“Medicine: When in good health, make fun of it.”
Gustave Flaubert

Today the pain in Paula Kamen’s head is a five out of 10. It’s not a bad day. But then, it’s not a particularly good day either. Kamen is accustomed to living with pain, however, because every day for some 15 years, she has suffered from what’s known as chronic daily headache.

Along the way, Kamen, a 38-year-old Chicago journalist and author, has become a self-educated expert on conventional and alternative therapies and therapists. At least, for her condition.

In her elegant, informative, and delightfully funny medical memoir, All In My Head: An Epic Quest to Cure an Unrelenting, Totally Unreasonable and Only Slightly Enlightening Headache (Da Capo Press, 2005, $35), she chronicles her search for relief.

In just over a decade, she saw seven neurologists, one brain surgeon, five acupuncturists, four physical therapists, three ear-nose-and-throat specialists, one neuro-opthamologist, three osteopaths, four chiropractors, four family doctors, four psychiatrists, countless massage and body-work therapists, and one shaman. The only therapies she didn’t try, she says, are colonic irrigation, Ayurvedic medicine, and whatever Jews for Jesus offers. She also spent tens of thousands of dollars on more than 40 types of prescription drugs and more than 50 kinds of herbal and vitamin treatments. As she can attest, when it comes to seeking help for hard-to-cure conditions, like chronic disease, it’s a minefield out there.

“Both alternative and Western medicine over-promise,” Kamen says in an interview from her home in Chicago. “Western medicine says, ‘Take this pill and you’ll have no pain in five minutes or less.’ Alternative medicine often says, ‘If you live a balanced life and think all the right thoughts, you will be cured’.”

Her frustrations with both domains are further captured by the following passage from her book: “With Western medicine, the hidden subtext of the visit was the doctors wondering if I was crazy. Now, with alternative medicine, I was having these doubts about them.”

Driven by desperation, she pursued and paid for one bogus remedy after another. Is the trial-and-error method the only way to go? Must those who suffer submit to guinea-pig status as they experiment with god-knows-what and are experimented on by god-knows-who?

Several elements of modern life combine to create fertile ground for the spirit of snake oil. One: we live in a health-obsessed and death-denying society where the quest for eternal youth, beauty, and sex is nothing less than a Holy Grail. Two: despite the fact that most Canadians report satisfaction with health care, faith in conventional medicine has fallen, perhaps because while doctors and drugs are good at treating acute physical disease, they are less successful at treating chronic disease and mental/emotional distress. Three: the vast majority of killer diseases—cardiovascular disease, diabetes, cancer, and chronic lung disease—are lifestyle related and thus largely preventable, but prevention is not medicine’s forté. And four: a flood of complex, often contradictory health information overwhelms many and makes some vulnerable to the allure of simple and simplistic solutions.

SCIENCE MAY REIGN in some circles but in the health marketplace, where dubious treatments and bogus healers abound, it’s hard to see what it has delivered. Some say scams are more abundant than ever, especially in that amorphous and semi-regulated area known as complementary and alternative medicine (CAM).

Others say mainstream medicine is where the real damage happens.

Drug stores, health stores, grocery stores, and the Internet are full of products claiming to burn fat, boost breasts, enhance sexual vigour, balance hormones, cleanse or “flush” kidneys, lungs, liver, blood, and bowels, strengthen and repair bones, joints, and immune systems, sharpen brainpower, calm nerves, reduce stress, aid sleep, slow aging, prevent disease, combat depression, and even increase happiness.

There is a brain-numbing array of therapies to tempt the curious (or, like Kamen, the desperate): crystal-bowl soundings, biological terrain assessments, vortex healing, angel readings, craniosacral therapy, meridian massage, constitutional iridology, and zero balancing, to name a few. Therapists describe themselves as certified angel practitioners, certified colon hydrotherapists, certified reiki practitioners, and lots of other “certified” therapists of one sort or another. Links to Native spirituality proliferate, including shamanic healing, medicine wheel teachings, drumming circles, and ancient teaching from Peru.

Canadians are turning to alternative therapies in unprecedented numbers. According to the Holistic Health Research Foundation of Canada, the use of alternative medicine has grown by more than 80 per cent in the past five years. Almost 45 per cent of Canadians use alternative products and practices, most commonly herbals, massage therapy, nutrition/diet supplements, chiropractic, naturopathy, acupuncture, and relaxation therapies. Contrary to the stereotype of alternative-health users as desperate, dying, or flaky, most are female, affluent, highly educated, between 35 and 54 years old, and likely to live in a western province. Vancouverites have the highest rate of alternative-health use in the country. The most significant increase in users nationwide was among 18 to 34 year olds.

