MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

Since more than 20 years, I have been writing about the risks of alternative therapies. One of my first papers on this issue was published in 1995 and focussed on acupuncture. Here is its abstract:

The use of acupuncture is widespread. The procedure is often claimed to be totally, or at least reasonably, safe. The published evidence regarding its potential risks is reviewed. The repeated and/or inappropriate use of an acupuncture needle carries the risk of infections. Amongst others, AIDS and hepatitis have been transmitted. Acupuncture needles may also traumatise tissues and organs. Pneumothorax is the most frequent complication caused in this way. Finally, needles may break and fragments can be dislodged into distant organs. A serious and more general concern related to the safety of acupuncture is the competence of the therapist, whether or not medically qualified. The “philosophy” of acupuncture is not in line with orthodox diagnostic skills; therefore acupuncturists can be dangerously unconcerned with diagnostic categories. Thus indirect risks might add significantly to the direct risks of acupuncture. It is concluded that the true risk of acupuncture cannot be estimated. Whatever its extent, it could and probably should be lowered by enforcing educational and clinical standards.

My reason for banging on about the potential harms (direct and indirect risks) of alternative medicine is fairly obvious: I want to alert healthcare professionals and consumers to the fact that these treatments may not be as harmless as they are usually advertised to be. Yet, I have often be called an alarmist fear-monger. In my view, nothing could be further from the truth.

Thinking about fear-mongering, I began to ask myself whether those who regularly accuse me are the ones guilty of the deed. Are alternative practitioners fear-mongers? Surely not all of them, but some clearly are. Here are a few of the strategies they use for their fear-mongering.

NON-EXISTING DIAGNOSES

Perhaps the most obvious way to instil fear into people is to tell them that they are affected by a disease or condition they do not have. Many alternative practitioners do exactly that!

  • A chiropractor might tell you that you have a subluxation in your spine.
  • A naturopath would inform you that your body is full of toxins.
  • An acupuncturist will tell you that your life energy is blocked.
  • A homeopath might warn you that your vital force is too low.

These diagnoses have one thing in common: they do not exist. They are figments of the therapist’s imagination. And they have another thing in common: the abnormalities need to be corrected, and – surprise, surprise – the very therapy that the practitioner specialises in happens to be just the ticket for that purpose.

  • The chiropractor will tell you that a simple spinal adjustment will solve the problem.
  • The naturopath will inform you that a bit of detox will eliminate the toxins.
  • The acupuncturist will tell you that his needles will de-block your chi.
  • The homeopath will persuade you that he can find the exact remedy to revive your vital force.

And there we have the third thing these diagnoses have in common: they are all treatable, will all result in a nice bill, and will all improve the cash-flow of the therapist.

MEDICALIZING TRIVIALITIES

But often, it is not even necessary for an alternative therapist to completely invent a diagnosis. Patients usually consult an alternative practitioner with some sort of symptom – frequently with what one might call a medical triviality that does not need any treatment at all but can be dealt with differently, for instance, by issuing some life-style advice or just simple re-assurance that nothing major is amiss. But for the fear-monger, this is not enough. He feels the need to administer his therapy, and for that purpose he needs to medicalize trivialities :

  • A low mood thus becomes a clinical depression.
  • A sore back is turned into a nasty lumbago.
  • A tummy upset morphs into a dangerous gastritis.
  • Abdominal unrest is diagnosed to be a leaky gut syndrome.
  • A food aversion turns into a food intolerance, etc., etc.

The common denominator is again the fact that fear is instilled into the patient. And again, a useless therapy is administered, if at all possible in the form of a lengthy series of treatments. This, of course, generates significant benefit – not therapeutic, but financial!

DEMONIZING CONVENTIONAL MEDICINE

But there is always the risk that the patient is wiser than expected. She might be so scared learning of her condition that she decides to see her doctor. That would mean a loss of income which has to be avoided! The trick to achieve this is usually not difficult: conventional healthcare professionals must be demonized.

  • They are not treating the root cause of the problem.
  • They are in the pocket of BIG PHARMA.
  • They prescribe medicines with terrible side-effects.
  • They have no idea about holism.
  • They never have enough time to listen, etc., etc.

I know, some of these criticisms are not entirely incorrect (for instance, many conventional medicines do have serious side-effects but, as I try to point out ad nauseam, we need to consider their risk/benefit balance). But that is hardly the point here; the point is to scare the patient off conventional medicine. Only a person who is convinced that the ‘medical mafia’ is out to get her, will prove to be a loyal customer of all things alternative.

