MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

How often have we heard the claim from proponents of alternative medicine that one strength of their approach is disease prevention (see for instance my previous post or this, this and this) and that conventional medicine neglects prevention almost completely? Such claims annoy me because they are demonstrably false.

I know, to some readers, this may seem like a bold statement; let me therefore try to justify it.

  1. So far, I have seen no good evidence that any alternative therapy might be effective in preventing any disease.
  2. Practically everything we know today about disease prevention originates from conventional medicine and science.
  3. There are thousands of papers that address prevention and, as far as I can see, they all originate from the realm of conventional medicine. Below is a list of just 7 recent reviews on the subject.

This paper is an update of the evidence for exercise as a prevention of heart failure. It concluded that exercise provides protective benefit in preventing HF (primary prevention). With HF present: exercise improvement with training provides benefits in HF (secondary prevention). The prediction of future in HF patients: exercise impairment, as a leading characteristic of HF, is used as a prognostic factor.

The aim of this review was to update evidence for the US Preventive Services Task Force on the benefits and harms of hormone therapy in reducing risks for chronic conditions. The authors found that hormone therapy for the primary prevention of chronic conditions in menopausal women is associated with some beneficial effects but also with a substantial increase of risks for harms. The available evidence regarding benefits and harms of early initiation of hormone therapy is inconclusive.

This paper reviewed the evidence for Implantable Cardiac Defibrillators (ICDs). The authors stated that individuals with stable ischemic heart disease (no recent myocardial infarction), especially those with inducible arrhythmias, seem to derive the highest mortality benefit from prophylactic ICD use.

These authors investigated whether neuromuscular and proprioceptive training is effective in preventing knee and anterior cruciate ligament (ACL) injuries. They concluded that neuromuscular and proprioceptive training appeared to decrease the incidence of injury to the knee and specifically the AC.

Other researchers summarized current evidence about real-world studies on apixaban for stroke prevention in atrial fibrillation. They concluded that the use of apixaban in real-life is associated with an overall similar effectiveness in reducing stroke and any thromboembolic events when compared with warfarin. A better safety profile was found with apixaban compared with warfarin, dabigatran, and rivaroxaban.

Finally, a review assessed the evidence of blood pressure (BP) lowering treatments as a means of reducing cardiovascular morbidity and mortality. The authors concluded that primary preventive BP lowering is associated with reduced risk for death and CVD if baseline SBP is 140 mm Hg or higher. At lower BP levels, treatment is not associated with any benefit in primary prevention but might offer additional protection in patients with CHD.

Testing preventative treatments is, of course, far from easy. Ideally, one would want to do an RCT, but often this is not possible, for instance, because the sample size would need to be prohibitively huge and the observation period prohibitively long (think of cholesterol-lowering for reducing cardiovascular risks, or smoking cessation for preventing cancer). Thus we rely frequently on other types of investigations such as epidemiological studies. This type of research is, however, rarely undertaken in alternative medicine, and when it does cover subjects related to this area, it is almost never done by proponents of alternative medicine.

The long and short of all this is depressingly simple: the often-heard claim that alternative medicine is strong on prevention is quite simply false. Proponents of alternative medicine like to talk about prevention (presumably because it is good for business), but when it comes to applying prevention and showing that their preventative interventions are effective, all this talk turns out to be little more than hot air.

I am sure – even hope – that some readers will disagree, and I look forward to their evidence proving me wrong.

 

11 Responses to Alternative medicine and disease prevention … repeating an untruth does not make it a truth

  • If you are referring to illness generally, then you don’t need pills and the other tools of conventional medicine to be healthy / prevent illness. You just have to eat certain healthy foods in moderation, ideally organic; avoid dairy products, meat products, junk food, processed food and all the stuff advertised on TV as being “food”; avoid sugary drinks; do plenty of exercise; pray and meditate; etc. But people generally don’t do this, so they get ill. By restoring the balance in the body when certain nutrients and vitamins are missing, do the other things above which they don’t do, they can cure themselves without pills. Big Pharma would not like people to do this or know this, though.

    It’s the same with agriculture. If the plants get the right nutrition, and the soil is full of microbial life, then the plants have a strong immune system and don’t get sick, and need protection from insects. If the plants get attacked by insects, restore the balance in the soil, the Brix level will rise, and the insects will not attack the plants because they don’t like a high Brix level in plants. Also, the plants give off infrared radiation and a vibration, which tell the insects that the healthy crops are not food.

    It’s all about balance. When there’s balance, you don’t need pills and plants don’t need chemical sprays.

