Reclaiming the linguistic high ground: Renaming “complementary and alternative” medicine and the power of language

A few days ago, I was amused by a term coined by Dr. R.W. The term, “quackademic medicine,” was meant to describe the unholy fusion of non-science- and non-evidence-based woo that has infiltrated academic medicine to a disturbing extent over the last decade or two. There was a lot of reaction, mainly positive, to the new term, and I even got an e-mail from a certain skeptical podcaster vowing to use the term every opportunity that he got. One reader, Jim Benton, made a comment that got me to thinking. Here’s the comment:

My ‘crusade of the year’ this year (other than getting a Democratic Congress that will deBushify the country) is to get Skeptics (and especially SkepDocs) to stop using the term ‘CAM’ or ‘Alternative medicine.’

‘Medicine’ is what you do, Orac, and Dr. R.W. and Flea and my own doctor. It is NOT what quacks, homeopaths, and woomeisters do!

I would suggest/beg at least the skeptical community to stop using ‘CAM’ and, if you HAVE to have a ‘polite’ name, to start calling their methods either

ATP (for Alternative Therapy procedures) or

ATM (for Alternative Therapy Methods or Modalities).

After spending much of my life watching the ‘good guys’ (scientific, political, etc.) cede the ‘linguistic high ground’ in various ways, I think this is one we can start stopping.

Ask yourself, would you allow Creationists to call their work “Alternative Geology” (or Biology) or Holocaust Deniers call their books “Complementary History”?

No?

Then WHY LET QUACKS GET AWAY WITH THE SAME THING?

It’s a thought-provoking concept, but would it help?


Certainly, language has power. It can frame an issue in a way that is advantageous or disadvantageous to one side or another. There are numerous examples of the use renaming or appropriating to try to change the public’s perception of an issue or to serve a purpose. Sometimes such attempts misfire badly (the ill-conceived idea of renaming secularists, agnostics, and atheists as a term as ludicrous as the “Brights” comes to mind), but often the change in language can be quite useful.

Advocates of CAM (for lack of a better term) know the power of language very well. Years ago, CAM nostrums were called by a variety of names because they encompass a wide variety of unrelated modalities. Such names included “folk medicine,” traditional Chinese medicine, herbalism, naturopathy, homeopathy, or even snake oil or quackery. The next term in the evolution of CAM was “alternative” medicine. The term “alternative medicine” unified these disparate and even contradictory therapeutic modalities under the rubric of a single term that encompassed pretty much all medicine that wasn’t encompassed by modern, science-based medicine. The term, although it served a purpose, had a fatal flaw, though. It implied that these modalities were somehow an “alternative” to modern medicine, even though there was a paucity of evidence that they were efficacious and, in a few cases, good evidence that they were harmful. Moreover, to the average person, the term connoted inferiority. This led to statements by critics of alternative medicine:

  • “…since many alternative remedies have recently found their way into the medical mainstream [there] cannot be two kinds of medicine – conventional and alternative. There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work. Once a treatment has been tested rigorously, it no longer matters whether it was considered alternative at the outset. If it is found to be reasonably safe and effective, it will be accepted.” (Marcia Angell, former Editor-in-Chief of the New England Journal of Medicine.)
  • “There is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data or unproven medicine, for which scientific evidence is lacking. Whether a therapeutic practice is ‘Eastern’ or ‘Western,’ is unconventional or mainstream, or involves mind-body techniques or molecular genetics is largely irrelevant except for historical purposes and cultural interest. As believers in science and evidence, we must focus on fundamental issues–namely, the patient, the target disease or condition, the proposed or practiced treatment, and the need for convincing data on safety and therapeutic efficacy.” (George D. Lundberg, former editor of the Journal of the American Medical Association (JAMA), and Phil B. Fontanarosa, Senior Editor of JAMA.)

I’ve said similar things frequently on this blog myself.

One thing you’ll note is that these articles date back to the 1990s, which was around the time that advocates of alternative medicine were trying to rename it. This was largely done in response to the realization that the vast majority of this “medicine” was completely unproven; consequently, it was reasoned, using it as an “alternative” to “conventional” medicine was a bad idea. Instead, it was said, it should be “complementary” to conventional medicine. Of course, for something to be complementary it needs to bring something to the table, add something to the treatment, so to speak, but this was about language, not fact

The evolution of the term “complementary and alternative” medicine (CAM) can actually be studied by examining the history of the federal agency, a branch of the NIH, whose charge is to study CAM, namely the National Center for Complementary and Alternative Medicine (NCCAM for short). In 1991, at the behest of a couple of powerful woo-friendly legislators, NCCAM was born in an embryonic form known as the Office of Alternative Medicine. By 1998, it had become a center and obtained its current name.

By the early 2000’s, however, it was clear that “complementary and alternative” medicine just wasn’t a simple enough. True, it had a catchy abbreviation (CAM), but it still had the word “alternative” in it, which still connoted inferiority to “conventional” medicine. Thus was born a new term for a new millennium: “integrative medicine.” It’s powerful. It’s concise. The word “integrative” is hip. It’s happening. It implies “integration” of the best of all modalities (both woo and non-woo). But, best of all, it got rid of the word “alternative.” So we now have a multitude of “Departments of Integrative Medicine” and a dwindling number of “CAM” programs, most of which are seemingly being renamed. Of course, from my perspective, I fail to see any advantage of “integrating” non-evidence-based woo with medicine that works, but that doesn’t take away from the power of reinventing CAM as “integrative medicine.”

So should we try to “rename” CAM or integrative medicine, at least when we are applying skepticism?

I’m of two minds on this. On the one hand, the terms “CAM” and “integrative medicine” are widely known among the public. They’re also ripe for parody. On the other hand, as Jim points out, it is ceding the linguistic high ground to let such terms stand unchallenged. Obviously, the term “quackademic medicine,” although amusing for use in particularly sarcastic takedowns of particularly egregious misadventures in “integrating” woo into academic medicine, is too harsh and snarky as a candidate for terms by which to identify CAM or integrative medicine routinely. Too much scorn will backfire. Personally, I’ve favored terms like “non-evidence-based medicine” (which is too long to be punchy) or “nonscientific medicine” or “nonscientific treatments” (both of which are better), but I readily concede that there must be a better term. For one thing, both of my favored terms contain the word “medicine,” and, as we have learned lately, it is not appropriate to refer to many of the practices that fall under CAM as “medicine,” given that they are based on religious beliefs from prescientific societies.

I’m not sure that I’m entirely convinced by Jim’s argument. On the one hand, I fully believe that, based on the available evidence, the vast majority of CAM therapies are not worthy of being called medicine. Certainly, following the analogy of creationism, we would never let creationists call their religion-inspired drivel “alternative biology” or to call “intelligent design” creationism “alternative evolution.” On the other hand, a poorly chosen moniker could risk being too obvious (like the “Brights”) and bringing much-deserved derision. That being said, I rather like the terms “alternative therapy modalities” or “non-science-based therapy.”

The reason I posted this is not so much to propose a term but to get feedback on this issue, as well as potential terms to use instead of CAM or integrative medicine. Remember, the reason “quackademic medicine” won’t do is because it’s too snarky except for the most blatant woo. Ditto “supplements and complementary and alternative medicine” (SCAM). I’m looking for at term that is serious and that does not contain the word “medicine.” It would be better if it could be turned into a memorable acronym as easy to remember as “CAM.” I’m also interested in learning whether readers even think that it is worthwhile to try to take the linguistic high ground back from the purveyors of woo who now seemingly hold it. However, if we’re going to try to do that, we need a term that does not use the word “medicine” and is not so derogatory that it backfires.