Natural Remedies, Complementary & Alternative Medicine
Natural remedies and complementary and alternative medicine (CAM) encompasses a large group of interventions or treatment approaches that lie outside mainstream or conventional medicine.
Although certain types of CAMs have become more available in recent years, most are not offered by traditional doctors. Also, the effectiveness or safety of CAM approaches have not been evaluated systematically in large, controlled clinical trials in the same way medications that are approved by the FDA or other drug authorities have been. Therefore, it is often difficult to determine how effective and, more importantly, how safe some CAM approaches are.1
What do the terms ‘complementary’ and ‘alternative’ refer to?
CAM approaches include two broad categories of interventions, those that are complementary and those that are alternative. Complementary approaches are those that are used alongside conventional treatments and work to complement them. Alternative approaches are interventions that are out of the mainstream and are used instead of conventional treatments. Most people who use non-mainstream therapies are using them in combination with standard treatment.2
Why do people with MS use complementary and alternative medicine?
A number of studies have surveyed people with MS to try to determine how common the use of CAM approaches is. Survey responses vary greatly, with a range of 33%-70% of respondents saying they use CAM approaches. Many people with MS who use CAM report that they get some relief from physical or mental symptoms. People also state that using CAM gives them a sense of empowerment and may help to improve their general health.3
Importance of letting your doctor know about CAMs
While you may be hesitant to let your doctor know about a CAM intervention that you are trying or interested in trying, it is important for your care team and doctor to have a complete picture of the treatments you are using. Always tell your doctor and the rest of your care team about all treatments, including supplements, vitamins, herbal products, body work, and alternative medicine approaches, that you are using. This is especially true with substances that may interact with the drugs that you are taking. For instance, certain natural pharmacologic treatments may interfere with the way your body uses your disease-modifying treatment or drugs you may use to control spasticity or fatigue. So, keep your doctor in the loop about whatever treatments, including CAMs, you are trying.
Why is there so much disagreement about the benefits of certain natural remedies & CAMs?
The gold standard in testing the effectiveness and safety of any medication used to treat a disease, including treatments for MS, is the randomized, controlled, trial (RCT). Typically, a RCT compares a medicine or treatment with placebo which is often a sugar pill that contains no medicine or, in the case of an injection or infusion, a liquid such as saline solution. The drug comparison is made by assigning groups of patients to receive either the drug or placebo. If the groups are large enough and the effects of the medication being tested are strong enough, a statistically significant difference between the effect of the medication and placebo may be established.
The statistical difference tells us that a medication works. Just to make sure that the results of one study are not a fluke, additional RCTs that replicate or repeat the results are needed. For many CAMs, there have not been nearly enough well-designed studies including enough people to determine with any confidence that the CAM being studied works. However, this is not true for all CAMs, so check individual interventions to see what the studies show.
RCTs are required to determine a real difference in the effectiveness of a medication and placebo, overcoming a potential placebo effect. Placebo effect is something that is seen in studies, where a percentage of patients who get placebo instead of active treatment will show an improvement. It may be their belief that they are receiving real treatment, or their confidence in their doctor, or just the power of positive thinking, but results from studies show that in some patients, placebo treatment results in a real, measurable health improvement.
Because of placebo effect and because of the rising popularity of CAMs, the US NIH started the National Center for Complementary and Alternative Medicine (NCCAM) to begin to promote systematic study and dissemination of study results of CAMs.2
How can I tell if claims about a natural remedy or CAM are trustworthy?
Be on the alert for the following red flags when you are considering a CAM:
Based on individual, anecdotal claims:
Does the product or intervention rely on the claims of individuals without any large group data from a formal study?
Claims to enhance or strengthen immune system:
MS is thought to be an autoimmune disease, where the immune system attacks the body, so an effective MS treatment would not be one that seeks to ‘strengthen’ or ‘enhance’ the immune system.
- Beware of claims that appear to be too good to be true, such as claims of total cure or resolution of all symptoms
- A certain amount of skepticism is healthy
- Demand full disclosure when it comes to any treatment
- Beware of treatments that claim to contain ‘secret ingredients’
No objective evidence:
Any treatment that you consider taking should have objective evidence to back up its claims
Relies on negative advertising:
- Suspect any advertising that depends on attacking conventional medicine
- An effective treatment should be able to stand on its own on the basis of objective evidence