And now for something completely alternative: Medicine...
If you are reading this on an ipad, ipad mini, iphone, imac, power mac or even a Newton message pad, then you have one man to thank and an indirect interest in alternative medicine. Because that man will tragically not invent more magical devices for your technological delight due to his misplaced belief in a fruit diet and hydrotherapy as a treatment for pancreatic cancer. The medical literature courteously refers to treatments such as these as ‘complementary and alternative medicines (CAM)’. Although there is no agreed definition, complimentary medicines are generally usually used along side traditional medical therapies and alternative medicines are used as definitive treatments in place of trialled medicines. But for many medical doctors, ‘alternative medicine’ is analogous to ‘alternative comedy’; it provides a distraction from main stream treatments (in the manner of say, John Bishop) and it is often inflammatory or even dangerous (like Frankie Boyle).
To Dawkensian sceptics and evidence based medicine evangelists the distinction is even clearer. Alternative medicine is quackery without any clinical evidence to support its use. Spend some time perusing the social networks, and it is increasingly obvious that an ethical and moral battle is being waged for your opinion on alternative therapies. But at the moment there the market statistics suggest there is only one winner. It is estimated that three quarters of the world’s population rely on herbal and traditional medicines as a basis for their primary health care, and this global market is valued at $60 billion/year. And don’t be fooled, we are not just talking about China and some worried looking tigers. 69% of Americans use some form of complementary and/or alternative medicine every year, and in the USA there are 50% more visits per year to CAM practitioners than to traditional medicine practitioners. So, can 5.3 billion people be wrong? Well, yes. Yes they can.
The reasons for the domination of this massive alternative medicines market are multiple. Firstly, the traditional medical profession has done itself no favours. Historically, its treatments were horrific. For example, during the "Age of Heroic Medicine" (1780–1850), physicians aggressively practiced such barbarous acts as bloodletting, intestinal purging, vomiting, profuse sweating and blistering which were all interventions guaranteed to make a bad situation worse. Modern medicine is hardly safe, and you have an approximately 1 in 10 chance of having a major adverse incident if you are admitted to hospital. And this is only if you are lucky enough to get into a hospital. There is the significant problem of health inequality and limited global access to basic 'traditional' healthcare (the Americans fought hard to reject Obamacare which will dramatically redress this issue in the most developed country on the planet) and it is associated with spiralling costs that are too much for most.
It is therefore no wonder that cheap, holistic, allegedly safe, painless approaches that promise a miracle cure are big business. Secondly, ‘big pharma’ has on occasion been economical with the truth, fuelling conspiracy theories and dangerous and incorrect assumptions about vaccines and other potentially life saving drugs. Jenny McCarthy may be hotter than Andrew Wakefield, but her campaign against vaccination is likely to have done inevitable and significant harm to innocent children. To prove this point, GSK, were recently fined a record sum of $3 billion for failing to declare safety information to the FDA about 10 of its drugs. Thirdly, the placebo effect is more powerful than Darth Vader with a death star. It has the capacity to dislodge reason and dispel logic from the brightest human being (even Steve Jobs) and this principle has been abused throughout history by charlatans and quacks.
In 1785 Benjamin Franklin investigated and disproved Mesmer's theory of animal magnetism through his knowledge of the placebo effect. Mesmer believed that every individual had magnetic fluid flowing through channels throughout his body, and that blockages in the flow of this fluid caused emotional or physical disease. Franklin showed that the subjects' imagination was the most important factor in explaining the bizarre effects and miraculous cures. Fourthly, the internet has provided the perfect soap box for any quack and poison pusher. Dr. Google provides a massive and totally indecipherable volume of permanently evolving information on all medical treatments to anyone without a medical degree. The job of a modern doctor is therefore increasingly becoming about knowledge management, data interpretation and patient advice and education because making sense of the evidence for traditional therapies is so hard. Moreover, less than 60% of the world’s children go to secondary school and even less use the internet. And where education fails superstition and fear fills the void, and when you have nothing but fear you will try anything for a cure even when that means gobbling on a rodent penis; a practice that pre-dates Mr. Andre and his celebrity jungle dwelling chums. Thus many alternative medicines also come with a devastating environmental cost. It is claimed that 13% of Traditional Chinese medicine contain animal tissues, such as tiger bones, antelope, buffalo or rhino horns, deer antlers, testicles and penis of the dog or bear and even snake bile. Finally, science is becoming more complex, not less.
Since the mapping of the human genome and the associated growth in bioinformatics the significant inter-individual variation in human biology is becoming much clearer. All drugs are poisons if you take enough of them, and so understanding how a drug works in an individual is important. But what works in me, may not work in you and more personalised, safer medical treatments are needed.
However, despite its faults the medical profession is regulated and its treatments may only be used (however flawed the process) once they have been subjected to the process of peer review and open clinical trials. It is these fundamental principles that separate ‘traditional’ medicine from quackery. And lets be clear, we don’t mean anecdotal evidence, of the sort that goes ‘it worked in me so it must be good’. This is not evidence, but merely coincidence and it is separate from prospective, randomised double blinded control trials. The worst part of alternative treatments is that they often prey on the vulnerable and the desperate. It is one thing to have a cold and try an over the counter herbal remedy endorsed by Gethin Jenkins, but it is a different matter when you have to sell your home to fund an alternative treatment for a terminal disease. This point has recently been illustrated by the case of the Burzynski clinic, which is operated in Texas by Dr. Stanislaw Burzynski. He sells very expensive treatments to patients who often have terminal cancer based on an alleged gene therapy known antineoplastins.
