MD, PhD, FMedSci, FSB, FRCP, FRCPEd

One thing that unites all (well, almost all, in my experience) proponents of alternative medicine is their intense dislike for BIG PHARMA. Essentially, they see this sector as:

  1. Driven by profit
  2. Employing unethical means to maximise profit
  3. Not caring for the needs of patients
  4. Attacking alternative medicine for fear of losing profit

And, of course, they claim that alternative medicine, LITTLE ALT MED, is fundamentally different from the cynically capitalist, malign BIG PHARMA.

I have no intention to defend the ways of the pharmaceutical industry – neither on this blog nor anywhere else. This industry is usually responsible to their share-holders and that constellation can lead to excesses which are counter-productive to our needs, to put it mildly. However, what I will question is the notion that LITTLE ALT MED is fundamentally different from BIG PHARMA.

Ad 1

We all have to make a living; to some extend at least we are therefore all driven by our desire to earn money. In alternative medicine, there are certainly not as many mega-enterprises as in the pharmaceutical industry but nobody can deny that many sizable firms exist which make a profit selling alternative remedies of one type or another.

And those parts of alternative medicine which are not into the sale of remedies, you may well ask – think of acupuncture, for instance. Well, those therapists are not exempt either from the need to make a living. Sure, this is on a different scale from BIG PHARMA, but it constitutes still a need for profit. If we multiply the relatively small sums involved by the vast number of therapists, the grand total of LITTLE ALT MED might approach similar orders of magnitude as that of BIG PHARMA.

Ad 2

Ok, but the alternative sector would not employ unethical means for securing or maximising profits! Wrong again, I am afraid.

My 20 years of experience of LITTLE ALT MED have let me witness several incidents which I would not hesitate to call unethical. One of the most recent and least pleasant, from my point of view, was the discovery that several German homeopathic manufacturers had given money to a ‘journalist’ who used these funds to systematically defame me.

Ad 3

What about the charge that BIG PHARMA does not care for the suffering patient? LITTLE ALT MED would never do that!!! Sadly this is a myth too.

Alternative practitioners and their organisations make a plethora of therapeutic claims which are not substantiated. Who would deny that misleading patients into making wrong health care decisions is not the opposite from ‘caring’? What seems even worse, in my view, is the behaviour that might follow the exposure of such behaviour. If someone is courageous enough to disclose the irresponsibility of bogus claims, he might be attacked or even taken to court by those who, in reality should be in the dock or, at least, do their utmost to get their house in order.

Ad 4

Finally, we have the notion of BIG PHARMA trying to suppress LITTLE ALT MED. I call this a myth too because I see absolutely no evidence for this rumour. Even those who circulate it can, when challenged, not produce any.

And, anyway, we all know how many of the big pharmaceutical firms buy into the alternative medicine market as soon as they see a commercially viable opportunity. Does that look like suppression?

So, what is the conclusion? BIG PHARMA can behave badly, no doubt, and when they do, I am as disgusted as the next man. However, LITTLE ALT MED also can behave badly – in fact, wherever there is money to be made, some people will behave badly some of the time.

Perhaps we should not judge an entire sector just by the bad actions of some of its members, but perhaps we should also consider whether or not it has done any good. Who would doubt that BIG PHARMA has helped to save lives – millions of lives?!

And now ask yourself: can we honestly say the same about LITTLE ALT MED?

57 Responses to The myth of BIG PHARMA and LITTLE ALT MED

  • The main homeopathy manufacturers in the UK are multi-million pound enterprises and the world’s largest manufacturer, Boiron, has a turnover of something like half a billion dollars.

    Of course, a good place to find out about the misleading claims made by a wide range of alternative therapists is the website of the Nightingale Collaboration.

    • Actually, Boiron’s turnover for 2012 was well over half a billion euros and is expected tpo pass 600 million euros this year.

      • …and they have almost no costs for research and development!
        …and a duck liver also does not cost the earth.

        • I’d like to see Boiron’s solid evidence for duck livers actually being used to make their supposedly derived product(s). I’d also like to see their evidence for ascertaining that the livers are 100% healthy rather than diseased.

