Alternative and Regular Medicine Are Speaking Different Languages
In Germany and elsewhere, a prevailing linguistic prescriptivism has resulted in the acceptance of an irrational terminology. This is reflected by the terms complementary, alternative, unconventional, and integrative medicine. Physicians believing in alternative methods and those adhering to regular medicine are using the same words for different things. As a consequence, any discussion between the 2 camps tends to become absurd. For example, alternative approaches are an inherent task of scientific medicine, but that aspect is not the topic of this special issue of the ARCHIVES. Conversely, we use in this issue the term alternative medicine for all those medical methods that do not constitute an alternative to regular medicine (Table 1). To speak with each other, we need a dictionary.
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Table 1. Two Different Definitions of Alternative Medicine
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An initial approach to such a glossary is presented in Table 2. For example, the euphemistic term particular therapeutic modalities is used in a German federal law protecting irrational doctrines such as homeopathy or anthroposophical medicine. Natural methods of healing include many that have nothing to do with nature, such as autohemotherapy, evacuation by drainage of amalgam, neural therapy, acupuncture, or electroacupuncture of Dr Voll. Extended therapeutic modalities or complementary medicine are nothing but irrational therapeutic modalities. The term Ganzheitsmedizin (holistic or integrative medicine) is used with either no meaning or with that of totalitarian medicine. The term paradigm shift means a turning away from rational thinking. Soft medicine is treatment by the power of suggestion. Allopathic means pharmacologically effective, whereas homeopathic means effective by suggestion. The term high potency is a poetic paraphrasing of nothing dissolved in a vehicle.
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Table 2. Glossary for a Dialogue Between Alternative and Regular Medicine
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Table 2 illustrates the difficulties inherent in any dialogue between the 2 camps.
Alternative Medicine Is Not Unconventional Medicine
Many German authors adhering to scientific medicine have adopted a strange linguistic prescriptivism by applying the term unconventional medicine to alternative methods.11 In fact, the regular scientific medicine should instead be called unconventional because all its concepts are continuously subject to the test of falsification. Conversely, alternative concepts usually represent doctrines announced by a master in whom one has to believe.12 A test of falsification is either forbidden or impossible because the dogma belongs to the category of faith rather than science; consequently, alternative methods are rigid and unsuitable for further development. For obvious reasons, such methods should be considered conventional rather than unconventional.
The Paradigm of Regular Medicine Is Rational Thinking
Many physicians are convinced that the basis of regular medicine is natural science. This is not correct because modern medicine includes several fields that, either entirely or in part, do not belong to natural science, such as medical sociology, medical ethics, psychosomatic medicine, or psychiatry.12 In fact, a paradigm common to all fields of regular medicine is rational thinking. It is difficult, however, to give an exact definition of rational thinking. Essential traits are abstraction, reproducibility of data, and the advancement of controllable terminologies and systems. According to Karl Popper,13 scientific research means a continuous testing of all concepts and theories by the trial of falsification.14 Another essential aspect is that rational thinking always has a moral dimension. Or, to give a rather sloppy definition—if you who are reading this article do not know what rational thinking means, you are beyond help.
The Paradigm of Alternative Medicine Is Irrational Thinking
Alternative medicine questions the crucial role of rational arguing and accepts other patterns of thinking.15 All concepts of alternative medicine have an alogical dimension that calls for faithful acceptance. This faith excludes abstraction, testing for reproducibility of data, or double-blind studies.
Alternative medicine claims that it deals with the patients themselves, whereas regular medicine primarily concentrates on diseases. The metaphysical approach results in an irrational language using terms such as holism, rejection of a particularistic ontology, extended modes of healing , or spiritual vital energy. Some doctrines, such as homeopathy16-17 or anthroposophical medicine,18 fulfill the criteria of a religion, and in many ways claim to be able to explain the unexplainable.
Physicians adhering to alternative methods are often referring to Kuhn19 who has advanced the term paradigm shift, or to Feyerabend20 who coined the misleading slogan "anything goes" and wrote: "We should learn that rational research [in Popper's sense: a theory should be regarded as correct until it is falsified] is only of temporary usefulness, and that . . . free discussions belong to the prerequisites of science." Consequently, alternative physicians ask for "pluralism of sciences" and claim that rational and irrational thinking should have equal rights.21
The Present Popularity of Alternative Medicine Can Be Explained by Romanticism
At the beginning of the 19th century, romanticism originated in Germany as a movement against enlightenment and sober rationality. Romanticism in art and lifestyle stood for rediscovery of magic, a cult of irrationalism, and a longing for naive originality, pristine naturalness, and lack of sophisticism. In 1798, the German writer Novalis22 enunciated:
The world has to be romanticized. . . . By giving to the ordinary a high meaning, by rendering to the normal a mysterious aspect, by bestowing upon well-known things the dignity of the unknown, by conferring to the finite an infinite appearance, I romanticize those things. . . .
