{"id":277,"date":"2021-03-16T14:12:01","date_gmt":"2021-03-16T14:12:01","guid":{"rendered":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/?post_type=chapter&p=277"},"modified":"2021-03-16T14:51:35","modified_gmt":"2021-03-16T14:51:35","slug":"placebo-effect","status":"publish","type":"chapter","link":"https:\/\/courses.lumenlearning.com\/suny-hvcc-healthpsychology\/chapter\/placebo-effect\/","title":{"raw":"Placebo effect","rendered":"Placebo effect"},"content":{"raw":"

Perceived mechanism of effect<\/span><\/h2>\r\nAnything classified as alternative medicine by definition does not have a healing or medical effect. However, there are different mechanisms through which it can be perceived to \"work\". The common denominator of these mechanisms is that effects are\u00a0miss-attributed<\/a>\u00a0to the alternative treatment.\r\n
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<\/div>\r\nHow alternative therapies \"work\":\r\na)\u00a0Misinterpreted\u00a0natural course<\/a><\/b>\u00a0\u2013 the individual gets better without treatment.\r\nb)\u00a0Placebo effect<\/a>\u00a0or false treatment effect<\/b>\u00a0\u2013 an individual receives \"alternative therapy\" and is convinced it will help. The conviction makes them more likely to get better.\r\nc)\u00a0Nocebo<\/a>\u00a0effect<\/b>\u00a0\u2013 an individual is convinced that standard treatment will not work, and that alternative therapies will work. This decreases the likelihood standard treatment will work, while the placebo effect of the \"alternative\" remains.\r\nd)\u00a0No adverse effects<\/b>\u00a0\u2013 Standard treatment is replaced with \"alternative\" treatment, getting rid of adverse effects, but also of improvement.\r\ne)\u00a0Interference<\/b>\u00a0\u2013 Standard treatment is \"complemented\" with something that interferes with its effect. This can both cause worse effect, but also decreased (or even increased) side effects, which may be interpreted as \"helping\". Researchers, such as\u00a0epidemiologists<\/a>,\u00a0clinical statisticians<\/a>\u00a0and\u00a0pharmacologists<\/a>, use\u00a0clinical trials<\/a>\u00a0to reveal such effects, allowing physicians to offer a therapeutic solution best known to work. \"Alternative treatments\" often refuse to use trials or make it deliberately hard to do so.\r\n\r\n<\/div>\r\n<\/div>\r\n \r\n\r\n<\/div>\r\n<\/div>\r\n

Placebo effect<\/span><\/h3>\r\nA\u00a0placebo<\/a>\u00a0is a treatment with no intended therapeutic value. An example of a placebo is an inert pill, but it can include more dramatic interventions like\u00a0sham surgery<\/a>. The\u00a0placebo effect<\/i>\u00a0is the concept that patients will perceive an improvement after being treated with an inert treatment. The opposite of the placebo effect is the\u00a0nocebo effect<\/i>, when patients who expect a treatment to be harmful will perceive harmful effects after taking it.\r\n\r\nPlacebos do not have a physical effect on diseases or improve overall outcomes, but patients may report improvements in subjective outcomes such as pain and nausea.[119]<\/a><\/sup>\u00a0A 1955 study suggested that a substantial part of a medicine's impact was due to the placebo effect.[120]<\/a><\/sup>[119]<\/a><\/sup>\u00a0However, reassessments found the study to have flawed methodology.[120]<\/a><\/sup>[121]<\/a><\/sup>\u00a0This and other modern reviews suggest that other factors like natural recovery and\u00a0reporting bias<\/a>\u00a0should also be considered.[119]<\/a><\/sup>[121]<\/a><\/sup>\r\n\r\nAll of these are reasons why alternative therapies may be credited for improving a patient's condition even though the objective effect is non-existent, or even harmful.[116]<\/a><\/sup>[35]<\/a><\/sup>[47]<\/a><\/sup>\u00a0David Gorski<\/a>\u00a0argues that alternative treatments should be treated as a placebo, rather than as medicine.[35]<\/a><\/sup>\u00a0Almost none have performed significantly better than a placebo in clinical trials.[8]<\/a><\/sup>[46]<\/a><\/sup>[122]<\/a><\/sup>[76]<\/a><\/sup>\u00a0Furthermore, distrust of conventional medicine may lead to patients experiencing the nocebo effect when taking effective medication.[116]<\/a><\/sup>\r\n

