Millennials and CAM use: Some depressing news

After having returned from TAM, I was pumped up by how much interest was shown in the case of Stanislaw Burzynski. More importantly, I was heartened to learn while I was there that the Texas Medical Board had submitted an amended complaint against him containing 202 pages worth of charges. Sure, the descriptions of the violations Burzynski committed in the care of seven patients cited got a bit repetitive, but that’s Burzynski. His MO has been consistent for 37 years, the only change being that in 1997 he decided to use and abuse the clinical trial process as a means to an end, that end being treating any patient he wants with his antineoplastons.

Yes, I was happy to read that the Texas Medical Board was going after Burzynski hard. Then, as I arrived home, I saw this depressing article by David Koeppel in The Fiscal Times entitled Millennials Embrace Alternative Medicine, a $32 Billion Business. Millennials, as you might know, are generally considered to be the generation cohort following Generation X. Although, unlike the case for Baby Boomers and Generation X, there isn’t as tight an agreement over what birth years define the Millennial generation, Millennials were born between the early 1980s and the early 2000s. So we’re talking about people ranging in age from their teens to their early 30s. Of course, these whole named generations are almost entirely arbitrarily defined, but for purposes of this discussion it doesn’t matter. What we’re talking about are teens and young adults, and, if this article is to be believed, young adults are seriously into woo:

Young people are generally healthy. But when 36-year-old Jessica Rich was diagnosed with multiple sclerosis earlier this year, she didn’t choose the conventional medical treatment and prescription drugs that would have attempted to slow the disease’s progress, prevent disability, and control pain. Instead, she opted for alternative treatments.

Rich’s traditional Chinese doctor prescribes herbs, and she’s also seen other alternative medicine experts, including a naturopath, a medic intuitive, and an energy healer – all at a whopping cost of $5,600. Her parents paid for most of this.

OK, it’s really tempting to make jokes about a 36-year-old needing her parents to pay for her basic needs. Or at least it would have been before the financial crash of 2008. I could also point out that, technically, she’s a Gen Xer. But that’s just me being pedantic. In any event, here is a relatively young woman with a serious disease, and, instead of choosing effective medicine, she’s choosing the purest quackery. Yes, this is just an anecdote. We can easily find examples of older people making the same sort of bad health care choices. However, if this article is to be believed, there really is a major increase in the use of alternative medicine by young adults. While Koeppel prefaces his next observation by pointing out that most in their 20s and 30s don’t chare Rich’s distrust of conventional medicine, a lot of them are into the woo:

Unlike Rich, most millennials more often use alternative medicine to prevent illnesses and maintain wellbeing – rather than to actually cure existing sicknesses. Rich was only recently diagnosed with MS; there is no way of knowing what path her illness will take or whether alternative medicine will be able to sustain her in the decades ahead.

Roughly 11 percent of millennials used homeopathic medicine in 2013, up from 4 percent in 2009, according to a 2013 report by the Natural Marketing Institute, a consulting firm in Harleysville, Penn. By comparison, only 6 percent of baby boomers and 7 percent of Gen Xers reported using homeopathic medicine in 2013.

My first thought was: Is this true? The reason, of course, is the source, a company called Natural Marketing Institute, which is a company that specializes in surveys looking at “wellness” (a term I absolutely loathe, given how meaning-free it seems to be), supplements, and the like, using it to maintain syndicated databases on health, wellness, healthy aging, and sustainability. These proprietary databases include a Health & Wellness Trends Database®, Sustainability Consumer Sustainability Trends Database®, Healthy Aging Database™, and Supplements/OTC/Rx Database™.

Be that as it may, assuming that this company relies on the accuracy of its databases in order to sell its services, it is worth looking at what it found. Unfortunately, to get access you have to pay; so it’s back to the article:

Millennials were also the largest growing segment of people to use supplements: In 2013, 68 percent reported that they took some type of supplement in the last 30 days, compared to 50 percent in 2009. The supplement industry is an approximately $32.5 billion business, according to the Nutrition Business Journal.

“Because they’ve been constantly exposed to new, new, new and different, different, different, this generation are early adopters and they are more likely to be accepting of newer ideas and certainly alternative medicines and alternative products,” says Maryellen Molyneaux, president of the Natural Marketing Institute.

