Australasian Science: Australia's authority on science since 1938

“Alternative” Is Not a Compliment

By Sue Ieraci

There is no such thing as “CAM”, only medicine, complementary therapy and scam.

The industry supplying “remedies” outside of conventional medicine is often referred to by the abbreviation “CAM” – complementary and alternative medicine. Within that title, however, resides a multitude of diverse therapies – some safe and potentially beneficial, others frankly deceptive and dangerous. It’s time to carve up the term “CAM”.

Medicine is therapy that works, complementary therapy can help well-being, and alternative medicine has not been shown to work. There is no “CAM” – only medicine, complementary therapy and scam.

Recent prominent media stories of fake cancer cures have brought this issue into sharp focus. “Alternative cancer treatments” are ones that can’t work, and don’t work. Packaging up the terms “complementary” with “alternative” can deceptively lead people to believe that the entire category is somehow embracing the “holistic” and “natural”, when the opposite is the case.

In actual fact, conventional cancer treatment is the most “holistic” service we have. Modern cancer institutes don’t just provide chemotherapy, radiation or surgery, but also counselling, peer support, psychology and psychiatry, social work and even fashion advice.

The Cancer Council of Australia lists evidence-based complementary therapies on its website. The practice of meditation or yoga, massage and even music therapy can enhance a person’s sense of comfort and well-being while undergoing conventional, effective cancer therapy. Eating well, gentle exercise and empathetic socialising all contribute to a “healthy lifestyle”.

None of these approaches, however, are alternatives to effective treatment. They don’t purport to be curative or to replace real medicine.

“Alternative” therapies are another thing again. From homeopathy to Gerson therapy, their proponents claim to cure. Disaster almost always follows when vulnerable people abandon conventional therapy and place themselves in the hands of the purveyors of these so-called “alternatives”. The providers of these “alternatives” offer false hope, often using persuasive communication methods and simplistic, directed advice to court their clients away from the uncertainty of conventional medicine.

What, then, are we to make of the term “Integrative Medicine”? As much as it is “holistic”, conventional medicine is also “integrative” in that it integrates multiple therapeutic modalities from counselling to surgery and from prevention and cure to palliation. What is now termed “Integrative Medicine” is actually an integration of the conventional and the “alternative” – medicine based on science with non-science-based therapies.

It is informative to examine the sponsors listed on the Australian Integrative Medicine Association’s website (tinyurl.com/q6lrh67). Much of the “integrative” therapy relates to nutritional supplements (including intravenous vitamins) and other therapies outside evidence-based indications, such as chelation therapies normally used for proven heavy metal poisoning. Evidence-based chelation therapy involves the administration of substances that bind to heavy metals in the blood, for serious conditions such as lead or iron poisoning. The treatment is not without risk, and should not be used outside of serious cases of poisoning. As the American College of Medical Toxicology warns, basing chelation therapy on non-conventional testing doesn’t benefit patients and may prove harmful. Similarly, while vitamin supplements to replace deficiency are evidence-based, intravenous high-dose vitamins can be toxic in themselves (IV vitamin C being a risk factor for kidney stones).

Doctors who practice “Integrative Therapy” can be popular because they may combine the benefits of science-based medicine with a sense of caring unconventionality. This may be appealing in our post-modernist society, where rebellion against orthodoxy is valued. In reality, though, these doctors may be providing an expensive and potentially dangerous placebo treatment – a practice no longer considered ethical in the practice of medicine. The provider’s personal charisma and rebellion against the mainstream should not be considered proof that their unconventional therapies are either effective or safe. Valid evidence is required.

Language is a powerful tool. Labelling various therapies or providers as “holistic”, “complementary” or “integrative” can provide a suggestion about their nature, which may be misleading. Labels can also classify various modalities together even if they are quite disparate.

So it’s time to hand the term “integrative” back to conventional medicine, and label the rest “unconventional”. It’s also time to stop allowing the providers of “alternative” cures to associate only themselves with gentle, caring complementary therapies. Vulnerable patients should not be placed in the hands of people who would endanger their lives with false promises.

There is no “CAM”. There is medicine, there are complementary therapies, and there are scams.

Dr Sue Ieraci is a Public Hospital Emergency Physician and a member of the executive of Friends of Science in Medicine.