Ken Barnes' defense of "Alternative" therapies in our April issue has sparked quite a response from our members. Their comments, and Ken's rejoinder, appear here.

On Anecdotes and Evidence Ken Barnes' article on "Healthy Alternatives" in the April 1996 Phactum contains some egregious errors. His argument against orthodox medicine in favor of alternative health treatments has many gaping holes. One of his most inaccurate statements is that "orthodox medicine is devoted exclusively to symptom suppression and crisis care." All the physicians I have ever worked with or consulted, including many who are personal friends, treat their patients as individuals, address the overall context of their patients illnesses, are concerned about prevention, are knowledgeable about nutrition and supplementation, and observe the dictum "above all do no harm."

Of course, there are good doctors and bad doctors, but Barnes' proclivity to impugn the entire field of orthodox medicine in favor of anecdotal alternative modes of intervention is dangerous. Barnes states: "Alternative practitioners work from anecdotal evidence of what works." There is no such thing as "anecdotal evidence" -- there are anecdotes and there is evidence. When my Aunt Matilda and her cronies assure me that drops of echinacea added to beet juice mitigated their arthritis, this is hardly evidence of anything other than the possible powers of suggestion and the likelihood that many arthritis sufferers have periods of spontaneous remission. Indeed, much of alternative medicine draws its very existence from the fact that placebos (through the mental set) can exert a powerful influence, and many illnesses are selflimiting.

Barnes argues that vitamins, herbs and minerals, because they are "naturally occurring substances," should not be held to the same standards of testing and proof that the pharmaceutical industry and the FDA demand of drugs and medicines. It seems to me that we need to know that whatever we ingest -- be it a slice of tomato, a vitamin pill or an antibiotic -- will prove helpful rather than harmful. I mention "tomatoes" because a friend whose orthodox doctor had established that he was extremely allergic to them, consulted an alternative medicine practitioner who gave him herbs containing powdered tomatoes. He almost died. I also know of a colleague who was diagnosed with prostate cancer that was amenable to radiation treatment (which his oncologist recommended). Instead, he consulted an alternative practitioner who gave him herbs and by the time he returned to his doctor the condition had metastasized and it was too late.

In essence, let us not confuse correlation with causation, and let us realize that only doubleblind controlled studies are capable of furnishing proof rather than anecdotes.

Doubt Orthodoxy Too

My best friend happens to have MS, and I know from long experience with her that orthodox medicine offers damn near nothing, not even consistently effective palliatives, much less hope of a cure. The handful of treatments available are usually considered "experimental" and thus insurers, including Medicare, tend to resist paying for them. I wouldn't blame my friend if she chose to go to Lourdes -- she has little to lose by trying her luck there.

From what I know of MS, I would tend to take anecdotal evidence of improvement with a grain of salt. Sometimes the disease is a long downhill slide; other people go into remission for decades. Establishing cause and effect connections between a treatment and the progress of the disease is thus very tricky. Ken Barnes seems to be arguing that we ought to suspend a questioning attitude for alternative healing, just as most of us do for orthodox medicine, and accept on faith the word of the practitioner that s/he's seen it work before and therefore it will again. I would say the exact opposite: that we should apply equal skepticism to orthodox and unorthodox medical claims. MDs do not know everything, although they think they do. The low success rate and high degree of collateral damage for many accepted procedures, such as chemotherapy, match those of many crank therapies. It was only after my father was diagnosed as terminal that I discovered how low the success rate was for chemoembolization, the relatively new procedure he had had in lieu of chemotherapy. If an alternative practitioner (rather than an oncologist at a suburban hospital) had treated my father with comparable results, skeptics would have jumped all over him.

I can't accept Barnes's contention that vitamins, minerals and herbs should not be held to the same standards as other substances for which healing claims are made. Megadoses can be toxic. In olden days, before chemistry isolated these compounds and you had to take them in food, it was much harder to build up to mega-doses. With unnaturally high doses so easily available in pill form, however, the average person is extra-likely to take them under the common misconception that if a little of something is good for you, a whole lot of it must be even better. At worst this fallacy can be fatal, and at best it's wasteful. If Mr. Barnes is eating a good balanced diet with adequate amounts of vitamins and minerals, however he gets them, it can only be good for him, along with getting adequate sleep, relaxation exercises -- stress exacerbates MS symptoms -- and seeking a temperate climate, particularly one that isn't too warm.