New ideas? Not so much. Most “alternative medicine” is based on prescientific vitalism that’s been around decades, if not hundreds of years, or on pseudoscientific ideas that have been variations on a few common themes dating back, again decades, if not hundreds of years. It only appears new because it goes against science-based medicine, and science doesn’t matter for alternative medicine. Homeopathy is a perfect example, and it’s truly depressing that homeopathy use appears to be nearly double among Millennials compared to baby boomers and Gen Xers and that it’s more than doubled among young people since 2009. Of course, when I read this, I wondered what the trend lines in the comparison groups were. Is use of homeopathy increasing among boomers and Gen X at a similar rate as it appears to be doing among Millennials? Or is it fairly stable?

It’s fairly instructive to look at another source, the National Health Interview Survey. We know from that survey that homeopathy use was reported by 3.7% of the population then. Unfortunately, the data were not broken down by age, and the report is a few years old. In any case, if it’s true that 11% of Millennials have used homeopathy, that’s a truly depressing bit of information. After all, health habits and attitudes toward medicine are usually developed and solidified during young adulthood.

There is, of course, the mandatory “tell both sides” segment by the token skeptic. In this case, it was Steve Salzburg. It’s a lonely job, one that I’ve done before, too; so I’m not denigrating what Salzberg said for this article. Rather, I’m once again complaining about the brain dead “tell both sides” narrative, which in this case paints alternative medicine and supplement use as growing in popularity based on a single survey from a marketing group whose profits depend in part on providing data regarding supplement and “complementary and alternative medicine” (CAM) use. Salzberg does what he does quite competently, as usual, pointing out how most CAM has no evidence to support it and is generally placebo medicine, while conceding that some modalities, like yoga, meditation and massage can be “helpful.” He also points out why he opposes teaching pseudoscience in the medical curriculum, as I do.

Unfortunately, the increasing openness to pseudoscience among young adults appears to mean that medical students and younger doctors are also susceptible to quackery and pseudoscience, and that’s a real problem. Here’s why:

Despite such skepticism, however, millennial devotees continue to use alternative medicine to address their overall wellbeing, particularly for prevention, and some medical schools are taking note. Harvard University, Boston University and Duke University are increasingly offering electives in mind and body practices.

Richard Nahin, the lead epidemiologist of the National Center for Complementary and Alternative Medicine (part of the National Institutes for Health), says that training physicians in these practices helps make them more sensitive to their patients’ needs when it comes to alternative therapies.

“Younger physicians are more likely than older physicians to recommend complementary medicine,” he says. “There’s also the gender effect. Female physicians are more likely to recommend and support CAM use than are male physicians.”

Yes, NCCAM is touting how younger doctors are more “open” to alternative medicine. I notice, however, that Nahim posits yet another false dichotomy of which CAM promoters are so fond. In this case, the implied claim is that you can’t be sensitive to their patients’ needs when it comes to alternative therapies without actually embracing those therapies. Let’s just put it this way, you can be sensitive about patients’ desires for pseudoscience without actually embracing that pseudoscience. You might even be able to make them understand why it is pseudoscience and quackery. Of course, that’s not what NCCAM and companies like the Natural Marketing Institute want. They want people to embrace CAM, protestations otherwise (particularly by NCCAM officials) notwithstanding.

One also notes that Harvard University and Duke Universities, at least, offer electives on far more than “mind and body” practices. Duke, for instance, offers lunch conferences on topics including acupuncture and other alternative therapies, various other electives, and an integrative medicine fellowship. offers an integrative medicine fellowship and continuing education courses that teach acupuncture to physicians.

If there’s one thing that I’ve realized, it’s that medical students and residents (and even fellow attendings) know very little about what alternative medicine really claims. I’ve lost track of how many times I’ve explained to medical students and/or residents what homeopathy really is. They’re virtually always astounded when I tell them that its two main principles state that you treat symptoms with compounds that cause the same symptoms in healthy people and that diluting a remedy makes it stronger. They’re particularly astounded when I take them through how a typical 30C homeopathic dilution is the equivalent to a dilution of 1:1060, which is more than 1036-fold greater than Avogadro’s number and means that the chances of a single molecule of the original remedy remaining to be infinitesimal, contamination aside. Before my explanation, nearly all of them think that homeopathy is just herbal medicine.

I hope this survey is just self-serving data from a company that sells such data to natural health companies, but it’s possible it could be correct. If it is, we have a real problem in this country that will only get worse with time.