Why Not Try This (2)

Washington DC

Ever since writing Why Not Try This (1), I’ve remained curious about why I refuse to try alternative treatments, so this post is a supplement to that one.  With this somewhat abstract essay, I don’t expect to convince anybody else, but I do want to understand myself.

I’m a doctor. I’m not naïve about the many problems in medicine and medical research,* but ultimately I trust them.  If there were an effective treatment for Alzheimer’s, I believe researchers would already be studying it and neurologists would be using it.  What ambitious young researcher wouldn’t want to win the Nobel Prize for discovering a cure for Alzheimer’s?

I know well that pharmaceutical companies refuse to fund research from which they can’t profit.  It’s also true that the decades of cutting federal funding for medical research has made independent studies more difficult.  Nevertheless, the government and some independent groups (eg, the Alzheimer’s Disease Cooperative Study) still fund research into treatments with no profit potential, for instance, studies of Vitamin E, Vitamin C, generic ibuprofen and several others have found no evidence of improvement and even some suggestion of harm to people with Alzheimer’s. 

The Scientific method

In order to make sure it’s the treatment that’s responsible for any improvement, the scientific method requires studies that are:

• Placebo-controlled: Somebody gets the drug and the others get sugar water to make sure it’s the treatment that’s improving things and not just the subjects’ desire for it to work.
• Randomized: Subjects are placed randomly into a treatment group and a placebo group to make sure the two groups are starting from the same place.
• Double-blind: To limit bias, neither patient nor researcher knows who’s in what group or what the test results look like until after the study is completely done and reported.
• Large enough so that they’re statistically valid.  A couple of anecdotes don’t prove anything.

If a treatment doesn't prove effective in such studies, I’m not going to waste my time with it.

What's Wrong With an Anecdote?

So why would a treatment that has been effective for a number of people not pass scientific tests?

•  The diagnosis may have been wrong in the first place, so a cure doesn’t imply anything about the impact on Alzheimer’s.  The husband of a friend became quite suddenly demented; he was helpless to care for himself and stayed that way for weeks.  With no real treatment, he returned to normal over several months.  Nobody knows what he had or why he’s better.   
• People with incurable diseases want to believe that a treatment will work.  The power of such faith can be staggering.  Improvement (or the belief in improvement) may have nothing to do with the actual treatment.
• We know that the symptoms of Alzheimer’s can vary considerably from day-to-day or week-to-week.  If a treatment coincides with one of those upswings, people may credit the treatment.
• Something else could be causing the improvement.  We already have drugs that improve the symptoms of the disease but don’t affect the underlying course.  Alternative treatments may also improve symptoms without affecting the disease process itself.

How Can It Hurt ?

All right, say my friends, why not try something anyway?  How can it hurt?  Well, any choice has side-effects.

• Many alternative treatments take significant time away from family, work, and life.
• Some of the drugs and other treatments are expensive.
• Other treatments have potential side effects: coconut oil, for instance, has high levels of saturated fat which may lead to heart attacks and stroke.
• Chasing after rainbows can become an obsession (for instance, my patient with MS in Why Not Try This (1))
• Especially since I’m a physician and a blogger on Alzheimer’s, my using a treatment just reinforces the unwarranted belief that there are cures out there. 

 I’ve always tried to avoid actions that don’t make sense to me.  To try a treatment because “it can’t hurt” would be for me a form of denial.  Perhaps that’s just pride; maybe so.

To be clear, I don’t want to deter anyone else from pursuing a treatment that gives them hope or comfort.  I’m just writing to explain my rationale for refusing to consider the many treatments continually suggested to me. 

 

* For a devastating critique of medical research, read “Lies, Damned Lies, and Medical Science” by doctor, researcher, and statistician, John Ioannidis.