Alternative medicines and therapies are not only costly and largely ineffective, they may harm the individuals who use them and, indirectly, harm the institutions that promote and teach these very dubious therapies.
I’m particularly concerned that some of the smaller universities – around 17 of them – are giving degree courses in “quackery”. They’re giving the imprimatur of the university to non-evidence based medicine and non evidence-based courses.
Chiropractic is one of them but homeopathy, iridology, naturopathy and various non evidence-based medicines are being taught at universities, and degrees are being given for these courses.
This undermines the credibility of the universities, particularly if there are true scientists in these universities trying to get funding for their science and trying to say their science is credible.
The best source to find whether something is efficacious or not, or safe or not, is to go to the Cochrane Reviews. These are independent, peer reviews.
If you look up the basis of commonly used alternative medicines such as Gingko biloba or Valerian, you’ll see that the Cochrane Reviews do not show efficacy.
When alternative medicine people say, “we have evidence”, they usually can’t show the evidence or they refer to highly selected, poor quality trials as their evidence. They ignore the Cochrane systematic reviews of the evidence.
Most alternative medicines and therapies – whether it’s chiropractic or acupuncture – do no better than a properly controlled placebo group. So a lot of these therapies are placebos.
And why shouldn’t people with a chronic illness be left to to use a placebo? Because here are four potential harms to these so-called “harmless therapies”.
1) They are a terrible waste of the health dollar.
Alternative medicine industry (the medicines alone) is a $4 billion a year industry in Australia, and there is probably the same again spent on therapies, such as acupuncture and chiropractic. This is a huge waste of the health dollar.
When the health system needs so much money for proven medicine, it seems silly to waste it on the unproven.
I’m the very first to say that there are also unproven medicines used in conventional medicine, and all the time conventional medicine is trying to root out its unproven therapies and get rid of the things that do more harm than good.
Conventional medicine is not immune to this but there is a better reputation in conventional medicine for trying to minimise the problems and test the value of these therapies.
2) Side effects and drug interactions, which are hugely under reported.
There’s no great obligation to report side effects from alternative medicines. Most patients don’t tell their doctor that they’re on alternative medicines. The patients don’t think their side effects could be caused by the “natural” therapies they’re taking and the doctors don’t know they’re taking it.
3) The depression, disappointment and disillusionment that comes from going to the health food shop shelf, buying one medicine after the other that’s recommended by an unqualified person behind the counter. For example, to relieve the symptoms of premenstrual syndrome or menopause.
But the placebo effect soon wears off and they have to move onto another expensive product and another expensive product. This makes the consumer more and more disillusioned and they question whether they should they believe any health professional.
4) This is the most harmful: the delay of effective therapy.
If you take a herb for your appendicitis you could easily have the appendix rupture and have a much worse situation than if you had sought early appropriate treatment in the first place.
If you are using an inappropriate supplement for your osteoporosis you will lose 1% to 2% of your bone each year and become more and more osteoporotic. When you eventually find that the supplement was not effective and you could have been on something better, it’s too late to restore your bone.
So there are many risks to these therapies. Universities need to look hard at themselves and stop trying to make money out of courses that are lowering their reputation and credibility. They should not be endorsing courses of quackery.
Finally, as an obstetrician I am concerned that pregnant mothers and babies are targeted by chiropractors and naturopaths.
The use of alternative medicines on children is a form of child abuse albeit well-intentioned. But it’s a form of child abuse and it shouldn’t be encouraged by alternative practitioners who try to make money out of gullible parents.
The four harms of the harmless therapies should be remembered.
9 Comments
Jon Wardle
NHMRC Research Scholar, School of Population Health at University of Queensland
Prof MacLennan makes some valid points. Opportunity costs of ineffective or inappropriately prescribed CAM are raised by CAM practitioners as well. But his absolutist arguments help no-one, least of all the patient. Some CAM is quackery, some is very useful. One should expect someone in the position of Prof MacLennan to be aware of some of the useful CAM that are out there - particularly in his field of Obstetrics and Gynaecology.
The important thing is to ensure that there are mechanisms to help identify which is which. Regulation is one aspect - the generally unregulated nature of CAM does attract cowboys that make unfounded claims and sometimes pose risk to patients, largely because there aren't any ways to legally hold them to account. But they are by no means representative, and blanket statements like these have very little evidence of their own.
