Alternative therapies do more harm than good
This post is dedicated to the memory of baby Gloria Thomas, who died in May 2002 and whose mother and homeopath father are standing trial in Australia for manslaughter by gross criminal negligence because they failed to get professional help for their child in spite of her “bleeding, crying and malnutrition”.
“In the last months of her life, baby Gloria Thomas suffered such terrible eczema her skin would weep and peel, sticking to her clothing when she was changed. Despite her bleeding, crying and malnutrition, her mother and homeopath father failed to get conventional medical help before she died a painful death, a Sydney jury has been told.”
In a more recent report we learn that her father “has admitted he failed his baby daughter by continuing to treat her chronic eczema with alternative instead of conventional medicine”.
It’s the worst case scenario and it happened: the death of a baby too young to choose for herself whether to be treated with the evidence-based medicine that could save her or useless cult therapies that would let her die slowly and painfully. Incredibly, her own parents were responsible in this instance, so abiding was their faith in their particular brand of witchcraft. But there are many more cases of tragic, preventable deaths and injuries because people who are old enough to know better trust the nonsense promoted by homeopaths and other quacks. If you can stomach reading any more accounts, try this one and this one and there are plenty more here.
Delayed or misdiagnosis are two of the dangers of alternative therapies cited by leading oncologist Michael Baum, Professor Emeritus of Surgery and visiting Professor of Medical Humanities at University College London, at a debate organised by the King’s College London Social Medicine Society last week.
The motion ‘this house believes that complementary and alternative therapies do more harm than good’ was proposed by Baum and seconded by Simon Singh co-author (with Edzard Ernst) of the excellent Trick or Treatment: alternative medicine on trial and opposed by Professor George Lewith, Professor of Health Research in the Complementary and Integrated Medicine Research Unit at the University of Southampton and Professor David Peters, Clinical Director, School of Integrated Health at the University of Westminster.
It is hard to imagine more thoughtful and persuasive presentations than those given by the proposers of this motion and I wish I’d gone armed with secret recording equipment so that what was for me quite an illuminating experience could have been preserved for posterity. The proposers had too short an allotted time into which to cram too much reason and intelligence, in stark contrast to their opponents who managed to make their equally brief time slots feel like an eternity.
Both the excellent speakers acknowledge that there is a potential role for therapies that made people feel better while receiving evidence-based treatment for life threatening diseases. Baum, a breast cancer specialist, has a personal passion for art therapy. It’s the therapies that are used instead of evidence-based medicine that do more harm than good, they argued.
Most alternative therapists are not equipped to diagnose serious conditions and the main danger is getting it as wrong as Gloria Thomas’ father and the other therapists in the stories I link to above. But there are other ways in which they harm us, argued Professor Baum and these include the unnecessary medicalisation of normal ups and downs in how we feel and the “infantilisation” of patients.
Like the pharmaceutical companies, alternative therapists are disease mongers. They medicalise non-medical problems by giving them labels and prescribing ‘remedies’ that are in fact placebos if they are anything at all. That the pharmaceutical companies should do this is no surprise — they want, above all else, to maximise profits. So do alternative therapists, of course, but instead of being open about it they prefer to talk of “empowering” patients to take control of their health. Empowerment means choosing useless alternative therapies that help alternative therapists line their pockets, apparently.
Ironically, what alternative therapists do is not empower people but infantilise them. A parent consoles a child who’s had a bump or a scrape by kissing it better. All over the web we see examples of the alternative therapist equivalent of ‘kissing it better’. I guess that’s what Gloria’s father did.
Alternative medicine is defined as medicine that doesn’t work, said Professor Baum. Simon Singh added that the remedies are biologically implausible. They can’t work. As an example he mentioned reflexology. Having your feet massaged might feel nice but there are no ‘reflex pathways’ connecting the sole of the foot to various organs of the body. “Of course there are!” shouted an angry reflexologist in the audience, while her fellow quacks — of whom there were many — sent her lots of positive energy vibes.
Singh also gave examples of therapies where any perceived benefits are clearly outweighed by risks. One of these is acupuncture which, it is claimed, can help everything from anorexia to hypothermia to quitting smoking to strokes. There are several Cochrane reviews of acupuncture trials and they suggest that there is no significant evidence to show that acupuncture is an effective treatment for these or any of a host of other conditions. Yes, there is some very limited and sketchy evidence that acupuncture may help with some kinds of pain and nausea (and there is also evidence to the contrary) but there are also risks and they are not all as minor as the transient bleeding and bruising that occur in ten per cent of patients or even the fainting, dizziness, nausea and vomiting occurring in a smaller number. As he wrote in Trick or Treatment (p. 183), there is a danger that acupuncture needles can puncture and damage a major nerve or organ. There are over sixty reported cases of punctured lungs, thanks to acupuncturists.