Regression to the mean<\/span><\/h3>\r\nA patient who receives an inert treatment may report improvements afterwards that it did not cause.[119]<\/a><\/sup>[121]<\/a><\/sup>\u00a0Assuming it was the cause without evidence is an example of the\u00a0regression fallacy<\/a>. This may be due to a natural recovery from the illness, or a fluctuation in the symptoms of a long-term condition.[121]<\/a><\/sup>\u00a0The concept of\u00a0regression toward the mean<\/a>\u00a0implies that an extreme result is more likely to be followed by a less extreme result.\r\n

Other factors<\/span><\/h3>\r\nThere are also reasons why a placebo treatment group may outperform a \"no-treatment\" group in a test which are not related to a patient's experience. These include patients reporting more favourable results than they really felt due to politeness or \"experimental subordination\",\u00a0observer bias<\/a>, and misleading wording of questions.[121]<\/a><\/sup>\u00a0In their 2010 systematic review of studies into placebos,\u00a0Asbj\u00f8rn Hr\u00f3bjartsson<\/a>\u00a0and\u00a0Peter C. G\u00f8tzsche<\/a>\u00a0write that \"even if there were no true effect of placebo, one would expect to record differences between placebo and no-treatment groups due to bias associated with lack of\u00a0blinding<\/a>.\"[119]<\/a><\/sup>\u00a0Alternative therapies may also be credited for perceived improvement through decreased use or effect of medical treatment, and therefore either decreased\u00a0side effects<\/a>\u00a0or\u00a0nocebo effects<\/a>\u00a0towards standard treatment.[116]<\/a><\/sup>\r\n

Use and regulation<\/span><\/h2>\r\n

Appeal<\/span><\/h3>\r\nPractitioners of complementary medicine usually discuss and advise patients as to available alternative therapies. Patients often express interest in mind-body complementary therapies because they offer a non-drug approach to treating some health conditions.[123]<\/a><\/sup>\r\n\r\nIn addition to the social-cultural underpinnings of the popularity of alternative medicine, there are several psychological issues that are critical to its growth, notably psychological effects, such as the will to believe,[124]<\/a><\/sup>\u00a0cognitive biases<\/a>\u00a0that help maintain self-esteem and promote harmonious social functioning,[124]<\/a><\/sup>\u00a0and the\u00a0post hoc, ergo propter hoc<\/a><\/i>\u00a0fallacy.[124]<\/a><\/sup>\r\n

Marketing<\/span><\/h4>\r\n
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<\/div>\r\nEdzard Ernst<\/a>, a leading authority on scientific study of alternative therapies and diagnoses, and the first university professor of Complementary and Alternative Medicine. Here in 2012, promoting his book\u00a0Trick or Treatment<\/a><\/i>\u00a0co-written with\u00a0Simon Singh<\/a>.\r\n\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\nAlternative medicine is a highly profitable industry, with a strong lobby. This fact is often overlooked by media or intentionally kept hidden, with alternative practice being portrayed positively when compared to\u00a0\"big pharma\"<\/a>.[6]<\/a><\/sup>\r\n\r\nThe popularity of complementary & alternative medicine (CAM) may be related to other factors that\u00a0Edzard Ernst<\/a>\u00a0mentioned in an interview in\u00a0The Independent<\/a><\/i>:\r\n
Why is it so popular, then? Ernst blames the providers, customers and the doctors whose neglect, he says, has created the opening into which alternative therapists have stepped. \"People are told lies. There are 40 million websites and 39.9 million tell lies, sometimes outrageous lies. They mislead cancer patients, who are encouraged not only to pay their last penny but to be treated with something that shortens their lives. \"At the same time, people are gullible. It needs gullibility for the industry to succeed. It doesn't make me popular with the public, but it's the truth.[125]<\/a><\/sup><\/blockquote>\r\nPaul Offit<\/a>\u00a0proposed that \"alternative medicine becomes quackery\" in four ways: by recommending against conventional therapies that are helpful, promoting potentially harmful therapies without adequate warning, draining patients' bank accounts, or by promoting \"magical thinking.\"[40]<\/a><\/sup>\u00a0Promoting alternative medicine has been called dangerous and\u00a0unethical<\/a>.[n 11]<\/a><\/sup>[127]<\/a><\/sup>\r\n
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<\/div>\r\nFriendly and colorful images of herbal treatments may look less threatening or dangerous when compared to conventional medicine. This is an intentional marketing strategy.\r\n\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n

