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

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:

  1. that I would like to see some evidence to support this statement;
  2. that, as long as SCAM proponents would not produce sound evidence, the statement amounted to a mere assumption which needed urgent testing;
  3. 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);
  4. that, in any case, the absolute risks were not as important as the risk/benefit balance for each SCAM;
  5. 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.

37 Responses to The never-ending and perfectly circular argument about adverse effects of so-called alternative medicine

  • I read this post to the end, hoping to be enlightened in some way. Unfortunately I had wasted my time – nothing new here. No doubt the SCAM opponents will gain some pleasure from this fictitious exchange between a quack (definition please?) and alleged ‘scientist’.

  • “SCIENTIST: I give up.”

    This is, of course, the objective: to “win” by sheer attrition, i.e. stupiding everyone else to death first.

    Due credit: at least they’re good at something.

  • Why dont you actually interview someone instead of making up strawman arguments?

  • Interestingly, whilst Prof. Ernst mumbles on about adverse effects, he forgets to reference this very informative article. Shame on you Prof. Ernst. You get an “E” for effort and I hope you can do better next time.

    https://www.jospt.org/do/10.2519/jospt.blog.20201118/full/?fbclid=IwAR1IYVqJLKdefGPVDWKtu4rGnZMp0SFC2IlTaLXazorcmRIKB-5oZnZkBls

    • if you had some brains, you would have noticed that my post was not a review of AEs
      but thanks for alerting me to this paper, I might write about it soon.

  • Attempting to reason with SCAM proponents and other science-deniers is akin to pigeon chess:
    “Debating creationists [or SCAMers etc.] … is rather like trying to play chess with a pigeon — it knocks the pieces over, craps on the board, and flies back to its flock to claim victory.

    The main problem is that these people do not abide by any rules or conventions, but instead make them up as they go along – and apply these made-up rules very selectively, at that.
    In their alternative universe, the efficacy of SCAM treatments can be ‘proven’ by a mere handful of clumsily drawn-up case reports; yet for real medicine, even systematic reviews based on hundreds of high-quality trials are often deemed insufficient evidence (e.g. for the safety of vaccines). And, of course, even if one shows thousands of examples of the utter failure of SCAM, they come up with countless reasons for that failure – but always omitting the single most important reason: that it Does Not Work. Usually, they blame the patient for not strictly adhering to the treatment or for being biased against SCAM and thus disregarding the positive effects etc. etc.. Or, as you aptly describe, they turn the argument around by claiming that real medicine is the actual killer.

    I think that the best way to deal with this is the same strategy that governs nuclear war games: don’t enter the game in the first place. Simply debunk the nonsense that they spout every now and then to make sure that theirs isn’t the only voice to be heard, but for all the rest refrain from personal interaction (unless, of course, for amusement value – which admittedly is my main motivation to occasionally engage these pigeons people in conversation).
    This will prevent a lot of unnecessary frustration and stooping to their level, and keeps the board clean for those who wish to have a serious exchange of ideas and opinions.

  • Your dialogue Edzard assumes Napoleonic law which is true for many countries. In the UK though we have Common law. As you know it is legal in the UK for practitioners to set themselves up so long as they dont claim to be Drs, dentists etc. There are though no legal requirements for AEs to be reported. You have to show harm done which is easy when anyone is using bleach or black salve. Not so easy for any common CAM therapy even with treatments involving needles and manipulation.
    So UK CAM practitioners at present dont have to justify themselves to you or to anyone. This is an area that could be improved and I think that any AE should be reported for any CAM treatment as a requirement of practise for the purposes of trending and investigation.
    In the absence of a difficult to achieve change in law this requires accreditation not self regulation. I thought though that sceptics were so keen to stop this? .eg PSA and homeopathy.

    • “In the absence of a difficult to achieve change in law this requires accreditation not self regulation.”

      Accreditation doesn’t do squat. I mean, it’s bad enough getting an august body like the GMC to take critical action against its own members, never mind a woo-soaked tribe of fellow true believers whose only concern is self-promotion. Look at Arleen Scholten: killed a man; still operating. Where’s the BCA? Too busy suing Simon Singh.

      We already have perfectly good laws for regulating CAM: financial fraud and practising medicine without a license. That they aren’t applied vigorously is because our society chooses to pull its punches on white-collar religious grifts. If you honestly cared for anyone else but yourself, you’d do something about that. But we know you won’t because you’re a fraud too.

      All you seek is validation. Stop lying to get it.

    • @Dendra

      this requires accreditation not self regulation

      Let’s go with this one for the moment, shall we?
      Accreditation is a process that is supposed to safeguard that a particular, well-defined service offered meets certain, well-defined quality standards.

      Question:
      – How would you define the service(s) offered? Is it defined as ‘health care’? In that case, one should simply apply accreditation criteria already in existence for real health care – in which case virtually all of SCAM would fail on things such as proven efficacy and best standard of care in accordance with modern science.
      – If we would try and consider each individual type of SCAM, we run into even more problems, to begin with the bewildering variety of SCAMs out there. And even if an accreditation body were established for merely the half-dozen or so most popular types of SCAM such as homeopathy and acupuncture, again the question arises how these could ever pass the basic requirements of proven efficacy and scientific standards.

      Simply put: how can one judge the quality of something that can’t even be shown to be real in the first place?

      • in a nutshell:
        accreditation of nonsense must result in nonsense.

        • Ok so you need a law change then. That will not be easy when CAM is driven by grass roots public.

