MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

We have discussed the diagnostic methods used by practitioners of alternative medicine several times before (see for instance here, here, here, here, here and here). Now a new article has been published which sheds more light on this important issue.

The authors point out that the so-called alternative medicine (SCAM) community promote and sell a wide range of tests, many of which are of dubious clinical significance. Many have little or no clinical utility and have been widely discredited, whilst others are established tests that are used for unvalidated purposes.

  1. The paper mentions the 4 key factors for evaluation of diagnostic methods:
    Analytic validity of a test defines its ability to measure accurately and reliably the component of interest. Relevant parameters include analytical accuracy and precision, susceptibility to interferences and quality assurance.
  2. Clinical validity defines the ability to detect or predict the presence or absence of an accepted clinical disease or predisposition to such a disease. Relevant parameters include sensitivity, specificity, and an understanding of how these parameters change in different populations.
  3. Clinical utility refers to the likelihood that the test will lead to an improved outcome. What is the value of the information to the individual being tested and/or to the broader population?
  4. Ethical, legal and social implications (ELSI) of a test. Issues include how the test is promoted, how the reasons for testing are explained to the patient, the incidence of false-positive results and incorrect diagnoses, the potential for unnecessary treatment and the cost-effectiveness of testing.

The tests used by  SCAM-practitioners range from the highly complex, employing state of the art technology, e.g. heavy metal analysis using inductively coupled plasma-mass spectrometry, to the rudimentary, e.g. live blood cell analysis. Results of ‘SCAM tests’ are often accompanied by extensive clinical interpretations which may recommend, or be used to justify, unnecessary or harmful treatments. There are now a small number of laboratories across the globe that specialize in SCAM testing. Some SCAM laboratories operate completely outside of any accreditation programme whilst others are fully accredited to the standard of established clinical laboratories.

In their review, the authors explore SCAM testing in the United States, the United Kingdom and Australia with a focus on the common tests on offer, how they are reported, the evidence base for their clinical application and the regulations governing their use. They also review proposed changed to in-vitro diagnostic device regulations and how these might impact on SCAM testing.

The authors conclude hat the common factor in all these tests is the lack of evidence for clinical validity and utility as used in SCAM practice. This should not be surprising since this is true for SCAM practice in general. Once there is a sound evidence base for an intervention, such as a laboratory test, then it generally becomes incorporated into conventional medical practice.

The paper also discusses possible reasons why SCAM-tests are appealing:

  • Adding an element of science to the consultation. Patients know that conventional medicine relies heavily on laboratory diagnostics. If the SCAM practitioner orders laboratory tests, the patient may feel they are benefiting from a scientific approach.
  • Producing material diagnostic data to support a diagnosis. SCAM lab reports are well presented in a format that is attractive to patients adding legitimacy to a diagnosis. Tests are often ordered as large profiles of multiple analytes. It follows that this will increase the probability of getting results outside of a given reference interval purely by chance. ‘Abnormal’ results give the SCAM practitioner something to build a narrative around if clinical findings are unclear. This is particularly relevant for patients who have chronic conditions, such as CFS or fibromyalgia where a definitive cause has not been established and treatment options are limited.
  • Generating business opportunities using abnormal results. Some practitioners may use abnormal laboratory results to justify further testing, supplements or therapies that they can offer.
  • By offering tests that are not available through traditional healthcare services some SCAM practitioners may claim they are offering a unique specialist service that their doctor is unable to provide. This can be particularly appealing to patients with unexplained symptoms for which there are a limited range of evidenced-based investigations and treatments available.

Regulation of SCAM laboratory testing is clearly deficient, the authors of this paper conclude. Where SCAM testing is regulated at all, regulatory authorities primarily evaluate analytical validity of the tests a laboratory offers. Clinical validity and clinical utility are either not evaluated adequately or not evaluated at all and the ethical, legal and social implications of a test may only be considered on a reactive basis when consumers complain about how tests are advertised.

I have always thought that the issue of SCAM tests is hugely important; yet it remains much-neglected. A rubbish diagnosis is likely to result in a rubbish treatment. Unreliable diagnostic methods lead to false-positive and false-negative diagnoses. Both harm the patient. In 1995, I thus published a review that concluded with this warning “alternative” diagnostic methods may seriously threaten the safety and health of patients submitted to them. Orthodox doctors should be aware of the problem and inform their patients accordingly.

Sadly, my warning has so far had no effect whatsoever.

I hope this new paper is more successful.

16 Responses to IMPORTANT: Diagnostic methods used by alternative practitioners are useless + dangerous

  • Several years ago, a woman acquainted with my mother (who had been a medical doctor working at a hospital) told my mother her medical history.