It is not fair to dismiss all alternative therapies as hocus-pocus . Therapies range from harmless (crystal healing) to promising but still unproven (acupuncture for chronic pain) to clearly beneficial (massage therapy) to dangerous (ear candling). Also, the natural world and Native cultures contain many effective remedies. But because of commercial interests and what some say is an ethnocentric medical establishment, many are downplayed in favour of pharmaceuticals. A good example is the recent study published in the British Medical Journal showing that St. John’s wort is just as effective in the treatment of moderate to-severe depression as drugs such as Prozac. Nevertheless, critics of alternative therapies have a point: other than blatantly injurious practices, almost anyone can do almost anything and call it “healing.”

In this flea market, how can you guard against getting duped, ripped off, misled, or hurt? First, tell your doctor or pharmacist about any CAM treatment you embark on—some therapies can alter and even conflict dangerously with conventional therapies. Charlatans promise to cure everything from acne to arthritis and do so quickly; they also use individual testimonials that are worthless. If it sounds too good to be true, it probably is. If you feel wronged, regulated therapists—naturopaths, massage therapists, traditional Chinese medicine practitioners, acupuncturists, and chiropractors—have professional bodies that handle complaints about their members. Disgruntled customers can also seek redress from the Better Business Bureau, the police, and lawyers. For natural health products, consumers can report any untoward effects to Health Canada’s toll-free number 866-234-2345. Still, checking the validity of an alternative therapy is no simple task.

If someone benefits from a product or process, no matter how half-baked, there’s no harm done. What if they only think they benefited? Same difference. Of more concern are therapies that don’t do what they claim, that mask or ignore an underlying, more serious health problem, or that cause direct harm. Ideally, the public and healers of every stripe would have enough information about safety and efficacy to take advantage of all therapies, conventional and alternative. If that were possible, that much-ballyhooed entity—“integrative medicine”—would be more reality than fantasy. However, research published in the April 2000 Journal of the Royal Society of Medicine found that academic reviewers were three times more likely to rate a study on a conventional therapy “important” than they were an otherwise identical study using an alternative method. Meanwhile, the Integrative Health Institute recently opened its doors in Calgary, and IN-CAM, a Health Canada-funded interdisciplinary team of academics, aims to foster CAM research.

But still, there is a bitter divide between those who view alternative medicine as a grab bag of magical practices and those who say orthodox medicine is blinded by its own intellectual arrogance.

From where I sit—smack on the fence—both arguments have merit.

Paul Benedetti teaches journalism at Western University in London, Ontario. He has been writing about alternative medicine for 15 years, originally for the Hamilton Spectator newspaper, and is co-author of the 2002 book Spin Doctors, a scathing indictment of the chiropractic industry. After investigating the principles and practices of chiropractors, Benedetti concluded that the therapy is “built on a deck of cards.”

“In 100 years, chiropractic has not proven that its fundamental idea is true,” Benedetti says.

He feels the same way about alternative medicine in general. Many therapies, such as iridology and reflexology, he points out, have been tested and found wanting. “So have they thrown those onto the junk heap?” he asks. “No. In fact, nothing has been thrown on the junk heap because alternative medicine never moves forward. It’s just mired in false and pseudo-scientific beliefs…. That’s why there’s no way there can ever be a blend of these two fields. The reality is there are only two kinds of medicine: medicine that is proven safe and effective, and everything else. It’s like alternative engineering; nobody builds a bridge using alternative engineering.”

Barry Beyerstein agrees. A Simon Fraser University biological psychologist, Beyerstein has been debunking alternative therapies for years. Besides chairing the Society of B.C. Skeptics, he is a founding member of Canadians for Rational Health Policy and a contributing editor to the journal The Scientific Review of Alternative Medicine. He defines alternative therapies as everything “lacking sufficient evidence that it works.” He acknowledges the benefits of things such as lifestyle counselling and a few safe, effective herbal products but, he says, “Complementary medicine is largely religion. It is part of the New Age world view and people who do it and buy it have a certain cosmology that goes with it.”

Many therapies, he says, fly in the face of basic chemistry, physics, and biology. An example is homeopathy, with its premise that a remedy’s power increases as the concentration of the active ingredient decreases. (From which comes the joke about the patient who forgot to take his homeopathic medicine and died of an overdose.) Says Beyerstein: “If you want me to believe in homeopathy, you’re asking me to believe that if I piss in Vancouver Harbour, I’ll pollute Tokyo Bay.”

