How popular is quackery? A Harris Poll answers: Very, particularly among Millennials!

One of the central messages that apologists for the use of alternative medicine and, particularly the integration of the unscientific and mystical treatment modalities of alternative medicine with real medicine—a phenomenon known as “complementary and alternative medicine” (CAM) or, more recently, “integrative medicine”—is that it’s popular. Oh. So. Popular. If you believe the promoters of these modalities, CAM modalities are used by almost everyone and loved by nearly as many people. I exaggerate, but only a little. It’s basically an appeal to popularity, one of the ultimate logical fallacies. Whenever I hear such an argument, I like to cite Bertrand Russell’s famous admonition, “The fact that an opinion has been widely held is no evidence whatever that it is not utterly absurd: indeed in view of the silliness of the majority of mankind, a widespread belief is more likely to be foolish than sensible.”

Unfortunately, if a Harris Poll I just heard about yesterday from a press release for it that showed up in PR Newswire thusly, Health and Healing in America: Majorities See Alternative Therapies as Safe and Effective: Younger generations more readily embrace alternative treatments than their older counterparts, accurately reflects public opinion, then Russell’s quip is correct about Americans’ attitudes towards alternative medicine. A lot of really dumb ideas about medicine are widely held beliefs. (Here are the actual Harris Poll and the full 125 page report of the results.)

Let’s start with the summary in the press release:

For many, the term “healthcare” likely leads to visions of doctors and prescriptions, but for some it can mean so much more. Alternative treatments – also known as non-conventional or naturopathic therapies, which include things like chiropractic care, massage therapy, and herbal remedies – are used in place of or in addition to conventional therapies. Overall, younger people are more willing to embrace these alternative therapies and to use them more widely. In fact, one in four Millennials (25%) are using alternative therapies more than conventional options, compared to just 5% of Matures.

However, regardless of age, Americans are keeping an open mind when it comes to less conventional options. Two in three Americans view alternative therapies as safe (69%) and effective (63%), and half think they are reliable (50%). Even more strikingly, majorities think some alternative treatments, like chiropractic and massage therapy, should be covered by insurance – more than actually have used them. These findings appear to suggest an expanded consciousness on what health and healing mean to Americans – not just prescription medicine and doctors, but also having greater access to techniques that have been used for centuries to make people better.

“Though alternative treatments often predate modern medicine, consumer interest in these treatments today is bolstered by two important consumer trends: finding affordable care in a high deductible world, and seeking natural approaches to pain and disease management,” adds Jennifer Colamonico, Vice President of Nielsen Healthcare. “As these trends are likely to continue for some time, we anticipate more consumers will consider and try alternative treatments as well as other types of self-care to achieve health and wellness goals.”

One in four Millennials is using alternative therapies more than conventional options? I couldn’t help but think while reading that that it must be nice to be young. After all, younger people are far less likely to have chronic health conditions that require real medicine to prevent death or severe disability. If diet and exercise fail, good luck treating that hypertension and diabetes with woo instead of metformin and lisinopril! In any case, I wondered whether this answer was just a function of age, given how few Matures (I hate that term, by the way, which refers to people 70 years of age and older) use more alternative medicine than real medicine. I bet there’s definitely an element of this, particularly given that the poll also found that higher percentages of people without health insurance use more alternative medicine and young people are more likely not to have health insurance—confounders, anyone?—but there’s no older poll with the same methodology to compare to see if this number has changed.

Of course, when examining these polls, it’s very important to pay close attention to what is considered to be “alternative” medicine, particularly when there is a sky high estimate of what percentage of people have used alternative medicine before. So I dove into the full report to find out, and below are the specific therapies I found mentioned (percent reporting use in parentheses). This poll, as has been the case for most polls on alternative medicine use, includes modalities designed to inflate the numbers. In this report, for example, Harris surveyed 2,252 U.S. adults online between December 9 and 14, 2015, and found that 71% of Americans have used some kind of alternative therapy before:

  • Herbs/herbal medicines/vitamins (37%)
  • Chiropractic (34%)
  • Massage therapy/acupressure (29%)
  • Aromatherapy/essential oils (22%)
  • Meditation (20%)
  • Acupuncture (11%)
  • Electrotherapy (9%)
  • Reflexology(5%)
  • Hypnotherapy (4%)
  • Reiki/energy medicine (3%)
  • Cupping (3%)
  • Other (3%)

I found it rather odd that Harris left out two big ones in the world of alternative medicine, homeopathy and naturopathy. That surprised me, given how ubiquitous naturopathy seems to be and how homeopathy is an integral part of it. What didn’t surprise me is how the numbers are inflated with people who have used vitamins and herbal medicines (by that standard, I would probably be forced to say that I’ve used alternative medicine before in my life, at least based on the way the question is phrased), meditation, chiropractic, and massage therapy. The true woo, like reiki, cupping, and reflexology, are all in the low single digit percentages. Electrotherapy, of course, is nothing more than transcutaneous electrical nerve stimulation (TENS), which isn’t really “alternative” at all, as I keep trying to remind people. On the other hand, this is the first time I’ve ever seen a poll where the percentage of people who have ever used acupuncture reached double digits, even just barely.

In actuality, this poll isn’t too far out of line with other polls that I’ve examined; the main difference between this on and many others that provide inflated numbers of people using alternative medicine is that this one doesn’t lump religion and spirituality in with alternative medicine. It does, however, suggest increases in the use of alternative medicine How valid the increases are, given the differences in methodology between polls, is not clear. For example, the percentage of people who’ve used chiropractic in this survey is higher than the previously reported percentage in the 2007 National Health Interview Survey (NHIS) Complementary and Alternative Medicine supplement, where chiropractic and osteopathic manipulation was used by 22%. On the other hand, the NHIS reported 1.7% of respondents using energy medicine; this Harris Poll, 3%. Both are still low single digits, and with such low percentages, it’s hard to tell how comparable these numbers are, but both still report very low numbers.