          I assume Boiron has fully documented the devastating effects resulting from potentizing a diseased duck liver thereby enabling them to quickly issue product safety recalls and to provide antidotes.

        • The big pharma companies also spend less of R & D than they would like us to think! They spend more on marketing which is also alt med companies biggeest cost (I assume from how the work – I have not seen their fianancial).

          The fallacy believed by med proponents seems to be: “big pharma are inethical, therefore slt med are trustworthy”. Not very logical. To quote from The Lion, The Witch and the Wardrobe “What do they teach in these schools? Its all in Plato”.

          • R & D expenditure by alternative reality medicine manufacturers is virtually zero. And what little there is is only for show. Claims of alt-reality med are better left unresearched as far as they’re concerned.
            Every time a proponent of the products of alternative reality science pleads that there ought to be more research (because they do claim this often, believing the product makers have no resources to conduct research), the real question ought to be, “why are you making so many claims to be able to cure everything in the absence of research?”.

            Basically there is little if anything to research once you get past the fact that there is no plausible mechanism by which most of it could possible work, and seemingly positive outcomes can be explained by straight-forward means. Hence “alternative”.

        • A whole duck liver per year? I would find that excessive. Personally I would be very disappointed if they used more than a few grams. The potency of the remedy would be severely compromised if a whole liver was used. They (we all know who “they” are don’t we?) say that Boiron freeze the duck’s liver from year to year, shaving off only a few grams each time. Word has it that the original duck that supplied the perpetual liver was a personal pet of Samuel Hahnemann. No wonder the remedy is so powerful.

      • Doh! Of course it’s in Euros. But just checked and their market capitalisation is just over 800,000 Euros.

  • Glad you mentioned Boiron, Alan.
    Very few alt-med people ever mention “Big-Vitamin” or “Big-Supplement”

  • Wow,

    I have to say very nice and dimplomatically written. Well done, I can learn a lot about how to talk to “alternative” people reading this blog.

    Did you know that in Germany it seems impossible to change the health insurance company to a company without paying also for alternativ unproved therapeutic techniques? I tried but every company told me no you have to pay the full rate we can not exclude the alternativ trash.

    This sucks so much. I have to pay for the medical stultification of other people. OK, I stop now complaining anymore.

    Thx for the article.

  • You sir, are an inspiration. I deal with autoimmune thyroiditis and have had all sorts of quackery suggested (sometimes really quite aggressively) and seeing you bring together the evidence of a complete lack of evidence makes all the world of difference. BTW my favorite line from every homeopath I have ever spoken to (they see the scar from my thyroid surgery and descend upon me like buzzards) is that I need to discontinue my hormone therapy as it is just an illusion and that I can cure my condition through what basically amounts to some sort of unconditional love. Its good to know that there are those who simply refuse this corrosion of reason.

    Thank you.

  • Is there not also the fact that a lot of “AltMed”, “BigVit” and “BigSupp” is cosily in bed with “BigPharma”? The Merck > Seven Seas (also formerly > New Era) is a case in point. I bet there are others.

  • One of the most important selling strategies of alternative reality medicine is to conflate the sometimes less than ethical business practices of the pharmaceutical industry with medical science, and taint the latter with the former. Conflation and confusion of issues, and outright deception, are of the utmost importance to the survival of alt-reality medicine.
    Pretty much everything about alt-reality medicine is dishonest and completely devoid of ethics, and I’d suggest very often (particularly with the bigger players like Boiron, Nelson, Helios, Boots, etc.) deliberately so.

    It’s simply not possible for a trained and qualified pharmacologist or pharmacist to sell something like homeopathy and not know it is fraudulent medicine. So there are lots of unscrupulous and unethical others, apart from the industry itself, directly who stand to profit too.

  • I always point out to people who go down this path of argument that the vast majority of pharmaceuticals are generic (or generic versions are available) and cost very little (and make little profit) in return for helping to increase our lifespan significantly. This usually goes a way to stopping the accusations. Many people simply haven’t thought beyond the superficial first phase of the Evil Pharma trope. I also ask them if their mutual funds or personal investments include Pharma shares. Most have no clue.

