Testing and alternative medicine.

Most alternative remedies have been around for a long time. The majority of them from before the time that the double-blind, placebo-controlled study was developed. The proponents of alternative treatments claim that they work; and they have plenty of satisfied customers to back up the claim: they know it works because they can see the results.

Of course, trying something and seeing if it works introduces all of the potential biases and confounding factors that both the practitioner and the patient are susceptible to: placebo effects; the power of suggestion; reinterpretation; observer bias; etcetera. Obviously, this kind of "evidence" does nothing to show whether a treatment has any real therapeutic value.

Alternative remedies tend to follow a similar route to existence:

1. The treatment may be ancient or traditional, new and innovative, or a different approach to treatment than conventional medicine. The method employed is usually discovered by trial and error and the evidence to back it up is anecdotal.
   
   
2. Skeptics will point out the flaw in this approach and question the value of the treatment, including the often bizarre mechanisms by which they are proposed to work. Practitioners will publish the results of their tests, which are open trials, as proof that their particular remedy works. Again, skeptics point out the flaws and state the need for double-blind testing to be done.
   
   
3. The practitioners of the alternative treatment will often do their own, small scale, poorly designed double-blind trials and publish the tests which have a positive result and not publish those that do not (see: publication bias). It is these trials that will be used in the future to support the claim that their treatment works.
   
   
4. Having become popular, with some evidence to back up the treatment's effectiveness, a large scale, well-designed, double-blind, placebo-controlled test will be done by serious, independent researchers. Invariably, the results show no difference between the treatment and the placebo control group.

By the time this stage is reached, however, the treatment will already be established and the belief system which supports it is firmly in place.

Having failed the scientific study, practitioners will come up with various get-out clauses as to why double-blind placebo-controlled studies are not the best way to test their particular treatment: e.g. it's holistic or treats individuals and not groups. This is known as special pleading and is not a valid defence.

If placebos give a perceived benefit, what's the harm?

1. If the illness is a self-limiting one then there should be little or no harm to the individual other than financial: alternative remedies are often expensive.
   
   Some alternative treatments do pose a risk to patients, chiropractic neck manipulations for example, so it needs to be considered whether any risk is worth taking when the treatment is not effective in any therapeutic sense.
   
   If the illness is potentially fatal however, no placebo response will prevent it from running its natural course.
   
   
2. Even if the illness is a self-limiting one, a placebo treatment is not going to be as effective as a real one. Placebo effects are present in all treatments; real treatments are those which are proven to work more effectively than a placebo.
   
   
3. Uncritically or willfully accepting that which is not real is another journey on the slippery slope to irrationality (see: what's the harm).

Although many alternative remedies may seem preposterous when their proposed mechanism is considered, it is still nonetheless worth testing them for validity. They may work by a completely different mechanism than that which is proposed, for example. Herbal remedies may have some active compounds in them that are medicinally useful, so it is useful to test for efficacy where they appear to have a real therapeutic effect. However, the same standards should be applied to alternative remedies that are applied to all proposed remedies that undergo rigorous testing. If they fail the tests, it should be recognised and accepted.

Testing alternative remedies does show that most of them are nothing more than elaborate placebos. The belief in them by their practitioners is formed by their pre-conceptions and the biases introduced by open testing methods, and the power of the anecdote in influencing the public's perception.

Modern, evidence-based medicine requires that treatments are proven to work more effectively than a placebo before they can be accepted for use. With alternative remedies it is quite the opposite: a belief system is created around them which is supported by the practitioners' claims and testimonials. By the time rigorous testing shows these practices to be no more effective than placebos, there is an established belief system and money-making industry in place.