“U.S. News‘s Avery Comarow has been editor of the America’s Best Hospitals annual rankings since their debut in 1990. In his reporting on all aspects of clinical medicine from the latest cholesterol guidelines to robotic surgery, he has kept one question in the front of his mind: What does this mean to patients? That perspective uniquely qualifies him to observe and comment on the efforts by hospitals and other healthcare providers to improve care and patient safety.”
“Academic medical centers all over the country—venerable altars of clinical research and practice like Mayo and Duke, top-ranked cancer centers, and even children’s hospitals—are scrambling to roll out therapies that five or 10 years ago most regarded as dubious at best, crackpot at worst. Acupuncture, homeopathy, herbs, traditional Chinese medicine.
When I began my reporting, one of the first things that struck me was that not a single researcher or clinician bothered arguing that the evidence for any of the alternative therapies they were testing and using on patients was persuasive. To the contrary, all agreed that almost none of the studies that show positive results have been designed or run very well.
If I wanted an evidence base, I was out of luck. But absence of evidence, as the late astronomer Carl Sagan said, is not evidence of absence. And if we lack an understanding of or explanation for how something works (as was the case for decades for how an airplane could stay airborne), that doesn’t give us the ammunition to state that it doesn’t work. In philosophy, that kind of reasoning is called argument by ignorance.
The patients I spoke with told me how acupuncture had made their allergies go away, how they were able to avoid painkillers after major surgery because of hypnosis or visualization or other mind-body techniques, how a homeopathic remedy that science would regard simply as water reduced swelling and pain within hours after an injury. I heard many such anecdotes, along with candid appraisals of treatments that seemed to be effective only for a short time or not at all. These people were not all true believers.
It may be that the placebo effect is behind most of the successes claimed for alternative therapies. I suspect it probably is—it can be quite powerful. Suppose we could tap into that power. Maybe we’d need to redefine our thinking about a therapy’s ability to work. What does “work” mean, anyway?
I wrestled with the story for weeks, because those patients made a considerable impact on me. Yes, I’m still an evidence guy. I still want well-done clinical trials to be the foundation for care. I still want researchers to set high standards and to meet them before claiming success. But we’ve been learning some amazing things in recent years about the way the mind affects the body and the body affects the mind, discovering a relationship far more dynamic and interlocked than anyone previously believed. It seems as though many alternative therapies may exploit this relationship. If there’s little risk, why not exploit the therapy?”