DISEASE PREVENTION

And a loyal customer is someone who comes not just once or twice but regularly, ideally from cradle to grave. The way to achieve this ultimate stimulus of the practitioners cash flow is to convince the patient that she needs regular treatments, even when she feels perfectly alright. The magic word here is PREVENTION! The masters here are the chiropractors, I guess; they promote what they call ‘maintenance care’, i.e. the regular treatment of healthy individuals to keep their spines subluxation-free. It goes without saying that maintenance care is a money-making scam.

The strategy requires two little lies, but that’s forgivable considering the good cause, boosting the income of the practitioner:

  1. Conventional doctors don’t do prevention.
  2. The alternative treatment is an effective preventative.

The first statement can be shown to be an obvious lie. All we know about effective disease prevention today comes from conventional medicine and science; nothing originates from the realm of alternative medicine. Remarkably, the most efficacious preventative measure of all times, immunisation, is frequently defamed and neglected by alternative practitioners.

The second statement is a necessary lie; how else would a patient agree to pay regularly for the practitioner’s services? I am not aware of any alternative therapy that can effectively prevent any disease.

CONCLUSIONS

  • Some alternative practitioners regularly instil fear into consumers.
  • Several strategies are being used for this purpose.
  • They have the aim of maximising the therapists’ income.
  • Fear-mongering is unethical and despicable.
  • Pointing out that a certain therapy might fail to generate more good than harm is not fear-mongering.

30 Responses to Are alternative practitioners fear-mongers?

  • From my experience, maintenance care is really in many cases, supportive care. Supportive care is an intervention that reduces symptoms when no treatment has been provided over a period of time. Patients who present with degenerative joint disease which may lead to degenerative scoliosis do benefit from supportive care.

    • and what’s your evidence for this statement?

      • My evidence is the guidelines published on 14 February 2017 by the American College of Physicians in the Annals of Internal Medicine regarding low back pain. Spinal manipulation and rehabilitation(exercise/traction) with periodic evaluations on pain and disability for patients with chronic pain is a valid and reasonable approach.

        • good joke!
          1) guidelines are no evidence
          2) the guidelines do not recommend maintenance

          • Noted.
            We agree to disagree. Guidelines are designed to lead clinicians and the public in an evidence-based direction. Chronic pain patients need safe clinical heath care support.
            For your information, in today’s New York Times, it’s reported that drug overdose is the number one cause of death for Americans under 50 years old. Opiates, as much as they can provide relief kill many addicted people who have chronic pain. Most have neck and back pain. Trust I am clear!

          • that’s a bit too simple!
            the guidelines said nothing about maintenance.

          • At the beginning of this thread, I said that many patients who attend to chiropractors for maintenance are really having supportive care to deal with chronic conditions. Supportive care is defined as management a condition that regresses over a period of time without treatment. I note that the guidelines provide recommendations only on treatment, not frequency for patients who have chronic conditions.
            Analysis of individual records of patient care are the only accurate method to know if patients are obtaining evidence-based care. I know mine would withstand a test from AHPRA.

          • @Dr Michael Epstein on Tuesday 06 June 2017 at 09:41

            “Noted.”, which means I read it and cognitive dissonance prevents me from understanding your point.

            “We agree to disagree.”, which means I don’t care whether there is evidence or not

            “Guidelines are designed to lead clinicians and the public in an evidence-based direction. Chronic pain patients need safe clinical heath care support.”, which means this offers something to which I can cling to try to validate my non-scientific and unproven methods.

            “For your information, in today’s New York Times, it’s reported that drug overdose is the number one cause of death for Americans under 50 years old. Opiates, as much as they can provide relief kill many addicted people who have chronic pain. Most have neck and back pain.”

            This fatuous argument has been used and debunked so many times before. What does it take for chiros to see past the end of their noses?

            “Trust I am clear!”

            As usual, NO. Are logical fallacies so hard to understand that you cannot stop yourself spouting them constantly? Silly question, after all, you are a chiro, that is, NOT a doctor.

        • Spinal manipulation and rehabilitation(exercise/traction) with periodic evaluations on pain and disability for patients with chronic pain is a valid and reasonable approach.

          What the guidelines suggest has nothing todo with chiropractic, the system of fake and unsubstantiated healing invented by D.D.Palmer and B.J.Palmer.