Nüchtern23 has delineated the parallels between this movement and the revival of romanticism in our days that is a worldwide phenomenon as illustrated, for example, by the incredible variety of publications offered today in the "new age" sections of American bookshops. The present popularity of alternative medical concepts reflects a deeply rooted propensity to romanticism, as a movement against the technical conditions of modern life.
Some Alternative Concepts Are Falsifiable, and Others Are Not
Many methods of alternative medicine are falsifiable, but this does not inhibit their defenders from applying them. Other concepts belong to the category of faith rather than science and can therefore not be falsified.14 The following examples illustrate the 2 categories.
A Falsifiable Concept: The Dogma of Potentation Through Dilution.
The potency principle belongs to the field of classic homeopathy and claims that an agent becomes more powerful as it is diluted. For the irrational thinker it is essential that this dilution be performed by means of a ritualized shaking procedure.15-16 Today it is well known that after a dilution of "D24" (1/1024) not a single molecule of active ingredient remains in the solution. To falsify the principle of potentiation through dilution, we gathered 8 different homeopathic drugs with a potentiation of D30, dissolved in 51% alcohol, eg, Lachesis mutus (bushmaster), arsenicum album, pyrogenium (extract of autolytic beef meat), sulfur, apis mellifica (honeybee), acidum nitricum , zincum metallicum , and Pulsatilla pratensis (pasqueflower). As a control we prepared a bottle simply filled with 51% alcohol but having likewise undergone 30 shaking procedures, as well as a bottle containing apis mellifica in a dilution of 10-30 but prepared without any shaking procedure. The experiment consisted in removing the labels from the 10 bottles so there was no longer any possibility of discriminating between them. There were neither chemical nor physical nor biological methods to identify the name of the mother tincture as originally indicated on the label. The verum bottles avoid no longer be distinguished from the control bottles. In this way the principle of potentiation through dilution can be regarded as falsified.
Notwithstanding, some recent studies have claimed that extremely high solutions can be distinguished by their biological effects. One example is the article by Davenas et al.24 Similarly, Reilly et al25 claimed that in patients affected with atopic asthma, nothing dissolved in a vehicle works significantly better than the vehicle containing nothing. Many other investigations26-28 have convincingly shown that highly diluted drugs were ineffective, but such studies have received less attention.
A Falsifiable Concept: Electroacupuncture of Dr Voll.
Electroacupuncture of Dr Voll represents an amalgam of oriental mysticism and occidental electrotechnology. Two electrodes are applied to distant acupuncture points. A bottle containing an allergen or other pathogen is placed between the electrodes, and the interference of the bottle with the electrical conductive qualities of the skin is measured. In controlled studies1, 29 the method has been shown to be ineffective. Notwithstanding, even some board-certified German dermatologists are using this technique as a test for allergies, environmental intoxication, and other ailments.
A Falsifiable Concept: The Bioresonance Method.
The bioresonance method is used to measure an ultrafine oscillation spectrum in the human organism that can be normalized if necessary.30 An allergic patient is said to be treated by a mirror oscillation of the allergen.31 Appropriately performed controlled studies,32-33 have shown that allergens cannot be recognized by this test, and that allergies can neither be extinguished nor otherwise influenced by this method. These negative results, however, do not interfere with the popularity that the bioresonance method presently enjoys in Germany.
An Unfalsifiable Concept: The Homeopathic Drug Picture of Pulsatilla.
In a homeopathic monography we read the following assertion on Pulsatilla pratensis (Figure 1): "The drug mostly corresponds to women with feminine forms, full hips, fair hair and blue eyes." Wiesenauer35 describes the principle signs corresponding to this plant in the following way: "Girls and women, fair-skinned, blond, feminine. Nature sensitive like that of a mimosa, with a tendency to weep; depressive, capricious, faint-hearted." We may consider these statements to be nonsense, but we cannot falsify them because we are not able to prove that this rare blue flower does not correspond to a fair-haired whiney woman with feminine curves. These assertions have nothing to do with science because a test of falsification is not possible.
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The pasqueflower corresponds, according to the doctrine of homeopathy, to a fair-haired, blue-eyed, whiney woman with feminine forms.34-35 (Reproduced with permission from Löhr.45)
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An Unfalsifiable Concept: Relationship Between the Spleen and Saturn.
