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A selection of skeptical articles and reports examining CAM (Complementary and Alternative Medicine).
A close look at 'alternative' medicine
A new magazine, What Doctors Don’t Tell You, claims to help the public find safer, more effective treatments. Margaret McCartney, a Glasgow GP, takes a critical look at the October issue:
It looks just like any other magazine on the shelves of the newsagent aimed at middle aged women: glossy, 100 pages, with a smiling, confident looking woman on the cover. What Doctors Don’t Tell You, a monthly magazine that launched in September 2012, claims to explain how to “discover treatments that are safer and more effective".
The headlines don’t mention celebrity gossip but instead promise subjects such as “Cervical cancer alert: what every mother (and daughter) should know about the new jab,” “How I avoided a hysterectomy through diet,” and “Unsteady gran? It’s drugs that cause the falls, not old age.” The magazine has regular columns, such as “Pet’s corner” and “My medical horror story,” and a column in which a retired general practitioner can “speak freely about his unorthodox but highly successful approach to treating ‘the incurables.’”
But how fairly does What Doctors Don’t Tell You reflect the evidence? It raises valid concerns in an article about the influence of the drug industry on doctors’ decision making in the United States. Another article on falls in older people describes how “prescription drugs are a major cause of the common problems we usually put down to ageing.” But rather than presenting “what doctors don’t tell you,” the article quotes from Michael Oliver, the professor of cardiology who wrote a personal view on overtreatment of older people in the BMJ in 2009 that was reported widely in the lay press. Several points in the article reasonably relay the associated problems of polypharmacy in older people. However, the article also states, for example, that drugs such as propranolol and dipyridamole are “too dangerous for use in the elderly,” referencing a study published in JAMA in 1994. This study was based in the United States, where prescribing policy is different, and so may not relate directly to the UK population, and it focused on “potentially inappropriate” drugs identified through a cross sectional survey rather than on individual assessment of each prescription.
The editor of What Doctors Don’t Tell You, Lynne McTaggart, ran the magazine originally as a website and newsletter, which launched in 1990. She told me, “The reason my magazine exists is because modern medicine just isn’t working very well. That’s the bottom line. The American Medical Association has come out to say that correctly prescribed drugs is the third leading cause of death in America and that probably goes for all of the West.” She is clear that her publication, which she says has a circulation of 40,000, is for “intelligent people of any age who want to know more about what works and what doesn’t work in conventional and alternative medicine. They want to know more, to be able to control their own health. They don’t want to be told after the fact, when they’ve suffered a side effect, ‘Oh yeah, that had to do with medicine,’ because they are not getting enough information.”
In the October issue’s news section the article “Thyme is better for acne than creams” starts, “Thyme is more effective than prescription creams for treating acne . . .The herb outperformed pharmaceuticals in a series of laboratory tests, killing the actual bacteria that cause acne . . . Not only is thyme more effective, but it’s kinder on the skin too, say the researchers. Most pharmaceuticals cause a burning sensation and irritation to the skin, whereas thyme and other herbal preparations have none of these side effects.” The article references the Society for General Microbiology’s spring conference in Dublin this year. This research was reported through a press release; it was an in-vitro model; and the researchers did not compare side effects with current prescription creams.
Another article says, “Army personnel with noise deafness and tinnitus are commonly deficient in B12, but enjoy an improvement in symptoms after taking B12 vitamins.” The study referred to contained 12 patients receiving vitamin B12 and was not a randomised controlled trial.
The editorial on Gardasil, headed “Lock up your daughters,” warned that “your doctor and your daughter’s school nurse are not likely to tell you about the 100-plus American girls who suddenly died after receiving an HPV [human papillomavirus] vaccine.” Although there are valid concerns about the long term efficacy of HPV, to suggest that it has led to death is alarmist and does not reflect or explain the evidence collated by the Food and Drug Administration. Informed choice has to be about fair information, not scaremongering; we should hardly wish for a repeat of the measles, mumps, and rubella (MMR) vaccine debacle.
Although medical journals carry advertisements for drugs, the ones in this magazine are an extraordinary shrine to non-evidenced based medicine, such as “Comra therapy,” which says it can treat “allergies, arthritis, asthma, autoimmune . . . muscles, neurology, organs, osteoporosis, skin, stress strokes and many more.” It costs from £1600 (€2000; $2600) and combines “infrared laser with magnetic field, ultrasound and colour LEDs.” Or there is the “Q-Link Clear device,” which can “fight electronic stress” and combat “poor performance and fuzzy thinking.” Is McTaggart satisfied with the advertisements her magazine publishes? She said that she was “not completely happy with some of them” and wanted “some of them changed” but declined to tell me which or why.
It is right to criticise medicine, but the same standards must be applied to all interventions, “alternative” or not. We now realise how important it is to ensure that fair evidence, free of bias, is used in making medical decisions. There is no point in substituting bad medicine for bad science, and it is not clear from this magazine where the hierarchies of evidence stand, and the limitations and uncertainties that arise in research are not consistently explained. The magazine’s liability statement — “the publishers cannot accept any responsibility for any damage or harm caused by any treatment, advice or information contained in this publication” — should perhaps be better printed on the cover, in an unmissable font.
1 Oliver M. Let’s not turn elderly people into patients. BMJ 2009;338:b873.
2 Willcox SM, Himmelstein DU, Woolhandler S. Inappropriate drug prescribing for the
community-dwelling elderly. JAMA 1994;272:292-6.