    • @PMc: HTF do you know this? Have you ever heard of entropy and aging? How about childhood cancer & diabetes, scoliosis, ALS, Malaria? What about diseases prior-to chemicals and industrial farming…and when EVERYONE was fully inculcated in prayer & meditation?
      Your pronouncements are just verbose, self-aggrandizements…trying to set yourself apart and above the ‘regular folks’ with your nonsense, suggesting insights you neither possess or deserve to possess.
      When you make a pseudo-reasonable comment you then seem compelled to infuse gibberish into it so as to try to make it all appear reasonable….but it all becomes gibberish.

    • Is that true, Peter? Any evidence to back up this assertion? I can share an anecdote if you like. Two patients of mine. Both vegan for 20+ years, took plenty of supplements, hyper-fit, slim, yoga fans, keen believers in the power of Alt Med, both dead by their late 50s, one of breast cancer, one of oesophageal cancer.

      Please also point out where doctors don’t advise their patients that eating a healthy diet and following a healthy lifestyle will reduce their chances of contracting certain diseases.

      Please also specify what diseases can be “cured without pills”.

      Please also read the story of Jess Ainscough “the wellness warrior” and her mother who followed similar lifestyle paths to cure themselves of cancer without pills and with similar results. https://en.wikipedia.org/wiki/Jessica_Ainscough

  • Like Trump, CAM con artists are experts in repeating lies, realizing many gullible consumers will believe them if they keep hearing alternative facts. Some specialists are trained more to treat diseases once they occur concentrating less on prevention, but primary care docs, especially Family Medicine, Internists and Pediatricians , have been trained to practice Preventive Medicine for decades, including patient education about healthy life styles, diet, exercise, car seats, colonoscopy, etc. These alternative SCAM practitioners advertise as if they invented health care and disease prevention, but yet many are strong opponents of vaccines and other proven prophylactic measures, and are proponents for excessive vitamins, supplements, magic detox cleanses for everyone with no reliable data.

    • And primary care physicians know how and when to call in the appropriate other health care specialists.

      I would not be terrible confident accepting detailed diet or physiotherapy treatment from my GP but he/she knows when to refer me to a dietician or physiotherapist. My doctor does not give me some sugar pills and tell me to avoid bananas as a cure for anything and everything.

  • Since many alt med proponents are also if not anti vaccine very sniffy about vaccines you have to marvel about the claim that only they are concerned with prevention.

    This claim is just another straw man used to characterise medicine that works. Other examples are claiming exclusivity over looking at the whole person or the latest idea the gut microbiome.

  • Michael: Aren’t you touchy today! I recommend the Emotional Freedom Technique to remove the energy of the anger. The food corporations will have us think that their processed food and junk food are healthy to eat. The agro-corporations will have us think that their chemical fertilisers, chemical pesticides, insecticides, and herbicides produce healthy food. Coffee producers will have us think that their coffee is healthy to drink. Monsanto will have us think that their GMO animal feed produces healthy animals and healthy food. Etc. If that is your paradigm, I wish you good luck! I’m sure that Big Pharma can cure you of the effects of the chemicals with its own chemicals. (It’s logical after all.) The Big Three (chemo, surgery, and radiation) have a 3% success rate globally apparently, so you might want to try alternative medicine instead. I wish you a healthy year ahead!

    • @PMcA: so you must have enjoyed the dark ages when 1 in 6 children survived their first year, blood letting, prayer and cabbage were the best interventions for any disease, when food rotted in days and skin lesions led to gangrene.
      Ah the sweet smell of true alternative medical successes.
      Yes you are a real trend setter. If your syllogism is followed to its logical-conclusion then the horse will soon replace the airplane and glasses and hearing aids will be made obsolete by eating spinach.
      You appear to me to be both ill-equipped to engage in critical thinking and under-educated YET you have managed to uncover the grandest of conspiracies and become one of the Illuminati via pretzel-logic and revelations usually only available to TV preachers.
      You shouldn’t fret so much in trying to bring about salvation to the rest of us however, as we may eventually be able to discover it through Scientology, the Rosicrucians or the Anthroposophical society (I’m sure you belong to all 3)…They, like you, stand ready to help the uninitiated MDs, PhDs and MA/MSc of the world find the real truth about life and health.

  • @Lenny: I invite you to go to http://www.nutritionfacts.org. There is so much scientific research evidence there about the effect of a plant-based diets in preventing and curing illness. Not curing every single illness on the planet, of course, but you will be healthy with a plant-based diet. If you are open-minded, you might like to watch some of Dr. Greger’s videos, such as : https://www.youtube.com/watch?v=lXXXygDRyBU : How Not To Die: The Role of Diet in Preventing, Arresting, and Reversing Our Top 15 Killers.

