Sensible advice for aches, pains & injuries

Alternative to What?

“Alternative” health care professionals need to decide what they are really the alternative to

updated (first published 2006)ARCHIVEDArchived pages are rarely or never updated. Most featured articles on are updated regularly over the years, but not archived pages.
by Paul Ingraham, Vancouver, Canadabio
I am a science writer and a former Registered Massage Therapist with a decade of experience treating tough pain cases. I was the Assistant Editor of for several years. I’ve written hundreds of articles and several books, and I’m known for readable but heavily referenced analysis, with a touch of sass. I am a runner and ultimate player. • more about memore about

Modern health care consumers are faced with a hair-raising dilemma: the hard choice between medical care that is often cold and tangled in red tape,1 or the so-called “alternative” options — nearly all of which are unproven by definition, and which would have long ago been adopted by doctors if they actually worked.2 It’s no choice at all.

Close-up photograph of several acupuncture needles in someone’s back.

Acupuncture is the ultimate in alternative medicine, allegedly proven by countless studies — most of which are poor quality and show only trivial benefits. See Does Acupuncture Work for Pain?

I quit! My own departure from alternative medicine

I am so concerned by some (not all) of what passes for health care in complementary and alternative medicine (CAM) that I gave up my credentials as an Registered Massage Therapist at the beginning of 2010 and I have move on to greener pastures. I am an alt-med apostate — one of the very few.

I quit because I wasn’t proud of being an “alternative” health care professional. I quit because there is no realistic hope of redefining alternative health care as simply the “warm and friendly” alternative to big and institutionalized medicine — it’s a lovely idea, but it’s never going to happen. I quit because the anti-scientific character of alternative medicine is well-established.3

However, for the record, alternative medicine didn’t have to turn out that way.

Alternative medicine could have grown-up to be something different and better than it is. And for individual ethical professionals, alt-med still doesn’t have to be that way. Being an alternative health professional can still be mainly about better bedside manners — spending more time with people, and offering a few of the more plausible and harmless treatment options, rather than pushing a bewildering array of dubious and unproven “miracle cures” on people.

Should we keep an open mind about astrology, perpetual motion, alchemy, alien abduction and sightings of Elvis Presley? No, and I am happy to confess that my mind has closed to homeopathy in the same way.

Mike Baum, The dangers of complementary therapy, Breast Cancer Res. 2007; 9(Suppl 2): S10

Mainstream medicine: impersonal and institutionalized

People love to hate “mainstream” medicine. Why? Simple: because it’s largely institutionalized. And institutions generally suck the life out of individuals.

Like many alternative health care professionals, I was originally inspired to pursue my career by some poor care I received from doctors — or so I thought. I have since come to understand that most doctor bashing is deeply unfair, routinely rooted in patient’s fear and pain, and in ignorance of the high-stakes, no-win situations that doctor’s face every day. The training and clinical experience doctors obtain deserves respect, and — however unwise it may be — their infamous arrogance is justified in many ways. The good doctors I know are my role models.

And they would be the first to admit that health care systems are in trouble around the world. Consider the increasingly grim outlook for the National Health Service in the UK. Jonathon Tomlinson, a London GP, writes:

I believe that the corporatisation of healthcare is dehumanising. By this I mean that real, whole people living with their hopes and worries, ideas and expectations, are broken down by the process of corporatisation into biological parts not for diagnosis and treatment but so that they can be measured and converted into profits. We are far more than the sum of our biological parts; we also have relationships with our past and future, our family and friends, our work and environment, our country and our home. We are irrational and passionate as well as calculating and objective; we need kindness, affection and understanding as well as diagnoses and treatments. And healthcare is far more effective when this is taken into account.

Patients not Profits; the NHS and Corporate Healthcare, by Jonathon Tomlinson

People are frightened to go the hospital. Many people have real horror stories about hospital experiences.4 Tragically, there’s more evidence every day that many surgeries — especially orthopedic surgeries — simply do not work and many more still have not been properly tested, exposing countless patients to serious unnecessary risks.5 Statistics about illness and surgical damage caused by doctors and hospitals seem like something from a third world country.67 Here in litigious North America, medical malpractice lawsuits are more an epidemic than any epidemic.8 Even while our economy groans under the weight of common problems like back pain, a few doctors have proven that the majority are appallingly incompetent at treating musculoskeletal conditions,9 and cannot offer nutritional advice.10 And the litany of problems with universal health insurance here in Canada, or with for-profit medical institutions in America, is overwhelming. Pharmaceutical companies are perpetrating some of the largest health care frauds in medical history.11

The roots of all this evil are an impersonal, institutionalized approach to health care, and of course the profit motive.