    The woman had noticed a small lump in her breast and went to an alternative practitioner (called “Heilpraktiker” in Germany). He performed iridology and told her that it was nothing serious. When the lump grew bigger, the woman went to a hospital and she was diagnosed with breast cancer.
    Although she started cancer treatment, the woman died from it not long after she had spoken to my mother (I think that it was one or two years later).
    According to my mother, the relatives of the deceased woman did not even sue the charlatan, so the guy continued with his “profession”.
    I wonder how a guy like this can sleep at night.
    I hope that he can´t.

    • Yes a sad story Jashak. However you like others on this forum/blog fail to acknowledge that for every ‘quack’ CAM practitioner you highlight, there are many more orthodox GP’s/MD’s Consultants etc working in the NHS and other State institutions that have been found guilty of equally serious mis-conduct or worse. Rarely do any of these health professionals get struck off for sometimes appalling and repeated ‘crimes’ against their patients. How about a more balanced approach by you and others? Now answer this: A very well know private HOLISTIC clinic in London employs a team of specialists with many years of experience. The clinic is run by a GP who is highly respected and has for many years taken a more holistic approach. Often she finds that ‘alternative treatment’ as you would describe it is far more effective than administering conventional drugs. The many thousands of testimonials from patients around the world confirm the clinic is not a scam, and it produces clinically measurable improvements to her patients when all other conventional treatments have failed. The ignorance and bias on this web site is truly shocking.

      • 1) “Rarely do any of these health professionals get struck off for sometimes appalling and repeated ‘crimes’ against their patients.”
        if you or anyone else knows of such cases, they should complain to the GMC. in the absence of such complaints, your statement is pure conjecture.
        2) “she finds that ‘alternative treatment’ as you would describe it is far more effective…”
        in this case, she must publish her findings for others to assess them and possibly learn from them. in the absence of such evidence, your statement is not credible.

        • Edzard, you are living in a fantasy world that seems to be riddled with bias. You said: “In the absence of such complaints, your statement is pure conjecture”… oh really? See below just one random media report I found in just a few seconds. There are hundreds that I have read that are either similar or far more serious. Yes some of these doctors are eventually struck off (not just for 12 months) but they are few and far between unfortunately. There exists an obscene arrogance in some sections of the medical profession that likes to assert its bogus ‘God Like’ status in society. You are obviously aware of countless complaints that continue to be made to the GMC, but judging from your general comments and claims on this blog you are sadly deluded – you continue to quote dubious ‘evidence’ while avoiding the truth for your own purposes – very odd. Get a grip on reality man!

          https://www.express.co.uk/news/uk/1053035/doctor-nhs-fake-qualifications-general-medical-council

        • As if that would convince anyone here, or in the medical community (or FDA). I am quite confident that Helen is not foolish enough to reveal any specifics about who and where. The doubters and wistleblowers would leap at the opportunity to notify the authorities, sieze a homeopath making such claims in order to destroy them. Better to leave the doubters in doubt than to risk health advancemtnt to the needy.

      • Helen

        We say again. The plural of “anecdote” is not “evidence”.

        If this anonymous GP (“you don’t know her, she goes to another school”) is producing such wondrous results then she should publish her methods and conduct some decent trials of them. Surely her keeping them to herself is denying high-quality care to others?

      • Dear Helen Murray,
        Quote#1: “Yes a sad story”
        Excuse my French, but you can f… off with your crocodile tears. For you, it might be just a story. For the relatives of this mistreated woman, it is more than just “a sad story”.
        And for people who have been diagnosed with cancer and have received beneficial treatment based on evidence-based methods (like me and several “others on this forum/blog”) from REAL doctors, your empty-headed comments about “ignorance and bias on this web site” are more than annoying.

        Quote#1:” Now answer this:”
        Another sign of your great intellect… you obviously forgot to include the question that you wanted me to answer.

        Regarding this holistic clinic: great story. I suggest that you learn something about how medical success is properly evaluated. As a clue: anecdotes from persons who make money with alternative treatments are not at all convincing.

      • Helen
        I believe your testimony, don’t listen to the A- holes here. They are all too full of themselves to know what true health is. In fact, many of the “doctors” here are carrying chronic disease themselves. Why do they think they should be consulting others about health ? …. ahh yes, I forgot, they got some formal instruction.

        • thanks for blurting out such vile stupidity; in case anyone was in doubt, we now know.

        • Yes RG, as we know (although Edzard will deny it), qualified General Practitioners and others in the ‘profession’ die a few years sooner than everyone else! And when questioned, many surveys of GP’s over the years always find that most Doctors would not take the same medicine they prescribe to their patients if they themselves suffered from the same condition. Just shows how much faith they have in the drug companies they represent at the sharp end (pun intended). And remember, GSK were fined over 3 BILLION DOLLARS a few years ago for bribing Doctors who went on to prescribe off-label drugs. Needless to say, no one got locked up or struck off.

          • “Yes RG, as we know (although Edzard will deny it), qualified General Practitioners and others in the ‘profession’ die a few years sooner than everyone else!”