3 Society for General Microbiology. Thyme may be better for acne than prescription creams.
28 Mar 2012. www.sgm.ac.uk/news/releases/DUB12_MGE.cfm.
4 Shemesh Z, Attias J, Ornan M, Shapira N, Shahar A. Vitamin B12 deficiency in patients
with chronic-tinnitus and noise-induced hearing loss. Am J Otolaryngol 1993;14:94-9.
5 Centers for Disease Control and Prevention. Human papillomavirus (HPV) vaccine: a
closer look at the safety data. www.cdc.gov/vaccinesafety/Vaccines/HPV/Index.html#data
British Medical Journal (10th October 2012) [BMJ 2012;345:e6817]
“Earlier this week, my colleague Dr. Gorski explored a common theme in alternative medicine: the idea that all disease is preventable. This implies that all disease has a discrete cause and that individual behavior can mitigate this cause. If biology worked this way, my job as an internist would be very different. Many people would love to believe that life is this predictable, and that they have that much control over their health, but they don’t. Most disease represents the interaction of environment and genetics, and you can’t change your genes (with a few exceptions, of course). It’s natural to want to be able to exert an impossible level of control over your health, but when unscrupulous charlatans play on these beliefs and fears, they can cause, rather than prevent problems.” Peter Lipson MD, Science Based Medicine (9th September 2010)
“A large amount of serious research into previously unstudied practices, largely funded by the NIH, has resulted in many articles in mainstream journals. And, guess what, almost ALL of the long-term traditional CAM practices have been found to be safe but INEFFECTIVE. And what has happened in practice? The American Medical Marketing Machine (AMMM) has done its thing. As the published scientific studies have one by one found CAM practices to be ineffective, more Americans are using CAM than ever. And, such use often is now in mainstream institutions, sterilized, and sold as "Integrative Medicine," which Mr. Google numbers at 1,230,000 results. Looks like there will always be snake oil sellers as long as there are snake oil buyers.” George Lundberg, MD, Editor-at-Large, MedPage Today (23rd August 2010)
“Cancer patients, as I say frequently, are among the most vulnerable of patients. Many of them are facing a very unpleasant death without treatment; seeing that they receive the most effective medicines and treatments we have, free of quackery, is a moral imperative, and I fear that we will soon be failing our patients. We now even have a Society of Integrative Oncology promoting the “integration” of pseudoscience into oncology.” David Gorski MD, Cancer Surgeon, Science Based Medicine (16th August 2010)
“I can think of many cases where absence of evidence provides robust evidence of absence. The key question is whether evidence should exist but does not.” Victor Stenger, Physicist; author of The Fallacy of Fine Tuning: How the Universe is Not Designed for Us (14th August 2010)
Despite the dramatic improvements in the extent and quality of our lives, largely owing to modern medicine, our current health care system has fostered a backlash, manifested in part by the emergence of non-science-based "alternative" health care practices . This trend has driven a need for dialogue on how best we should balance evidence-based decisions against demands for consumer choice - regardless of the science. In this presentation, Scott Gavura, BScPhm, MBA, discusses how health care decision-making differs from all other goods and services, and how this impacts on the choices we make, both as individuals, and in aggregate. Through an interactive discussion, he facilitates a dialogue on the opportunities for science advocates to effect positive change in health at the patient- and population-level. Toronto (28th May 2010) [1:14:09mins]
"Our obsession with media-anointed physicians has its pitfalls. A standardised approach to medicine and a focus on 'feel-good' topics are among them." Los Angeles Times (14th June 2010)
“Quacks are fond of using cuddly words like ‘holistic’ and ‘integrative’, partly, one suspects, in an attempt to gain respectability and to disguise some of their barmier views.” Professor David Colquhoun, DC Science (25th May 2010)
“…next time you are offered a paper from a peer reviewed journal, remember this story.” Majikthyse blogspot (27th April 2010)
“Looking at the whole patient in its real life context is a valuable element to understanding health and disease. Using any and all therapies that sound good to us regardless of whether or not they have real value is a mistake. Unfortunately, the popular use of “holistic” to market CAM therapies confounds these unrelated approaches.” SkepVet blog (27th April 2010)
“Chiropractors, homeopaths, naturopaths, acupuncturists, and other alternative medicine practitioners constantly criticize conventional medicine for “only treating the symptoms,” while alternative medicine allegedly treats “the underlying causes” of disease. Nope. Not true. Exactly backwards…I’ve discovered the one cause of all the one-cause theories: a deficiency of critical-thinking skills combined with an overactive imagination. And, of course, a failure to test beliefs using the scientific method.” Harriet Hall MD, Skeptical Inquirer, (January/February 2010)
A critical essay by Thomas Wheeler, Evidence-based Integrative Medicine (2003) [pdf]
“Weasel words give the impression of taking a firm position while avoiding commitment to any specific claim. Advertisements tell us that certain products help or may help (prevent, stop or fight) this or that. A toothpaste helps fight tooth decay. A new drug may help relieve pain. Note that the ads do not say specifically what the product will or can do. The only weaker claim they could make would be that their products may or may not help this or that.” (The Skeptic’s Dictionary)“Weasel words give the impression of taking a firm position while avoiding commitment to any specific claim. Advertisements tell us that certain products help or may help (prevent, stop or fight) this or that. A toothpaste helps fight tooth decay. A new drug may help relieve pain. Note that the ads do not say specifically what the product will or can do. The only weaker claim they could make would be that their products may or may not help this or that.” (The Skeptic’s Dictionary)
'60 Minutes preview. Hidden cameras expose medical conmen who prey on dying victims by using pitches that capitalise on the promise of stem cells to cure almost any disease. CBS News (16th April 2010)
Part 1: 'Finding A Niche.' Article by Prometheus, A Photon In The Darkness blogspot.com (October 2005)