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

I started my full-time research into so-called alternative medicine (SCAM) at Exeter in 1993. It became soon clear to me that the most urgent subject to investigate was the safety of SCAM. Safety is more important than efficacy for treatments that are already out there. My decision to prioritise safety quickly led to the bewilderment of the SCAM community. They pointed out that SCAM was safe and that the true risks in healthcare were with conventional medicine. Belief was strong, but data were scarce.

My counter arguments therefore were:

  1. Safety is too important a subject to leave it to belief, and we need evidence.
  2. SCAM is hugely popular and it was my ethical duty to provide data on safety.

The SCAM community were unconvinced by my logic. But that did not stop me.

In the course of dozens of investigations, we then found that adverse effects of SCAM do exist and some can be quite dramatic. Again, I was told that this might be so, but the real dangers surely lie elsewhere, namely in conventional medicine.

Meanwhile, I began to find that, while the direct risks of SCAM were real, the indirect risks were much more important. During virtually every talk I gave and in most papers I published, I started including this message:

EVEN A HARMLESS SCAM WILL BECOME LIFE-THREATENING, IF IT IS USED AS AN ALTERNATIVE TO CONVENTIONAL CARE FOR A SERIOUS CONDITION.

Even though the statement seems quite clear, it does not really capture the complexity of the issues involved. Let’s take (yet again) the example of homeopathy (because it is one of the most clear-cut cases).

The remedy is normally harmless; after all it contains nothing. Therefore, there are no or very few adverse effects. If a patient is naïve enough to use homeopathy in an attempt to cure a life-threatening condition, it is hardly the fault of homeopathy – at least this is what some defenders of the homeopathic realm claim. So why blame homeopathy?

Indeed, this could be unfair, because then we would have to say that water is dangerous because you can easily kill yourself with it.

But the water companies do not recommend abusing water for suicidal purposes!

And homeopaths do unquestionably recommend homeopathy for serious conditions!

So, it is not the remedy and not homeopathy itself that makes it dangerous. What makes it risky is the combination of two things:

  1. the inertness of the remedy
  2. the unsubstantiated claims that are being made for it.

The two together create a potentially deadly mixture. Without false claims, nobody could classify homeopathy as life-threatening. Due to the plethora of false claims, nobody can reasonably deny that it is.

What follows is simple, I think: one would only need to stop the claims. Subsequently, homeopathy – and many other forms of SCAM – could be classified as harmless (yes, I know, this is purely theoretical because in practice this will never happen). They would still be ineffective, of course, but safety was and is the priority.

14 Responses to Contemplating the risks of so-called alternative medicine (SCAM)

  • Apparently the govt and people of the Indian state of Kerala dont think homeopathy is a SCAM:
    “There are 669 homeopathic dispensaries, 14 District hospitals, 17 taluk hospitals, 2 ten-bedded hospitals and one hospital with total bed strength of 100 under homeopathy department in the State. ….
    Homoeopathic medical education is imparted through two Government homoeopathic medical colleges, at Thiruvananthapuram and Kozhikode. In addition to this, 3 aided colleges and one unaided college are functioning under this Department. Total bed strength of the Governmenthomoeopathic medical college at Thiruvananthapuram is 118 and the patient treated in 2017-18 in IP was 1,192 and OP was 1,14,215. Total bed strength of the Government Homoeopathic Medical college at Kozhikode is 100 and the patient treated in 2017-18 in IP was 1678 and OP was 1,55,093.”
    Maybe you should go visit homeopathic hospitals and clinics throughout India and report back.
    https://invest.kerala.gov.in/wp-content/uploads/2019/02/Economic-Review-2018.pdf

    • maybe you should not promote BS!

    • Interesting…
      Can you explain why the average life expectancy in my country, with no homeopathic hospital and only very few homeopaths is 82.2 years, while in the relatively affluent state of Kerala with all those homeopathic hospital beds and clinics, is only 74,9 years and in India on average only 69,7 years despite the general availability of homeopathic services?

    • I know this will surprise you, Rog, but a belief, no matter how strong, how long-standing or how prevalent, does not make it a fact.

      An example. . . Most right-thinking people might believe you are an apologist for homeopaths when, in fact, you might just be a sh!t-disturbing idiot.

    • Hi Roger, my name is Aravind and I am from Kerala. It is a fact that there are many Govt and private homeo hospitals and dispensaries in Kerala. But just because a govt supporting homeo doesn’t mean that it is correct. Homeo still remains as a pseudoscience and only a small proportion of people go to these homeopaths for treatment.

  • I think what comes across from this interesting post, is the intertwangled-ness of safety and efficacy. Clearly the use of a treatment of unknown efficacy instead of a treatment of known efficacy, is an inherently unsafe course. I have enjoyed the consideration of these issues in “More Harm then Good”. SCAM is big money, and sometimes does not seem to live up to medical responsibility in an ethical way.

    In one of his entertaining and well-written books recounting his progress through the ranks in his medical career, Dr. Max Pemberton writes of the lady who was seriously ill after taking large doses of Hypericum Perforatum (St. Johns Wort) on top of other medication, whose effects were substantially heightened by interaction from the herb. The lady protested that because it was plant-based, she thought it would be harmless. (This despite the fact that almost anyone must be aware that there are highly poisonous plants readily to be found, like Foxglove and Belladonna, Rhubarb leaves, green potatoes etc etc). To drive the point home that not all plants are harmless, the Consultant told her “In my garden I have a plant growing that sitting underneath for half an hour would result in death”. Dr. Pemberton later asked the Consultant, What was the plant, to which the Consultant replied “A water-lily”….

  • Dr. Ernst, out of curiosity, did you start out as a true believer in alternative medicine that became convinced of its unscientific foundations, or were you already skeptical when you decided to study it?

    Regarding homeopathy, it’s also worth mentioning that these products are often adulterated with real drugs or contaminated with other substances. They also put an additional financial burden on patients.

  • Thanks for the response. I will check out your book.

    No, I was referring to products labelled as homeopathic. I probably shouldn’t have claimed that they are *often* contaminated or adulterated, but this has been described in the literature:

    https://www.tandfonline.com/doi/full/10.1081/CLT-120026518

    https://onlinelibrary.wiley.com/doi/full/10.1111/fct.12148

    https://sciencebasedmedicine.org/fda-zicam-warning/

    https://www.fda.gov/news-events/press-announcements/fda-warns-homeopathic-firms-putting-patients-risk-significant-violations-manufacturing-quality

    • these reports refer to homeopathic products that have been wrongly manufactured and thus contained actual molecules of the poisonous substances printed on the label. normally these should have been diluted out in the process of potentisation.

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