Pseudoscience and anti-science

On the other hand, so-called “alternative” health care is dangerously anti-scientific — as a group, many CAM practitioners are actually hostile to science. This is the main reason I got out. Sometimes CAM attacks doctors and medical care for some of the right reasons (see above), but mostly for the wrong ones. CAM generally treats science as the enemy!

Naturopathic doctors in North America are trained well enough to know better,12 but still routinely sell products and services of dubious value, in league with a supplements and “natural” medicines industry that is almost as profitable and actually much more corrupt and dishonest than their “Big Pharma” counterpart.13 Homeopathic remedies in particular have been proven to be ineffective over and over again,14 and they have recently suffered serious public relations damage from exposés like the 2006 BBC story about dangerous anti-malarial substitutes.15 For the last ten years, acupuncture has failed one fair scientific test after another,16 like the recent inability of acupuncturists to treat back pain in a particularly well-designed German study17 — yet acupuncture persists as a profession as if this research never happened. Doctors of traditional Chinese medicine, now popular in the west, continue to rely far too heavily on a variety of unproven folk remedies as if they were effective simply by virtue of being popular in China for a long time.18

In the physical therapies, the profession of chiropractic remains popular but the value of the profession’s services remain controversial. I avoid criticizing chiropractors directly on this website, due to legal concerns.19 Questioning chiropractic is better left to heavyweight experts and organizations.20 Training standards for massage therapy are all over the map; even here in BC, where massage therapists are trained better (and more scientifically) than anywhere else in the world,21 my own colleagues still routinely promote scientifically questionable ideas to patients (see sidebar). And a dizzying variety of superstitious sub-disciplines like craniosacral therapy, reflexology, and therapeutic touch/Reiki — fringe therapies that have failed to prove their efficacy despite many fair tests.22

In general, CAM practitioners are not the humble alternative to doctors — indeed, they generally seem to think much too highly of their training and abilities23 and suffer from “healer syndrome.”24 These practices and attitudes constitute a clear and present danger to the health of patients, and to their pocketbooks. Journalist and chronic pain patient Paula Kamen brilliantly exposes them for what they are in “Mind-Wallet Connection,” a chapter of her brilliant book, All in My Head, where she describes an tragicomic series of failed attempts to cure her nasty, chronic migraine with alternative therapies:

I was becoming turned off by what I saw as a lackadaisical attitude on the part of many healers. They had all the time in the world to follow “the mystical course of nature.” Just as no neurologist had ever admitted to me, “I don’t know,” none of them had said, “Well, you’ve given this enough of a try. You can stop these twice-weekly sixty-dollar visits.” If I didn’t stop these sessions, they would go on indefinitely, and we would grow old together.

All in my head, by Paula Kamen, p. 191

The shame of medical care

Like community policing or town meetings, house calls and humane, personal, socially interactive medical care has nearly disappeared from civil society. Such qualities are more likely to be found in places we consider “primitive” or “underdeveloped” because they lack adequate facilities — yet they may well be friendlier. The voice of Dr. Patch Adams, the most prominent medical spokesman for a “nicer” kind of medical care,25 has been completely drowned out. The failure to transcend bureaucracy and to be more about people than machines and money is the true shame of modern medicine.

Alternative health care, therefore, should be all about spending time with patients, listening to them, being personal with them. Alternative health care should be to mainstream medicine what small-scale organic farming is to industrialized farming.

Alternative health care, therefore, should be all about spending time with patients, listening to them, being personal with them.

But it isn’t. Instead, alternative health care has firmly established itself as the alternative to scientific health care. The message our industry sends out to the public is: “We’ll sell you whatever the doctors disapprove of. We’ll tell you what you want to hear. We’ll sell you ideas and potions that you’ll enjoy believing in, and we won’t spoil the experience with any boring, depressing science.”

But science is not the enemy: arrogant, impersonal, institutionalized health care is the enemy. That is what we should be the alternative to.

Science is good!

Science is a pretty good system for slowly but surely revealing all that is true in nature. However strange or difficult to understand, whatever actually is can sooner or later be understood as a part of the natural world — there is no such thing as “paranormal,” for, if it exists, it is normal.

Being anti-science is like being anti-honesty.

And science is not guilty by association with bad things that some people do with science.

I can appreciate the confusion, though, among alternative health care professionals and consumers alike. The “bad guys” try to use science all the time to defend ethically dubious practices. As long as tobacco companies and polluting industries continue to claim that “studies show” that they are innocent, it’s going to be hard to shake the impression that science is guilty by association. As long as technology continues to be used so disastrously to make war, it will be easy to see science and scientists as evil.

