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Reader, I went to a complementary therapy debate and had these thoughts

I went to a debate on complementary medicine recently, hosted by the KCL Social Medicine Society.  Despite being held on Guy’s Hospital Campus, a supposed stronghold of conventional medicine, the lecture theatre was awash with complementary therapists and when the pre-debate votes were taken the numbers were two to one against critics – like me – of complementary practice.

The speeches for and against the motion, although equally disadvantaged by the lack of anticipated audiovisuals, were, by and large, as I had expected as they rehearsed well known arguments on medical evidence and the primacy of double blind randomized control trials.  What I hadn’t been expecting was the degree of tension between the two viewpoints; for instance several audience members felt regularly moved to heckle Simon Singh, co-author of Trick or Treatment – a paean to evidence based medicine, not content that he is already subject to a libel lawsuit from the British College of Chiropractors.

After the addresses, relations deteriorated further when participation was invited from the floor.  It wasn’t just that some of the points made were verbose and closer to statements than actual questions, the vehemence of the complementary therapy supporters disagreement with a conventional medical approach was striking.  It was almost as if they felt that those opposing their view not only disagreed with them, but did so malignly with murderous intent.

Of course the sample of people I saw was self-selecting, but why would people feel so strongly that conventional medicine, and by extension doctors, wished them ill?  A partial answer as to the schism between complementary and conventional medicine is provided by Bad Science guru Ben Goldacre, who in his recent book lists reasons why ‘clever people believe stupid things’.  His argument is psychologically based: people are biased; see patterns where there is only random noise; see causal relations where there are none and overvalue and seek out confirmatory information.  From these beans a beanstalk grows all the way up to Matthias Rath.

I don’t doubt Goldacre’s assessment, but it cannot wholly account for the hostility which I witnessed.  The supporters of complementary medicine at the debate seemed to feel entirely disenfranchised by conventional medicine, and alienated even from cordial debate.  The root of this emotional intensity may be that although the majority of people tolerate the NHS’s faults and are basically satisfied with the service they receive, some people’s experience of conventional medicine can be poor.  Consider the people who feel unheeded by their doctor who can only allot them seven minutes, or those upset and resentful about their parent who died from the effects of chemotherapy; or those suffering from medicine side effects or whose operations lead to complications. For some, it won’t just be the message, but the messenger too: doctors nearly all come from a privileged swathe of society and our relative erudition and advantage will make some patients, whose achievements may on the face of it seem more humble, feel unpleasantly diffident.

Other factors against doctors are wired in from our training.  Despite modern efforts, it all too rarely leads us to heed that a patient’s experience of receiving their healthcare can be even more important than the healthcare itself and we still tend to see people in terms of aggregations of symptoms, ignoring that most of our patients come to see us for reasons only partially related to an identifiable disorder.  Although improvements have been made and medical schools have pulled up their socks, the MRCPsych and other membership exams give pitiful consideration to the cultural forces behind poor health.    Overall, and especially post graduation, our manner with our patients and our ability to help them in any way beyond a narrow biomedical confine it is not treated as central to what we do but rather something we are expected to pick up as we go along.

Could complementary therapy for its staunch adherents be then one in the eye to all the people like doctors who ‘think they’re clever’ and fail to adequately assess or understand patient difficulties?  Is it an inevitable outcome as the result of some people wishing for a more equal partnership for healing? For the disenfranchised, complementary medicine may be something that they can own, and a haven from the people whose education unfortunately makes them seem intimidating and unapproachable.

Addendum 4 June 2009:  In an earlier version of this email I used the spelling complimentary as in ‘to offer praise’ rather than the correct complementary as in ‘to act as an accompanyment’.  Gradually chipping away at my ignorance….  Indebted to TimA for his wise counsel.

Guardian A sceptical inquiry 9 March 2009

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  1. I think Steven Novella summed it up best describing the anti-vaccine crowd, when he was discussing with someone the lack of sympathy the anti-vacc showed to the parents of a baby who died of whooping cough. It’s like a cult. They’re small groups of people with authoritarian leaders, who often believe that there is a vast conspiracy against them. I’m not sure if it’s correct, but social psychology talks about how often when opposed by on opposite view, people tend towards the extreme’s into order to fight the opposing view. You also have to bear in mind that often these people feel like they’ve been wronged by conventional medicine in some manner.

    I’ve experience it myself when I voiced my suspicion of cold laser therapy administered by a chiropractor, they go ape mad and start obsessively attacking you. One of their favourite methods is to accuse you of a conspiracy.

