Does complementary and alternative medicine represent only placebo therapies?

Complementary and alternative medicine (CAM) is “something you heard about from your hairdresser, who thinks she saw it on Oprah—a category that . . . includes acupuncture, homeopathy, healing magnets and assorted herbs and supplements.” This is a quote from Jerry Adler’s editorial in the December 1, 2007, issue of Newsweek titled, “A Big Dose of Skepticism.” The editorial represents a strong “shot across the bow” of the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health as well as the tens of thousands of licensed CAM practitioners and millions of their patients who regularly employ what have been termed “CAM therapies.” Mr Adler states that his 2008 resolution as a medical writer is to “not report on any new treatments for anything, unless they were tested in large, randomized, placebo-controlled, double-blind clinical trials published in high-quality peer-reviewed medical journals.” He takes his lead in this advocacy from the recent book, Snake Oil Science: The Truth About Complementary and Alternative Medicine by R. Barker Bausell, PhD. In essence, Bausell makes a strong case using his background as a former director of research for the University of Maryland’s Center of Complementary and Alternative Medicine that all CAM therapies have an impact on health only by placebo-related effects. He bases his conclusions on the effi cacy of CAM therapies on the following 5 criteria: 1. Studies of CAM therapies that show benefi t beyond placebo effects have not been done well, whereas studies of CAM therapies that are methodologically sound have not demonstrated benefi t beyond placebo. 2. Scientists and clinicians engaged in either the administration or study of CAM therapies have an inherent bias in support of the positive nature of the therapies, and therefore their conclusions are suspect. 3. Scientists and clinicians associated with CAM therapies do not understand methodological issues in the science of clinical trials such as the placebo effect, attrition/drop-out, the natural history of the disease in question, the Hawthorne effect, regression to the mean, or statistical methods of analysis. 4. No scientific mechanism of action for the validity of CAM therapies has been proven beyond that of the known mechanism of action of the placebo effect. 5. There is a lack of understanding of the concept of parsimony (ie, Occam’s razor) that results in unusual and unproven mechanisms beyond placebo effect to be ascribed to CAM therapies.