    I end by telling them that two drugs (costing less than $20/mo) have prolonged my life so far by twenty years. I make sure they understand that my condition is genetic and not from a bad lifestyle; i.e., poor diet or lack of exercise. If I have enough time, I add that diet and exercise are very much a part of “mainstream” medicine and that I am talking about fruits, veggies and whole grains plus a bit of fish in appropriate servings–NOT fads, single substance miracle claims, or organic, or GM-free, or supplements.

  • I agree that alt medecine companies are not innocent by definition.

    They might adopt the same ethics BIG pharma has adopted : supporting entire medical schools and guiding research to arrive to favorable conclusions, or to hide the side effects of the medication they want to sell.

    However big pharma is the protagonist of this game today because they have all the money and power.

    Finally, there is no incompatibility, between conventional medicine and alt medicine –in Europe and in the US many MDs are also trained homeopaths etc….for the ones who want to try these therapies.

  • George said:

    However big pharma is the protagonist of this game today because they have all the money and power.

    Apparently not. If they did, how would you explain the facts that Boiron is worth €800 million, homeopathic ‘medicines’ are given a free ride by the medicines regulator, you can buy them in many Boots and other pharmacies and it’s available on the NHS?

    Finally, there is no incompatibility, between conventional medicine and alt medicine

    You mean other than the fact there is no good evidence that homeopathy has any medical benefits?

    in Europe and in the US many MDs are also trained homeopaths etc….for the ones who want to try these therapies.

    Yes, that’s unfortunate but is more an indication that some doctors are unable to follow where the good evidence leads.

    • Allan: it is kind of a joke to wonder whether the big Pharma dominates the market through research, paying for entire medical schools and for promoting their products. Take a look at the numbers especially in the US – it is easy to find out. All the vaccine industry is …alternative medicine?

      As I said many MDs are certified homeopaths and they know the limitations of their alternative practice.

      Regarding the evidence for or against is really controversial – What do you mean good evidence ? Homeopaths typically do not have the means to run trials with thousands of participants. However there are some studies showing efficacy especially in individualized homeopathy according to the mainstream literature -http://www.ncbi.nlm.nih.gov/pubmed/12614092

      There are different views on these studies and nothing is really conclusive but rational minds do want to investigate even when they see a moderate level of positive outcome ( from these studies ) or even anecdotal evidence —if a method is 200 years old. Being irrational does not help in research.

      • George said:

        Allan[sic]: it is kind of a joke to wonder whether the big Pharma dominates the market through research, paying for entire medical schools and for promoting their products.

        I see you didn’t answer my questions, though. However, Big Pharma doesn’t pay for medical schools here. Do you think they should be banned from promoting their products?

        Take a look at the numbers especially in the US – it is easy to find out. All the vaccine industry is …alternative medicine?

        I have no idea what you’re trying to say.

        As I said many MDs are certified homeopaths and they know the limitations of their alternative practice.

        How do they know the limitations of their alternative practice and what are they?

        Regarding the evidence for or against is really controversial

        What’s controversial?

        Homeopaths typically do not have the means to run trials with thousands of participants.

        How much do you think it costs to do a decent trial of homeopathy?

        However there are some studies showing efficacy especially in individualized homeopathy according to the mainstream literature -http://www.ncbi.nlm.nih.gov/pubmed/12614092

        Linde et al. conclude:

        There is a lack of conclusive evidence on the effectiveness of homeopathy for most conditions. Homeopathy deserves an open-minded opportunity to demonstrate its value by using evidence-based principles, but it should not be substituted for proven therapies.

        How do you believe citing that paper helps your cause?

        There are different views on these studies and nothing is really conclusive but rational minds do want to investigate even when they see a moderate level of positive outcome ( from these studies )

        So, we have ‘inconclusive’ studies and calls for yet more research, yet homeopaths seem somewhat reluctant to do that research. Meanwhile, many make claims of homeopathy being the greatest medicine on earth and make all sorts of claims for it that are not backed by the evidence. Do you think these claims should be made when there is no good evidence?

        or even anecdotal evidence —if a method is 200 years old.