A particularly annoying aspect of this poll is that it doesn’t really define what is “alternative medicine” other than the modalities above and that it isn’t “Western” and “conventional” medicine. That is, of course, the false dichotomy that has been driving me crazy for at least a decade. First of all, it’s a racist construct. There’s nothing inherently “Western” about scientific, conventional medicine any more than there is anything “Eastern” about woo. After all, The One Quackery To Rule Them All (homeopathy) was concocted by a German. It’s “Western” medicine. Actually, it’s “Western” medicine that’s just as much woo as the “Eastern” medicine that is acupuncture is. Given its questions and how it fails to define alternative medicine adequately even for purposes of the poll, I can’t help but think there was serious bias in the construction of this poll’s questions.

That being said, as sloppy and obvious a bit of pro-alternative medicine propaganda as this Harris Poll is, I still can’t help but be troubled by its results, for a number of reasons. First, I really do think that it probably does reflect a change in attitude towards alternative medicine, particularly among the young. This result is quite plausible and would make sense if true. After all, most Millennials were either children or not yet born when alternative medicine was being transformed by advocates from quackery to CAM in the 1990s and moving from disreputable storefronts to being studied in highly respected academic medical centers who fell prey to the lure of quackademic medicine. Decades of “respectable” centers of quackademia relentlessly promoting the message that some alternative medicine “works” and advocating the “integration” of quackery with science-based medicine as an unabashed good, aided and abetted by the media regurgitating the same message because it comes from what are considered reliable and respectable sources, couldn’t help but have an effect on Millennials, who grew up never knowing anything different.

I often like to refer to a 1983 New England Journal of Medicine editorial that referred to much of “holistic medicine” (remember, this was before the terms “CAM” and “integrative medicine” had been coined) quite rightly as quackery. That’s ancient history, unfortunately. For the entire living memory of the Millennial generation, alternative medicine has not been widely referred to as quackery but rather in terms of weasel words designed to imply that “integrating” alternative medicine with real medicine is the “best of both worlds.” Why shouldn’t they accept alternative medicine as effective and reliable? That’s what they’ve been told their whole lives!

The result is this:

Majorities believe chiropractic (67%) and massage therapy (53%) should be covered by insurance. Nearly half say the same of acupuncture (48%), including about six in ten Matures (61%).

For the rest of the alternative therapies presented, less than one third think each should be covered by insurance:

  • Herbs/herbal medicines (30%)
  • Electrotherapy (23%)
  • Hypnotherapy (19%)
  • Reflexology (16%)
  • Meditation (15%)
  • Aromatherapy (13%)
  • Cupping (11%)
  • Reiki (9%)

I’m sure insurance companies would be overjoyed to pay for the glorified faith healing that is reiki substitutes Eastern mysticism for Christian beliefs and posits such obviously ridiculous ideas like healing over a distance. Then there’s reflexology, which posits nonexistent links between locations on the palms and soles and various organs in the body. It’s basically the idea that giving a good foot massage can cure disease.

Finally, this Harris Poll looks at the politics of alternative medicine:

In this political season, it is interesting to note that Independents are more likely to use alternative therapies as often as conventional therapies (23% vs. 13% Republican), and are specifically more likely than their Republican counterparts to use things like meditation (24% vs. 13% Republicans), massage therapy (34% vs. 26% Republicans) and herbal medicines (41% vs. 33% Republicans).

To be honest, when I read this but before I looked at the full report, I couldn’t help but wonder why Democrats weren’t mentioned. I checked and found that, most likely, it’s because there appears to be no difference between Democrats and Republicans in terms of their attitudes towards alternative medicine or between liberals and conservatives. Indeed, Republicans reported slightly more use of alternative medicine than Democrats, while liberals reported slightly more use than conservatives. I’m guessing that neither were statistically significant differences, given that they weren’t mentioned in the summary.

One aspect of this poll that caught my attention is only visible if one dives into the actual full report. I’m referring to one of the later questions, in which respondents were asked to state how much they agree or disagree with certain statements. One finding that I have a hard time disagreeing with is the finding that 86% of respondents think that alternative treatments should be FDA-evaluated for safety and efficacy in a similar manner to conventional “Western” treatments. OK, it irritated the crap out of me that the poll used the term “Western treatments, as that particular term is pretty damned racist. After all, there is no “Western medicine” or “Eastern medicine” with respect to science-based medicine. There is medicine that has been shown to be safe and effective by science; there is medicine that has not been shown to be safe and effective, and there is medicine that has been shown not to be safe and effective. Guess which two categories alternative medicine falls into? Hint: It’s not the category of treatments that have been shown to be safe and effective by science.

As I contemplated the results of this survey, I had a hart time not being depressed and disturbed. After all, the poll showed that a large percentage of Americans have a disturbingly credulous attitude towards alternative medicine. Worse, this poll actually echoes the findings of a previous report pointing out Millennials’ proclivities towards alternative medicine. Worse, there was definitely a correlation between education and alternative medicine use, with people with postgraduate training reporting significantly more use of alternative medicine than those with a high school education or less.

As sloppy and disturbing as it is, this poll represents a snapshot, a single point in time. It doesn’t really tell us whether use of alternative medicine is increasing or decreasing. However, what is disturbing about its results is the high level of “openness” to alternative medicine respondents expressed, particularly Millennials. If this poll is an accurate representation of the American public’s beliefs with respect to alternative medicine, those of us who have dedicated our blogging to promoting and teaching critical thinking have a more difficult task ahead of us than we thought, because we’re getting older and the most avid believers in woo are the youngest generation who will replace us.