      • EE. try this, but before you revert to a tirade of, “It is not-proven”, and “Where are the studies?”, How about you tell us why mechanical stimulation of joints will not result in regeneration.
        Biochem Biophys Res Commun. 2012 Aug 10;424(4):724-9. doi: 10.1016/j.bbrc.2012.07.019. Epub 2012 Jul 16.
        Indian hedgehog Is an Essential Component of Mechanotransduction Complex to Stimulate Chondrocyte Proliferation
        Cartilage regeneration for treatment of osteoarthritis: a paradigm for nonsurgical intervention

        • @GibleyGibley on Monday 05 June 2017 at 23:32

          Trust you, camel, to ask a stupid question, desperately looking for anything to give some/any credence to your non-medicine.

          If it was so obvious to you, where is the paper you wrote about the RCT you did? Oh, you mean there is no evidence and these are preliminary studies?

          • To Frank Collins,
            Your comment at 10:24 states that my comments are illogical because I’m “Not a Doctor.” I need to remind you of a common fallacy in logic called Acceptance Based on Authority. Whilst I do not have a PhD, just because I do not have a Doctor of Medicine but a Doctor of Chiropractic does not preclude me from presenting a logical argument which you can only comment on as irrelevant by attacking my professional character.

  • While I don’t disagree with a word of this post, it has to be acknowledged that orthodox medicine also engages in fear-mongering. Not for profit, in the way you describe the motives of pseudo-medicine practitioners, but in the way the results of medical research are often presented.

    No-one could (or should) argue with fear-mongering over the risks to health of smoking, heavy alcohol consumption and obesity: these are huge contributors to disease. But we’ve now reached the point where it’s become statistically possible to detect very tiny associations between factors (usually, but not always, dietary) and specific diseases.

    These research findings are blown up by journalists in big headlines, e.g. ‘Eating red meat increases your risk of heart attacks’, which induce great fear among the public. Yet the limitations of such research findings (including that the conclusion may be over-simplistic or even wrong) are seldom discussed or even hinted at in the fearmongering articles.

    Fear of illness and death is a common, and understandable, human condition. Most of us live in fear of requiring medical attention through disease or trauma. In these circumstances, the practitioners of the many forms of Big Snakeoil ought to reflect on whether their invented diagnoses (exemplified in this post) are making things better, or worse.

    • what you describe is fear mongering not by orthodox medicine but by journalists!

      • Agreed: I already said “…in the way the results of medical research are often presented.”

        But the people doing the research are often expected to agree to the hyped-up presentation in press releases, from which the fear-mongering inevitably flows. Academic and medical research institutions nowadays know you have to hand the media juicy stories to stand any chance of publicity. The system changed in the late 20th century from ‘a researcher is only as good as their last paper’ to ‘a researcher is only as good as their last grant’. And media publicity is seen as a reputation extender for the researcher and the institution.

        Even the medical and science journals play the lurid press release game nowadays. It seems that any publicity is good publicity as long as the name of the researcher/institution/journal is spelled correctly.

      • Wanted to say exactly same thing. Always after these headlines you should search soon articles which are something like “what this latest research/news really said” or “what is really behind this latest research/news” etc. Like the news with bacon and afterwards there were headlines like “Bacon Causes Cancer? Sort of. Not Really. Ish.” “Bacon Causes Cancer, But Don’t Worry About It”

  • As any random sales professional or anyone dealing in the stock market can tell you, important buying decisions are based on hope, fear or greed. If it is the buyer acknowledging that there is a pain to be addressed, or if it’s a friend making a recommendation the effect is stronger than if it’s the salesperson talking.

    The “toxins everywhere!!!” narrative is useful to get people to seek solutions, and people enjoy telling themselves and anyone around that back in the old days everyone was healthier, food was better, work was harder (and more honest), life was simpler, etc.

    All these ideas can be challenged, but what matters is that they are comforting for the person communicating them and can spread without much effort or investment. The naturopath quack is aided by this wishful thinking and that’s why hypochondria is an obvious part of what they promote.

  • @Edzard ‘All we know about effective disease prevention today comes from conventional medicine and science; nothing originates from the realm of alternative medicine.’

    This really is nonsense. Chinese medicine, as I’ve pointed out before, has been discussing the vital impact of diet and lifestyle on our health for millennia.

    • yes, but I was talking about evidence!
      the Chinese have been talking about a lot of things for millennia, but never managed to provide us with sound evidence for anything.

