To sum up the critics here: basically, if it works for people, it’s medicine (including diet, exercise, natural remedies, etc.), and if it works for people, but hasn’t been tested and verified by formal studies it’s quackery.

Er, no. If it works for people and has been tested and verified, it’s medicine. If it works for people, but hasn’t been tested and verified, then it’s unverified and not to be trusted. If I hand over a car to you and say it works, you’d want to test it before buying no? You wouldn’t just take my word for it!

Simply because it hasn’t been formally studied, doesn’t automatically mean it doesn’t work.

No. It just means we’re not going to take other people’s word for it that it does. Here’s what you’re missing: we would like evidence. We don’t care which way the results go, we just want proof that it does anything at all (good or bad). Anecdotes don’t equal data. In short, that’s pretty much the main issue of your misunderstanding. There’s a reason why we study things: because memory can be unreliable, because of the post hoc fallacy, because of the placebo effect, because other people can influence our impressions of things, etc etc. And your thing of “if it worked for someone else, then give it a go” is the main reason why people try things and get hurt because of it (whatstheharm.net).

No one is dismissing the possibility that something might work, what we’re saying is that until it is studied, people shouldn’t just dive in and try it and hope they get better. Leave the trial and error to the scientists, that’s what they’re there for and can actually catch problems with efficacy/safety before anything gets to the patient.

Personally, I think Oz ought to be struck from the register of medical practitioners. That might give his audience pause, I would think.

It also irks me to see the false belief propagated that doctors and health authorities don’t promoting these as a generally good idea.

Grr.

Anyway, carry on.

To me, if it worked for someone it’s worth a shot (pending risk vs benefit of course), formally tested or not

Formal testing is how one determines whether or not it actually worked for someone.

I’ve been probing how people define alternative because I’m still not clear on what people consider alternative. To me, if it worked for someone it’s worth a shot (pending risk vs benefit of course), formally tested or not – like the natural fungus cures. I also would never assume that any doctor would recommend an alternative treatment if he/she didn’t have some evidence that it works, whether by word of mouth from other patients or doctors, or as part of a study. That’s all I’m trying to clear up here because just about all the critics here defend themselves against alt meds using the excuse that it hasn’t been tested when clearly formal testing is not always required to prove that certain natural treatments are effective.

It would absolutely be irresponsible to seek untested alt meds to treat serious diseases, but that doesn’t mean they’re all bunk or can’t be effective elsewhere. It’s really common sense – I don’t know any doctor that would prescribe such measures if there wasn’t a notion of supporting evidence. Any doctor that prescribes something without a notion of proof isn’t a doctor at all and I think many of those here have been conditioned to see “alternative medicine” and automatically generalize it with “snake oil” and “quack” without actually researching known (yet formally untested) effective alternative treatments – the bias is exposed in the responses to my inquiries basically trying to label me an illogical nut.

I’d also like to add that my OTC treatment was composed of undecylenic acid, which is actually a natural FDA approved medication derived from castor oil. Would this be considered alternative to those here since it’s considered a natural remedy or modern medicine since it’s OTC?

It’s FDA approved. Duh. It’s proven medicine.

Furthermore, multivitamins and omega 3 supplements are not approved by the FDA and studies haven’t proved they prevent or cure disease, yet they’re recommended by a majority of physicians in promoting general healt

The FDA does approve the supplements; they’re just only approved as food. (The “F” in FDA stands for “food” — they regulate more than just medicine). Without proving they can prevent or cure disease, manufacturers are forbidden from claiming they do. That doesn’t prevent doctors from recommending people supplement their diets in a science-based way, and that’s not quackery, nor alt med. Claiming that taking megadoses of Vitamin C will prevent allergies is alt med, however.

It *is* mainstream medicine to consider diet and exercise. You’re right that it’s a problem that alt med is attempting to falsely claim that it’s actually an alt med thing that mainstream medicine neglects. Alt med muddies the waters severely in this way, and often deliberately, because they then can use the proven benefits of exercise to make it look like alt med is reasonable, when this is actually not logical.

As for the fungal nail infections, I look to myself as a source and my own research on the topic.

Toenail fungal infections often recur, regardless of the treatment; don’t assume that this means melaleuca works better. It doesn’t mean that; it means that melaleuca was the last thing tried. And your infection might still come back; that’s always a possibility. There are many organisms that can cause toenail infections; they’re sensitive to different things.

