On Being an Open-Minded Skeptic

Introduction: This article is adapted from a presentation given by Dr. Joseph Parisi at the Federation of State Medical Boards Regional Workshop, “Deceptive Healthcare Practices — Implications for State Medical Boards,” in September 2000.

The proliferation of alternative medicine has become one of the many challenges confronting today’s health care practitioner. The extent to which these approaches are utilized by patients depends on how the term is defined. Using a broad definition that included acupuncture, chiropractic, and massage therapy, D. Eisenberg, in the New England Journal of Medicine, et al completed telephone interviews in 1993 with 1,539 adults (response rate was 67%) in a national sample of adults 18 years or older.¹ They found that an estimated 34% of the population used at least one unconventional therapy approach in 1990, and that a third of these individuals saw providers for such therapy, with this latter group reporting an average of 19 visits to alternative practitioners within the preceding year. Of those who utilized alternative medicine for serious medical problems, 83% also sought treatment for the same condition from their medical doctor.

What was disturbing, however, was that 72% of these individuals did not mention their alternative practices to their physician. Extrapolation of these figures to the U.S. population suggests that in 1990 Americans made approximately 425 million visits to providers of unconventional therapy, and that this exceeds the number of visits to all U.S. primary care physicians (388 million) that year. In a follow-up study, published in the Journal of the American Medical Association’s issue devoted to alternative medicine, Eisenberg found that in 1997 Americans made an estimated 629 million visits to alternative practitioners, compared to 386 million visits to all primary care physicians.² Moreover, it is expected that the expanding availability of alternative health centers, some of which are hospital based, will result in alternative medicine’s continued increase and public acceptance.

The appeal of alternative medicine appears to stem from several sources. Foremost is that it is a backlash against the increasingly impersonal and technological focus of modern-day medicine. Upset with the hurried and limited interactions they often have with their physicians, patients welcome the time and attention alternative practitioners usually take to talk to them about their concerns and to develop personal histories. They experience the warmth and caring of this process in stark contrast to the technological focus of traditional medicine. Alternative therapies may also attract patients because they increase the patient’s ability to take a more active role in their care and thereby feel in greater control of their health. Furthermore, the aura of mysticism and intrigue that often surrounds these interventions is appealing for many individuals, as it allows them to integrate their religious and spiritual beliefs into their health care. Finally, Andrew Weil, MD, believes part of the appeal of alternative medicine is due to the fact that a large number of patients, for whom traditional treatment failed, have found helpful alternative treatments that their physicians did not know or advise them about.³

There is no clear definition as to what constitutes an alternative medicine procedure. When the term is applied to everything that is, or might have been, outside of mainstream medicine, a broad spectrum of practices and beliefs are grouped together. For example, chiropractic, homeopathy, biofeedback, meditation, prayer, aromatherapy, acupuncture, exercise, massage, and herbal supplements have all been labeled alternative medicine. Yet, research to support the efficacy of these approaches can range from non-existent to substantial. Theoretical backing in accepted scientific postulates can likewise range from non-existent to significant. And while the practitioners of some of these approaches have worked closely in an integrative fashion with the medical establishment, others have had an adversarial relationship with the medical profession, to the point of encouraging individuals to abandon mainstream medicine in favor of their alternative practices.

Given the lack of definition and substantiation, it is tempting for traditional health care practitioners to become frustrated with anything called alternative medicine and summarily reject it. Some in the health field even went so far as to adamantly oppose the Congressional mandate establishing an Office of Alternative Medicine at the National Institutes of Health in 1992. Other practitioners have gone in the opposite direction and uncritically accepted alternative practices while denying the need for traditional research since their patients say it is helpful. Neither of these responses is helpful. Responsible practice demands that we insist upon and support the scientific evaluation of alternative medicine procedures. The challenge for health care practitioners is deciding what to do until adequate research data becomes available. Until that time arrives, I suggest we will be best served if we can adopt a posture of being open-minded skeptics. As part of being an open-minded skeptic, we must become aware of our cultural biases and how these influence our perceptions and attitudes towards health care. To facilitate this process, a cognitive framework dividing alternative medicine into the following four categories might be beneficial.