        Anecdotes tell us very little, especially when they are contradicted by well-designed and controlled trials. Do you think it’ll take another century or so before homeopaths come up with that good evidence?

        Being irrational does not help in research.

        Indeed.

        • Alan, it is boring to repeat and explain self evident facts that the big Pharma dominates the market through research, paying for entire medical schools in the US and for promoting their products through universally – many times – unethical practices. The vaccine industry is a typical example — what exactly you don’t understand. ???

          This does not mean that Alt Med is innocent. But the big sinner here is the big pharma because they the power and the money.
          I have no…. cause — by the way.

          The paper you cited also says

          “Three independent systematic reviews of placebo-controlled trials on homeopathy reported that its effects seem to be more than placebo, and one review found its effects consistent with placebo. There is also evidence from randomized, controlled trials that homeopathy may be effective for the treatment of influenza, allergies, postoperative ileus, and childhood diarrhea. ”

          As I said, if there is some evidence showing some positive outcomes, rational minds would request more research. Irrational minds who are religiously convinced that it is impossible for homeopathy to have a therapeutic effect would disagree.

          Finally if there are studies showing some effects, most of them are NOT individualized – as homeopathy dictates and/or they test for conditions that they are inappropriate. It is difficult for homeopaths to conduct a large study – that requires money and support– again another obvious fact you should not ignore.

          • The paper you cited…

            Actually, it was a paper you cited.

            …also says

            “Three independent systematic reviews of placebo-controlled trials on homeopathy reported that its effects seem to be more than placebo, and one review found its effects consistent with placebo. There is also evidence from randomized, controlled trials that homeopathy may be effective for the treatment of influenza, allergies, postoperative ileus, and childhood diarrhea. ”

            Actually, the paper itself doesn’t say that. It’s a quotation from the abstract. If you look at the paper it isn’t always quite so positive. For example, it says (p. 397) that for postoperative ileus “the evidence from controlled trials is inconclusive”; in the case of allergic rhinitis, it notes a particular study, but goes on to say that “A larger study using a similar protocol did not reproduce this clinical effect”. The evidence in diarrhoea is an analysis of three small studies by the same team. In the case of influenza, it cites a Cochrane review that has since been withdrawn and replaced with one by Mathie, Frye and Fisher that concludes that there “is insufficient good evidence to enable robust conclusions to be made”. If you look more closely at the “systematic reviews of placebo-controlled trials on homeopathy” it cites, you will find that they heavily qualify their positive findings because of study quality issues, with the most positive having since been described in a more recent review by its authors as having “at least overestimated the effects of homeopathic treatments” (see also Professor Ernst’s comments about systematic reviews of homoeopathy here). It has also been overtaken by events to some extent, as it was published too late to take account of the 2005 Shang analysis.

            As I said, if there is some evidence showing some positive outcomes, rational minds would request more research.

            But if as more good quality research is done the apparent effect keeps getting smaller, “rational minds” can also draw conclusions from this.

            Finally if there are studies showing some effects, most of them are NOT individualized – as homeopathy dictates and/or they test for conditions that they are inappropriate.

            However, there have been studies of individualized homoeopathy, and a systematic review of them was published in 1998. It found that while there was an apparent effect when all trials were considered, it disappeared if only the best quality trials were considered, and said that “methodological shortcomings and inconsistencies” made the evidence for homoeopathy unconvincing. This is pretty much exactly what the reviews of all trials have said over the last couple of decades, which suggests that the lack of efficacy they show is not some sort of artifact caused by lack of individualization.

          • I messed up some of the formatting there. The paragraph starting “Finally if there are studies showing some effects…” should be a quotation from George, and the link to the Mathie, Frye and Fisher paper doesn’t work; it should lead here.

          • Mojo: I’ve corrected your comment as you indicated.

  • Anyone with common sense understands that the principles of homeopathy cannot be better than real, scientifically proven medicines. Let me take 1mg of Tylenol, throw it into a lake, drain the lake into a massive container and then sell that for a ridiculous amount of profit and pretend that headaches will be cured…

    • Common sense does NOT guide scientific investigation.