In a 1997 article published in Skeptical Inquirer magazine, titled Why Bogus Therapies Seem to Work, Beyerstein blames “vigorous marketing of unsubstantiated claims,” “the poor level of scientific knowledge in the public at large,” and the “will to believe so prevalent among seekers attracted to the New Age movement” for the legions of satisfied alternative-health customers. He advises consumers to dismiss any therapy flaunting testimonials and look, instead, for evidence of efficacy found in randomized clinical trials and published in peer-reviewed scientific journals.

Both Beyerstein and Benedetti admit that traditional medicine is far from perfect, particularly as one sordid tale after another unfolds about poisonous pharmaceuticals and tainted medical research. But they insist that science learns from its mistakes and continues, slowly, to advance.

The head of Canadian Physicians for the Environment disagrees entirely. Warren Bell—Salmon Arm family doctor, member of the Association of Complementary Physicians of B.C—says that as a McGill University medical student, he felt like an anthropologist entering a strange new culture, one that was not particularly curious, or intellectually stimulating, or wanting to impart much more than a how-to manual for the human body.

“We don’t think about why we’re doing what we’re doing. We don’t think about the long-term impact,” Bell says. “You know, they talk about the political cycle being five years. Well, the doctor’s cycle is 15 minutes. Maybe six weeks, if you are a surgeon and take a gall bladder out. We’re still very pragmatic. We’re resolutely physical in our orientation.”

Healing is currently in the grip of “the corporate, pharmaceutical, and intellectual-property-right world,” Bell says. As such, the dichotomy between alternative and conventional medicine has little to do with evidence and much to do with economics and culture. The influence of the global patent system on medicine, he says, is so pervasive it is invisible. Yet, more than anything else, patent protection relegates therapies into “conventional” and “alternative” roles. The result, he says, is that the volume of research devoted to CAM is infinitesimal compared to that devoted to pharmaceuticals. Bell acknowledges that there is as much nonsense in CAM as there is elsewhere in our state of frenzied consumption.

“With CAM, it’s the nonsense of the Arab bazaar where every vendor is screaming at the top of his or her lungs: ‘No, buy mine, buy mine. Mine’s better. This stuff will make you strong, happy, youthful, beautiful, whatever.’

“But is that any less dishonest than the Viagra ad that says, loud and clear, in its images: ‘Take this. It will make you happy’? It’s just better-done crap. Crap is crap. It’s just that, if you have enough money, you can make that crap look like crap is good for you.”

In the end, he says, “I would prefer an idiot I can tell a mile away who I can ignore from an idiot I invite into my home and he marries one of my children and they have 17 grandchildren and then I discover he is fake. And that’s what I think Big Pharma has done to the medical profession.”

His advice is to “keep an open mind but not so open that your brains fall out.” As for the quack-buster crew, as he calls CAM critics: “Their minds are so closed, the only thing that gets out is a tiny constipated turd from one moment to the next. They should come out and say, ‘We don’t like this stuff. It makes us nervous. It’s icky’.”

Liked or not, CAM practices are increasingly being put under the microscope of standard medical research, a process that won’t satisfy everyone. But, as Beyerstein says, it may be the only way to determine what works and what doesn’t. One of the best places to access high quality research is Informed Health Online (informedhealthonline.org).

Produced by a non-profit Australian organization called Health Research and Education Foundation, the site allows access to easy-to-read summaries of systemic reviews by the Cochrane Collaboration, the leading source of information on health interventions in the world. You won’t find anything on colon irrigation, or soul extraction, or colloidal silver. You must be prepared for many the-jury’s-still-out conclusions. And also, depending on your bent, you may not like what you read. There is no evidence, for instance, that homeopathy does anything to prevent the flu.

What you will find, however, are hard-nosed assessments of everything from herbal therapy for migraines to therapeutic touch for healing wounds to Tai Chi for rheumatoid arthritis. But don’t stop there. Once you’ve checked the alternatives out, do a similar scrutiny of conventional medical therapies and drugs. You’ll find many of those at Informed Health Online also. After all, as Paula Kamen writes, “The price of good care, like the price of democracy, is constant vigilance.”

Kamen should know. After more than a decade seeking a cure, she’s cobbled together a collection of coping strategies from both alternative and conventional worlds. They include yoga, massage therapy, lavender oil, and the antidepressant Prozac. More importantly, Kamen now accepts her headache as an integral part of her biology. There is no cure, only ways to ensure that more days are good than bad.

Nobody said relieving pain, curing disease, or restoring health would be easy.