Social factors<\/span><\/h4>\r\nAuthors have speculated on the socio-cultural and psychological reasons for the appeal of alternative medicines among the minority using them\u00a0in lieu<\/i>\u00a0of conventional medicine. There are several socio-cultural reasons for the interest in these treatments centered on the low level of\u00a0scientific literacy<\/a>\u00a0among the public at large and a concomitant increase in\u00a0antiscientific<\/a>\u00a0attitudes and\u00a0new age<\/a>\u00a0mysticism<\/a>.[124]<\/a><\/sup>\u00a0Related to this are vigorous\u00a0marketing<\/a>[128]<\/a><\/sup>\u00a0of extravagant claims by the alternative medical community combined with inadequate media scrutiny and attacks on critics.[124]<\/a><\/sup>[129]<\/a><\/sup>\u00a0Alternative medicine is criticized for taking advantage of the least fortunate members of society.[6]<\/a><\/sup>\r\n\r\nThere is also an increase in\u00a0conspiracy theories<\/a>\u00a0toward conventional medicine and pharmaceutical companies,[34]<\/a><\/sup>\u00a0mistrust of traditional authority figures, such as the physician, and a dislike of the current delivery methods of scientific biomedicine, all of which have led patients to seek out alternative medicine to treat a variety of ailments.[129]<\/a><\/sup>\u00a0Many patients lack access to contemporary medicine, due to a lack of private or public\u00a0health insurance<\/a>, which leads them to seek out lower-cost alternative medicine.[130]<\/a><\/sup>\u00a0Medical doctors are also aggressively marketing alternative medicine to profit from this market.[128]<\/a><\/sup>\r\n\r\nPatients can be averse to the painful, unpleasant, and sometimes-dangerous\u00a0side effects<\/a>\u00a0of biomedical treatments. Treatments for severe diseases such as\u00a0cancer<\/a>\u00a0and\u00a0HIV<\/a>\u00a0infection have well-known, significant side-effects. Even low-risk medications such as\u00a0antibiotics<\/a>\u00a0can have potential to cause life-threatening\u00a0anaphylactic<\/a>\u00a0reactions in a very few individuals. Many medications may cause minor but bothersome symptoms such as cough or upset stomach. In all of these cases, patients may be seeking out alternative therapies to avoid the adverse effects of conventional treatments.[124]<\/a><\/sup>[129]<\/a><\/sup>\r\n