Being anti-science is like being anti-honesty.

And it’s not helping that politicians now reflexively refer to “the science” without ever actually understanding it or properly referencing it. In fact, science tends to get co-opted by practically anyone who wants to seem legit for the duration of a sound bite: even the flakiest of flakes will greedily cite a scientific study that seems to support their ideas,26 only to turn around and ignore and attack science the moment it clashes with their ideology.27 Talk about a fair weather friend!

In alternative medicine, hypotheses function more as fixed beliefs, and there is no study that can invalidate them. No matter how many times a hypothesis fails, the worst that happens is a call for more research.

Dr. Peter Lipson, for

Just because science and poor medical care often seem to be mentioned in the same breath does not mean that they are actually the same thing, or that the shame of medical care is also the shame of science. On the contrary, just as alternative health care professionals have a lot to answer for in their rejection of science, doctors are also guilty of abusing and ignoring relevant scientific evidence.28 Many doctors do not “practice what they preach.” While this is defensible — doctors are human too, and should not have to paragons of virtue in order to practice medicine — it is a neglected issue.

My simple, unlikely prescription for complementary and alternative medicine

It will never happen, but … my prescription for alternative medicine is simply to embrace the science and embrace the client. Focus on spending time with patients discussing rational, science-based clinical options. Be more personal than most doctors have the opportunity to be. Be the alternative to institutionalized care. But also learn and promote the science of medicine!

In other words, be compassionate and attentive not only to your patients, but to your colleagues in mainstream medicine as well. In particular, don’t try to claim that alternative medicine has some kind of a monopoly on compassionate, attentive care — almost everyone in health care really wants to help, and is doing the best they can with the resources they have. Work with them.

The notion that only those who preach the gospel of integrated medicine are able to perform the art of medicine is as ridiculous as it is insulting to everyone in healthcare who does his/her best to meet the needs of their patients. The assumption that unproven or disproven treatments become acceptable simply because they are often administered in a kind and caring fashion is quite simply not true.

The “integrated medicine” straw-man, by Edzard Ernst

About Paul Ingraham

Headshot of Paul Ingraham, short hair, neat beard, suit jacket.

I am a science writer, former massage therapist, and I was the assistant editor at for several years. I have had my share of injuries and pain challenges as a runner and ultimate player. My wife and I live in downtown Vancouver, Canada. See my full bio and qualifications, or my blog, Writerly. You might run into me on Facebook or Twitter.

Related Reading

What’s new in this article?

Added citation to Louw 2016 about bogus surgeries, plus a couple minor edits. Added a picture.


  1. More specific criticism of medical care will be provided below. However, for some healthy criticism of “conventional” medicine and just a generally interesting read, see Jerome Groopman's excellent book, How Doctors Think. BACK TO TEXT
  2. Again, more specific evidence will be provided below. As a general source, see: QuackWatch (

    Quackwatch fights health-related frauds, myths, fads, fallacies, and misconduct. Its primary focus is on health consumer information that is difficult or impossible to get elsewhere. Dr. Stephen Barrett, the founder of QuackWatch and author of most of the articles, is one of the great figures of anti-quackery activism. For many years now, I’ve been watching his work and the controversies and legal battles that swirl around QuackWatch, and I have been consistently impressed by Dr. Barrett’s integrity and intelligence — and unimpressed by the tactics and quality of his critics. He is also providing a vital service and a sorely neglected perspective on health care.

  3. As Dr. Steven Novella has written: “Fifty years ago what passes today as CAM was snake oil, fraud, folk medicine, and quackery. The promoters of dubious health claims were charlatans, quacks, and con artists. Somehow they managed to pull off the greatest con of all — a culture change in which fraud became a legitimate alternative to scientific medicine, the line between science and pseudoscience was deliberate blurred, regulations designed to protect the public from quackery were weakened or eliminated, and it became politically incorrect to defend scientific standards in medicine.” BACK TO TEXT
  4. Like my friend, after a motorcycle accident, who was refused a spinal X-ray by emergency room doctors at Royal Jubilee Hospital in Victoria, BC, only to discover the next day that his vertebrae were indeed broken. Like one of my own stories: an battle royale to prevent a determined nurse from dragging me off for a chest X-ray, even though my arm was in a sling because of the elbow injury that had brought me there. Or one told by a client, about having to advocate for himself while drugged, to convince a surgeon that he was in the hospital for a foot problem, and did not need abdominal surgery. BACK TO TEXT
  5. Louw A, Diener I, Fernández-de-Las-Peñas C, Puentedura EJ. Sham Surgery in Orthopedics: A Systematic Review of the Literature. Pain Med. 2016 Jul. PubMed #27402957. PainSci #53458.

