Heard the one about the healers who can perform internal surgery on you with their bare hands – leaving not a mark behind? Or the woman who thinks we should have 12 strands of DNA, not just 2? It’s what the Atlanteans had – but don’t worry, a small fee and she’ll kindly restore them for you. You’ve got cancer? Don’t worry – if you eat nothing but liquidised grapes for a month, it’ll disappear. Laughing? You shouldn’t be. These are all genuine ‘treatments’ offered to the desperate: people who have lost faith in conventional medicine, people whom conventional medicine cannot help; and the ‘worried well’: people who have been persuaded that they are ill despite being in the pink of health, by health scammers eager to make money off the gullible and the vulnerable. Recently, channel 4 showed a two-part documentary, featuring Richard Dawkins, dramatically entitled, ‘The Enemies of Reason’ which targeted such scammers. He was determined to expose how the tricks of the quacks, and the damage they have done. Not content with that, however, he launched an attack on the ‘irrational NHS’, and proponents of all complementary therapy. Is all ‘alternative medicine’ a foolish waste of time? Or would we be fools, to dismiss it out of hand? ‘Snake-oil under a different name.’It cannot be disputed that ‘alternative’ medicine peddlers have strong associations with quacks, charlatans, and showmen – exploiters of the vulnerable and ill, selling medicines that have no proven health benefits. An inventory of examples and cases can be seen on Quackwatch, a site dedicated to exposing fallacious or misleading health treatments, is part of a circle of sites which tackle a variety of common alternative health treatments, covering aspects as diverse as acupuncture, homeopathy, chiropractic practice, and nutrient scams. Alternative medicine, the site states, often claims to be holistic, but in fact is extremely narrow: chiropractors believe all ill health is caused by poor posture: acupuncturists think that acupuncture can cure everything from short sightedness to impotence, while health-food advocators often encourage dangerous diets – in extreme cases, consumption of nothing but one food-stuff (grapes, milk, cabbage) for long periods of time in serious illness. And advocates are fond of using jargon or pseudo-scientific terms – ‘energy balance’ ‘quantum interactions’ ‘detoxification’ – to bewilder the potential patient – with possibly fatal results. For those who think that’s a bit harsh, believing that alternative treatments are at the best helpful, at the worst, harmless, Dr Jarvis, President of the National Council Against Health Fraud, lists the ways in which such treatments harm cancer patients. “Harm can be direct [as a result of treatment]…Cyanide poisoning from ingesting apricot pits or laetrile, Salmonella dublin infection from drinking raw milk, electrolyte imbalance caused by coffee enemas, internal bleeding from deep body massage, and brain damage from whole-body hyperthermia have all caused needless death of cancer patients.” He also warns that there is much ‘indirect harm’: diets which weaken the patient, warnings not to trust ‘orthodox’ medical treatment which can lead to fatal delays in seeking professional help, and false reassurances and hope which can be psychologically devastating. The ‘worried well’, too, don’t escape unscathed. Patients may be told they have cancer or other incurable illness and told to apply potentially harmful cures – for an illness they have not got. If they seek professional advice and are told they are healthy, the alternative practitioner may tell them that conventional medicine is often unreliable in detecting their particular disease. The psychological (as well as physical) damage, again, can be devastating. Even self-medication with over-the-counter herbs carries hidden dangers when their active ingredients interfere with other medication, and can lead to fatalities. Homeopathy, one of Dawkins’ (and I admit, my own) pet hates, is a scheme of treatment where the active drug is diluted so much in water there is often not a single molecule of the original ingredient left by the time it is given to the patient. Its effects are, to say the least, controversial. Yet the NHS spends around £3 million on it a year, and 8.5% of the British population use it. Despite opposition from the scientific community, including protests from senior doctors and scientists, the NHS has continued funding a treatment that has no real evidence behind it. Michael Baum is emeritus professor of surgery at UCL who organised one such protest letter last year. In an interview to the Guardian, he voiced his concerns. "My concern is the issue of opportunity cost. If the NHS is spending good money on placebos at the cost of not providing effective medicines, then it does matter. The UCL hospital trust has spent £20m on refurbishing the Royal Homeopathic hospital. If that sum of money was spent on making available Herceptin and aromatase inhibitors [to treat breast cancer], then it could be saving in my own health district 600 lives a year." Absence of evidence is not evidence of absenceThere is a danger, however, that science has a knee-jerk reaction to the sound ‘alternative’ which has resulted in lack of funding and research into very real therapeutic possibilities. There’s a fine line between a healthy and logical scepticism, and smug dismissal of anything vaguely outre. Realising the potential of some alternative therapies, he National Institute of Health (USA) now has a research wing dedicated to investigating complementary medicine, and it has turned up some interesting results. Meditation has been shown to boost immune activity. Tai-chi may help preserve bone density (and thus fight osteoporosis). Acupuncture is now generally accepted to have a real and significant analgesic effect, possibly by physical stimulation of large sensory nerve fibres (though there are also cases where wrongly applied needles have caused serious injury…) Indeed, much of modern medicine is derived from active ingredients in herbal treatments – aspirin, for example, isolated from willow bark. St John’s wart is generally thought to have no side effects (apart from interfering with some prescription drugs), and effective in treatment of depression. Artemisin, extracted from ancient Chinese herbal remedies long dismissed by the West, turned out to be an excellent treatment for faciparum malaria – increasingly important in an age of chloroquinine resistance. The tricky thing is that medical science can be – and is frequently – wrong. Science, Kuhn proposed, moves in waves of fashion, is hounded by dogma, petty academic rivalry, and stubbornness to change – like the very religions, superstitions, and ‘alternative’ treatments scientists like Dawkins rave against. While no one doubts the tools that science uses are necessary for a rational life – investigation, experimentation, controlled trials – it is only reasonable to doubt that these tools may be misused, trials badly designed, or evidence poorly examined. Just because a treatment claims it’s based on ‘chi’ – and because, to our rational minds, ‘chi’ doesn’t exist – does not mean the treatment doesn’t work. Perhaps it works on perfectly sound physiological principles we in our smug superiority have not yet seen. Western medicine also has its faults. It’s strongly biochemically based, and in practice often doesn’t take into account enough the patient’s mental outlook, diet, and general condition, preferring to focus on the specific site of injury, and treating symptoms individually as they come up. Wards are understaffed and doctors have little time to listen to patients. Misdiagnoses are understandably made. Sitting in on a GP consultant, I was struck by how many times he interrupted and misinterpreted what the patient was trying to say. Patients often feel undervalued, patronised, and coerced – and confidence and morale are hugely important in recovery. Even Dawkins conceded that alternative medical practioners often spend more time with their patients and that this could have a beneficial effect (‘but not enough to outweigh good science-based medical care.’) While alternative treatments are often in their own way narrow, aspects of their philosophy may still be helpful in providing better care. It is not as simple as a divide – us against them, science against the 'enemies of reason'. The practitioners of science have their own weaknesses, blindnesses, irrational foibles and fashions. And one day treatments we consider alternative may become not so alternative after all. The real enemies of reason are those who dismiss any challenging idea out of hand, because it poses a threat to their own personal philosophy, whether they call themselves a scientist or not. Links and resources
http://www.quackwatch.com/ – Quack watch
http://www.skeptic.com/ – Sceptic net
http://nccam.nih.gov/research/ – the National Institute of Health (USA)’s funding body for research into alternative and complementary medicine, with current research findings, goals, and information
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The Enemies of Reason?