Prevalence of use<\/span><\/h3>\r\nAccording to recent research, the increasing popularity of the CAM needs to be explained by moral convictions or lifestyle choices rather than by economic reasoning.[131]<\/a><\/sup>\r\n\r\nIn\u00a0developing nations<\/a>, access to essential medicines is severely restricted by lack of resources and\u00a0poverty<\/a>.\u00a0Traditional remedies<\/a>, often closely resembling or forming the basis for alternative remedies, may comprise primary healthcare or be integrated into the healthcare system. In Africa, traditional medicine is used for 80% of primary healthcare, and in developing nations as a whole over one-third of the population lack access to essential medicines.[132]<\/a><\/sup>\r\n\r\nSome have proposed adopting a\u00a0prize<\/a>\u00a0system to reward medical research.[133]<\/a><\/sup>\u00a0However, public funding for research exists. In the US increasing the funding for research on alternative medicine is the purpose of the\u00a0US National Center for Complementary and Alternative Medicine<\/a>\u00a0(NCCAM). NCCAM has spent more than US$2.5 billion on such research since 1992 and this research has not demonstrated the efficacy of alternative therapies.[122]<\/a><\/sup>[134]<\/a><\/sup>[135]<\/a><\/sup>[136]<\/a><\/sup>[137]<\/a><\/sup>[138]<\/a><\/sup>\u00a0The NCCAM's sister organization in the NIC\u00a0Office of Cancer Complementary and Alternative Medicine<\/a>\u00a0gives grants of around $105 million every year.[139]<\/a><\/sup>\u00a0Testing alternative medicine that has no scientific basis has been called a waste of scarce research resources.\u00a0[140]<\/a><\/sup>[141]<\/a><\/sup>\r\n\r\nThat alternative medicine has been on the rise \"in countries where Western science and scientific method generally are accepted as the major foundations for healthcare, and 'evidence-based' practice is the dominant paradigm\" was described as an \"enigma\" in the Medical Journal of Australia.[142]<\/a><\/sup>\r\n

In the US<\/span><\/h4>\r\nIn the United States, the 1974\u00a0Child Abuse Prevention and Treatment Act<\/a>\u00a0(CAPTA) required that for states to receive federal money, they had to grant religious exemptions to\u00a0child neglect<\/a>\u00a0and\u00a0abuse<\/a>\u00a0laws regarding religion-based healing practices.[143]<\/a><\/sup>\u00a0Thirty-one states have child-abuse religious exemptions.[144]<\/a><\/sup>\r\n\r\nThe use of alternative medicine in the US has increased,[10]<\/a><\/sup>[145]<\/a><\/sup>\u00a0with a 50 percent increase in expenditures and a 25 percent increase in the use of alternative therapies between 1990 and 1997 in America.[145]<\/a><\/sup>\u00a0Americans spend many billions on the therapies annually.[145]<\/a><\/sup>\u00a0Most Americans used CAM to treat and\/or prevent musculoskeletal conditions or other conditions associated with chronic or recurring pain.[130]<\/a><\/sup>\u00a0In America, women were more likely than men to use CAM, with the biggest difference in use of\u00a0mind-body therapies<\/a>\u00a0including prayer specifically for health reasons\".[130]<\/a><\/sup>\u00a0In 2008, more than 37% of American hospitals offered alternative therapies, up from 27 percent in 2005, and 25% in 2004.[146]<\/a><\/sup>[147]<\/a><\/sup>\u00a0More than 70% of the hospitals offering CAM were in urban areas.[147]<\/a><\/sup>\r\n\r\nA survey of Americans found that 88 percent thought that \"there are some good ways of treating sickness that medical science does not recognize\".[10]<\/a><\/sup>\u00a0Use of magnets was the most common tool in\u00a0energy medicine<\/a>\u00a0in America, and among users of it, 58 percent described it as at least \"sort of\u00a0scientific<\/a>\", when it is not at all scientific.[10]<\/a><\/sup>\u00a0In 2002, at least 60 percent of US medical schools have at least some class time spent teaching alternative therapies.[10]<\/a><\/sup>\u00a0\"Therapeutic touch<\/a>\" was taught at more than 100 colleges and universities in 75 countries before the practice was debunked by a nine-year-old child for a school science project.[10]<\/a><\/sup>[75]<\/a><\/sup>\r\n

