Some practitioners of “complementary and alternative medicines” (CAM) maintain that they are a genuine alternative to mainstream medicine. Other CAM practitioners seem happy to be seen as providing a “complement” to scientific treatments, even though the procedures they offer, unlike mainstream medicine, are not evidence-based. Interestingly, the term “alternative” is being dropped by many Australian practitioners of CAM.

The reality is that modern medicine is already complemented by a number of allied health sciences professionals whose disciplines conform to scientific principles, such as physio­therapists, nurses, pharmacists, midwives, optometrists, audiologists, occupational therapists, health social workers, clinical psychologists, psychotherapists, radiographers, podiatrists and dieticians.

Setting aside philosophical considerations, you simply need common sense to distinguish between good science and wacky pseudoscience in health care. A good place to start is by comparing the genuine allied health sciences with the corresponding varieties of CAM. Optometrists do not use iridology, audiologists do not use ear candling, and physio­therapists do not treat chiropractic “subluxations” or apply reflexology principles.

An obvious distinction is the plausibility underlying these practices. The allied health sciences do not make claims that are incompatible with modern science and modern medicine. They do not ascribe their techniques to mysterious knowledge, “forces” or metaphysical principles. Their techniques are well-founded on empirical evidence.

By contrast, “complementary” practitioners cite absurd principles behind their interventions. Reiki and iridology practitioners, crystal healers, ear-candlers and others invoke forces like “reiki” and “chi” but cannot provide any evidence of them.

For example, iridologists claim to be able to determine the health of every bodily system by examining the iris in the eye even though pigmentation of the iris is a local process with no plausible biological links to the rest of the body.

Similarly, chiropractic claims that an innate intelligence acts via a “force” entering the spine to keep people healthy, and that misalignment of the spine (the mythic “subluxation”) causes all diseases, are unfounded, absurd and sometimes dangerous. Mystical forces are untestable; this fact alone disqualifies any claim that the practices that depend on them are scientific.

If a child gives us a “pretend explanation” we immediately see through it for what it is – a magic wish. Unchecked imagination provides the endless world of children’s fairy tales. If adults were to give similar “pretend explanations” based on wishful magic we would immediately point to their absurdities.

The perplexing reality is that the world of CAM is full of explanations that defy common sense, let alone the more serious analysis already performed on many “complementary and alternative” interventions showing that, at their best, they act only as placebos.