    • I can’t speak for the totality of the stuff in nutritionfacts.org but it does, for sure, contain ample amounts of crap:

      The study established a causal relationship between dietary patterns and chronic diseases.

      Umm, nope!

  • Dear Peter McAlpine, please, do yourself and humanity a favor and try to distance yourself a bit from your passion for food-based medicine. You are providing very spurious advice that do more harm than good in the end (let alone you believe in the efficacy of things that don’t really exist). Nobody said that food doesn’t play a part, but it doesn’t exactly cure or prevent illnesses, it’s not that simple.

    Just to help you understand your flawed reasoning, let me give you an example of bad inference. If I recall correctly, you think that broccoli helps children with autism. Let me tell you why it’s not that simple.

    Why it’s not that simple:
    This trial used sulforaphane, derived from broccoli sprouts, to treat autism. The results were “promising”, i.e. positive, but, of course, there are multiple reservations, which is only natural. We need replication, somewhat larger sample sizes etc. However, let’s omit that for now. Sulforaphane is contained in broccoli. Peter McAlpine, you thought, this is evidence that broccoli helps with autism, so autism symptoms can be treated with broccoli. Cheers!

    Now, some details, taken from within the referenced study:

    The participants were dosed according to body weight: 50 µmol (one capsule) of sulforaphane for 200 lb.

    I understand that you may not really feel comfortable with what kind of a quantity a μmol represents. It doesn’t matter for now. Sulforaphane belongs to isothiocyanates (it’s a bit complicated, I know, just skip that too). This study measured total isothiocyanate content in certain raw vegetables, including your favourite… broccoli!

    Now let’s read carefully, on average, broccoli contained 6.9 (2.6 – 18.1) μmol/100g of WET WEIGHT. Perfect, it’s less than 10 μmol/100g of raw wet weight. What’s the next statement (indirectly referenced in the study):

    boiled vegetables and found loss of glucosinolates in a range of 18.1 to 59.1%, with the highest loss by boiling (McNaughton & Marks, 2003).

    Next?

    It has been reported that cooking reduces isothiocyanate exposure from cruciferous vegetables by 60% to 90% (Conaway, et al., 2000; Getahun & Chung, 1999; Rouzaud, Young, & Duncan, 2004; Shapiro, et al., 1998)

    And a necessary reminder for you, Peter. The authors measured total isothiocyanate content, not sulforaphane in specific!

    Do you follow Peter? What’s wrong with that? Let me tell you… considering an extremely optimistic average sulforaphane content of 10 μmol/100g of wet weight of raw broccoli, ignoring for a moment the quite significant loss of sulforaphane due to cooking and the fact that broccoli is typically not consumed raw, and the fact that sulforaphane is even less than the above referenced values because these represent total isothiocyanate yield:

    IF the effects rendered in the sulforaphane trial on autism symptoms are actually causal, they were achieved with a consumption of 50 μmol of sulforaphane for “participants up to 100 lbs”, which would be quite reasonable to rephrase as “participants at about 12-13 years of age“, if we take the 50th percentile, that is. So, this is, under our earlier assumptions, the equivalent of feeding 12-13 year old children half a kg of raw broccoli.

    Now, suddenly, reality kicks in! Sulforaphane is less than 10 μmol/100g of wet weight of broccoli, on average. Probably closer to 5 μmol/100g, considering the facts given earlier, to which our assumptions were in really-not-so-good accordance. So it would take ~1kg of raw broccoli to achieve the “therapeutic” dose of sulforaphane given in the trial. If we consider the losses due to boiling etc., we are looking at more than 1kg of initial raw quantity, and this is also optimistic… to feed to 12-13 year old individuals. For heavier individuals, we’d need double that amount and more.

    Do you still follow me, Peter? Ignoring the weaknesses of the trial, the obvious need for replication of the trial to even establish the case for correlation between sulforaphane and autism symptom amelioration, and even ignoring the fact that this is a symptomatic relief modality so we do not speak of a cure, we are looking at establishing an advice of feeding a couple kgs of broccoli to children who already exhibit some level of troubled behavior towards feeding. And that’s why it’s not that simple to say that broccoli ameliorates symptoms of autism in children. According to some weak evidence, it would take impractical amounts of broccoli to try and mimic the dosage of the trial that achieved the purported effects. That’s where bad doctors and bad true scientists come in… and try to isolate the active substance and create some drug to be of some actual assistance.

    Dear Peter McAlpine, let’s go over this again. Even under the most lenient scientific spirit, it would still be a terrific stretch to say that you just have to eat some healthy foods and you’ll be fine. Please, stop providing overstretched claims, because for each of your ignorant, instantaneous suggestions that some random onlooker might take seriously, it takes quite some time and effort to explain as clearly as possible, why they are unfounded.

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