My Open-Minded Approach to Alternative Medicine

Answering the naysayers

Getty Images

Several people recently asked me why I can’t be more open-minded to alternative medicine. This isn’t a new question. Reporters, commenters on social media, and even colleagues have asked.   

The Merriam-Webster dictionary defines open-mindedness as “receptive to arguments or ideas.” We must be careful about applying this to science because all arguments and ideas don’t carry the same scientific weight. For example, a scientist who knows the earth is round isn’t being close-minded about the philosophy of flat earthers! 

Alternative practices are alternative because they have not been proven safe, effective, or both, meaning they have not shown the scientific merit needed to be accepted by medicine. If they had been shown to work, they would be in national guidelines and hence not be alternative. One big issue is that “alternative” implies the therapies are an accepted alternative by some scientific standard when what we are discussing are under-studied or unstudied therapies. Now, let’s have another look at the original question, but I will rephrase it with more precise language.

“Dr. Gunter, why can’t you be more open-minded to unstudied and under-studied therapies?”

Hits a bit different, eh?

Many under-studied and unstudied therapies are promoted because they sound like a good idea and have a biologically plausible hypothesis, but a biologically plausible hypothesis doesn’t always pan out to be a good idea. This is where clinical trials come in. Here are two solid examples. We used to recommend infants at higher risk of food allergies avoid peanut butter in hopes that it would reduce the development of allergies. Through research, we now know that strategy has the opposite effect and increases the risk of peanut allergies. We also thought using vitamin E to prevent heart disease would be a good idea because vitamin E is an antioxidant. After all, in observational studies, people with a diet high in vitamin E had less heart disease. Multiple clinical trials have shown no benefit from vitamin E supplementation on the heart. This latter example also shows us how observational data should not be used to change guidelines and why clinical trials are so important (remember that the next time an observational study about menopause hormone therapy and dementia comes along).

When I write about any therapy, I always write about the available data, the risks, and the benefits. The idea that understudied or unstudied therapies should not face the same level of evaluation because they fit a marketer's definition of “natural” or “ancient” doesn’t work with me. Too often, people let this slide in women’s health care because of the gaps, but filling gaps with under-studied and unstudied therapies is exploitation, not medical care. If you want to fill the gaps, you should do quality studies. Unless, of course, you only think men deserve quality studies?

Back in 2021, someone asked me a question about Flo Vitamins for PMS. I took the product’s claims seriously and looked at the data precisely because I am open-minded. I did what I always do: I looked at the marketing language, which claimed the product was “scientifically backed.” Then, I looked at the ingredients to see exactly what scientific backing they had. The product has four ingredients, only one with some supporting data, albeit lower quality. One ingredient was lemon balm or Melissa officinalis, and while widely recommended by herbalists and naturopaths for PMS, there is only one low-quality study showing benefit. Flo Vitamins apparently included lemon balm because the “Ancient Greek botanist Theophrastus wrote about lemon balm around 300 B.C.” So…a company claims it chose an ingredient because someone who believed the uterus wandered the body also thought lemon balm was a good idea. I’m sorry, that’s fucked up. I ended the piece on Flo Vitamins by explaining that calcium and vitamin B6 probably had the best data for those who wanted to try a supplement for PMS, although I admitted the data was lower quality.

If you want to take Flo VItamins for PMS, you should know more than what the company tells you to have informed consent. If people hear the data is low quality and still want to use it, that’s their choice. It’s when there are false claims or implied benefits yet little to no data that I get pissed.

Claiming that those of us who believe women deserve evidence-based medicine aren’t open-minded is a straw-person argument, which is a fallacy that attacks a distorted version of the question or issue at hand. I gladly welcome new, quality data, but the fact that data doesn’t exist for the therapies that some people want to take doesn’t make me less open-minded, it means I’m not going to compromise my medical ethics for therapies because a naturopath or functional medicine doctor claims the therapy is “natural” or  “ancient.”  

The inconvenient truth is complementary and alternative medicine (CAM) is the close-minded approach because it seems happy to replace tough questions and validated research with anecdotes, beliefs, and faith. It demands rigid adherence to philosophies that revolve around  being “ancient” or “natural.” I wonder if this is why some people get so upset when I debunk a lot of these therapies because it feels like I’m attacking a religion. 

(Also, using the word “natural” is especially creepy when the products are aimed at women, as natural means un-interfered with or unspoiled. How’s that for tapping directly into purity culture’s aorta?)

As for the invariable claims that Big Pharma isn’t interested in natural or alternative therapies, I say, bullshit! In 1960, the National Cancer Institute started a multi-year project to find new drugs for chemotherapy from botanical sources. Plants have many bioactive substances, and these are great starting compounds for research. For example, two chemotherapy drugs originally came from yew trees: docetaxel (Taxotere) from the needles of the European yew tree and paclitaxel (Taxol) from the bark of the Pacific yew tree. They are now both made synthetically. Making paclitaxel from Pacific yew trees killed anywhere from two to ten trees to treat just one person, so it was especially important to find a synthetic alternative. 

In 1967, a similar plant screening research program in China was undertaken to find treatment for malaria (to help the North Vietnamese in the war against the United States). Dr. Youyou Tu, a pharmacological chemist, successfully isolated an extract called artemisinin from the plant Artemisia annua, using a low-temperature extraction method that she said was inspired by writings from 340 CE (she subsequently won the Nobel Prize). Researchers then later identified the genes in the plant that code for artemisinin, and now the drug can be made in yeast, which is a far more efficient method than getting it from the plant.

