What is the Harm of Alternative Medicine?

By Darcy Cowan 26/01/2010

Yesterday fellow Sciblogger Grant posted about homeopathic medications in pharmacies and questioned the legitimacy of reputable organisations selling such patent snake oil. The comments to this entry reveal one of the most frustrating aspects of speaking out against unscientific medicine and can be summarised thusly: ’I’m far too sophisticated to be taken in by this stuff myself but other people seem to like it and if it doesn’t work then what’s the harm?’.

This attitude is ever present and comes from a reasonable starting point i.e. everyone is entitled to their own opinion and it’s not my job to save them from themselves. I can totally get behind that, usually. When it comes to ineffective medications of the alternative variety however this impulse though understandable is misguided and I’d like to put down a few reasons why I think so, some are speculative but I think the possibility of harm is great enough that they deserve to be considered.

For a start there may well be direct harm caused by using alternative remedies. As there is little to no regulation of these medications then no proof of safety or efficacy is required for sale. Witness the Zicam debacle last year regarding a ’homeopathic’ cold medication.

Further more the possibility for indirect harm (as multiply alluded to by Grant) may be significant. In case your imagination is not up to the task I will outline a few ways this may be the case. For instance the underlying principles of something like homeopathy are no only unscientific they are in direct contradiction of the last 200 years of scientific understanding. If they are used as the basis of reasoning about health then the results can be more dire than someone getting a bad nights sleep (in the case of the homeopathic sleep aid Grant used as an example).

Use of these therapies for minor ailments by the ’worried and wonky well’ may increase the possibility they they will be used for more serious health issues where the results could be deadly.

Look no further than the position statement of the WHO regarding the use of homeopathy in the treatment of Malaria and AIDs (among other things). The consequences of such thinking could be incalculable in terms of human suffering and spread of disease. But what’s the harm, right?

Additionally it is one thing for adults to make an informed choice for themselves based on available evidence filter through their particular world view but what about when this choice id forced on their children? The recent case of parents being found guilty of manslaughter over giving homeopathic remedies to their sick daughter is a terrible reminder that sometimes it is innocent children that pay the price for people’s gullibility. But, you know, what’s the harm?

When ostensibly professional medical providers such as pharmacists sell demonstrably irrational treatments they lend credibility to them that the average person uses to base decisions on. I mean the wouldn’t sell it if it didn’t work, right?

So while I understand the commitment to individual autonomy and freedom of choice that leads to the ’What’s the Harm?’ question, I fail to see how this means that fraudulent therapies must be let off the hook simply because there is a demand for them.

This has been a more vitriolic post than I normally write but what’s the point of a blog if you can’t vent once in a while?

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Posted in Alternative medicine, Medicine, Questionable Techniques, Sciblogs, Science, skepticism Tagged: alternative, health, Health and Medicine, Homeopathy, Medicine, Practitioners and Clinics, Science and Society, Scientific method

0 Responses to “What is the Harm of Alternative Medicine?”

  • A blogger on Sciblogs (Darcy? Grant? – I give permission for either of you to ask for my email from SCIBLOGMAN) may be interested in what (hopefully) will be turning up in my mailbox. A response to an OIA request to ACC asking them if they fund and or use CAM (Complimentary and Alternative Medicine) in the rehabilitation of their “clients”. And a little more besides.

    It is late arriving but Assoc Minister Wong’s Office has assured me it will be arriving shortly.

    Moderator: If you would like you can send this to either Darcy or Grant and they can contact me direct. Feel free to leave the above off the blog comments.

  • Ross & others wishing to contact bloggers,

    You can contact people through the ‘Contact’ pages, too. It’s near the top of each blogger’s page. This is probably the best way to go about it.

    However, as bloggers are the moderators they can see your email address so Darcy will have Ross’ already. I can’t see it! 🙂

  • Darcy,

    Surely the escalation in use of homoeopathic remedies (to be applied to more serious conditions) would only take place if the patient was happy with the results on lesser ailments – at least for rational patients? (And you probably can’t help the irrational as they base their decisions on something other than effectiveness of the treatment…). As homoeopathic remedies probably don’t work, surely there’s no risk of that? Sounds awfully like you’re saying you respect freedom of choice, unless the chooser picks something you don’t believe in.

    If there is direct harm done by a product, by all means, restrict it or legislate against it – perhaps you could start with alcohol or tobacco if you want to make a real improvement in social outcomes. But you cannot legislate to prevent human stupidity, and to attempt to do so is either arrogance or folly.

    And I hate to tell you this, but pharmacies are merely stores to buy drugs, and have been so for ever. Finding a product on the pharmacy shelf is hardly an endorsement as to it’s effectiveness!

    Disclosure: I am deeply sceptical about homoeopathy, to say the least, and have only used a homoeopathic product once – when “prescribed” by a podiatrist to treat a wart. It had as much effectiveness as all of the other treatments I have tried, natural, herbal, synthetic, alternative, or mainstream – which is to say none at all.

  • Rainman,

    The best of us still suffer from the cognitive biases the human race is prone to, one of which is a poor ability to attribute causation. If we are feeling ill and we take something we think should help and we feel better it is natural for us to think that there is a causal relationship, perhaps, perhaps not. A single instance is not enough to draw a meaningful conclusion but we do it in our personal lives all of the time. I expect medical interventions to have a higher level of evidence than this. There are enough people getting sick and trying all sorts of remedies that it is likely at least a few of them will commit this type of error.

