Matter of Perspective

CAM is controversial for many different reasons. One important issue to keep in mind is that of perspective. Because of differences in perspective, mainstream health care providers and people with a disease may view the same set of facts differently.

Physicians view the use of basic science and rigorous clinical trial methods as a powerful tool to develop new disease understanding and new therapies. People with MS may believe that this process is powerful, but that it is also slow and may yield limited advances during their lifetimes.

The "gold standard" for developing new therapies is a randomized, controlled clinical trial. This clinical testing employs specific and rigorous methods, including the use of a placebo-treated group, "blinding" of patients and investigators (so that neither patients nor investigators know who has received placebo and who has received active medication), and randomly selecting those who will receive placebo or active medication. Physicians and other mainstream health care providers generally use therapies only after they have been found to be effective in these well-designed clinical trials. Through this process, a black-and-white distinction exists between those therapies that have been proven effective in clinical trials and those that have not.

Some of the interest in and controversy over CAM stems from the fact that there may not be such a black-and-white distinction, but rather shades of gray. For example, some therapies have not undergone rigorous large-scale clinical testing, but scientific studies in animals or small clinical studies in people have produced promising results. These types of therapies generally are not incorporated into mainstream medicine. However, people with a disease may have an interest in such promising therapies, especially if they are relatively safe and inexpensive.

Another difference in patient-physician perspective is apparent with proven mainstream therapies. Conventional medications that are 30 to 40 percent effective may represent a major advance for physicians and other health care providers but, for people with MS, these therapies may be seen as 60 to 70 percent away from a cure (which would be 100 percent effective).

In some areas of CAM, the same set of facts is viewed negatively by conventional medicine and positively by some people with MS. This emphasizes the importance of first establishing the facts about a therapy and then realizing that these facts may be interpreted differently by mainstream health care providers and people with MS. Under some circumstances, it is as if two different cultures exist: that of the health care provider and that of the person who has the disease. These two cultures may have strikingly different belief systems.

The difference in perspective becomes especially apparent when a physician develops a disease. In this situation, a dramatic shift may occur in an individual's attitudes about what constitutes an appropriate medical therapy. There have been several published examples of this shift in perspective.

Dr. Alexander Burnfield, an English psychiatrist who has MS, wrote a book entitled Multiple Sclerosis: A Personal Exploration. With reference to evening primrose oil, he states: "I started taking it before the research was published and, being only human, take it just in case I get worse if I stop. This is, I know, an unscientific and emotional response, and the logical-doctor part of me is quite shocked" (16).

Dr. Elizabeth Forsythe, also an English physician with MS, wrote Multiple Sclerosis: Exploring Sickness and Health. With reference to diet and MS, she states: "It is what you feel in your own body and mind that is the most important thing, and it is very easy for doctors and patients to forget that. I believe that a little of what you fancy does do you good!" (17).

In Healing Lessons, Dr. Sidney Winawer, chief of gastroenterology at Memorial-Sloan Kettering Hospital in New York City, gives a provocative account of his transformational experiences with CAM through his relationship with his wife, who pursues various unconventional and unproven cancer therapies. He writes: "I failed to see that Andrea's cancer, of all things, would wake us up. I knew least of all that my beliefs as a doctor were about to be turned upside down" (18). He also begins to view therapies from a different perspective: "I shared her conviction that uncertain hope was better than hopeless certainty" (19).

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