Prevalence of use of specific therapies<\/span><\/h4>\r\nThe most common CAM therapies used in the US in 2002 were prayer (45%),\u00a0herbalism<\/a>\u00a0(19%),\u00a0breathing meditation<\/a>\u00a0(12%),\u00a0meditation<\/a>\u00a0(8%),\u00a0chiropractic medicine<\/a>\u00a0(8%),\u00a0yoga<\/a>\u00a0(5\u20136%),\u00a0body work<\/a>\u00a0(5%),\u00a0diet-based therapy<\/a>\u00a0(4%),\u00a0progressive relaxation<\/a>\u00a0(3%),\u00a0mega-vitamin therapy<\/a>\u00a0(3%) and\u00a0Visualization<\/a>\u00a0(2%)[130]<\/a><\/sup>[148]<\/a><\/sup>\r\n\r\nIn Britain, the most often used alternative therapies were\u00a0Alexander technique<\/a>,\u00a0Aromatherapy<\/a>, Bach and other flower remedies, Body work therapies including massage, Counseling stress therapies,\u00a0hypnotherapy<\/a>,\u00a0Meditation<\/a>,\u00a0Reflexology<\/a>,\u00a0Shiatsu<\/a>,\u00a0Ayurvedic medicine<\/a>, Nutritional medicine, and\u00a0Yoga<\/a>.[149]<\/a><\/sup>\u00a0Ayurvedic medicine remedies are mainly plant based with some use of animal materials.[150]<\/a><\/sup>\u00a0Safety concerns include the use of herbs containing toxic compounds and the lack of quality control in Ayurvedic facilities.[69]<\/a><\/sup>[71]<\/a><\/sup>\r\n\r\nAccording to the\u00a0National Health Service (England)<\/a>, the most commonly used complementary and alternative medicines (CAM) supported by the NHS in the UK are: acupuncture, aromatherapy, chiropractic, homeopathy, massage, osteopathy and clinical hypnotherapy.[151]<\/a><\/sup>\r\n

In palliative care<\/span><\/h4>\r\nComplementary therapies are often used in\u00a0palliative care<\/a>\u00a0or by practitioners attempting to manage chronic pain in patients. Integrative medicine is considered more acceptable in the interdisciplinary approach used in palliative care than in other areas of medicine. \"From its early experiences of care for the dying, palliative care took for granted the necessity of placing patient values and lifestyle habits at the core of any design and delivery of quality care at the end of life. If the patient desired complementary therapies, and as long as such treatments provided additional support and did not endanger the patient, they were considered acceptable.\"[152]<\/a><\/sup>\u00a0The non-pharmacologic interventions of complementary medicine can employ\u00a0mind-body<\/a>\u00a0interventions designed to \"reduce pain and concomitant mood disturbance and increase quality of life.\"[153]<\/a><\/sup>\r\n

Regulation<\/span><\/h3>\r\n
\"\"<\/a><\/div>\r\n
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<\/div>\r\nHealth campaign flyers, as in this example from the\u00a0Food and Drug Administration<\/a>, warn the public about unsafe products.\r\n\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\nThe alternative medicine lobby has successfully pushed for alternative therapies to be subject to far less regulation than conventional medicine.[6]<\/a><\/sup>\u00a0Some professions of complementary\/traditional\/alternative medicine, such as\u00a0chiropractic<\/a>, have achieved full regulation in North America and other parts of the world[154]<\/a><\/sup>\u00a0and are regulated in a manner similar to that governing science-based medicine. In contrast, other approaches may be partially recognized and others have no regulation at all.[154]<\/a><\/sup>\u00a0In some cases, promotion of alternative therapies is allowed when there is demonstrably no effect, only a tradition of use. Despite laws making it illegal to market or promote alternative therapies for use in cancer treatment, many practitioners promote them.[155]<\/a><\/sup>[156]<\/a><\/sup>\r\n\r\nRegulation and licensing of alternative medicine ranges widely from country to country, and state to state.[154]<\/a><\/sup>\u00a0In Austria and Germany complementary and alternative medicine is mainly in the hands of doctors with\u00a0MDs<\/a>,[36]<\/a><\/sup>\u00a0and half or more of the American alternative practitioners are licensed MDs.[157]<\/a><\/sup>\u00a0In Germany herbs are tightly regulated: half are prescribed by doctors and covered by health insurance.[158]<\/a><\/sup>\r\n\r\nGovernment bodies in the US and elsewhere have published information or guidance about alternative medicine. The\u00a0U.S. Food and Drug Administration<\/a>\u00a0(FDA), has issued online warnings for consumers about medication health fraud.[159]<\/a><\/sup>\u00a0This includes a section on Alternative Medicine Fraud,[160]<\/a><\/sup>\u00a0such as a warning that Ayurvedic products generally have not been approved by the FDA before marketing.[161]<\/a><\/sup>\r\n