      If it were, they would not have attempt to study homeopathy and other methods, theories or hypotheses — take a look at the history of science.

      And read the papers they have been published – there is link above.

      • george said:

        Common sense does NOT guide scientific investigation.

        Indeed.

        If it were, they would not have attempt to study homeopathy and other methods, theories or hypotheses

        And arguments from personal incredulity are fallacious.

        • The term fallacious makes sense in the context of logic ( you can also look this up – logic definition etc )

          In the history of science many great hypotheses – later confirmed – were NOT common sense. Can you think of any examples?

          • george said:

            The term fallacious makes sense in the context of logic ( you can also look this up – logic definition etc )

            It’s called argumentation. You should try it sometime.

            In the history of science many great hypotheses – later confirmed – were NOT common sense.

            Quite possibly. However, that does not change the evidence for any altmed treatment.

            Can you think of any examples?

            Possibly an interesting diversion, but irrelevant to this article.

  • Alan you seemed impervious to logical arguments – Try to respond to what has been said, rationally, otherwise it is kind of boring to keep talking to you.

  • There are studies in homeopathy – according to several papers – which show an effect over placebo —–and it is rational for someone to want to investigate more.

    Even the paper Mojo cited trying to argue against homeopathy confirms that:
    http://www.ncbi.nlm.nih.gov/pubmed/9884175

    Conclusion : The results of the available randomized trials suggest that individualized homeopathy has an effect over placebo. The evidence, however, is not convincing because of methodological shortcomings and inconsistencies. Future research should focus on replication of existing promising studies. New randomized studies should be preceded by pilot studies.

    • …results not convincing… THAT SAYS IT ALL, PARTICULARLY WHEN IT COMES FROM PRO-HOMEOPATHS

      • (I m not saying that Homeopathy is proven -by the way)

        Regarding the paper.

        It says “not convincing because of methodological shortcomings and inconsistencies” not because there were sound trials and the evidence was insignificant———and it invites for MORE studies.

        It does NOT say it is ALL placebo – and no more research is needed. The opposite.
        And this is one more:

        http://www.ncbi.nlm.nih.gov/pubmed/12634583

        The results from these studies confirm that individualized homeopathic treatment decreases the duration of acute childhood diarrhea and suggest that larger sample sizes be used in future homeopathic research to ensure adequate statistical power. Homeopathy should be considered for use as an adjunct to oral rehydration for this illness.

        • “It says “not convincing because of methodological shortcomings and inconsistencies” not because there were sound trials and the evidence was insignificant———and it invites for MORE studies.”

          Indeed. But it also said that when the soundest trials were looked at “no significant effect was seen” (apologists for homoeopathy seem to use what the House of Commons Evidence Check described as “selective approaches to the treatment of the evidence base” with regard to this particular result, if they dare to mention this study at all). And there has been no sign, over the 15 years since it was published, of “MORE studies” coming up with positive results for homoeopathy. In fact, as Professor Ernst pointed out in his evidence to the House of Commons, “the evidence is getting weaker”.

        • As an example of “research [focusing] on replication of existing promising studies”, here’s a study that tried to replicate a promising finding of the 2005 Bristol homeopathic customer satisfaction survey, which reported that “the biggest improvements were seen in children with asthma”. It found that “Evidence in favour of adjunctive homeopathic treatment was lacking”.

  • George, anyone can cherry-pick a study that contains a half-promising sounding sentence in it. The passage you quote makes the very important point that these trials that show a positive result for homeopathy are methodologically flawed, therefore they are unconvincing. There have been hundreds of trials of homeopathy and the totality of evidence available to us indicates that it’s a crock, which isn’t surprising because it is based on fanciful pre-science notions of disease and the remedies typically contain no active ingredients.

    • This kind of thinking is really irrational and religious – I have nothing agains religion. Try to read more critically ALL the evidence not only what is compatible with your beliefs –

      The ” no active ingredients – therefore cannot have an effect” line is really fallacious ….

      • what is fallacious about remarking that a particular therapy has zero biological plausibility? arguably, it is fallacious not to say so.

