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

It is hard to deny that many practitioners of so-called alternative medicine (SCAM) advise their patients to avoid ‘dangerous chemicals’. By this they usually mean prescription drugs. If you doubt how strong this sentiment often is, you have not followed the recent posts and the comments that regularly followed. Frequently, SCAM practitioners will suggest to their patients to not take this or that drug and predict that patients would then see for themselves how much better they feel (usually, they also administer their SCAM at this point).

Lo and behold, many patients do indeed feel better after discontinuing their ‘chemical’ medicines. Of course, this experience is subsequently interpreted as a proof that the drugs were dangerous: “I told you so, you are much better off not taking synthetic medicines; best to use the natural treatments I am offering.”

But is this always interpretation correct?

I seriously doubt it.

Let’s look at a common scenario: a middle-aged man on several medications for reducing his cardiovascular risk (no, it’s not me). He has been diagnosed to have multiple cardiovascular risk factors. Initially, his GP told him to change his life-style, nutrition and physical activity – to which he was only moderately compliant. Despite the patient feeling perfectly healthy, his blood pressure and lipids remained elevated. His doctor now strongly recommends drug treatment and our chap soon finds himself on statins, beta-blockers plus ACE-inhibitors.

Our previously healthy man has thus been turned into a patient with all sorts of symptoms. His persistent cough prompts his GP to change the ACE-inhibitor to a Ca-channel blocker. Now the patients cough is gone, but he notices ankle oedema and does not feel in top form. His GP said that this is nothing to worry about and asks him to grin and bear it. But the fact is that a previously healthy man has been turned into a patient with reduced quality of life (QoL).

This fact takes our man to a homeopath in the hope to restore his QoL (you see, it certainly isn’t me). The homeopath proceeds as outlined above: he explains that drugs are dangerous chemicals and should therefore best be dropped. The homeopath also prescribes homeopathics and is confident that they will control the blood pressure adequately. Our man complies. After just a few days, he feels miles better, his QoL is back, and even his sex-life improves. The homeopath is triumphant: “I told you so, homeopathy works and those drugs were really nasty stuff.”

When I was a junior doctor working in a homeopathic hospital, my boss explained to me that much of the often considerable success of our treatments was to get rid of most, if not all prescription drugs that our patients were taking (the full story can be found here). At the time, and for many years to come, this made a profound impression on me and my clinical practice. As a scientist, however, I have to critically evaluate this strategy and ask: is it the correct one?

The answer is YES and NO.

YES, many (bad) doctors over-prescribe. And there is not a shadow of a doubt that unnecessary drugs must be scrapped. But what is unnecessary? Is it every drug that makes a patient less well than he was before?

NO, treatments that are needed should not be scrapped, even if this would make the patient feel better. Where possible, they might be altered such that side-effects disappear or become minimal. Patients’ QoL is important, but it is not the only factor of importance. I am sure this must sound ridiculous to lay people who, at this stage of the discussion, would often quote the ethical imperative of FIRST DO NO HARM.

So, let me use an extreme example to explain this a bit better. Imagine a cancer patient on chemo. She is quite ill with it and QoL is a thing of the past. Her homeopath tells her to scrap the chemo and promises she will almost instantly feel fine again. With some side-effect-free homeopathy see will beat the cancer just as well (please, don’t tell me they don’t do that, because they do!). She follows the advice, feels much improved for several months. Alas, her condition then deteriorates, and a year later she is dead.

I know, this is an extreme example; therefore, let’s return to our cardiovascular patient from above. He too followed the advice of his homeopath and is happy like a lark for several years … until, 5 years after discontinuing the ‘nasty chemicals’, he drops dead with a massive myocardial infarction at the age of 62.

I hope I made my message clear: those SCAM providers who advise discontinuing prescribed drugs are often impressively successful in improving QoL and their patients love them for it. But many of these practitioners haven’t got a clue about real medicine, and are merely playing dirty tricks on their patients. The advise to stop a prescribed drug can be a very wise move. But frequently, it improves the quality, while reducing the quantity of life!

The lesson is simple: find a rational doctor who knows the difference between over-prescribing and evidence-based medicine. And make sure you start running when a SCAM provider tries to meddle with necessary prescribed drugs.

12 Responses to No chemicals please, we are alternative!

  • Thank you for this balanced exposé. However, I think that the problem of unnecessary medication is real and serious for more than one reason, and deserves some more in-depth attention (maybe an idea for a future blog article?).
    – As you already explain, unnecessary medication can cause a decline in life quality without health benefits.
    – Unnecessary medication creates unnecessary expenses (duh).
    But these are only what I call ‘first-order’ problems. There are second-order problems as well:
    – When unnecessary medication has side effects, more medication is often used to suppress those side effects.
    – More medication greatly increases the chances of medication errors – and these errors are actually a huge problem, leading to countless hospitalizations and tens of thousands of deaths annually in Europe alone.
    – And these problems are further compounded if medication affects neurological functioning.
    – Also, especially in the case where people use half a dozen or more medicines on a daily basis, patients themselves often don’t know what several of those medicines are for exactly (just ask around in nursing homes for examples).

    But as you already say, this doesn’t mean that people should simply abandon their prescribed medicines – and most certainly not at the advice of a quack who thinks that shaken water is a medicine, or because of what they see on Facebook or YouTube.

    My advice to people who take medicines (prescription AND over-the-counter(!)) on a regular basis: plan an annual ‘pharma-consult’ with your GP, in order to refresh your memory as to what exactly those medicines are for, if they are still necessary, and if there are any alternatives (pharmacological or otherwise(*)) that may be appropriate. And if specific details about medicines are not clear, ask the pharmacist.