To sum up the critics here: basically, if it works for people, it’s medicine (including diet, exercise, natural remedies, etc.), and if it works for people, but hasn’t been tested and verified by formal studies it’s quackery.

You misunderstand. It’s not quakery if it works but hasn’t been tested. It’s quackery if we don’t actually know it works (or know it doesn’t) and people push it anyway as if it’s proven. Without studies, we don’t actually know it works, for the most part. The placebo effect isn’t actually about mind over matter; it’s about perception, and that includes both subjective things like pain and also things like regression to the mean and confirmation bias and the many other ways a treatment can appear to be working when it is not actually doing anything at all.

Quackery isn’t the promotion of things that work but aren’t proven. Quackery is the presentation of things that aren’t proven as if they are.

I’m sure there hasn’t been studies on tea tree oil and vinegar for treating nail fungus, but it worked and was prescribed by real doctors – albeit after I had tried an OTC treatment. Simply because it hasn’t been formally studied, doesn’t automatically mean it doesn’t work.

I realize absence of evidence isn’t evidence of absence. That’s not the point. The point is that absence of evidence means you don’t know it works.

As to tea tree oil, there actually have been studies of it for treating nail fungus; it is a bona fide antifungal and antiseptic, so I have no doubt that it worked on your toenails. I’m not saying you should use Lotrimin next time; the difference probably has less to do with “natural versus artificial” and more to do with the specific organism.

I’d also like to acknowledge that natural doesn’t always mean safer, as you mentioned, but that’s not relevant here as we’re talking about alternative treatments vs. modern medicine, not about their safety.

How can you dismiss safety and then go on and say “but oral fungal medications are particularly high risk when considering the condition”? Obviously part of your argument is safety based.

And it should be. One cannot separate out the safety discussion when deciding whether there is merit to a particular treatment. It’s all about risk versus benefit. If there is a high risk and a low benefit, you probably shouldn’t do it. Whether or not it’s proven factors into that, mostly because it’s what gives you confidence in the risk and benefit claims. Otherwise, you’re just guessing.

My beef with people like Dr Oz minimizing the possible risks and unproven nature of alt med is that they make it harder for the general public to make an informed risk/benefit analysis. And people who actively sell things that are unproven while promoting them as proven are even worse — they’re the actual quacks.

Incidentally, you bring up antibiotics as being “not particularly dangerous” and creating superbugs. Natural products can do this too; before the Internet went flaky on me and I had to stop researching (stupid DNS server — I can only hope this message submits okay) I found that studies showed that low concentrations of melaleuca were able to produce resistant populations of microorganisms. What’s more, antibiotics actually have significant side effects as well. There were the infamous terfenadine (Seldane) interactions, which killed a few people and resulted in the manufacturer voluntarily withdrawing Seldane from market (and making the safer relative fexofenadine, aka Allegra). Ciprofloxacin can cause damage to the ligaments, particularly of athletes, and this can be crippling if things go particularly wrong. Many antibiotics can cause photosensitivity. Diarrhea and yeast infections are common side effects, and not to be sniffed at, really. They can also be hard on the kidneys and liver.

I think for the most part, Pablo, we’re in violent agreement. I think our only real disagreement is how casually one should treat unproven therapies being actively promoted. Is it a real problem, or should we shrug and let it go?

http://www.livestrong.com/article/29128-alternative-treatments-toenail-fungus/

http://www.livestrong.com/article/287375-white-vinegar-for-toenail-fungus/

As for the fungal nail infections, I look to myself as a source and my own research on the topic. My doctors, primary care and podiatrist, both recommended natural remedies over the medication due to serious side effects. In my case, tea tree oil and daily soakings in a white vinegar mixture did the trick – need to create an acidic environment. I had tried topical OTC anti-fungals before, but the condition came back, so I tried something else. However, fungal infections are very hard to get rid of regardless of natural or prescription treatments, but most doctors would recommend a natural approach to nail fungus before seeking prescriptions. Once again, an example of seeking alternative medicine or is this a modern medical approach? On the contrary, if this had been a serious internal fungal infection, prescription oral medications would be the only effective approach.

To sum up the critics here: basically, if it works for people, it’s medicine (including diet, exercise, natural remedies, etc.), and if it works for people, but hasn’t been tested and verified by formal studies it’s quackery. I’m sure there hasn’t been studies on tea tree oil and vinegar for treating nail fungus, but it worked and was prescribed by real doctors – albeit after I had tried an OTC treatment. Simply because it hasn’t been formally studied, doesn’t automatically mean it doesn’t work.