    • @Tom Kennedy on Monday 05 June 2017 at 15:17

      For Tom, that “talking” constitutes research when you read this nonsense; http://www.tomtheacupuncturist.com/research/.

      I might be in Bristol (Clifton Village) in four months. I’ll ensure I don’t venture anywhere nutbaggery though.

  • We call this out when we see it and report it to the registration board if it breaches code of conduct. A Chiro here was recently found guilty in court and fined following complaint by chiropractors.
    We call it “Scare Care” and preying on the “Worried Well”.
    Zero tolerance.
    All health care should be about building the patients resilience, understanding and independence, not fostering a toxic dependency in the patient and/or the practitioner.

    • And efficacy? Silly question, you are a chiro, and for whom the word means nothing.

    • Nothing about “Chiropractic” intersects with reality or actual biomechanics….when it does it’s always “borrowed” (and likely bastardized via a pernicious mixing-in of irrelevant money-making schemes like spinal-fixation/improper motion etc) from the real-scientists that researched it. Chiropractic remains utterly superfluous. IF ‘coaching’ better posture and ergonomics is beneficial there are innumerable better clinician-types to choose.
      Always wondered IF the spine is so precarious as to be able to be ‘pushed back in’ how have Homo sapiens managed to live past 12 years old? And how can DCs be so certain that they aren’t ever ‘pushing things into a worse position’?? If subluxation occurs so readily and so randomly via vicarious actions, surely a “mis” applied thrust right on the spine should be devastating. And since the tests used to “find” the sweet-spot ALL lack reliability and validity (and are whimsical to each D.C.)….logic begs any reasonable mind to call it fraud.

      • Chiropractors developed the ideal and average human spinal model. Please review the papers published by the late Donald D Harrison, DC MS PhD. We and spinal surgeons are also aware that due to variance to human skeletal human morphology, there are groups of people whose normal is not average. There are ways to measure on standing radiographs what a person’s normal sagittal cervical and lumbar lordosis should be. This is a biomechanical model and not a biomedical model of thinking.

        • Dr Michael Epstein,

          You wrote: “We and spinal surgeons are also aware that due to variance to human skeletal human morphology, there are groups of people whose normal is not average.”

          QUOTE
          In colloquial language, an average is the sum of a list of numbers divided by the number of numbers in the list. Most of the time this is used in finding a number. In mathematics and statistics, this would be called the arithmetic mean. In statistics, mean, median, and mode are all known as measures of central tendency.
          https://en.m.wikipedia.org/wiki/Average
          END of QUOTE

          QUOTE
          In probability theory and statistics, variance is the expectation of the squared deviation of a random variable from its mean, and it informally measures how far a set of (random) numbers are spread out from their mean. The variance has a central role in statistics. It is used in descriptive statistics, statistical inference, hypothesis testing, goodness of fit, and Monte Carlo sampling, amongst many others. This makes it a central quantity in numerous fields such as physics, biology, chemistry, cryptography, economics, and finance.
          https://en.m.wikipedia.org/wiki/Variance
          END of QUOTE

          QUOTE
          About 68% of values drawn from a normal distribution are within one standard deviation σ away from the mean; about 95% of the values lie within two standard deviations; and about 99.7% are within three standard deviations. This fact is known as the 68-95-99.7 (empirical) rule, or the 3-sigma rule.
          https://en.m.wikipedia.org/wiki/Normal_distribution
          END of QUOTE

          The ineptitude of your statement beggars belief.

      • @Frank Collins
        Have you heard of PROMs and PREMs? Silly question, you are an entrenched critic for whom reform and EBP where you measure outcomes means nothing.

        @Michael Kenny
        You seem to be stuck in the subluxation, bone-out-of-place, biomechanical era with the dinosaurs. Are you aware of the latest research and researchers? “when it does it’s always “borrowed”” would indicate otherwise.

        • The “newest research” is not “Chiropractic”…chiropractic which means: bone out of place, racked back in by hand. It’s essence must be defined by the subluxation. When you define it as “global posture permutations and loss of “proper” curves, you are so broadening its definition as to leave it undefined.
          Harrison was also a mathematician and engineer and hired other PhDs. Mathematical spinal models are never “Chiropractic” as chiropractic is a religious dogma. Harrison showed numerous times postural permutations require remodeling traction not ‘racking the spine’ based on invalid and unreliable arcane tests made up by pseudoscience.
          And of course Harrison’s methods are not well accepted in chiropractic and are used by well under 25% of practices. And the essence of these procedures certainly do not require a D.C. degree.

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