Adverse effects of so-called alternative medicine (SCAM) are, in my view, the most important and the most under-researched subject in the realm of SCAM. When I started my job at Exeter in 1993 declaring that I intended to make it a focus of my research, the SCAM scene was first puzzled and subsequently annoyed. SCAM proponents argued that the important risks in medicine are not in SCAM but in conventional medicine. I countered:
- that I would like to see some evidence to support this statement;
- that, as long as SCAM proponents would not produce sound evidence, the statement amounted to a mere assumption which needed urgent testing;
- that, when considering the safety of SCAM, we need to consider both the direct risks (for instance, adverse effects of a homeopathic or herbal remedy) and the indirect risks (for instance, the risks of consulting a homeopath or herbalist and adhering to their advice);
- that, in any case, the absolute risks were not as important as the risk/benefit balance for each SCAM;
- that we needed to research the risks of SCAMs much better in order to consider their risk/benefit profiles.
Since then, I have had hundreds (perhaps even thousands) of discussions, disputes and quarrels about this, repeatedly also in the comments section of this blog. Even though the issues are often complex, most of the ensuing circular argument can be condensed into a short dialogue between a fictional QUACK and a fictional SCIENTIST:
- QUACK: There are no adverse effects associated with my SCAM; after all, it’s been around for a very long time and we would by now know about any problems.
- SCIENTIST: But how can you be so sure without a reliable monitoring of adverse effects?
- QUACK: There is no need for one, because my SCAM safe.
- SCIENTIST: This what you think.
- QUACK: Alright, then show me some peer-reviewed articles about adverse effects of SCAM.
- SCIENTIST: How about this pile of papers reporting adverse effects of your SCAM?
- QUACK: That’s just a collection of anecdotes! Anecdotes are not evidence! Show me the systematic research.
- SCIENTIST: Here is a pile of systematic reviews on the subject. Happy?
- QUACK: No, these are systematic reviews of case reports. Case reports are just anecdotes.
- SCIENTIST: [slightly impatient] That’s because there is no monitoring of adverse effects in your field.
- QUACK: There is no need, because it’s safe, and you have no evidence to show otherwise.
- SCIENTIST: The burden of proof is not on my but on your shoulders.
- QUACK: I have given you the proof – after hundreds of years of using my SCAM, there is no evidence of adverse effects.
- SCIENTIST: [very impatient] Go yonder and multiply.
- QUACK: You see, you have no evidence to prove that my SCAM is not safe, instead you just claim that it’s unsafe and even insult me.
- SCIENTIST: I give up.
Instead of going through such discussions again and again, in future, I will just provide commentators on this blog with a link to this post. That should save both time and nerves.