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A look at complementary and alternative medicine
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In October, the American Academy of Pediatrics held its National Conference and Exhibition in Boston that included a symposium on complementary and alternative medicine. Infectious Diseases in Children described the symposium in a front-page article in the November issue. Quotes from participants and a summary of events represent a worrisome trend in pediatrics.
First, although no specific therapies were described in the article, it’s been my experience that some practitioners of complementary and alternative medicine recommend against one or more vaccines, offer “natural” products that are potentially harmful, and promote untested and potentially dangerous biomedical treatments for autism. These aren’t alternative recommendations; they’re antiscience recommendations
Indeed, one could argue there’s no such thing as alternative medicine. If a medicine works, it’s not an alternative. And if it doesn’t work, it’s not an alternative. Excellent large, placebo-controlled studies have shown that St. John’s wort doesn’t treat depression, garlic doesn’t lower low-density lipoprotein cholesterol, milk thistle doesn’t treat hepatitis, gingko doesn’t affect memory, and chondroitin sulfate and glucosamine don’t treat arthritis. Because these therapies don’t work, they’re not an alternative. Conversely, omega-3 fatty acids can prevent heart disease, calcium and vitamin D in postmenopausal women can prevent osteoporosis, and folic acid during pregnancy can prevent neural tube defects. The same can be said for the value of eating lots of fruits and vegetables, getting plenty of exercise and sleep, and reducing stress.
“There’s a name for alternative medicines that work,” said Joe Schwarcz, PhD, a professor of chemistry and director of McGill University’s Office for Science and Society in Montreal. “It’s called medicine.”
Then the article gets to the heart of the issue: money. According to Timothy Culbert, MD, medical director of integrative pediatrics at the Ridgeview Medical Center in Chaska, Minn., “The first argument is the business case, which means that consumers want it, and it adds value by creating alternative revenue streams and provides a good marketing tool for the hospital.”
However, patients aren’t customers and pediatricians aren’t waiters. The goal for pediatricians isn’t to give parents what they want; it’s to direct them to the best science-based therapies available; to use their expertise to help them through the dense thicket of medical therapies so they won’t be hoodwinked; and to set a high standard of professionalism.
Pediatricians aren’t helping children by delaying vaccines because parents are fearful or offering biomedical treatments for autism because parents are desperate, or recommending unproven dietary supplements because parents think they might work. There’s a name for the kind of medicine that encourages superstition, magical thinking, and potentially harmful and expensive therapies not supported by science. And it isn’t complementary and alternative.
Dr. Offit is chief of infectious diseases at The Children’s Hospital of Philadelphia and professor of pediatrics at the University of Pennsylvania School of Medicine. Dr. Offit is also a member of the Infectious Diseases in Children Editorial Board. Disclosure: Dr. Offit reports no relevant financial disclosures.
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