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Alternative UniverseThe homeopathic crowd meets academic medicine.

By Kent Sepkowitz Posted Wednesday, Aug. 13, 2008, at 12:36 PM ET

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Atul Gawande offered the "placebo effect" as an explanation for the success of alternative medicine trends. Eliza Truitt considered the effects of various massage techniques. Seth Stevenson wondered if nutritional supplements affect your mood. Loath to exclude man's best friend from the possible healing power of acupuncture, Jon Katz looked into the benefits of holistic medicine for pets.

But to consider the issue more closely, we have to define alternative medicine with greater care. A 2004 government report divided the field into four big pieces: 1) biologically based practices, including herbs, special diets, and megavitamins; 2) energy medicine, which embraces the concept of magnetic fields; 3) manipulative and body-based practices such as massage and yoga; and 4) mind-body medicine, including prayer and meditation.

Costly attempts to demonstrate efficacy, paid for with taxpayer dollars, have been launched in each of the four areas. To date, as recently detailed, the results have been awful. Take the example of echinacea, an herb used by 40 percent of all natural product gobblers, who take it to ameliorate the symptoms of the common cold. Echinacea was rushed into numerous clinical trials. The result: The research shows that it doesn't work. Or even sort of work.

Rather than admit that they're discouraged or embarrassed by this cold, hard evidence, the alterna-crowd has claimed (OK, whined) that academic-type studies by definition are stacked against them. They consider the bedrock of Western medicine—the randomized, placebo-controlled, double-blind clinical trial—too hard-edged and difficult to implement, just the sort of cruel-hearted gaming of people and disease that so characterizes most things Western. With echinacea and other botanicals, they make the additional complaint that the various trials used the wrong preparation of the magic herb. This problem is indeed critical and slows the pace of assessing various alternative remedies. Unlike standard pharmaceuticals, the production of which is fiercely regulated (another example of the sharp-elbowed West), production of echinacea and its cousins is more laid back. This helps the producer who can sell his wares with little interference, but it's a bit of a nightmare when it comes to mounting a costly clinical trial. If one guy's preparation does or doesn't work, does that mean another echinacea will or won't work, too? The looseness of the alternative approach is part of its appeal—but also hinders it from finding sure footing in the academic realm.

At the same time, to dismiss alternative medicine too quickly is to miss a central question: What is the role of health care? Is the enterprise aimed only at preventing and treating illness, or should it also try to make us feel better? Treating an illness Western-style can mean chopping off a leg, giving chemotherapy, hooking someone up to dialysis. All of this is done to score the touchdown of American medicine: extension of survival by a week, a month, a year, anything. No doctor wants a patient to suffer, but in the Western view the long-term goal of survival comes first. The focus of many Eastern approaches, on the other hand, is on feeling better now rather than lasting longer. And this is something altogether different.

The two goals—treatment and prevention on the one hand and making patients feel better on the other—really are often at odds. And in the future, they surely will diverge further as Western medicine becomes even more technologically sophisticated. A treatment with stem-cell or gene therapy isn't going to be like drinking a glass of orange juice in the morning. The disruption and discomfort the therapies likely will inflict may make today's medicine seem mild. The best response to the über-tech may be an equal and opposite move toward the more benign alternative realm.

Alternative medicine needs money and many years to find its way, and despite the early setbacks for echinacea and other treatments, it would be a mistake to call off the federal investment. Such an absolutist stance ignores the observations of thousands of people over thousands of years as well as the true pace of medical progress, which is at best herky-jerky and aimless. That's not to say that alternative medicine is the equal of Western medicine, or will prove to be, many millions of research funds later. As Steve Jobs discovered, a special organic diet will not cure pancreatic cancer, whereas a six-hour surgery might. As brutal as Western medicine is, it remains a wonder of the modern world. So let's hope that the two sides can find room for each other: The West needs the East's soothing calm to round out its prickliness, while the East needs the West's thuggish urge to push ahead and prove results. I think that's called yin and yang.