Risks and problems<\/span><\/h2>\r\n

Negative outcomes<\/span><\/h3>\r\n
See also:\u00a0List of herbs with known adverse effects<\/a><\/div>\r\n

Adequacy of regulation and CAM safety<\/span><\/h4>\r\nMany of the claims regarding the safety and efficacy of alternative medicine are controversial. Some alternative therapies have been associated with unexpected side effects, which can be fatal.[162]<\/a><\/sup>\r\n\r\nA commonly voiced concerns about complementary alternative medicine (CAM) is the way it's regulated. There have been significant developments in how CAMs should be assessed prior to re-sale in the United Kingdom and the European Union (EU) in the last 2 years. Despite this, it has been suggested that current regulatory bodies have been ineffective in preventing deception of patients as many companies have re-labelled their drugs to avoid the new laws.[163]<\/a><\/sup>\u00a0There is no general consensus about how to balance consumer protection (from false claims, toxicity, and advertising) with freedom to choose remedies.\r\n\r\nAdvocates of CAM suggest that regulation of the industry will adversely affect patients looking for alternative ways to manage their symptoms, even if many of the benefits may represent the placebo affect.[164]<\/a><\/sup>\u00a0Some contend that alternative medicines should not require any more regulation than over-the-counter medicines that can also be toxic in overdose (such as paracetamol).[165]<\/a><\/sup>\r\n

Interactions with conventional pharmaceuticals<\/span><\/h4>\r\nForms of alternative medicine that are biologically active can be dangerous even when used in conjunction with conventional medicine. Examples include immuno-augmentation therapy, shark cartilage, bioresonance therapy, oxygen and ozone therapies, and insulin potentiation therapy. Some herbal remedies can cause dangerous interactions with chemotherapy drugs, radiation therapy, or anesthetics during surgery, among other problems.[37]<\/a><\/sup>[116]<\/a><\/sup>[33]<\/a><\/sup>\u00a0An example of these dangers was reported by Associate Professor\u00a0Alastair MacLennan<\/a>\u00a0of Adelaide University, Australia regarding a patient who almost bled to death on the operating table after neglecting to mention that she had been taking \"natural\" potions to \"build up her strength\" before the operation, including a powerful anticoagulant that nearly caused her death.[166]<\/a><\/sup>\r\n\r\nTo\u00a0ABC Online<\/i>, MacLennan also gives another possible mechanism:\r\n
And lastly there's the cynicism and disappointment and depression that some patients get from going on from one alternative medicine to the next, and they find after three months the placebo effect wears off, and they're disappointed and they move on to the next one, and they're disappointed and disillusioned, and that can create depression and make the eventual treatment of the patient with anything effective difficult, because you may not get compliance, because they've seen the failure so often in the past.[167]<\/a><\/sup><\/blockquote>\r\n

Side-effects<\/span><\/h4>\r\nConventional treatments are subjected to testing for undesired\u00a0side-effects<\/a>, whereas alternative therapies, in general, are not subjected to such testing at all. Any treatment\u00a0\u2013 whether conventional or alternative\u00a0\u2013 that has a biological or psychological effect on a patient may also have potential to possess dangerous biological or psychological side-effects. Attempts to refute this fact with regard to alternative therapies sometimes use the\u00a0appeal to nature<\/a><\/i>\u00a0fallacy, i.e., \"That which is natural cannot be harmful.\" Specific groups of patients such as patients with impaired hepatic or renal function are more susceptible to side effects of alternative remedies.[168]<\/a><\/sup>[169]<\/a><\/sup>\r\n\r\nAn exception to the normal thinking regarding side-effects is\u00a0Homeopathy<\/a>. Since 1938, the\u00a0U.S. Food and Drug Administration<\/a>\u00a0(FDA) has regulated homeopathic products in \"several significantly different ways from other drugs.\"[170]<\/a><\/sup>\u00a0Homeopathic preparations, termed \"remedies\", are extremely dilute, often far beyond the point where a single molecule of the original active (and possibly toxic) ingredient is likely to remain. They are, thus, considered safe on that count, but \"their products are exempt from good manufacturing practice requirements related to expiration dating and from finished product testing for identity and strength\", and their alcohol concentration may be much higher than allowed in conventional drugs.[170]<\/a><\/sup>\r\n

