Trick or Treatment—The Undeniable Facts about Alternative Medicine (Electronic book text)

And introducing patients to alternative therapists in relation to a minor condition could act as a gateway to a longer-term reliance on alternative practitioners. In turn, this might lead to treatments that are both ineffective and expensive, and possibly even dangerous. Moreover, there is a likelihood that the alternative practitioners will go on to counsel against proven conventional interventions, such as vaccinations, or meddle with prescription drugs. This undermines the role of doctors and endangers patients’ health.

One solution is for doctors to be more honest with patients (‘In a few days you’ll be fine’). Another solution, which is something of an awkward compromise, is to offer patients a so-called impure placebo, which is more ethical than a pure placebo. Homeopathy is a good example of a pure placebo, as its only impact is via the placebo effect, and there is no justification at all for using it based on any scientific evidence. By contrast, magnesium in the treatment of anxiety is a good example of an impure placebo. This is because magnesium cannot really treat straightforward anxiety, but it can successfully treat some very rare conditions that have symptoms similar to anxiety. Hence, a doctor who treats a patient complaining of anxiety with magnesium might conceivably be giving the perfect remedy, because the patient might have one of these rare conditions. In reality, however, it is much more likely that the magnesium will only alleviate the patient’s anxiety through the placebo effect. This form of impure placebo is much more acceptable than a pure placebo, because we are avoiding complete lies. On the other hand, we are still dealing in half-truths, as opposed to complete truths.

So far we have two categories of problematic physician. First, there is the ignorant doctor who advises alternative medicine, but who is unaware that it does not really work. Second, there is the lazy doctor, who advises alternative medicine in order to satisfy patients with otherwise untreatable conditions. Both types actively steer some patients towards alternative medicine; but there is a third category — the inconsiderate doctor — who inadvertently frustrates patients so that they seek out alternative therapies.

Surveys from across the world show that users of alternative medicine are motivated at least in part by their disappointment with conventional medicine. Doctors may well do a good job getting the diagnosis and the treatment right, but many patients feel that other, equally crucial, qualities of ‘good doctoring’ are missing. They feel that their doctor has too little time, sympathy and empathy for them, whereas survey data confirm that patients consulting an alternative practitioner are particularly keen on the time and understanding they often receive. In a way, it seems as though some doctors delegate empathy to alternative practitioners.

We believe that there is an important message here: alternative medicine is not so much about the treatments we discuss in this book, but about the therapeutic relationship. Many alternative practitioners develop an excellent relationship with their patients, which helps to maximize the placebo effect of an otherwise useless treatment.

The message for mainstream medicine is clear: doctors need to spend more time with patients in order to develop better doctor — patient relationships. The average consultation is as little as seven minutes in some countries, and even the most generous countries struggle to achieve an average of fifteen minutes. Of course, increasing consultation times is easier said than done. Alternative therapists happily devote half an hour to each patient, because they are generally charging a great deal of money for their time. Extending consultation times with GPs would require greater government investment.