Emily in the latest Grand Rounds says this about my post on alternative medicine: Dr. R.W. Donnell, in Notes from Dr. RW, urges readers to beware of "woo" - scientifically unsupported alternative medicine - particularly when it's combined with allopathic offerings. Dr. RW, and others, I'd like your thoughts. Not to plug alternative medicine - ANY modalities used on patients should be tested if possible in randomized studies - but how can patients be sure that "standard" procedures and treatments are evidence-based? What about that full-body scan, or the drug that's been around so long no one's ever tested its safety in an RCT? Is that not, in effect, a form of woo, too?
How can patients be sure if a treatment is valid? In many cases they can’t----they have to trust us. That’s the whole point about fiduciary duty. Many of the woo providers of the world are easy to spot because they make no pretense about being based on Western science. What the patient sees is what the patient gets. The ethical problem, the real deception, comes from the mainstream’s more subtle promotion, hiding the woo behind its reputations and scientific credentials. It’s one thing when the shaman down the street tells patients they need a colon cleanse. It’s quite another thing, and far more concerning when Vanderbilt----Vanderbilt, mind you---promotes Qigong or UCSF promotes herbal tea to “boost the immune system.”
Emily correctly points out that conventional medical treatments aren’t always evidence based. She asks “Is that not, in effect, a form of woo, too?” The breach between evidence and practice to which she refers, let’s call it the quality chasm, while every bit as serious as woo, is not in fact woo in most cases. The quality chasm is not a result of outlandish or implausible claims, (e.g. that water has memory) and that’s what distinguishes it from woo. The quality chasm results from an extremely complex interplay of cognitive and system barriers to the consistent application of best evidence in practice. Mainstream medicine recognizes the need for widespread system change and promotion of evidence based medicine. Although there’s no simple fix to the quality chasm, many in mainstream medicine are trying, which is in ironic contrast to the fact that mainstream medicine also increasingly promotes woo. For the mainstream, especially academic medicine, to promote woo is to engage in unethical scientific pretense and active deception of patients. It seems to me that the solution to woo in the mainstream is much simpler than the quality chasm: Mainstream medicine just needs to say NO.