Treatment delay<\/span><\/h4>\r\nAlternative medicine may discourage people from getting the best possible treatment.[171]<\/a><\/sup>\u00a0Those having experienced or perceived success with one alternative therapy for a minor ailment may be convinced of its efficacy and persuaded to extrapolate that success to some other alternative therapy for a more serious, possibly life-threatening illness.[172]<\/a><\/sup>\u00a0For this reason, critics argue that therapies that rely on the placebo effect to define success are very dangerous. According to mental health journalist\u00a0Scott Lilienfeld<\/a>\u00a0in 2002, \"unvalidated or scientifically unsupported mental health practices can lead individuals to forgo effective treatments\" and refers to this as\u00a0opportunity cost<\/a>. Individuals who spend large amounts of time and money on ineffective treatments may be left with precious little of either, and may forfeit the opportunity to obtain treatments that could be more helpful. In short, even innocuous treatments can indirectly produce negative outcomes.[173]<\/a><\/sup>\u00a0Between 2001 and 2003, four children died in Australia because their parents chose ineffective naturopathic, homeopathic, or other alternative medicines and diets rather than conventional therapies.[174]<\/a><\/sup>\r\n

<\/span>Unconventional cancer \"cures\"<\/span><\/h4>\r\nThere have always been \"many therapies offered outside of conventional cancer treatment centers and based on theories not found in\u00a0biomedicine<\/a>. These alternative cancer cures have often been described as 'unproven,' suggesting that appropriate clinical trials have not been conducted and that the therapeutic value of the treatment is unknown.\" However, \"many alternative cancer treatments have been investigated in good-quality clinical trials, and they have been shown to be ineffective....The label 'unproven' is inappropriate for such therapies; it is time to assert that many alternative cancer therapies have been 'disproven'.\"[118]<\/a><\/sup>\r\n\r\nEdzard Ernst<\/a>\u00a0has stated:\r\n
any alternative cancer cure is bogus by definition. There will never be an alternative cancer cure. Why? Because if something looked halfway promising, then mainstream oncology would scrutinize it, and if there is anything to it, it would become mainstream almost automatically and very quickly. All curative \"alternative cancer cures\" are based on false claims, are bogus, and, I would say, even criminal.[175]<\/a><\/sup><\/blockquote>\r\n

