My letter, never published, imagine that, to the Annals of Internal Medicine.
Alternative to what? Therapies that work? 99.999% of "CAM" (I prefer quackery) is superstitious, irrational, ignorant and just plain stupid bullshit. Yes, bullshit. And the .001% that is effective is of marginal benefit in self limited disease.
52% of Americans believe in they can talk to the dead, 37% in UFO's, 25% in reincarnation, and 14% in fortune telling. 53% do not know that it takes the earth a year to go around the sun. 42% think humans and dinosaurs lived at the same time. It is no surprise that 34% of Americans have seen a CAM provider. As PT Barnum noted long ago, nobody ever went broke underestimating the intelligence of the American public. Or, I might add, their 'alternative' health care providers.
Just because stupidity, ignorance, and superstition are popular is no reason for the Annals to support it. The vast majority of practices that fall under the rubric of CAM are based on principles that violate our understanding of the known world. They aremoreakin to belief systems and cults, than systematic, rational approaches to the understanding and treatment of human disease. They are, to use a popular term, bullshit.
Acupuncture, Naturopathy, Homeopathy, Energy Therapies, etc etc are all bullshit. You can put them all in one box, decorate them with a pink bow and give them a pretty name, but does not change the fact they are bullshit.
There may be more in heaven and earth that is dreamt of in my philosophy, but either 500 years of understanding in the sciences are correct and the premises of CAM is wrong, or the sciences has been missing insights into the fundamental laws of the universe that will revolutionize our understanding of nature.Somehow I doubt I will see chi, or pathological subluxations, or auras, or physiologic effects of hyperdilute solutions,proven valid and the discoverer collecting her prize in Stockholm. Instead,like allpurported paranormal and metaphysical phenomena, their effects will be marginal, statistical aberrations, in diseases that are self-limited or have a major psychological overlay. To answer your questions: Conventional and CAM practitioners do not share an ethical imperative.
Their practice is based on lies and deception and cannot be ethical. Should physicians know about CAM? If so, which ones? How about bleeding, cupping and purging? How about those whose diseases are cured by space alien kidnapping and probing? Or cured by by psychics? Should we embrace Christian Scientists? Or any number of the irrational mythologies invented by those who need to make a dollar off the gullibility and fears of the ill? Medicine is a complex and difficult profession; we should not have to be held responsible for knowing bullshit. Which interventions are effective? None. Are there appropriate referrals to CAM? Never. I feel it is my duty as a physician to be honest with my patients and basing their health care on lies and wishful thinking is the ultimate malfeasance.
Ignoring CAM is not an option, but neither is embracing it. When I cannot find funding for therapies that do work, to waste further money on evaluating quacks, frauds and charlatans is a further malfeasance. To throw good money after bad to the detriment of our patients in unethical and harmful. And no amount of research will convince the believers that their systems are ineffective. Data does not alter belief systems; humans interpret results to reinforce already held beliefs and ignore data that that contradicts it (an argument I look forward to being thrown back at me, being the closed minded arrogant sub-specialist that I am).
The growing data in support of CAM will always be dwarfed by data that denies it, but the rationalizations of the negative data can be remarkable. I use the discussion section of the article on the negative results of Echinacea published in the Annals as an example of how negative data leads to rationalization rather than repudiation of CAM. The paths of CAM and rational medicine are and always will be divergent. We have nothing in common. Except, perhaps, wanting a bigger slice of that 30 billion dollar pie, especially in a time of decreasing reimbursements for medical care. Some of that could be mine, if only I could abandon my ethics, my honesty, my integrity and my critical thinking. You judge a man by the company he keeps; your reviews on CAM cast a pall of doubt on all your articles. I do not have the expertise to evaluate studies outside my specialty and have to rely on the editorial staff of the journals as my surrogate. If the intellectual rigor you displayed in, for example, your homeopathy review is indicative of the quality of the other articles, I can no longer trust the Annals as a source of excellence in medicine. Editors come and go, however, and I look forward the day that I will no longer have to say to the residents, that article was published in the Annals. It used to be a reputable journal.
PS. If you decide this is to be published and you think that your readers are too squeamish for the word bullshit, you may substitute on the the following synonyms: nonsense, balderdash, baloney, bull, bunkum, crap, hooey, horseshit, malarkey, poppycock but those words do not give the flavor I am striving for.