    This review of a half dozen good quality tests of four popular orthopedic (“carpentry”) surgeries found that none of them were more effective than a placebo. It’s an eyebrow-raiser that Louw et al could find only six good (controlled) trials of orthopedic surgeries, and all of them were bad news.

    Surgeries have always been surprisingly based on tradition, authority, and educated guessing rather than good scientific trials; as they are tested properly, compared to a placebo (a sham surgery), many are failing the test. This review introduction is excellent, and does a great job of explaining the problem. As of 2016, this is the best single academic citation to support the claim that “sham surgery has shown to be just as effective as actual surgery in reducing pain and disability.” The need for placebo-controlled trials of surgeries (and the damning results) is explored in much greater detail — and more readably — in the excellent book, Surgery: The ultimate placebo, by Ian Harris.

    The surgeries that failed their tests were:

    • vertebroplasty for osteoporotic compression fractures (stabilizing crushed verebtrae)
    • intradiscal electrothermal therapy (burninating nerve fibres)
    • arthroscopic debridement for osteoarthritis (“polishing” rough arthritic joint surfaces)
    • open debridement of common extensor tendons for tennis elbow (scraping the tendon)

  6. [Internet]. Lewis A. Quack Word #20: ‘Iatrogenic’; 2007 Jul 3 [cited 16 Feb 11].

    “Iatrogenic illness,” or medically induced harm, covers the concept of harm having been done by the healer . In 2000, a presidential task force labelled medical errors a “national problem of epidemic proportions.” There are many technically correct and hair-raising stats about just how dangerous medicine can be — but the term and the stats are also often badly abused for ideological reasons. This article does a good job of putting it all in perspective.

  7. Perspective and context: people find stats about doctor-caused illness and injury to be shocking, but they almost never consider how many lethal, no-win situations doctors are faced with. You try running a hospital and get the error rate down to zero. Good luck with that! That’s not to say there aren’t serious systemic and institutional problems that need solving — there definitely are — but it’s because good health care is just inherently extremely challenging. People who point and blame without any sympathy or interest in those challenges are not helping. See Medical Errors in Perspective. BACK TO TEXT
  8. [Internet]. In Hospital Deaths from Medical Errors at 195,000 per Year USA; 2004 [cited 10 Nov 2].

    This article focusses on a major American study of medical error, summarizes the results of other similar studies, and paraphrases their conclusions: “medical errors caused up to 98,000 deaths annually and should be considered a national epidemic.”

  9. Doctors lack the skills and knowledge to treat most common aches, pains and injury problem, especially stubborn cases, and even the best are poor substitutes for physical therapists. Many doctors are well aware of this, but some are alarmingly oblivious. Dr. Jonathon Tomlinson, an instructor at St. Leonards Hospital in Hoxton, explains that “undergraduate training is focused on hospital orthopedics (broken bones and anything else that’s amenable to surgery) or rheumatology (nasty inflammatory diseases) which comprise a minority of the aches/pains/strains and injuries that people actually suffer from.”

    Medical researchers have done many studies showing that most doctors do not understand aches and pains or heed expert recommendations. A good example is a paper in the Archives of Internal Medicine showing that family doctors frequently ignore guidelines for the care of low back pain — see Williams et al. In 2002, Freedman et al wrote: “It is ... reasonable to conclude that medical school preparation in musculoskeletal medicine is inadequate.” In 2005 in Journal of Bone and Joint Surgery, Matzkin et al concluded that “training in musculoskeletal medicine is inadequate in both medical school and non-orthopaedic residency training programs.” In 2006, Stockard et al found that 82% of medical graduates “failed to demonstrate basic competency in musculoskeletal medicine.”

  10. See Matzkin, Freedman, and Stockard. BACK TO TEXT
  11. I am referring generally to the case of anti-depressants, which are not “medicine” and specifically to well-documented cases of companies like Ely Lilly trying to buy American juries in order to set favourable precedents for other cases involving SSRI anti-depressants like Prozac. See SSRI Antidepressants Are Not Medicine. BACK TO TEXT
  12. That is, all the basic medical science classes are in the curriculum — anatomy, physiology, pathology, and so on. BACK TO TEXT
  13. Being virtually unregulated (see Scott Gavura’s Supplement Regulation: Be Careful What You Wish For), they sell useless and contaminated products at markups that the average person would regard as egregious (see Scott Gavura’s Do the Natural Health Products Regulations Benefit Canadians?). BACK TO TEXT
  14. [Internet]. Science-Based Medicine Homeopathy Resource Page; 2010 [cited 12 Feb 19]. BACK TO TEXT
  15. [Internet]. Jones M. Malaria advice ‘risks lives’: Some high street homeopaths claim they can prevent malaria, a Newsnight investigation has found; 2006 [cited 12 Feb 19].