It was amusing to hear from the quack-packed audience snorts of derisive laughter at the mention of ear candling. I hadn’t realised there were therapies that even CAM therapists think are nutty. Singh chose it as an example of a practice that has no benefit whatsoever but which poses a number of dangers including being burnt by hot wax. If there were any ear candlers in the audience, they were evidently too intimidated to defend themselves to the condescending homeopaths and aromatherapists.
As I have to rely on memory and a few scribbled notes, I’m not pretending this is a comprehensive review of the debate. I can only report on what I remember and, of the contributions from the speakers opposing the motion, I remember very little except that they mostly avoided dealing with the substantive points made by the proposers. George Lewith started with the usual quack tactic of focussing on some of the problems of conventional medicine. (If I’ve said it once, I’ve said it a hundred times: pointing out problems with conventional medicine is a red herring. It doesn’t prove that alternative medicine is effective, useful, harmless or anything else.) He also scoffed at Singh’s assertion that it can’t work, came up with the same old stuff about how randomised controlled trials aren’t particularly useful when it comes to testing alternative therapies because they are ‘individualised’.
One thing one of the proposers did say that bears repeating is that patients who use complementary therapies are frequently too intimidated to tell their (proper) doctors that they do so. If they do pluck up the courage, the therapies are often dismissed by the doctors. This in turn affects the morale of the patient and their confidence in their doctor and they end up abandoning the conventional treatment rather than the alternative therapy.
I think he’s right. When a friend of mine consulted his GP after developing osteoarthritis in one hand, he came away disillusioned at her negative response to his enquiry about whether taking fish oils might help. “She said there wasn’t any point,” he told me. “She’s probably right,” I said. “But she could have at least said it was worth a try,” he countered, angrily.
There’s a moral there somewhere about remembering that human beings aren’t always rational. There are many who want to be lied to, who want to be given false hope, and who want placebos. This, I think, lies at the heart of the disagreement between the quackers and the anti-quacks. Do we want to move backwards and have our doctors lying through their teeth to us whenever they perceive it is in our best interests to do so? I don’t.
One young woman in the audience at the debate evidently disagreed. Furious at the reduction of homeopathic services provided by her local Primary Care Trust, she complained that her fundamental human right to choose useless remedies and for these to be funded by the taxpayer was being denied. Laying the blame squarely at Michael Baum’s feet (because of a letter he co-authored to NHS Trusts a few years ago), she whined and harangued at the top of her voice, repeatedly interrupting the speakers, until the Chair threatened to have her ejected. In his response to her, Baum pointed out that funding homeopathy when there was a budget shortfall for evidence-based treatment for breast cancer was unacceptable. “You can buy your homeopathy if you want but you can’t have it at the expense of other women’s lives,” he said. “I haven’t chosen Tamoxifen,” the young woman screeched in response. Somehow, I don’t think she’d ever had breast cancer. If she had, and had relied on homeopathy, she’d be dead, obviously.
Lewith triumphantly pointed out that homeopathic services and cancer treatments were funded from a different budgets. He seemed to think this undermined Baum’s point. So did most of the audience judging by the applause. I’m not sure whether they don’t realise that the NHS is publicly funded or are simply too stupid to work out that if public money isn’t squandered on useless therapies, it can be spent on useful ones.
The debate wasn’t chaired well and several quacks abused what was supposed to be an opportunity to ask questions of the panel in order to make long, tedious speeches of their own. A young acupuncturist told a long story of how she helped someone by using acupuncture. Simon Singh responded charmingly, “OK, you’ve convinced me. I’m changing sides,” he said. As she — like most there — had clearly failed to understand his arguments, I doubt if she realised he was joking.
I’ve always had doubts about the usefulness of debates in closed rooms (without cameras for the benefit of a wider audience) because they are so often filled with people who are staunchly for one side or the other and there isn’t a chance in hell that they are going to change their minds as a result of what they hear. So I was pleasantly surprised to see that apparently a few minds were changed during this debate and changed in our favour. At the start of the debate there were 27 of us for the motion and 116 against. At the final count, the number for had increased to 36. The number against had decreased to 109. (The only people I saw entering the room after the first vote were three ladies who made it clear they were opposed to the motion. I saw nobody leave.)
Listening to some of the angry tirades by quacks in the audience, I was reminded of comments made by a couple of quacks in response to my previous post. “So much hate, Skepticat,” lamented one, without irony. “Perhaps you should take an anger management course,” opined another. Actually I did and they suggested I try blogging, which I’m finding quite therapeutic.
But, strangely enough, stories about babies suffering in agony and dying needlessly because of people like them and the nonsense they are promoting still make me angry.