    *: E.g. when an overweight patient with emerging diabetes type 2 has lost significant weight over the past year, it may be an option to cut down on medication and shift the focus to more exercise and other lifestyle changes. But ONLY after consulting with a real doctor. (And no, I am not a doctor.)

    • thanks
      there is a substantial literature on this already – mostly by experts who know more about the topic than I do.
      I prefer to write about SCAM, the subject of this post.

      • I prefer to write about SCAM, the subject of this post.

        Ah yes, of course you are right. (This subject appealed to me because I once developed an electronic medicine alarm, for which I did some research into the subject.)
        Still, unnecessary medication can also pertain to SCAM – e.g. those orthomolecular quacks who ‘diagnose’ all sorts of imaginary deficits and imbalances in order to sell expensive supplements. In your recent book Alternative Medicine – A Critical Assessment of 150 Modalities, this modality is categorized as moderately safe, but it may still be harmful. One notorious example is a Dutch Olympic champion speed skating by the name of Sven Kramer, who suffered serious neural damage in his leg muscles as a result of excessive intake of vitamin B6, prescribed to him by his personal orthomolecular therapist. Kramer lost a full season in his sports career due to this.

        • this is copied from my book:
          5. The assumptions of orthomolecular medicine lack biological plausibility.
          6. Although there are some encouraging reviews e. g. no compelling evidence exists that orthomolecular treatments are clinically effective for patients who do not suffer from nutritional deficiencies.
          7. Pauling’s foray into alternative medicine is a telling example how even the smartest people can get it wrong when they leave their area of expertise.

          PLAUSIBILITY Negative
          EFFICACY Negative
          SAFETY Debatable
          COST Negative
          RISK/BENEFIT BALANCE Negative

          • This is just making an unwarranted superficial summary of a huge field. I will just take one example, Vitamin C, for which Linus Pauling was justly famed. They now have many studies that show it is a good treatment for sepsis, for which CON-MED has poor results.

            https://www.ncbi.nlm.nih.gov/pubmed/30098738

            There is ongoing research in orthomolecular medicine showing good results just like there is ongoing drug research.

          • you have not the faintest idea what reliable evidence is, have you?
            Pauling was famed for his 2 Nobels, both unrelated to medicine, plus for having made a fool of himself with his VitC claims.

          • @Roger
            Orthomolecular ‘medicine’ is quackery – not just because there is no body of evidence for its purported medical benefits, but also because the majority of its practitioners have no medical education to speak of (at least here in the Netherlands).

          • Roger

            We know you’re not very bright so let’s explain this simply as regards Vit C

            “They now have many studies that show it is a good treatment for sepsis, for which CON-MED has poor results.”

            Preliminary studies have shown interesting results but it is not just Vitamin C. It is thiamine, hydrocortisone and ascorbic acid used as a combination and as an ADJUNCTIVE therapy to help improve tissue bioavailability of oxygen. Adjunctive therapy means it is used WITH other treatments. It is not AltMed in any way, shape or form and in no way validates the specious twaddle that Linus Pauling made a fool of himself with regarding Vitamin C. Proper, large-scale studies are being performed to see if the combination therapy is of any use.

            https://ccforum.biomedcentral.com/articles/10.1186/s13054-018-2217-4

            If it is shown to be of benefit, it will be adopted. You know, Roger. Science and stuff. This is not doctors blindly pumping Vitamin C into critically ill septic patients and watching them leap from their beds, miraculously cured no matter how much you might wish otherwise.

  • Great article! Thank you! I have shared it on Twitter.

  • Two of the examples that you give, chemo and statins, are particularly egregious examples of CON-MED. Neither have been shown to extend life very much or at all depending on the drug and the condition. So even if someone stopped them and did an ineffective alternative treatment, but their QoL improved and they died comfortably, that is a big win.

    Most new drug studies now use Relative Risk as a measure of success which exaggerates the benefits of a drug, compared to Absolute Risk which puts the results in proper perspective compared to the size of the test group. So a huge number of people have to take the drug in order for a handful of people to see any benefit. Meanwhile the entire group of people taking it have to deal with the co$$t and possible side effects.

    I sat in on Dr Farokh Master’s busy clinic in Mumbai and watched intakes and read through his case records. Anybody willing to can do the same. He had good results treating a full range of illnesses including cancer, heart disease and hypertension. All using homeopathy. Many other homeopaths do as well.

    • 1) “In adults at increased CVD risk but without prior CVD events, statin therapy was associated with reduced risk of all-cause and cardiovascular mortality and CVD events, with greater absolute benefits in patients at greater baseline risk.” https://www.ncbi.nlm.nih.gov/pubmed/27838722
      2) your chemo-myth has been debunked by others already, I believe.
      3) Dr Farokh Master either is faking his records, or they are true in which case he has a moral/ethical duty to let us all know about it via peer-reviewed articles in accessible journals, so that millions of other patients can benefit. he has not a single paper on Medline. this means, regardless of whether he is correct or wrong, he is a charlatan.

    • Most new drug studies now use Relative Risk as a measure of success which exaggerates the benefits of a drug, compared to Absolute Risk which puts the results in proper perspective compared to the size of the test group.

      I think most doctors prescribing prophylactic treatment will know the incidence of the condition they are trying to prevent, and with that information it is straightforward to work out how the absolute risk changes given the relative risk. Standard guidelines take this into account, which makes prescribing decisions even simpler. In any case you can usually find absolute risks in the reports.

      The problem comes with how the press reports new findings – I don’t think the PR departments issuing press releases or the journalists reporting them know the difference between relative and absolute risk.

      Another problem with preventative treatments is that it is impossible to identify the individual events which have been prevented. The person who gets side-effects from a statin will complain about them, but the person who is still alive because they never had their heart attack will be completely unaware of the fact.

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