Herbal medicine, manipulation, meditation, yoga, shark cartilage, acupuncture: Why don’t we know with any degree of certainty that any of these do or don’t work? We can do rigorous studies on pharmaceutical chemicals and surgical techniques and we are convinced that they do (or don’t) work.
Leaving aside the issue of how “rigorous” those studies really are, traditional science is ill equipped to handle so-called “alternative” medicine. Herbs, for example, contain hundreds of chemicals. There are countless chemical interactions in this complex milieu of chemicals. Each chemical is a complex structure, difficult to isolate and difficult to understand. Modern* science can’t deal with this complexity, even with microarrays and high throughput analyses.
The realm of alternative medicine is those complaints which are mild enough not to warrant the adverse side effects that seem inseparable from modern medicine. These types of complaints are typically highly responsive to a placebo effect. A strong placebo effect means that a good portion of the control group will improve. You need a much larger sample size, and a much stronger effect, to show that the people receiving alternative treatment improved more than the people receiving placebo. Large expensive studies are for only the most promising potent drugs.
The idea of a placebo at all is problematic when studying mind/body therapies like exercise, meditation, yoga, or manipulation. How does a control group believe it is getting the same treatment as the treatment group, when the treatment is physical like exercise or yoga?
Finally, consider that many traditions of herbal medicine or mind/body healing call for individualized treatment. Today’s randomized, double-blind, placebo-controlled trial is meaningless when therapy means a treatment specific to each individual.
But I don’t bring “half a thing”, a problem with no solution. How can alternative medicine be legitimized by science? My answer: by bringing “modern” science up to date. Multi-investigator studies and large databases. This approach will improve traditional medicine as well as establish alternative medicine. I’m afraid it will mean standardizing a lot of things that aren’t yet standardized and more electronic paperwork. Every health practitioner enters every bit of information about the patient and how she treated the patient. The data is de-identified and goes to a central repository. Researchers come along and mine the database looking for patterns. It will only be as good as the data entered, so there have to be standardized ways of talking about all aspects of the patient, the disease, and the treatment.
This isn’t a new idea. Some of it is being done already. It’s strictly voluntary, and getting volunteers is tricky because doctors don’t want to volunteer for more electronic paperwork. It’s not yet standardized, with a lot of variability among how things are reported. It will take many decades before it happens. It probably will happen eventually. Unless our society completely collapses, which is not outside the realm of possibility.
*Do you like how I use “traditional science” and “modern science” interchangeably? That’s probably a statement about something.