  2. The Q & A portion of debates/talks is often quite painful but I can only imagine what it would have been like in this case.

    It’s a pity I didn’t know about this event as I would have liked to attend myself but thanks for the write up!

  3. Humans are gullible and the placebo effect is very powerful. I am currently moderating an ongoing debate surrounding “fat burning beads” which the UK has banned the sale of, but Americans are still getting spammed to death. People want to believe it works. Research (citation required…) has shown that acupuncture/acupressure does have a beneficial effect, but only due to the powerful placebo effect. People think it makes them better, so it does. After explaining this, one would be customer actually said “Would a placebo help me?” Ummm… yeah, so long as you do not know its a placebo …..

    The keyword here though is complimentary. Compliment good medicine, but never use only alternatives.

    As for vaccines, people just ignore science. There are countless research papers proving that there is no link between MMR and Autism, but just because a tabloid doctor said there was 10 years ago, people still refuse to vaccinate their children. Madness. Another problem is religion. I have met people of certain orders that do not use medicine due to one line in a religious text, that has been taken totally out of context. But people do insist on believing in superstitions and not qualified professionals. Humans eh?

  4. I think I tend towards the ‘cult’ view point on this. While the majority of people are probably quite unaware that alternative therapies such as chiropractic and homeopathy are based on such bizarre ideas (try it out for yourself, see how many people you know are actually aware that homeopathy is about ‘like cures like’ and diluting down to pure water, with more dilution = more power) the ‘true believers’ are socialised into a cult which has ‘radical’ and ‘holistic’ undertones which chime with their interests.

    Alternative practitioners themselves I think are somewhat deluded, and, rather than antipathy towards the educated medics, I think it is more that they genuinely don’t think there’s too much to medicine. If it were a class thing then alternative medicine would be the preserve of the working class, not the middle class.

  5. My admirable better half (who has seen a fair bit of the inside of Guys and St Thomas’ of late) suggests that alternative medicine presents a greater sense of control: I can take something that seems simple, non-harming and natural or someone will do something I can understand. Scientific medicine does not always do this. Medicines have strange names and a mix of brand and generic names, they have side effects. Control seems much diminished.

    Furthermore, alternative practitioners tend to charge for their services and often give 30 minute appointments – enough time to talk and, more importantly, listen. I also suspect that it is a rare alternative practitioner who tells a patient that ‘there is nothing we can do’. A patient who has been told there is no certainty in a diagnosis at a hospital is likely to reach for certainty and in my experience (limited but not uncommon from what I’ve read elsewhere) some alternative practitioners seem more willing to provide certainty. The last time I went to an osteopath he told me to stop taking anti-depressants – a very dangerous kind of certainty indeed.

    Finally, you may wish to amend the text to read complementary rather than complimentary – that would be a most endearing form of treatment!

  6. This is an argument that I tend to have with myself more than with other people, as it usually creates the kind of tension written about above. It may even be up for consideration to be added to the list of things you simply don’t bring up, after religion and politics, respectively.

    While I am trained in the sciences, to be objective, and tend to see all complementary medicine as pseudo-scientific, lately the world of the subjective has begun to haunt me. Keep in mind I have no medical training. But, I’ve had a hard time writing off the effectiveness of a placebo and wonder why we don’t investigate more deeply.

    I’ll try to illustrate. If you feel stressed out, you may develop tension. This is an effect of your mental state on your physical state. “Feeling stressed” is subjective. But the tension, if measured by say a rise BP or tightening of certain muscle groups, etc can be measured. So it is an objective change in your physical state. This is pretty obvious.

    There have been studies that correlate weakened immune systems and higher frequencies of illness among people who receive a great deal of contempt from their partner.

    Again something highly subjective that has a measurable effect.

    When it comes to something like acupuncture, and a lot of other complementary medicinal practices, why do we not give weight to their ability to manipulate the subjective side of the healing equation. I’m not trying to argue that acupuncture works. But wonder about the role “feeling” something has in medicine.

    The statement, “They feel like it helps so it helps a little” is, to me, one that is under analyzed given that the changes are measurable. If we know certain feelings can assist in the healing process, why do we not dig deeper and try to find out what feeling may have helped create the illness?
    Is that nuts? Has medicine solved the origin of disease to point where this query is no longer valid? To say “thinking positive” or “thinking negative” will help or hurt a patients chances of recovery means to me there is much more to learn about the role of thinking in healing.

  7. I think that Ben Elton summed it up well in a stand up show I saw a while back when he said that these day people trust no-one but believe anything!