    Secret filming revealed homeopaths were claiming their preparations could be used instead of anti-malarial drugs to protect travellers in high risk areas such as sub-saharan Africa.

  16. See my review of recent evidence in Does Acupuncture Work for Pain?. BACK TO TEXT
  17. See Haake and a detailed discussion that paper in Does Acupuncture Work for Pain?. BACK TO TEXT
  18. Hopefully it’s obvious that a billion Chinese can be wrong. They can be. They routinely are. BACK TO TEXT
  19. The chiropractic profession has often responded to scientific criticism with legal threats. I have even received legal threats from chiropractors for saying that— oh, irony! The most famous example of chiropractic litigiousness was the (fortunately unsuccessful) attempt to sue science journalist Simon Singh, forcing him to spend vast sums of money to defend his right to express an opinion. It was like Hollywood suing a movie reviewer for criticizing a film. BACK TO TEXT
  20. For more about this cautious approach to evaluating chiropractic, see Does Chiropractic Work? BACK TO TEXT
  21. See Massage Therapy In British Columbia, Canada. BACK TO TEXT
  22. Many of my readers may find that last statement too harsh. Perhaps a clarification will help, however: I do not attack the reputation of such practices because I have any doubt that “The universe is not only queerer than we suppose, but queerer than we can suppose.” (Haldane), but rather because of it. I do not doubt that the universe is a fascinating and bizarre place and that there are many wonderful things yet to learn about it. What I do doubt is that my fellow alternative health care practitioners are able to comprehend it well enough, without benefit of rigorous study and insights into biology the likes of which no serious scientist enjoys, in order to offer patients therapeutic benefits by completely unproven methods. In other words, I question their competence. If they were ethical, they would be more honest and humble about the limitations of their knowledge and skill — a quality conspicuously lacking from a group of people so fond of referring to themselves as “healers” and “masters.” BACK TO TEXT
  23. Many alternative health care practitioners, especially chiropractors, claim that they are as well trained as physicians. This is false. Doctor’s academic training is routinely longer, and — more importantly — most of their serious learning occurs during extensive on-the-job training, where they are thrust into demanding clinical environments and supervised for years as they deal with a great variety of clinical situations and many extremely sick and hurt patients. That hands-on phase of their training is where all doctors will tell you that they became professionals — and there is nothing like it in any non-medical health care training.

  24. “Healer syndrome” is a common delusion of grandeur in alternative medicine, especially massage therapy, naturopathy, and chiropractic, where many afflicted professionals like to be known as “healers” with allegedly unusual curative powers, vaguely defined, pseudoscientific, or based on the exaggerated importance of a single idea. Such lack of humility is tragically common. Healer syndrome has reached its most extreme in some of the founders of methods of therapy, what I call “modality empires.” See Healer Syndrome: The problem with health care professionals, especially in alternative medicine, who want to be known as “healers”. BACK TO TEXT
  25. Gesundheit! ( BACK TO TEXT
  26. Flamm B. The Columbia University ‘Miracle’ Study: Flawed and fraud. Skeptical Inquirer. 2004 Sep/Oct;28(5):25. PainSci #57193.

    A Columbia University paper published in a peer-reviewed scientific journal claimed clear evidence of the efficacy of remote prayer, and was reported with great enthusiasm by the American media in the aftermath of post-9/11, and continues to be widely cited routinely in support of similar claims. Yet the first-named author “doesn’t respond to inquires,” the “lead author said he didn’t learn of the study until months after it was completed,” and then the third author, “indicted by a federal grand jury, has pleaded guilty to conspiracy to commit fraud” — not with regards to the study, but several other charges of fraud.

  27. PS Ingraham. Ioannidis: Making Medical Science Look Bad Since 2005: A famous and excellent scientific paper … with an alarmingly misleading title. 2624 words. BACK TO TEXT
  28. For instance, the “soft” social sciences in particular, but also hard biochemistry, have produced reams of data about the medical importance of “subtleties” like the relationship between outcomes and time spent with patients, the effects of fear and anxiety, the need for better nutrition in hospital meals, the hazards of impersonal care, setting a good example in lifestyle habits, and so on and on and on. BACK TO TEXT