Rejection of science<\/span><\/h3>\r\n
There is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data or unproven medicine, for which scientific evidence is lacking.\r\n
\u2014\u2009P.B. Fontanarosa,\u00a0Journal of the American Medical Association<\/a><\/i>\u00a0(1998)[42]<\/a><\/sup><\/cite><\/div><\/blockquote>\r\n\"CAM\", meaning \"complementary and alternative medicine\", is not as well researched as conventional medicine, which undergoes intense research before release to the public.[176]<\/a><\/sup>\u00a0Practitioners of science-based medicine also discard practices and treatments when they are shown ineffective, while alternative practitioners do not.[6]<\/a><\/sup>\u00a0Funding for research is also sparse making it difficult to do further research for effectiveness of CAM.[177]<\/a><\/sup>\u00a0Most funding for CAM is funded by government agencies.[176]<\/a><\/sup>\u00a0Proposed research for CAM are rejected by most private funding agencies because the results of research are not reliable.[176]<\/a><\/sup>\u00a0The research for CAM has to meet certain standards from research ethics committees, which most CAM researchers find almost impossible to meet.[176]<\/a><\/sup>\u00a0Even with the little research done on it, CAM has not been proven to be effective.[178]<\/a><\/sup>\u00a0Studies that have been done will be cited by CAM practitioners in an attempt to claim a basis in science. These studies tend to have a variety of problems, such as small samples, various biases, poor research design, lack of controls, negative results, etc. Even those with positive results can be better explained as resulting in false positives due to bias and\u00a0noisy data<\/a>.[179]<\/a><\/sup>\r\n\r\nAlternative medicine may lead to a false understanding\u00a0of the body<\/a>\u00a0and of\u00a0the process of science<\/a>.[171]<\/a><\/sup>[180]<\/a><\/sup>\u00a0Steven Novella<\/a>, a neurologist at Yale School of Medicine, wrote that government-funded studies of integrating alternative medicine techniques into the mainstream are \"used to lend an appearance of legitimacy to treatments that are not legitimate.\"[181]<\/a><\/sup>\u00a0Marcia Angell<\/a>\u00a0considered that critics felt that healthcare practices should be classified based solely on\u00a0scientific evidence<\/a>, and if a treatment had been rigorously tested and found safe and effective, science-based medicine will adopt it regardless of whether it was considered \"alternative\" to begin with.[12]<\/a><\/sup>\u00a0It is possible for a method to change categories (proven vs. unproven), based on increased knowledge of its effectiveness or lack thereof. A prominent supporter of this position is\u00a0George D. Lundberg<\/a>, former editor of the\u00a0Journal of the American Medical Association<\/a>\u00a0(JAMA).[42]<\/a><\/sup>\r\n\r\nWriting in 1999 in\u00a0CA: A Cancer Journal for Clinicians<\/i>\u00a0Barrie R. Cassileth<\/a>\u00a0mentioned a 1997 letter to the\u00a0US Senate<\/a>\u00a0Subcommittee on Public Health and Safety, which had deplored the lack of critical thinking and scientific rigor in OAM-supported research, had been signed by four Nobel Laureates and other prominent scientists. (This was supported by the\u00a0National Institutes of Health<\/a>\u00a0(NIH).)[182]<\/a><\/sup>\r\n\r\nIn March 2009, a staff writer for\u00a0the Washington Post<\/a><\/i>\u00a0reported that the impending national discussion about broadening access to health care, improving medical practice and saving money was giving a group of scientists an opening to propose shutting down the\u00a0National Center for Complementary and Alternative Medicine<\/a>. They quoted one of these scientists,\u00a0Steven Salzberg<\/a>, a genome researcher and computational biologist at the University of Maryland, as saying \"One of our concerns is that NIH is funding pseudoscience.\" They noted that the vast majority of studies were based on fundamental misunderstandings of\u00a0physiology<\/a>\u00a0and\u00a0disease<\/a>, and had shown little or no effect.[181]<\/a><\/sup>\r\n\r\nWriters such as\u00a0Carl Sagan<\/a>, a noted astrophysicist, advocate of\u00a0scientific skepticism<\/a>\u00a0and the author of\u00a0The Demon-Haunted World: Science as a Candle in the Dark<\/a><\/i>\u00a0(1996), have lambasted the lack of empirical evidence to support the existence of the putative energy fields on which these therapies are predicated.[74]<\/a><\/sup>\r\n\r\nSampson has also pointed out that CAM tolerated\u00a0contradiction<\/a>\u00a0without thorough reason and experiment.[183]<\/a><\/sup>\u00a0Barrett has pointed out that there is a policy at the NIH of never saying something doesn't work, only that a different version or dose might give different results.[122]<\/a><\/sup>\u00a0Barrett also expressed concern that, just because some \"alternatives\" have merit, there is the impression that the rest deserve equal consideration and respect even though most are worthless, since they are all classified under the one heading of alternative medicine.[184]<\/a><\/sup>\r\n\r\nSome critics of alternative medicine are focused upon health fraud, misinformation, and quackery as public health problems, notably\u00a0Wallace Sampson<\/a>\u00a0and\u00a0Paul Kurtz<\/a>\u00a0founders of\u00a0Scientific Review of Alternative Medicine<\/a>\u00a0and\u00a0Stephen Barrett<\/a>, co-founder of\u00a0The National Council Against Health Fraud<\/a>\u00a0and webmaster of\u00a0Quackwatch<\/a>.[185]<\/a><\/sup>\u00a0Grounds for opposing alternative medicine include that:\r\n