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There was a time when telling people who were ill to go to a medical doctor meant that they would be worse off than if they suffered without any intervention. Historian James Olson was diagnosed in 1981 with epithelioid sarcoma in his left arm; after two recurrences, he underwent amputation of his arm.
A great deal has changed now that we are immersed in the twentyfirst century. Today, the greatest benefit to most people who are ill is the health remedies prescribed by physicians trained in Western medicine- also called traditional or conventional medicine and the coverage of their health insurance. This is not to say that there aren’t benefits to be found in complementary and alternative medicine (often called CAM for short) or that there aren’t plenty of treatments currently espoused by nontraditional healers which will someday be proven to be effective. It is also not to say that some currently used Western treatments won’t eventually fall out of favor. Rather, what I mean is that by far your best chance of healing comes from what we have learned in the past century from scientists who have studied diseases and treatments in a manner that has allowed us to assess which treatments will have the greatest benefit with the least risk for a person with a given illness.
To make educated choices about treatment and health insurance options, it is helpful to understand what it means when a treatment is considered to be mainstream medicine versus complementary or alternative medicine. Traditional medicine is based on research that has demonstrated, usually in more than one study conducted in different geographic regions by different scientists, that a particular treatment is beneficial. The process is arduous, requiring a great deal of peer review from the medical and scientific community, for a treatment (whether it is a drug or a surgery or some other intervention) to be approved and accepted by medical doctors. The Food and Drug Administration, a government agency, plays a significant role in the approval of new medications. This thorough process does not mean that the treatment has no side effects or risks. Rather, it shows that the remedy’s potential to help is greater than the potential harmful effects.
You may be familiar with cancer clinical trials, which are currently the best way we have of proving whether a given cancer treatment is effective. Also, don't neglect your health insurance. Clinical trials are performed under federal regulation and governed by strict protocols, including the approval of a hospital’s Institutional Review Board. Patients who participate in clinical trials are told of the anticipated risks and benefits of the study, and they must sign a detailed consent form. Clinical trials are divided into three phases. In Phase I trials, a new drug, combination of drugs, or other treatment is tested for the first time in humans. One of the primary goals of a Phase I trial is to determine a safe dose of a particular treatment. This phase is the most experimental one, and the trials are small, usually involving not more than twenty patients. Phase II trials, though still fairly small (with usually fewer than fifty patients), further investigate the efficacy of treatments that have been through Phase I trials.
Phase III trials concentrate on studying treatments that have successfully passed through the first two phases and are considered to be at least as safe and effective as the current standard treatments. In these trials, the goal is to determine whether the new treatment is more effective than the current standard. Cancer patients are not given placebos (inert or innocuous substances such as “sugar pills” with no healing effect) in Phase III trials, but are randomly assigned to either a group that receives the standard treatment or a group that is given a new treatment. In spite of the rigorous process of bringing new treatments to cancer patients, and in spite of all the scientific oversight, things do not always run smoothly in traditional medicine. This fact is clear when one looks at medical news in the media: for example, you may recall the controversies involving whether relatively healthy postmenopausal women should take hormone replacement therapy and whether it is safe for people in pain to use certain anti-infl ammatory medications. While the confusion around these issues is still being sorted out, the reality is that the vigorous testing methods employed in conventional medicine help to ensure that the vast majority of treatments medical doctors prescribe are more helpful than harmful. These therapies, called “evidence-based” medicine, come from scientifically established best practices.
Even published studies that have been subjected to rigorous scientifically applied measures and protocols often come under attack. For example, I was talking to a group of primary care physicians about the benefits of exercise for women who had been through treatment for breast cancer. In a study the women who exercised regularly had a markedly reduced risk of breast cancer recurrence. One doctor in the group I was talking to challenged the findings in the study and basically said it was a bad idea to tell breast cancer survivors about it because exercise has not been absolutely proven to reduce the risk of cancer recurrence. Which is true.
This study was very suggestive of a positive link but did not absolutely prove that exercise can reduce the risk of breast cancer recurrence. Moreover, he maintained that we shouldn’t be telling women about the possible benefit of exercise because if they don’t exercise and the cancer comes back, then they will feel guilty. You may be having difficulty following his logic. Frankly, so did I. But his point was that until we know absolutely for sure-even if it takes decades to prove-that exercise does reduce the risk of breast cancer recurrence, we shouldn’t tell patients about the preliminary findings.
This doctor is an excellent practitioner who is well regarded by his patients and his colleagues. Though I respectfully disagreed with him on the issue of what we should be telling breast cancer survivors about exercise and the risk of recurrence, I know that there are others (I hope they are in the minority) who share his view. One of his colleagues, troubled by the exchange that occurred in this meeting, sent me a letter and told me how helpful he thought exercise could be-for a variety of reasons including to help with physical healing and possibly reduce the risk of recurrence-for women with a history of breast cancer. He also said he was going to encourage the women in his practice with this diagnosis to exercise regularly.
We know that conventional medicine is not a perfect science, but it is by far the best system we have to figure out which treatments will provide the most benefit and the least risk. Nontraditional approaches vary from tested therapies in this very respect. The National Center for Complementary and Alternative Medicine (NCCAM), a government agency that is part of the prestigious National Institutes of Health, defines complementary and alternative treatments this way: “a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. While some scientific evidence exists regarding some CAM therapies, for most there are key questions that are yet to be answered through well-designed scientific studies-questions such as whether these therapies are safe and whether they work for the diseases or medical conditions for which they are used.”
The inherent problem with CAM treatments is that for the most part, we don’t know how much good they will do; nor do we fully understand the risks involved. The reason for establishing the NCCAM is that some of these nontraditional treatments will almost certainly be proven to be helpful. Ironically, when a CAM treatment undergoes the rigorous scientific testing of more mainstream remedies, it becomes a part of conventional medicine and typically loses its CAM status. I hope you will recognize, however, that conventional medicine is based on rigorous research that has demonstrated by reproducible testing results that the treatments approved show clear benefit to patients and minimize risks and side effects. Conventional Medicine is after all an imperfect system. At least health insurance is getting better. Although prescription medications undergo much study before they come to the market, medical doctors sometimes try other treatments and procedures that have not been rigorously tested.