To the Editor:

In “The Ethics of Alternative Medicine: An Alternative Standard?” [April 2005, page 13], James Glazer, MD, sounds like I did 10 years ago, when I refused to even look at the evidence in support of alternative medicine because of “ethical” considerations. While I agree that the evidence supporting many of these therapies is scant or nonexistent, we shouldn't throw the proverbial baby out with the bath water.

Calling those who advocate exploration of this realm “snake oil salesmen” is hardly the way to stimulate discovery and will certainly cause some patients to look elsewhere for their care. Where there is evidence, we should share it, especially when there is no effective “traditional” option or when other options are expensive or potentially harmful. When my patients ask me about alternative therapies, I give them the best synopsis of the evidence I can. Academic family physicians are in the perfect position to add to this body of evidence. If we don't, who will?

I am currently investigating the effect of evening primrose oil on diabetic neuropathy with a randomized, controlled, double-blinded, crossover trial. Maybe snake oil works. I'll let you know!

To the Editor:

I agree with Dr. Glazer that we must practice with integrity. I have often told residents and students that I do not believe in “alternative medicine,” but I quickly go on to say I am willing to use any proven method of care to benefit my patients.

The problem often is our bias toward allopathic medicine. Over the years, we've seen many “beneficial treatments” do more harm than good. But as doctors we need to be as skeptical of allopathic medicine as we are of other modalities and apply the same standards to both.

To the Editor:

I was appalled by how many unfounded statements Dr. Glazer made in his slam on alternative medicine. What we casually call “alternative medicine” has been “mainstream medicine” in many countries of the world for millennia; Dr. Glazer's paradigm of health has been around for little more than a century. Furthermore, a very large (and growing) body of evidence shows the benefits of complementary therapies.

A good entry point into this research is Dr. Robert Anderson's collection of annotated abstracts, “The Scientific Basis for Holistic Medicine.” It presents a thorough compilation of thousands of references that evaluate the gamut of complementary practices and refute the claim that there is no evidence in the medical literature to support the use of alternative medicine.

I agree that there are complementary practices that have not been evaluated and can imagine that some individuals are advocating these for personal gain. However, Dr. Glazer's assumption that this is the situation in the field of complementary therapies as a whole is totally unfounded.

To respond to patients “with truth and integrity” as Dr. Glazer describes, we must be well informed. I applaud his initiative in looking for venues to increase his knowledge about complementary therapies but regret that the faculty of the event he attended misrepresented the field of complementary medicine. I encourage him to continue his soul searching by attending one of the CME events sponsored by the American Board of Holistic Medicine or the American Holistic Medical Association.

Author's response:

Dr. Mongan summarizes my ideas in one paragraph far more effectively than I: that we must be careful to apply the same standards of proof to all forms of medicine.

Exploration of alternative therapies is exactly what I advocate; marketing without evidence, no matter what the tradition, seems unethical. Application of proven theories, whether they be from other traditions or our own Western ones, is the “good medicine” of which I speak. I do not imagine that no alternative treatments have been scientifically proven to be safe; instead, I have specific concerns about the ethical dilemma of advocating untested therapies.

I am not impressed by the argument that alternative treatments are effective simply because they have been in use for millennia. If time were the true litmus of science, then germ theory, a relatively recent innovation, would not carry much weight. Being open-minded and scientifically rigorous is not about embracing fads. Instead, as Dr. Mongan states, it is about using any and all proven methods to help our patients.

Unfortunately, the place to search for truth in alternative therapies is not the soul, as Dr. Carpio-Cedraro suggests. Instead, we should search in the same place where we find truth in allopathic therapies: in scientific evidence.