        • This “zero biological plausibility” is really under dispute. Since there IS evidence that something is going on and it is measured by what they call” golden standard method of research”, then it is reasonable and probably wise to adopt an agnostic point of view and try to learn more through research.

          • “Since there IS evidence that something is going on…”

            Since the anecdotal evidence is contradicted by properly conducted trials of homoeopathic treatment, whatever “is going on” is not that the remedies work.

            “…it is measured by what they call” golden standard method of research”…”

            Why do you think proponents of homoeopathy say things like “the placebo-controlled randomised controlled trial is not a fitting research tool with which to test homeopathy”?

            “…it is reasonable and probably wise to adopt an agnostic point of view and try to learn more through research.”

            An “agnostic point of view” would be that we can’t find out whether it works (“Agnostic” is defined by the Concise OED as “a person who believes that nothing is known or can be known of the existence or nature of God”). Actually, this is quite close to the position that many apologists for CAM take when they claim that their therapies cannot be tested scientifically. From this point of view further research is, of course, pointless.

      • @George

        “Try to read more critically ALL the evidence not only what is compatible with your beliefs”

        You really ought to try this yourself, rather than cherry-picking positive results.

        • this post was NOT about results, data etc. it was an opinion piece; perhaps I should have made this clearer.

          • sorry, but there is no dispute. the phenomena you refer to last only nano-seconds, and even, if the were permanent, they would not explain health-effects at all.

  • I think that if a scientist who holds a Nobel disputes it – It is surely can be regarded as a controversy. I m not saying he is correct …but

    http://www.huffingtonpost.com/dana-ullman/luc-montagnier-homeopathy-taken-seriously_b_814619.html

  • That’s a great argument …Really rational…

  • If you just want to cite Nobel Prize winners, we could always look at how Montagnier’s research was received when he presented it at a meeting attended by other Nobel laureates:

    Professor Luc Montagnier, a French virologist, stunned his colleagues at a recent international conference when he presented a new method for detecting viral infections which bore close parallels to the basic tenets of homeopathy.

    Although fellow Nobel prize winners — who view homeopathy as quackery — were left openly shaking their heads, Montagnier’s comments were rapidly embraced by homeopaths in Britain eager for greater credibility.

    The article also goes on to note that Montagnier didn’t actually mention homoeopathy. Montagnier himself has been quoted as saying that he “cannot extrapolate it to the products used in homeopathy”.

    Even your fallacious argument fails to support your cause.

    • Read Ullman’s article even if you disagree with him.

      What fallacious argument ? it is not a rocket science — these are facts —

      He said -, “I can’t say that homeopathy is right in everything. What I can say now is that the high dilutions are right. High dilutions of something are not nothing. They are water structures which mimic the original molecules.”

      You don’t have to agree with this but saying that he did not relate his work with PART of homeopathy ideas is somehow beyond bias. And this is scary when this mode of thinking dominates people’s minds who think they are skeptics they have embraced scientific thinking while they cannot even accept reality.

      I don’t agree with Dr. Ernst and J.Randi in everything but I cannot deny that their criticisms on quackery is sometimes well founded.

      (On the other hand I do understand —this is characteristic of all —isms ( rational skepticism ) rational ——so to speak.)

  • I looked at the profit issue a few years ago, and I compared Boiron and the German Merck. It turned out that Boiron was twice as profitable as Merck. Furthermore, Merck spent 18% of its sales on research, while Boiron spent 0.8% of its sales on research. These numbers are based on the official 2009 financial reports for both companies. Worse still, Boiron has publicly and on the record admitted they don’t do much research because their customers are not asking for it…

  • Dear Bart B. Van Bockstaele, can you please give me the links to the Merck and Boiron figures you quote, and also the Boiron statement on non research. I’d like to quote these things first-hand. Thank you!

    • Dear Olle Kjellin, the comment you answered to is from last year! If you want to “quote” the figures (to whom?), why not try that new internet thing called “search engine”?
      Boiron financial reports: boiron.com
      Merck financial reports: merckgroup.com
      The claim that there isn’t much demand for research was made (by a Boiron rep) in a ‘CBC Marketplace’ report on homeopathy IIRC.

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