Are You Crazy? Why Patients Use Complementary Medicine

A recent study in JAMA reported on the possible effects of acupuncture on women undergoing in vitro fertilization. 848 women undergoing in vitro fertilization (IVF) in Australia and New Zealand with half receiving three treatments with acupuncture during an IVF cycle and the other half undergoing sham acupuncture with less invasive needles at body points unrecognized as credible acupuncture points. The results, 18.3% live births in the acupuncture group, 17.8% in the sham control group. Acupuncture made no difference. Other studies have documented that about 16% of couples utilize acupuncture during IVF treatment and the percentage rises to almost 30% when herbal remedies are added to the mix. Why would people do this? Before you conclude that they are crazy, ignorant or misguided; another study on why people choose traditional Chinese medicine (TCM) over Western medicine (WM) provides some answers and leaves us with some questions. 

Why would anyone choose complementary medicine?

Healthcare has cultural roots, chicken soup as “Jewish penicillin” exemplifies culture’s role in signifying quality, remedy and affective connotations like comfort. These cultural factors may bias studies of TCM in the US, but this research was conducted in China, where traditional Chinese medicine and western medicine are both viewed as efficacious and widely available reducing that effect. While both TCM and WM are derived from what we see and experience, their most significant differences are in the explanation of these empirical findings. Western medicine is based on measurable, biologically plausible, processes that through cause and effect drive disease and treatment. Traditional Chinese medicine is a more holistic approach correcting imbalances of primal elements within the patient and their environment. 

The study consisted of written scenarios, manipulating the probability and severity of an illness as well as the speed of recovery and relief provided by the remedy. It was administered to groups of about 100 undergraduate Chinese university students. Given the small sample, the relatively few significant illnesses experienced by young people and written scenarios rather than actual behavior we can skip the scientism of the p-values. They found:

• Both TCM and WM were considered equally efficacious (98% or more) in the settings the student chose. 
• Western medicines were chosen when a specific disease could be identified and where relief was needed rapidly and effectively. For example, a sore throat due to strep. Cause and effect were unambiguous, and patients balanced speed and efficacy of relief against perceived more significant side effects utilizing “non-natural” chemicals. 
• Traditional Chinese medicine was chosen when the underlying disease was unclear and the time frame to achieve improvement was not as constrained. For example, a sore throat “going around” where a specific cause, like strep, was not a consideration. TCM was chosen when the underlying problem was more ambiguous balancing a longer wait for relief and more “natural” herbal treatments. 

So bottom line, patients/consumers matched their choice of treatment to the perception of their illness, they were theory agnostic. The use of TCM by IVF patients may be based on the uncertainty of IVF resulting in pregnancy. If you consider other conditions where TCM is offered as complementary therapy, e.g. chronic pain, I think you will see the same considerations. TCM appears to be chosen when the underlying cause is unclear, where the problem is chronic and where time to relief can be extended. 

There is another difference to consider. In WM’s cause and effect paradigm, treatment, often in the form of medication, is sufficient to cure the underlying problem. The medication acts as a “get out of jail free” card and physician admonitions to exercise more or eat differently are unnecessary. TCM’s paradigm, based on imbalances within the patient and environment, requires lifestyle changes as part of the treatment. Could the cause and effect paradigm that has brought us so far, also act to undermine the need to engage in healthy behavior? 

Source: Effect of Acupuncture vs. Sham Acupuncture on Live Births Among Women Undergoing In Vitro Fertilization Randomized Clinical Trial JAMA DOI:10.1001/jama.2018.5336

Health Remedies: From Perceptions to Preference to a Healthy Lifestyle Wharton School, University of Pennsylvania