            I suspect is Helen is butchering something like this study which reports that 19th century doctors died earlier than other professionals; not really surprising considering their constant exposure to infectious diseases and lack of knowledge in how to avoid catching those diseases themselves. Of course, the 20th century saw huge improvements in both understanding of infectious mechanisms and prophylactic and therapeutic measures, even as its success created new problems such as long irregular hours and constant high stress.

            Frustratingly, I couldn’t easily find a good comparison of medical professionals vs other professionals in the late 20th and early 21st centuries, which would be far more meaningful and revealing. What I did find (pre-chewed version) lumped medics together with all the other professions, so only show that professionals as a whole live longer than the manual trades; there’s no way of determining if medics fall at the high-, middle, or low-end of that professional range.

            I wouldn’t be surprised if accountants and lawyers outlive them for the aforementioned reasons, though at the same time I doubt the difference is larger than between professionals and non-professionals as a significant outlier would likely be detected and reported on.

            Of course, I’m sure Helen has reliable, citable sources for her initial claim and will be along with the links to those sources any moment now.

            “And when questioned, many surveys of GP’s over the years always find that most Doctors would not take the same medicine they prescribe to their patients if they themselves suffered from the same condition.”

            Once again, I’m sure Helen has the sources for this claim immediately to hand and it was purely an innocent oversight that she forgot to link them here. (Protip, Helen: <a href=”URL-GOES-HERE”>CLAIM GOES HERE</a> if you want to show off your l33t HTML skillz and back up your assertions in once go.)

            this reporting, which discussed how doctors, particularly when faced with a terminal condition and having a more realistic understanding of the capabilities and limitations of today’s medicine, would more frequently opt for palliative treatment rather than heroic measures, in comparison to non-doctors who’d desperately try anything and everything, no matter how futile or damaging to remaining quality of life. (Though, in typical science fashion, this matter is far from settled and is still being researched and argued.)

            In other words, doctors are less likely to be pushy patients demanding a pill for every ill, particularly when such pills are medically inappropriate or worthless (and unethical) “piss-off-and-stop-bothering-me” placebos.

            “Just shows how much faith they have in the drug companies they represent at the sharp end (pun intended). And remember, GSK were fined over 3 BILLION DOLLARS a few years ago for bribing Doctors who went on to prescribe off-label drugs. Needless to say, no one got locked up or struck off.”

            Shock news: People whose jobs it is to sell stuff caught selling stuff! Not everyone in the world 100% ethical!

            Congrats, Einstein. You found some people doing things they should not have been doing in order to make money. So did the law, which is why they got busted for it. The System; it works. Well, up to a point anyway; lots of folks would really prefer to see the individuals responsible being fined and/or jailed, rather than just punishing shareholders (i.e. folks like you and me who have pension funds). But how to pin down individual culpability and prosecute it successfully is an entirely separate discussion; one for the legal and legislative forums.

            Bad actors are found in all kinds and sizes of business; it is inevitable some pop up in pharma, and while their self-serving actions can and do threaten life and limb (e.g. Vioxx) they are only one of many industries that can do so (e.g. exploding Pintos). Hence the need for robust self- and outside regulation at all levels and stages of organization and procedure. No system is perfect, which is why it needs counter-systems to keep it in usable, if imperfect, balance. As in our bodies, as in our societies.

            Pharma survives as an imperfect system because the benefits it provides outweigh its costs more often than not. A drug that can hasten the deaths of thousands may also extend and improve the lives of millions more. Vioxx was a wonder drug for many millions of people suffering chronic debilitating pain that other NSAIDs could not touch, and for whom long-term steroidal and opiate treatments are nearly as cruel as the sickness they treat. The self-serving scumbags who gamed Merck’s internal systems and lied to the world about the true risks of its product once known not only stiffed their employer and were culpable in maybe 50,000 early deaths for which they will never be held directly accountable, they also fucked over millions upon millions of pain patients and didn’t do any of our pension pots any favors either. (Having spent three years with chronic nerve pain myself, I have massive sympathy for others desperate to achieve effective pain control. Alas, sympathy doesn’t cure squat.)

            ..

            It is a good question though: How can/should/do we as a society ensure individuals are held personally responsible for the negative consequences of their words and actions. Even if those consequences play out indirectly, in places and times a world away from the perpetrator.

            ’Cos you know else sells unethical, inappropriate, worthless, dangerous, and even downright lethal shit? And not only are completely non self-regulating but all too often maim or kill with little, if any, fear of external regulation or punitive correction too? Not least because victims are often extremely reluctant to accept that they’ve been willfully harmed, never mind come forward to public media or law enforcement; while they themselves actively seek to defeat legislative protections being applied to their services and products.

            Go on, I’m sure it’s on the tip of your tongue.

        • @ RG

          Quite right. I have no idea what “True Health” is.

          Would you care to enlighten me as to its true nature? What is it? How do we achieve it? How can it be quantified?

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