Alternative medicine: How to figure out what works (and what doesn’t)

When I tell people about the Evidence-Based Living Blog, many of them want to know about alternative medical treatments. “Does X really work?” they will ask. “X” could be anything from ginkgo biloba, to meditation, to massage, to dietary supplements. Answering that question has always been hard for me, because finding and evaluating the evidence seems so complex.

The clearest explanation I have ever seen comes from Dr. Mark Lachs in his terrific new book Treat Me, not My Age. It’s a book targeted to the baby boomers and beyond about how to get the best care as one gets older. But it’s filled with general advice for how to work with your physician to get optimal care, no matter how old you are.

Dr. Lachs begins by noting that his patients are often surprised when he tells them that he’s open to alternative therapies. In fact, he’s prescribed meditation and yoga, recommends massage, and suggests certain supplements be tried first instead of medications. His advice to his patients is critically important however: You don’t need to be defensive about alternative treatments – but you have to understand what you are taking and whether it actually works.

The first thing Dr. Lachs recommends is that you do your own research. In case you feel that’s too daunting, he reminds us that we often find researching consumer purchases, like a new car, enjoyable – so why not research alternative treatments? He suggests (as we so often also do here at EBL) that you access the scientific evidence yourself.

Dr. Lachs gives you two approaches: the easier “take-out” approach, and the “do-it-yourself” approach. If you don’t want to look up scientific articles yourself, one key source is the National Center for Complementary and Alternative Medicine, part of the National Institutes of Health. It has lots of easily accessible information on supplements and alternative therapies. The Cochrane Collaboration is another site where you can find scientific reviews of alternative therapies.

You can also access the scientifc research yourself. But how do you evaluate the evidence you find in these articles? Here’s where Dr. Lachs really helps us. He sums up five things you need to consider (the headings are Dr. Lachs’s):

• Make sure that what’s being studied is what you’re interested in. Sounds simple, but actually it’s how many people take a wrong turn. For example, say you want to take a supplement – you have to make sure that the research is about the same dosage and ingredients, or it may not apply to you. For something like yoga or massage, read the article carefully to see if there are other treatments involved in the study, how long people did the activity, and similar specifics.
• Be sure the patients in the study are as like you as possible. Were the people in the study like you? Something that benefits 60-year olds may not apply to college students, and vice versa. Look for studies with people close to you in age, same gender, and other characteristics.
• Assess the quality of the study. You can look on this site under The Learning Center for posts about evaluating study quality. Dr. Lachs notes that you should look for randomized trials, where people are randomly assigned into a group that gets the treatment or that doesn’t. Also look for how well people stuck with the therapy over time and side effects reported.
• Look for self-effacing scientists. Good scientists talk a lot about the limitations of their studies at the end of the article. Be skeptical if the authors are too unequivocally positive about a treatment.
• Involve your physician in this “journal club.” Talk to you doctor about what your research has found; you can even share a scientific article with him or her. Dr. Lachs says this may make your physician more amenable to trying an alternative treatment.

Here’s what I love about Dr. Lachs’s perspective: It empowers all of us patients. He encourages us to drop rigid views: either “all alternative treatments are better than regular medicine” or “all alternative treatments are garbage.” We have the power to find out the scientific evidence and share it with our physicians – and that’s a very healthy thing in and of itself!