    You agree with me that direct harm should be legislated, but such is the power of the natural medicines zeitgeist that they tend to bypass this sort of scrutiny prior to sale (part of the point of my Zicam example). The Therapeutic Medicines Bill that was to attempt this was roundly criticised for “Restricting freedom of choice”. The tobacco and alcohol examples, while I do agree cause great harm, 1. are not the focus of this post and 2. no-one (any more) claims that they are beneficial to your health (frequent reports about the protective effects of a glass of wine etc. not withstanding. In any case there is no claim that the alcohol itself is the cause of any benefit)

    Pharmacies market themselves as health professionals with your best interests at heart and run by well trained personnel, slogans tend to be of the “Ask your Pharmacist” sort, not “We’ll sell any crap you’re willing to buy”. At least some pharmacist organisations agree with me on that point as evidenced by the National Association of Pharmacy Regulatory Authorities in Canada that released a position statement on this issue that includes the following:

    “Pharmacists are obliged to hold the health and safety of the public or patient as their first and foremost consideration. As such, they must follow very specific standards of practice to fulfill this role. When presented with a product that does not bear a number issued by Health Canada, it leaves the pharmacist and their patient with no confirmation that the product was properly assessed for its safety, efficacy and quality nor granted approval for sale.”

    So I have to disagree with you there. As I suspect would the Pharmacy Council of New Zealand.

    On the suggestion that I’m for “freedom of choice, unless the chooser picks something you don’t believe in. “, well it’s not about belief I’m afraid it’s about evidence. Phrasing it this way turns it into a battle of faith with each side equally valid. Will it is true that I don’t believe homeopathy is effective it is a belief based upon evidence (and not the anecdotal kind).

  • Darcy,

    Yes, we are largely an irrational lot. I’d counsel acceptance – I suspect it would be more than a life’s work to fix that particular foible! (T’would be a better approach than regulation, though). I have a friend who is determinedly anti-conventional – you know the type, falls hook line and sinker for any passing theory (as long as it’s rebellious, I suspect). I once tried to argue against his “you can run your car on water” theory – a complete waste of an hour. I wouldn’t bother arguing a more complex issue like homoeopathy with him, tbh. I just accept him as he is, nutty or no.

    The Zicam issue sounds like a simple failure to regulate – it seems to do direct harm so I’d agree it should go. But it seems to have discernible active ingredients so I’m not sure how it’s the same thing as other homoeopathic substances.

    If I ask my (highly trusted) pharmacist to recommend me something, I doubt he’d offer a homoeopathic remedy; he does have them for sale though, and if I insisted on buying one he’d certainly take my money. I could not comment on other pharmacists, although I’m prepared to believe they would suggest things based on what they genuinely think is best. It’s not about them, though – if you stop homoeopathic preps from being sold in pharmacies, they would just be sold elsewhere. If you want to ban them, you need solid evidence of direct harm – hard to do while maintaining they do nothing. Indirect harm doesn’t cut it – people do stupid and harmful things all the time, to themselves and others. Homoeopathic lolly-water would seem to me to be quite far down the list.

    I don’t contend that both sides in the “battle of faith” are objectively equally valid – merely that objective reality (if such a thing exists) is of less concern to many people’s decisions than you and Grant seem to allow. You certainly have the right to express your views and lobby to have pharmacists only carry proven effective remedies, but in a democracy, so do the other parties. Perhaps over time well-articulated reason will win out and more people will be persuaded of the exclusive virtue of modern medicine, and perhaps homoeopathic goods will go the way of Grant’s mausoleums – but perhaps not in our lifetimes.

  • I’d settle for pharmacies ceasing to sell ineffective remedies, they can go elsewhere and there is no shortage of people willing to sell them.

    Zicam is marketed as homeopathic, the label refers to the method of preparation not the dose. It got a free pass from providing evidence of safety based on this. From the Zicam website:

    “Regarding questions from consumers as to whether Zicam Cold Remedy products are really homeopathic, let me simply state, yes, they are. If you read the packaging on our Cold Remedy products, you’ll see that the active ingredient is a compound called Zinc gluconate. This compound is listed as a drug in the Homeopathic Pharmacopeia of the United States (HPUS) (a compendium of the FDA). To be clear, this ingredient and its concentration in Zicam intranasal Cold Remedy products are in compliance with this reference guide. Zicam intranasal products are labeled, marketed and sold in accordance with the Homeopathic Pharmacopeia of the United States and the Federal Trade Commission. You can read more about the chemistry and pharmacology of Zinc gluconate at http://www.Zicam.com and http://www.Zicamlawsuits.com.”

    That is part of the harm.

    Fine, we have different opinions on this.

  • Hi there, can I just say there are a lot more “alternative” treatments than homeopathy, and I’m sorry to see them all lumped together like this. For instance acupuncture and other traditional Chinese medical practices have been shown to be therapeutic for certain conditions, and while some scepticism is healthy, dismissing anything which doesn’t fit with our conventional medical model seems arrogant.

  • Grace, sorry about the delay approving your comment.

    It is true that the banner of altmed has a large range of therapies under it, I chose homeopathy to focus on as it has been much in the news (and all the examples that I remembered off the top of my head were homeopathy related).

    While we should not be dismissive purely on ideological grounds (which I don’t think I was, and this cuts both ways) neither should we be expected to give therapies a free pass simply because of their background either. “Conventional” modern medicine has to prove itself in being safe and effective, so should alternative therapies. This is a continual process and even practices that were implemented before proper controls were implemented and continued to be used because of conventional wisdom are put under the microscope. Sometimes mainstream medicine does not live up to this ideal but at least the principle exists and encouraged.

  • Hi Grace
    Can I just add (later as ever, sorry Darcy!) that the list of ailments for which acupuncture is therapeutic is extremely small (see my own recent post on this issue) & the same is true for other TCM practices. For most things they perform no better than (a rather expensive) placebo, & in some instances there is the potential for harm, especially treatment/advice mask some underlying condition.