Friday, March 1, 2013

Nothing Special about Alternative Medicine

Note: When traditional medicine fails patients many turn to unregulated
supplements - which as this journalist says isn't necessarily bad as long
as you understand the risks and mechanisms involved. Always make sure your
physician knows if you are taking supplements as they can interact with
other drugs and supplements.

Emily Willingham 2/28/2013

There's Nothing Special About Alternative Medicine

I know that a lot of people turn away from industry pharmaceuticals and to
'natural' or 'alternative' meds because 'natural' sounds better for healing
and health than 'industrial' does, and 'alternative' implies a mavericky
nosethumbing at authority. There's a reason Aretha Franklin sang about
feeling like a natural woman, instead of an industrial or artificial or
synthetic one.

But here's the thing: Whether the drug you're taking came to you by way of
'Big Pharma' or 'Big-AltMed' or 'Big Street Dealer', if it has an effect,
it's doing that in the same basic way: It interacts with some molecules in
your body and changes the way a process happens. That change is what you
feel, unless you're just enjoying the relative innocuousness of the placebo
effect. No drug varies from this basic framework of activity, regardless of
where it came from. 'Natural' doesn't mean 'my body will know this one
better and it will be safer because they're both Nature'.

Where the difference between 'natural' and industry comes in is that what
you get from regulated drugs, whether synthetic or naturally derived, has
been tested. Once results from simulated lock-and-key fitting of molecules
or case studies hint at possibilities, several levels of testing come next.
The candidate drug goes from testing in a lab dish to rodents and usually
through several stages of clinical (with people) trials. Researchers follow
it every step of the way, often in different research groups, evaluating a
variety of doses in assorted patient populations, tracking side effects and
adverse events and developing a 'safety profile' for the intervention. The
dosages are standardized, and when you get such a medication, you generally
know what you're getting.

It's the rare alt-med intervention that has undergone this level of
evaluation or standardization. Any related scientific studies tend to be
scattered and in search of a hypothesis, and results often contradict each
other. When investigators do conduct trials, the findings are often
disappointing. Echinacea, I'm talking to you.

The alt-med types of interventions tend to come to us instead by way of the
anecdote grapevine or, worse, peddlers of such things who tell you what
problem you have and then try to sell you an unregulated alt-med to solve
it. They've got an industry, too, you see. There are two possible
explanations for people who go this route and claim benefit: The placebo
effect is real, or … well, if the meds are really doing something
therapeutic for you, then they're doing it within exactly the same basic
biological framework as a regulated drug. 'Natural' and 'alternative' are
simply cultural appellations with their attendant cultural meanings,
designations that our physiology doesn't give a rip about.

Yes, research suggests a bias toward favorable findings in industry-funded
studies. There have unquestionably been real tragedies with some
industry-derived drugs. Yet, alt-med also has a muddied track record,
sometimes because of erratic dosing or drug interactions and sometimes
because they redirect a person from life-saving conventional medicine. A
breast cancer specialist once told me that in one year, she'd had four
women come to her with a previously detected breast cancer who'd been
trying alternative meds as treatment — for too long. By the time they got
to her, their cancers had progressed beyond what would have been a
relatively treatable stage.

And then there's the concept of the informed patient. With any federally
approved pharmaceutical–say, bupropion–I can go to the prescribing
information for that drug and read it, in its entirety. There, I will find
details about the standardized studies with this drug and the results. I'll
get long lists of all events that happened to people while they were on
treatment in a study and their frequency. I'll see tables of information
comparing placebo outcomes with those of the drug and data from animal

The prescribing information will tell me how the drug works–if that's
known. It says who shouldn't be taking the drug and why or what they
shouldn't take it with, something we know thanks to those thorough
laboratory and clinical studies. It's all there, the information I need to
make an informed decision about an intervention that will interact with
some molecules in my body, cause a change, and have an effect. And in the
case of bupropion, if the effect fails, regulators tracking post-marketing
reports get the alert and try to find out why.

And that kind of evidence-based data gathering is something that I
generally cannot do with alternative meds, supplements, or other untested
interventions because that information usually does not exist. You've got a
choice between often-not-at-all-tested versus

There's nothing inherently wrong with choosing alternative meds, 'natural'
meds, and supplements if you find that for you, there's a benefit, and
particularly if you can find evidence-based information about what they do.

But it's important to know that if they are having an effect, when it comes
to your body, they're no different from industrial pharmaceuticals. The
meds interact with some molecules and change the way something works,
regardless of what you call them. It's just that with the alt-meds, we
often don't know anything else. By their 'natural', usually untested
nature, they leave us uninformed.

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