I’d also like to acknowledge that natural doesn’t always mean safer, as you mentioned, but that’s not relevant here as we’re talking about alternative treatments vs. modern medicine, not about their safety. I never claimed that ALL modern medicine is dangerous, but oral fungal medications are particularly high risk when considering the condition. And antibiotics, while not particularly dangerous, create resistant bugs with liberal use. I wouldn’t acknowledge anyone to take herbal supplements, for example, without consulting a professional as drug interactions and side effects could be serious – as any doctor would advise.

Still missing the point. The point is that these so-called alternative treatments (diet, exercise, therapy) are already part of the standard medical practice.

Yes, so why are *you* characterizing them as alt med nad using them to support an argument that sometimes it’s okay to use alt med, and that doctors generally don’t recommend them first? It is a common argument by defenders of alt med that “exercise works, therefore alt med deserves consideration”, but I just don’t follow the logic.

Going back to one of your older posts:

Another fine example is that of treating fungal nail infections, which could be treated with dangerous medications (very hard on the liver) or a variety of natural or OTC topical treatments.

Citations, please? You seem to be setting up a false dichotomy — either the patient can choose dangerous medications that are very hard on the liver, or a natural topical treatment which, by implication, you are characterizing as alt med and *safe*.

Fungal nail infections can be very hard to kick. For most cases, topical treatments will not be enough — the nail is very good at doing its job of protecting the nailbed, which will make it difficult to get the topical agents to the pathogens. There are a variety of these: Lamisil, Diflucan, Nizoral, etc. The one chosen may depend on the organism. If the organism isn’t known, there may be some guessing involved before finding the most effective antifungal. Lamisil is the frontline choice, and is associated with side effects to the liver (among other things); the risk will be proportionate to the dose and duration of treatment, so it’s a good idea to address the infection *early*. The longer you wait, the stronger it will get, and the longer it will take to cure it. There are some studies showing that combining oral agents with topical antifungals improves treatment — however, these studies did not look at “natural” agents, but rather various pharmaceuticals. Debridement can help, and there has been some research into a urea paste that is encouraging.

There are some natural antifungals on the market, with one of the most effective being Australian tea tree (Melaleuca) oil. This is the substance I’ve used to treat fungal infections in my pet fish. (Unsuccessfully; they still succumbed, in part because it has some nasty side effects of its own.) It’s plausible that topical Melaleuca would help as the pharmaceutical topicals do, but again. But it’s not exactly safer than the prescription drugs. If you manage to keep it outside of your skin, it’s probably okay, but you wouldn’t want to get it in your food. Besides tasting nasty, it’s poisonous if drunk, and some people experience contact allergies from handling it. Natural substances can certainly work (a great many pharmaceuticals started out that way, and many are still made from plants or animals), but there’s really no reason to think they’ll be safer.

The problem with alternative medicine is that it’s _rumored_ to work, not that it’s been throughly studied and found to consistently work in the majority of those treated. Alternative medicine is primarily here’s your witch doctor potion and with lots of luck it might work as intended, if it works at all and if that’s the thing that actually healed or cured you. It’s probable a consistent mind trick placebo effect occurs with alternative medicine. We could be seeing an example of the power of the positive mind (stress level, emotional state, immune function) over the falsely perceived power of an inferior alternative for tested and proven medicine.

http://en.wikipedia.org/wiki/Alternative_medicine
“Richard Dawkins, an evolutionary biologist, defines alternative medicine as a “set of practices which cannot be tested, refuse to be tested, or consistently fail tests.” He also states that “there is no alternative medicine. There is only medicine that works and medicine that doesn’t work.” He says that if a technique is demonstrated effective in properly performed trials, it ceases to be alternative and simply becomes medicine.”

Rest, careful exercise, diet control is not alternative medicine. It’s medicine. When science has said, “This works. It might help,” it moves from being alternative medicine to medicine. If science can’t say that, a doctor (who is paid to advise patients on how to recover from illness or injury) is committing fraud if he recommends something that he does not know works.

Not to pile on here, but I’m fairly certain that it’s well accepted in the medical community that psychotherapy with medication works better then either of them by themselves anxiety and depression. The only people who exclusively deal with medication are psychiatrists, and they don’t dismiss things like cognitive-behavioral therapy – on the contrary, they recognize it as important for long-term recovery – but they’re specialists in psychopharmacology, so that’s all that they deal

Allyson: depression is pretty life-threatening if not treated by actual medicine and therapy. There aren’t a whole lot of not-depressed people who commit suicide. If one is chronically depressed, one should not look to St John’s Wort. One should see a doctor, preferably a psychiatrist who can diagnose and treat mental illness.in.