Monika Merkes
Honorary Associate, Australian Institute for Primary Care & Ageing at La Trobe University
To add to the previous comment, here is an example where mainstream medicine seems to be oblivious to the evidence: Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed type of antidepressant medicines, yet there is evidence that, compared with placebo, they do produce clinically significant improvements only in the most severely depressed patients. See for example here: http://dx.doi.org/10.1371%2Fjournal.pmed.0050045. Even a Cochrane review concedes that ‘the effects of antidepressants may generally be overestimated and their placebo effects may be underestimated’ http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD003012/frame.html.
SSRIs, expensive placebos with unpleasant to fatal side effects? Conventional medicine could learn from 'alternative' medicine (I prefer the term 'complementary') and harness the therapeutic effects of placebos.
Rey Tiquia
Dr. at University of Melbourne
Trials, not tribulations
The best way to protect the consumer and the public from spurious and deceptive claims of therapeutic efficacy by advocates of complementary and alternative medicine (CAM) is to establish sound methodological investigation to clinically evaluate these claims.
This was in fact, one of the major recommendations of a study commissioned by Victorian, New South Wales and Queensland departments of health in 1996.
The purpose of this recommendations was to encourage national funding bodies such as the National Health and Medical Research Council to "allocate funding for sound methodological investigation of the clinical efficacy of Chinese herbal medicines and acupuncture."This recommendation has not been carried out.
The recommendation would have established an appropriate clinical trial protocol to evaluate the efficacy of these medicines or devices.
Andrew Kinsella
General Practitioner.
logged in via email @gmail.com
As a general practitioner I used to hold this view about all complementary therapies.
However 18 months ago a complementary practitioner identified my subluxed atlas showed me the clinical signs of it so that bothmy GP wife and myself could physically identify them and then corrected it with a single treatment.
The effects of this treatment were far reaching, improving not only my neck and back pain but also my irritable bowel syndrome, my migraines and resolving my ADHD.
When I was well enough…
show full commenttiml
logged in via Twitter
Let me start by saying I agree with the overall argument made in this article, and I think it's an issue which should get more exposure.
After a friend disagreed with some of the premises in the article, I had a look around the Cochrane review to see what it said about acupuncture. The article suggests that there is nothing to be gained from it, and does not distinguish between it and, say, homeopathy (which I think we can all agree is a load of baloney).
The review appears to show mixed results…
show full commentLauren Trevorrow
Ms.
logged in via email @gmail.com
I remember reading a Cochrane review of person-centred care (a type of care for people living with dementia). Person-centred care is a vague ill-defined term, but it basically means that when you care for a person with dementia, you should make an effort to get to know them and who they are as a person, because that will lead to better care.
Anyway, the Cochrane review said there was no evidence that this was an effective treatment for dementia.
So I don't agree that Cochrane is always the best source of what is efficacious.
Terry Hilsberg
Mr
logged in via email @gmail.com
The problem with this article is that most, if not all of the criticisms of alternative medicine, could also be applied to conventional medicine, most of which is not evidence based. It was not a homeopath who bled George Washington to death, but rather a conventional medical practitioner. As set out in a recent Atlantic Monthly article "Lies, Damned Lies, and Medical Science", the percentage of evidence based practice is increasing, but is probably still a minority. (http://www.theatlantic.com/magazine/archive/2010/11/lies-damned-lies-and-medical-science/8269/).
Stephen Lehocz
Mr
logged in via email @bigpond.net.au
Thank you, I will try this Ginko biloba, - then the effectiveness of this product for my health and quality of life will be decided by the only important person, ME.
Michael J. Biercuk
Senior Lecturer in the School of Physics at University of Sydney
Thank you for this article. It's frightening to me that Universities are now giving degrees in this nonsense. Alternative medicine at large is modern-day snake oil. Moreover, people seem unable to acknowledge that alternative medical treatments using herbs and the like are really just drug therapy. Drug therapy with no evidence, safety measures, or regulation behind it.
But to pick up on comments of some earlier posters, I wonder how much harm traditional medicine is doing to itself via tolerance…
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