These bioactive molecules are not known of in traditional medical practices or biomedical science and no randomised control trials have been published using his treatments. Dr. Burzynski is notoriously litigious and aggressive in his stance against his critics, to the point he recently threatened libel action against an english 17 year old blogger called Rhys Morgan who questioned his expensive and unproven therapy. His supporters demonstrate the sort of zeal you would find in a cult (watch his movie online at www.Burzynskimovie.com, its excruciating) and he has proven to be an effective evader of the Texas state board of medical examiners. However, his patients who reject standard therapy and die without their miracle cure have no recourse and no way of getting their money back for their famillies.
This litigious behaviour is far from unique in those that practice alternative medicine. Dr. Simon Singh was famously sued by the British Chiropractic association for libel after he challenged the claims of the organisation that it could help cure a number of childhood disorders, including colic, asthma and bedwetting. He successfully defended himself, but his raised significant issues over the validity of alternative medical organisations that were not able to tolerate a robust debate over their medical claims, and the ease with which they can stifle or suppress legitimate scientific debate; a healthy part of the scientific process. Perhaps most worrying is the sheer bloody mindedness of some of alternative medicine practitioners who will avoid modern medicine at all costs. This is sadly demonstrated in the case of Gloria Thomas, whose homoeopathist parents were found guilty of her manslaughter. They had been treating her eczema so aggressively with homeopathy, that she became profoundly malnourished and succumbed to sepsis after she contracted an eye infection.
However, the global medical industry has big problems. Its drug pipelines are drying up and we have new diseases to fight (obesity, diabetes and HIV to name but three). As a result modern medicine has not totally rejected alternative practices such as homeopathy or Chinese medicine as a potential cure for these pressing problems. The Office of Cancer Complementary and Alternative Medicine (OCCAM) was created by the US National Cancer Institute in 1998 and since 2004, it has annually invested an average over $120 million each year in the cancer CAM research. But, other than showing that shark fins don’t cure lung cancer (this has done precious little to save the shark) its results have been meagre. The current UK minister for health Jeremy Hunt is a believer in homeopathy and by default he must therefore believe that water with ‘memory’ has medical properties. This should trouble you greatly. Prince Charles is another follower of Samuel Hahnemann’s philosophy of homeopathy which was first described in 1796. The prince may be interested to know that according to the Bach flower remedy system, the flower Centaury can be used by people who find it difficult to say 'no' to others or who lack courage. This nonsense probably explains why Dame Sally Davis, the UK’s Chief Medical Officer recently referred to Homeopaths as ‘peddlers’ and homeopathy as rubbish. Despite this there are homeopathic hospitals you can visit in the UK in Bristol, Liverpool and London which are funded in part by the NHS and who will provide you with alternatives to modern medical practices.
So what should you do if you are considering taking some an alternative medicine? Well, please take my advice and start with an established treatment. If you wish to try complimentary medicines, seek help from your family doctor and discuss the risks first. Don’t ask Dr. Google, he will either frighten you or convince you that for $499.99 the treatment will definitely, absolutely positively work. It won’t.
Our top ten terrible alternative medicines:
2. Foot detox
5. Life Extension (who would want that?)
7. Unani (Not Vic Reeve’s catch phrase. But cupping, and not in a good way).
9. Doctor fish
10. Rubber Neti: It will cure your common cold. And make you vomit.
All medical treatments (traditional and alternative) have risks, and much of the Internet is devoted to their description. But here are our top ten good alternative medicines, gone bad:
An over enthusiastic therapist inserts the needles all the way into the chest. This is not uncommon, and there are numerous reports in the medical literature on retained acupuncture needles.
2. Garlic burns: Woman burns the inside of her mouth with the application of Garlic.
(She was not a vampire)
Just like visiting the local purveyor of recreational pharmaceuticals on the local street corner, you never really know what you are going to get with some herbal remedies. Even the plant names change. Be like Zammo, and just say no! (Hum Exp Toxicol. 1990 May;9(3):195-6)
4. Indian carp (Labeo rohita) gall bladder poisoning-report of four cases in a single family (Indian J Pediatr. 2011 Jun;78(6):749-52)
Fish are gutted for a reason. Speak to a fish monger before trying anything like this.
5. Scissors in brain: an unusual presentation of tribal culture in India (Turk Neurosurg. 2011;21(3):413-7.)
Local practices for dealing with head aches vary. We don’t recommend this.
This person should have smelt a rat.
If something feels like it is getting under your skin, it may be alternative medicine.
8. Rectal perforation from colonic irrigation administered by alternative practitioners (Med J Aust. 2004 Nov 15;181(10):575-6)
The only person that should be putting anything up your bum in the name of medical science is a fully trained endoscopist.
9. An unusual cause of burns due to cupping: complication of a folk medicine remedy.
Pain is good.
Autoimmune disease caused by bee venom. That’s got to sting.