Whether you are chronically ill or not, learn your way around your own individual body -- what your "normal" temperature, blood pressure, schedule of bowel movements, etc. are. Read medical books and journals. You cannot become a doctor by diligent homework, but you can become a knowledgeable (and skeptical) patient. Your orthodox MD will hate you almost as much as your quack practitioner, but you can defend yourself against the honest failings and occasional charlatanry of either.

Healthy Orthodoxy

I must respond to Ken Barnes' article on "Healthy Alternatives." I am sorry that he has a disease that is so resistant to the methods of orthodox medicine. It is understandable that he is tempted to search among alternative medicines for a cure. However, he makes a false generalization when he says that orthodox medicine has no cures. Just because some diseases are not yet understood, this does not mean that all diseases are not understood and cannot be cured.

Let me give some examples from my own experience: Over 50 years ago I came down with bacterial meningitis (in the army, of course). Penicillin was not yet readily available, but sulfathiazole was. The drug did not merely get rid of my symptoms; it killed the bacteria responsible for the disease. Otherwise I would be dead.

Ten years ago my diabetes became serious enough to require injections of insulin twice a day. True, the insulin does not "cure" the diabetes. However, it replaces the natural insulin that is no longer being generated by my pancreas, so the disease is completely controlled.

Two years ago I was diagnosed as having prostate cancer. Radiation treatment eliminated the cancer, leaving me with some side effects that died down during the next several months. Radiation is not a benign treatment, but it did cure the disease. After the radiation treatment I still had severe pains in my legs, and these did not go away, so my doctors and I decided it was not a result of the radiation. A Nuclear Magnetic Resonance Image (MRI), showed that my spinal cord was being compressed by a couple of vertebra. A skillful surgeon relieved the pinching by performing a bilateral decompression laminectomy. The day after the surgery there was no more pain in my legs.

I cite these anecdotes as my personal responses to Ken Barnes' statements that doctors deal only with symptoms and not with causes. We see that in numerous cases doctors can deal with causes. He complains that some treatments are dangerous. But living without the treatment can be more dangerous. This is a matter of risk/value assessment. My surgeon claims a 90% success rate, which is good enough for me.

One thing Mr. Barnes leaves out of his account: What effect did the alternative medicine treatments have on his disease? Was he cured? Did he feel better? Did it have any effect at all? I think we ought to know.

Ken Barnes replies:

The purpose of my article in the April 1996 Phactum was to to educate Skeptics to look at health issues from the point of view of the individual who must make decisions with less than perfect information. I would like Skeptics to think through the way ideas about evidence are to be applied by the person making decisions about health treatment.

One major point of my article was that anecdotal evidence is to be taken seriously. I know, as well as anyone, that anecdotes are weak evidence. They are certainly not proof. But then, we all have to decide when we can afford to wait for more information and when we have to act on what we know. Dr. Lazarus (as well as others speaking from the Orthodox position) seems to suggest that we should never act without proof. My contention is that this is not an option for people with health problems.

There are a few points in the responses to my article that I should comment on:

1. Of course I know that Orthodox medicine has cures. I don't have to be convinced of that. My point was that alternative therapies should not be rejected simply because orthodox practitioners (and Skeptics) do not understand them.

2. I did not say that anything that is natural must be good for you. With all of the poison plants and venoms in the world only a soft-headed New Ager would make such a claim.

3. I appreciate Milton Rothman telling us about his experiences. It should be noted that his letter provides anecdotal evidence to support his argument. Some 'only double blind studies are proof' Skeptics would reject this letter as not containing any evidence at all. It should be obvious to any reader why there is no justification for this Skeptical position.

4. I agree completely with Willment, that we should apply equal skepticism to orthodox and unorthodox medical claims. As a skeptic I would like to know more about how to apply skepticism in this realm. To make clearer what I am looking for, the progression towards certainty might have these steps; Some evidence from an unfamiliar source, Evidence from an otherwise reliable source, Evidence from many different sources, Lots of evidence for, but it doesn't work every time, Lots of evidence for and the underlying 'science' is understood.

5. I did not say anything about my own experiences in my article because that would just be an anecdotal report. I wanted to promote a serious discussion of what we take as evidence.

6. I will be contacting Dr. Lazarus about meeting some nutritionally knowledgeable practitioners.