Absence of Proof is not Proof of Absence


Recently, I have been supporting a good friend who suffers from various health issues. During the process, we discovered that alternative therapies, not hard medicines, are often beneficial. Exercise, acupuncture, acupressure, meditation, herbal or dietary supplements often may come to rescue as prescribed medication alone may not resolve the health issues. In combination, however, they can reach the desired effect (cure or improvement of the condition).

I strongly believe in the value of modern medicine. I have spent many years in drug development seeing promising and effective new drugs and devices reaching the market and helping patients. I follow medicine’s discoveries and progress on a regular basis. I also enjoy being part of the pharma business. However, in my view, healthcare is relying on ‘hard proof’ too much, too often.

In medicine and science, any hypothesis on the pharmacologic effect of a particular compound has to be first proven, before it reaches the patients, with series of well-designed experiments and clinical studies. For the sake of this short article, I want to separate the pharmaceutical business from the healthcare providers (e.g. physicians, nurses, other healthcare specialists). The first category operates in a highly regulated environment; they have to follow all rules and regulations to get the thoroughly tested drug to the patients. It is understandable, as the majority of pharma are for-profit organizations and should be scrutinized to guarantee the safety of their products. The second category, healthcare providers, in my opinion, should have some flexibility when recommending treatment strategies to their patients. Recommendations should be possible independently of the quality of the ‘proof’ available, especially when it comes to alternative medicine.

My observation is that U.S. physicians tend to avoid suggesting any alternative treatments where there is no clinical proof available (e.g. no randomized clinical studies). Thus most likely patients are missing out on other options that should also be considered as a treatment regiments. I am not discussing here serious illness as cancer (although the use of medical cannabis could be one of the examples), but rather less severe conditions and disorders where alternative medicine could potentially be helpful, while not adding significant risks for the patients.

Interestingly, a study looking at alternative and complementary medicine use in Americans, published in journal Health Services Research in 2011, finds physicians and nurses are more likely than the general public to use alternative and complementary medicine for their own health ailments.

Generally, two factors concern me when dealing with healthcare providers those days.

First of all, I see how medicine started to be very much robotic discipline, focusing on treating symptoms. Not always on identifying triggers or causes. So many patients are being frustrated with that approach. You can see that when you go and visit the patients’ internet forums when patients are successful in self-discovery (e.g. identification of the causes/triggers for chronic illnesses) and self-treatment (elimination of symptoms/disease with use of holistic Chinese medicine, yoga, dietary supplements, life style changes). Examples are acne, migraine sufferers, patients with heart arrhythmias, fibromyalgia’s, IBS, chronic pain to name the few.

Second, of all, very few health care providers dare to recommend alternative medicine to the patients, and they limit themselves to ordering additional lab tests, referring patients to surgeons/other specialists, and prescribing multiple drug prescriptions. Those behaviors are the result of how our physicians are educated and trained, and what they can vs. can not legally recommend to the patients. 

My friend is living proof, among many others, that alternative therapies may add some benefits for the patients who suffer from various illnesses, even if clinical evidence is anecdotal (e.g. acupuncture, chiropractic, herbs, cannabis).

I wish U.S. healthcare system was less strictly regulated and cared for the patients more broadly and holistically, giving them some alternatives to the meds. I met very few physicians with that mindset, and well, they were usually not the US trained. Does not look like a coincident to me.

Our healthcare providers and regulators should remind themselves that ‘absence of proof is not proof of absence.’ I think there is no harm in trying to go the extra mile for the patients and informing eligible patients (capable of recognizing and understanding insufficient clinical proof and thus not having unrealistic expectations) about alternative treatment approaches.

The two examples of stories behind the use of medical cannabis for various chronic diseases or pain management issue, while facing the opioid crisis in the USA, show that role of the alternative treatments may sometimes get elevated. This year the FDA has proposed that doctors learn about acupuncture as an alternative treatment for pain. It is nice to see that progress. In their statement, FDA representative stated: ““[Health care providers] should be knowledgeable about the range of available therapies, when they may be helpful, and when they should be used as part of a multidisciplinary approach to pain management,” the agency wrote in the proposal.”

The sure thing is, patients should not be struggling alone. They should be taken care of. Which means physicians and nurses should be in a position to recommend not only the approved drugs but also guide the patients through alternative treatment options to maximize the effectiveness of the overall therapy.


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