Too true. Of course, in some cases St John’s Wort is all the person can afford. Don’t even get me started on that, though.

Full disclosure: I’m someone who’s struggled with depression over the course of about 15 years, and I also work on a suicide crisis hot-line, so this is obviously a subject that I have more then a passing interest in…

Meditation? Fatal? I’d like to see studies on THAT!

You make a good point otherwise, but I don’t think meditation should be put into the same category as “alt med”. My own doctor (a GP of good reputation who doesn’t promote woo) gives out meditation tapes to his patients to help with such issues as anxiety and high blood pressure. I’m fairly sure meditation has a lot more scientific evidence behind it then, say, acupuncture.

Of course, part of the problem is the tendency of “alt med” practitioners to lump all these treatments into one category. It makes it difficult to talk about them, as these treatments run the gamut, from effective for a given goal (meditation) to having real physical effects but being potentially dangerous (herbs) to having no effect whatsoever (homeopathy).

Because non-serious ailments such as these always require prescription meds…..? Many people with degrees of those conditions have benefited from exercise, changes in diet, CBT, and meditation/yoga either alone or in conjunction with medications. A good doctor would also prescribe those measures along with medications if necessary – as most doctors do. Are these not alternative because they’re not pills or are they because science has shown these to be effective for those respective conditions? I believe the problem is the confusion between what’s defined as alternative and what’s classified as modern medicine.

“And they would be correct. You’re arbitrarily redefining parts of mainstream medicine as alternative to lend false legitimacy to quackeries such as acupuncture which have no evidence to support their use.”

http://health.usnews.com/health-news/family-health/cancer/articles/2011/04/25/acupuncture-may-help-ease-hot-flashes-tied-to-prostate-cancer-treatment

http://articles.timesofindia.indiatimes.com/2011-04-22/health/29462670_1_hot-flashes-prostate-cancer-hormone-therapy

http://www.ncbi.nlm.nih.gov/pubmed?term=%22acupuncture%22Majr%20OR%20%22acupuncture%20therapy%22Majr%20AND%20%22therapeutic%20use%22Subheading%3Anoexp%20AND%20%28%22humans%22MeSH%20Terms%20AND%20%28Meta-Analysisptyp%20OR%20Reviewptyp%29%20OR%20systematicsb%20AND%20Englishlang%20AND%20%222005/10/13%22PDAT%20%3A%20%222010/10/13%22PDAT%29&cmd=DetailsSearch

http://www.ncbi.nlm.nih.gov/pubmed?term=%22acupuncture%22Majr%20OR%20%22acupuncture%20therapy%22Majr%20AND%20%22therapeutic%20use%22Subheading%3Anoexp%20AND%20%28%22humans%22MeSH%20Terms%20AND%20Randomized%20Controlled%20Trialptyp%20AND%20Englishlang%20AND%20camsb%20AND%20%222005/10/13%22PDAT%20%3A%20%222010/10/13%22PDAT%29&cmd=DetailsSearch

@Allyson: I never said non-prescription treatments work alone, but many depressed people do indeed benefit for natural remedies as depression can have a number of biological causes such as low vitamin B or lack of exercise. For all but the most serious conditions, as mentioned earlier, either exercise/therapy/lifestyle changes and medication – either alone or in conjunction can benefit the patient. Of course, no doctor would simply recommend exercising more often and CBT to someone who is seriously depressed on the verge of suicide, but it would make sense for someone that’s experiencing malaise on a daily basis over a relatively short period of time as a result of a bad life experience or the winter blues (seasonal affective disorder) that doesn’t significantly affect his/her daily activities.

Everyone here seems to pick the most severe circumstances and focus on why alternative treatments wouldn’t work – and I’d agree, for the most serious cases something tried and true is necessary. However, for mild cases, alternative treatments (diet, exercise, therapy) do indeed prove beneficial.

Doctors who simply prescribe drugs for certain conditions without first addressing known natural remedies is foolish and irresponsible. … I’ve never known a doctor to simply prescribe surgery and diet pills before first seeking a lifestyle change.

So, you’ve never known an instance of it but you’re complaining about it anyway?

Regarding the efficacy of the placebo effect, while it’s been established that it can be better than no medicine, it’s not better than actual, established treatment.