Spinal cord injury or disease often presents their sufferers with difficult physical challenges as well as existential challenges that go to the very core of their being. If you add to this mixture of physical and spiritual challenge the promise of a new cure, or at least significant symptomatic relief for the injured person, you can begin to understand the appeal of complimentary and alternative medicine (CAM) over conventional medicine. The appeal of CAM is all the more powerful when conventional medical therapies have not provided the patient with a cure, restoration of normal function, or even symptomatic relief. This article examines the issue of whether or not the hope that CAM provides to individuals is well placed. My view is that the therapies generally falling under the rubric of CAM are not efficacious and in some instances may be harmful. Nonetheless, there are a number of lessons that medical professionals and the public they serve can and should learn from the phenomena of CAM, lessons that may do much to improve our understanding of the effectiveness and ends of conventional medicine.

complementary and alternative medicine (CAM), conventional allopathic medicine, spinal cord disease, spinal cord injury, randomized clinical trials
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This scenario and the reaction I describe here are not peculiar to me. I have been active in the paralyzed veterans community (at one time having played wheelchair basketball on a Paralyzed Veterans Association sponsored team) and I know many paralyzed individuals face this exact situation time and again.
My point here is not meant to impugn conventional medical practice as mere guesswork. There is a great deal of scientific data backing up conventional medical therapies, and physician’s “hunches” are heavily influenced by that data and their experiences. Nonetheless, medical science is not an exact science (what applied science is?) and both physicians and especially patients should recognize that fact.
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Potential adverse drug interactions or other adverse outcomes from different treatment protocols by different practitioners present a growing danger to patients in these dual settings.
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The school of philosophy known as the logical positivists, with A.J. Ayer as its most wellknown English-speaking proponent, held the view that a proposition had to be empirically verifiable to have any meaning. See Ayer’s Language, Truth and Logic. New York: Dover; 1952. Karl Popper, although not exactly of the same school of thought as the positivists, sought to demarcate science from pseudoscience using the criterion of empirically falsi fiable. Only genuine scientific theories were falsifiable; pseudo-theories were not. See Popper’s Conjectures and Refutations. New York: Harper and Row; 1968.
The Flexner Report of 1910, which argued for a more research-based approach to medicine, was instrumental in effecting this change.
The earlier quotation from Marcia Angell represents an acceptance of this unified approach to science and medicine.
For a short but more detail overview of this history of the connection between positivism and medical science, see Tauber AI. The quest for holism in medicine. In: Callahan D, ed. The Role of Complementary and Alternative Medicine: Accommodating Pluralism. Washington, DC: Georgetown University Press; 2002:179–184.
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Clearly I have greatly simplified Kuhn’s argument here, and there are others who contributed to this new conception of science and scientific inquiry. Paul Feyerabend, who argued that no rules should govern science, particularly comes to mind.
Witness the funding appeals of so many organizations seeking donations to study various diseases. They ask the public to send money so that society can defeat or cure spinal cord injury, heart disease, cystic fibrosis, cancer, lung disease, muscular dystrophy, etc.
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And yet, there are physicians (even those working in a managed care setting) who do find the time and energy to interact with their patients in meaningful and positive ways—so the task is not impossible.
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