Apparently, Dr. Tu and her colleagues evaluated 200 recipes with traditional Chinese herbs and tested 380 extracts from the herbs to get one home run. 

When a potentially promising plant is identified by Pharma, the active ingredient is isolated and tested and then possibly improved upon. Then, a method is designed to mass produce the drug, typically in a way that produces a more reliable and scalable supply than a crop. The concentration of bioactive compounds in plants can vary, and Pharma wants a consistent supply, they can’t afford a year when the weather affects growth in some way and, hence, the availability of a raw compound. A case in point is the production of estrogen, which was covered in my previous post. We’re all at the mercy of soybean crops until someone can figure out how to make the starting chemical in yeast. 

The problem is that we don’t see this kind of important bench research and clinical trials with CAM therapies. And I don’t buy that there isn’t enough money in it. Alternative medicine is a multi-billion dollar industry. There is obviously money in studying plants for medicine as Big Pharma does it and is making a pretty penny. However, candidate drugs often don’t work as it can take years of research, and if it progresses to market, the drug may still be a bust. Then there are FDA rules and regulations. The fast, easy money is in untested supplements. You don’t have to prove it works, make vague claims, and you can start selling it almost immediately… all unregulated. Claiming Big Pharma doesn’t want you to know about “natural’ substances is a classic conspiracy theory.

This is a good time to remind people that many of these CAM therapies are not benign. Supplements are a significant cause of liver failure, using antioxidant supplements during chemotherapy for breast cancer is associated with recurrence and death, and only folic acid has been shown to reduce neural tube defects. 

I bristle at the idea that testing some of these alternative therapies is “too hard.”  When my son was two years old, he had a hole in his heart closed with a device that could be collapsed down so it was small enough that his interventional cardiologist could put it in a catheter that fit into a vein (he weighed 20 lbs, so pretty small veins), snake it up through his vena cava into his heart, seat it correctly in the hole in his heart, and then pop it open. If my son had been born 10 or so years sooner, he’d have needed open heart surgery. That device was approved based on basic science, animal studies, human trials, and finally, pediatric trials. That’s hard. Don’t tell me that testing alternative therapies and proving they work is harder than what I just described. Really, it isn’t.  

We should accept no less than this same rigor for everything in women’s health. For example, there are companies, naturopaths, and functional providers who make bold claims about probiotics for vaginal health. I’d love to tell my patients they worked and were an easy answer, I really would. But the data is abysmal or shows they don’t work, hence why they are not in any guidelines. My patients deserve to know that. While there are plenty of untested over-the-counter therapies, there are also companies doing actual research and following the same pathway that led to my son having the hole in his heart closed without cracking open his chest. For example, to know if a probiotic could help with bacterial vaginosis, research would start with identifying communities of bacteria associated with good vaginal health (probiotics), then find a way to keep the candidate probiotic alive, and next test women without bacterial vaginosis to see the effect. Then, small groups of women with bacterial vaginosis would be tested, and finally, clinical trials on larger groups of women with bacterial vaginosis would take place. And then, if effective, the researcher would seek FDA approval. One such probiotic currently in the pipeline is Lactin-V, and while the results are encouraging, it’s still in development. Don’t women deserve this kind of rigorous pathway?

Whenever I post on Instagram about how this or that CAM therapy doesn’t work, there are invariably personal attacks. Like I’m a bad person or a Luddite for wanting women to have quality care. It’s always fascinating that no one ever responds with quality evidence to prove me incorrect, just anecdotes. I also hear how their naturopath or functional provider listened to them and validated their concerns, something medicine clearly needs to do better. But I never get actual data. If someone proved a CAM therapy worked, I’d say, “Great, now I have more options for my patients and readers.” And, of course, anyone who believes in evidence-based medicine would say the same. Recently, The Menopause Society reviewed all the data for non-hormonal therapies for hot flashes, and not one supplement could be recommended because the quality of the data was so poor. If people want supplements, they should be angry at the supplement companies for not doing the research, not those of us who have to explain to people how the science is lacking and that they spent a lot of money on something that seems useless at best. 

Being open-minded means being open to the evidence, it doesn’t mean accepting an understudied or unstudied therapy because someone who profits from it says so. And it’s not just the companies that profit, every naturopath, functional medicine doctor, or functional nutritionist that charges you for the privilege of getting this care is also profiting from the appeal to natural and ancient therapies and conspiracy theories about Big Pharma.

The real question should be, why aren’t people promoting so-called alternative medicine doing better research? 

I mean, I know the answer. Many women are desperate because of real gaps that exist in medicine. These gaps are exploited in the name of profit by people who blame the lack of scientific support for “alternative medicine” by making excuses about why it can’t be studied while using quasi-scientific language that often ties into purity culture to make the sale. 

I think women deserve better.

References

Miller LH, Su X. Artemisinin: discovery from the Chinese herbal garden. Cell. 2011 Sep 16;146(6):855-8. doi: 10.1016/j.cell.2011.08.024. Epub 2011 Sep 9. PMID: 21907397; PMCID: PMC3414217.