The idea that the role of the spleen within the human organism corresponds to the significance of Saturn within the planetary system is an integral part of anthroposophical medicine18 and is believed, for example, at the University of Witten-Herdecke. This view belongs to a system of doctrines advanced by Steiner:
Because the spleen is the first organ presenting itself to the blood . . . the ancient occultists thought that it should be best named after the star that, according to the ancient occultists and in line with their observations, presents itself as the first one in the space within the solar system; for this reason they called the spleen "Saturnian" or an "internal Saturn within man."36
This assertion can be rejected as an absurdity, but it is unfalsifiable because we cannot prove that there is no relationship between the spleen and Saturn. Such irrational dogmas represent a dimension inherent in many methods of alternative medicine.
Alternative Medicine and Evidence-Based Medicine Are Mutually Exclusive
If scientific evidence can be provided for the effectiveness of any unconventional approach, this method becomes a true alternative and, therefore, an integral part of regular medicine. Today it has become trendy to speak about evidence-based medicine37 but we should not forget that this form of medicine has always been the raison d'être for every scientific medical journal. Some authors38-39 pretend to adopt a neutral position by arguing that alternative methods may indeed be effective although proof is so far lacking, and that evidence-based medicine will establish some alternative methods in their full glory. This attitude, while seeming scientific, disregards 2 important points. First, other studies showing the ineffectiveness of alternative methods have already been performed, and second, alternative concepts cannot be falsified because they do not belong to the category of science. This irreconcilability of alternative and scientific medicine is often overlooked.
Placebo Effect Is an Important Factor in Regular Medicine, and the Exclusive Therapeutic Principle in Alternative Medicine
In all therapeutic measures as performed in regular medicine, the placebo effect plays an important role. In practice it is not our task to exclude it but to make appropriate usage of it.12 In clinical trials, however, scientific medicine has to distinguish between such effects and the true efficacy of a therapeutic measure, ie, to disintegrate things and to consider them in abstraction. Conversely, the integrative principle of alternative medicine is exclusively based on the placebo effect. This view, however, will always remain controversial.21
Regular and Alternative Medicine Have Different Aims: Coming of Age vs Faithfulness
The aim of regular medicine is a patient who has come of age and is able to make his or her own decisions. For obvious reasons this aim often remains utopian. Rational thinking always includes the doubt, but in clinical practice we have to weigh carefully how much doubting can be tolerated by a given patient.
The aim of alternative medicine is a faithful patient who does not ask for rational explanations. The degree of absurdity of concepts to which some of our patients adhere is often amazing. This may be explained by an increasing estrangement to the faith as offered by the churches established in Germany. Apparently, an a priori need for metaphysical bonds remains unsatisfied and causes one to seeks a substitute. A similar trend appears to prevail in the United States, as illustrated, for example, by the delirium that the Hale-Bopp comet has recently evoked in some people. The fact that alternative medical approaches are not compatible with rational thinking renders such methods especially attractive. As a witty man said: "Since people decided to believe in nothing, they believe in all sorts of things."
Alternative Methods Are Not Always Safe
Similar to the methods of regular medicine, alternative approaches may be associated with severe and even life-threatening adverse effects.40-41 This should be emphasized because such risks are frequently denied by the apologists of soft medicine. A serious aspect is the triggering of psychotic diseases by alternative approaches:10 general chemophobia (multiple chemical sensitivity syndrome); sick building phobia; clinical ecology syndrome42; and amalgam phobia. In dermatological practice we are nowadays confronted rather frequently with such problems.
Alternative Medicine Is Uneconomic
Hartnack43 analyzed applications for reimbursement as filed by private insurance companies and showed that alternative medicine is rather expensive and uneconomic. For example, the German amalgam phobia of recent years has resulted in a wave of useless diagnostic measures and unnecessary dental procedures.10 Similarly, an Australian study44 has shown that alternative medicine constitutes a considerable financial burden.
Alternative Medicine Will Always Exist
Alternative medicine represents the most ancient form of medicine, and it will continue to exist just as long as there are human diseases. Such methods meet the need of many people seeking some metaphysical bonds and a simple explanation of complex or inexplicable things. As a particular fact, however, alternative medicine is today an integral part of medicine as taught at German universities, as well as of the physician's fee schedule. Hopefully, this aberration of mind will only last for a short time. After this fad of collective irrationalism, alternative methods will regain their previous status as a marginal field of medicine that has nothing to do with science and cannot be reimbursed by the social health care plan.
