Page 72 Guide to Pain Management in Low-Resource Settings

60 Barrie Cassileth and Jyothirmai Gubili

But do complementary therapies health-food company marketed a dietary supplement
actually work? called Vitamin O in full-page newspaper advertise-
ments. Vitamin O turned out to be saltwater.
Every culture throughout time and in every corner of 2) Th e discoverer may say that powerful people are
the world has developed herbal remedies. When sub- trying to suppress his work. Often, he claims that main-
jected to study, some of these remedies are shown to be stream medicine is part of a larger conspiracy that in-
worthwhile, but others often prove ineff ective. In addi- cludes industry and government.
tion, the public internationally is confronted with magi- 3) Th e scientifi c eff ect involved is diffi cult to detect.
cal or superstitious remedies. Th ese may have great ap- 4) Th e evidence is anecdotal. Th e main thing that
peal because they are inexpensive, readily available, and modern science has learned in the past century is not
perceived as safe and eff ective because they are viewed to trust anecdotal evidence. Because anecdotes have a
as “natural.” However, two false beliefs about “natural” strong emotional impact, they keep superstitious beliefs
products are seen around the world: the belief that “nat- alive in an age of science. Th e most important discov-
ural” remedies are harmless; and the belief that rem- ery of modern medicine is not vaccines or antibiotics—
edies in use for decades or centuries must work. Both it is the randomized trial, which shows what works and
myths are incorrect. Th is is a special problem when what does not. Th e plural of “anecdote” is not “data.”
treatable diseases are not managed properly, as patients 5) Th e discoverer says a belief is credible because it
may die or their disease may worsen when they fall prey has endured for centuries. Th ere is a persistent myth
to useless remedies and waste precious time. that long ago, before anyone knew that blood circulates
For many reasons, therefore, it is important to throughout the body or that germs cause disease, our an-
distinguish between evidence-based, helpful therapies cestors possessed miraculous remedies that modern sci-
and those that have no value. Baseless promises may come ence cannot understand. In fact, much of what is ancient
from well-intended people, or they may be promoted by cannot match the results of modern scientifi c study.
unscrupulous vendors, as has been recognized in many 6) Th e discoverer works in isolation. In fact, sci-
parts of the globe, especially in Western Europe, Austra- entifi c breakthroughs are almost always the work of
lia, and the United States. Early in the 21st century, the many scientists.
WHO named 2001 to 2010 the decade for modernization 7) Th e discoverer proposes new laws of nature to
of African traditional medicine. Africa would thereby join explain how it works. A new “Law of Nature,” invoked
Western nations, China, and other areas of the world in to explain some extraordinary result, must not confl ict
a dedicated eff ort to modernize traditional medical prac- with what is already known. If new laws are proposed
tices: Th e WHO advised Africa to establish standards and to account for an observation, the observation is almost
process for intellectual property rights, research herbal certainly wrong.
compounds to determine their value, formalize the train- Th e seven “signs” noted above separate quack-
ing of traditional medicine practitioners, and deal with ery from helpful therapies. To identify useful therapies,
quackery. Quackery in Africa may be similar to that in including complementary and traditional methods, sev-
other continents, where it is a lucrative business that preys en other signs may be used:
on vulnerable people facing pain, cancer, or other serious 1) Th e therapy was studied and shown to be useful
health problems. Robert L. Park, University of Maryland, for a particular problem.
writes about quackery in several publications, including 2) Th e study included a methodologically sound tri-
his book Voodoo Science: Th e Road from Foolishness to al in humans, such as a randomized clinical trial.
Fraud. He talks about the seven “Warning Signs of Bogus 3) Safety and effi cacy were established.
Science and Medicine.” Th ese are: 4) Results were made public, preferably through a
1) Th e discoverer pitches the claim directly to the peer-reviewed medical journal.
media or the public. Th e integrity of science rests on 5) Agents taken by mouth were standardized and
the willingness of scientists to expose new ideas and active ingredients documented.
fi ndings to the scrutiny of other scientists. An attempt 6) It is helpful, but not necessary, to have informa-
to bypass peer review by taking a new result directly to tion about mechanisms of action. First it is determined
the media or the public suggests that the work is un- that something works, and then its mechanism (how it
likely to stand up to examination by other scientists. A works) is explored.