          You need to prove harm but you cant can you? You and your friends call be dumb, troll, liar but you have no proof. Not even this circular argument blogpost will convince the public or authorities Edzard. You can only convince a small minority. Meanwhile CAM marches on and accreditation is more likely in an ever increasing regulatory world.
          You never know what surprises will be coming up in 2021?
          I think that you are in for a few surprises.

  • I was shocked to discover this letter containing over 130 signatories of respected health professionals endorsing a SCAM supplement. And just when I was about to agree with the anti-SCAM commentators on this forum, I may just decide to agree with the eminent Phd professors and others listed in this letter (sent to World Governments) who believe there is a case for supporting the innate and adaptive immune system with allegedly ‘dangerous’ and ‘toxic’ vitamins. You decide:
    https://vitamindforall.org/letter.html

  • Edzard: You write a load of old rot!
    Dendra: Oh no I dont!
    Edzard: Oh yes you do!
    Dendra: You write a load of old rot!

    Thought I would start a circular argument Edzard.

  • I think that you created your circular argument Edzard. Put it to peer review if you like. Maybe you will have better luck in 2021.
    Anyway you still cant prove that CAM is ‘costing lives’.
    Surely the Lancet ,BMJ should be taking this up and save lives? All you need is evidence. Da da da da da.
    Anyway, your distractions into circular arguments are proving effective on here.
    I mean has gets it.
    Well done. It is a start I suppose.
    Merry Christmas as this is my Christmas day so I have to right now help with the turk…..

    • Honestly, Dendra, you could be standing in a pool of the victim’s blood, with blood up your arms and the ax in your hand, and you would still declare “It wasn’t me! Where’s your evidence? You can’t prove it!”

      But okay, here’s a classic example of death by homeopathic misadventure:

      https://www.watoday.com.au/national/western-australia/dingles-cruel-cancer-remedies-20100622-yv12.html

      Now, I know you’ll argue that it wasn’t the homeopath’s fault, they only told the patient what she wanted to hear, gave her only what she wanted to take; and besides the patient did eventually go for surgery (likely only palliative, considering the stage) so it’s really the allopathic medicine’s fault she’s dead and also her own fault for just not believing hard enough. After all, AltMed never fails the patients; it’s the patients who fail AltMed. But still, a woman is dead; who died a really painful unpleasant death, who even if she had pursued conventional treatment at initial detection might still have eventually died of that cancer (albeit with longer and better quality of life inbetween); who trusted her friend, the homeopath, to have her best interests at heart. You didn’t do it, you weren’t there, and it’s not your job to track Adverse Effects arising from homeopathic treatments because homeopathy is perfectly safe so why should you have to prove it. And so on, and so on, yada yada yada. Because we know you, and you can evade better than a top-scoring premier league striker hiding his earnings from the taxman.

      So let me say it again: a woman is dead.

      Because it is your (lack of) reaction to that simple statement of fact which tells us everything we need to know about whose interests you really put first; and whose you don’t even put last.

  • Time to call the authorities has.

  • Go to the authorities with your classy, emphatic narrative and your evidence.
    Why the delay? Is it introspection?

    • “empath[ic]”

      ‘emphatic’

      Yup.

      • At last you have some proof has. The dictionary agrees with you.

        • The difference between a narcissist and a psychopath is that a psychopath can at least fake empathy.

          Hey, at least you’re not a psychopath.

        • @ Dendra

          so you want more proof of the adverse events from SCAM?
          well I guess death is a pretty serious AE so here are some more for you – of course this is only scratching the surface since SCAMmers don’t keep any kind of record preferring to sweep their AEs under the carpet, so we have to rely on other means of keeping track. The real totals are therefore likely many factors greater:

          https://www.ncbi.nlm.nih.gov/books/NBK91735/

          https://www.physiciansweekly.com/master-herbalist-convicted-of-practicing-medicine-without-a-license-in-death-of-13-year-old-boy/

          https://www.nhs.uk/news/cancer/alternative-cancer-therapies-may-increase-your-risk-death/

          https://www.sciencedaily.com/releases/2018/10/181025103344.htm

          https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3103684/

          https://www.cancer.org/latest-news/the-truth-about-alternative-medical-treatments.html

          https://www.theguardian.com/science/2010/oct/18/dozens-killed-acupuncture-needles

          https://www.cbc.ca/news/canada/calgary/tamara-lovett-holistic-medicine-trial-1.3869951

          https://www.bloomberg.com/news/features/2020-10-07/lyme-disease-dubious-alternative-treatments-are-killing-patients

          https://www.sciencedaily.com/releases/2010/02/100209183337.htm

          do you still argue that SCAM has no AEs?
          I haven’t even mentioned the less than fatal reactions!

          There are literally hundreds more – maybe thousands – I gave up counting. Either from the directly harmful effects of these silly SCAMs like chiropractic broken necks or acupuncturists causing haemopericardium. Or from the toxic effects of overdoses of certain herbs or drug/herb interactions. Or the idiocy of people being encouraged to take poisons like laetrile.
          Then there are the poor souls who forsake real medicine in the misbegotten belief that homeopathy or some other half-baked SCAM can treat their serious illness. These are indirectly causing death just as certainly.

          It is one thing to do as you like in your own delusion – but it is totally irresponsible to involve others and allow their health to be harmed just because one is too deluded to listen to reason and accept facts when they are crystal clear – all in the name of profit.

          • I am one of those millions of ‘poor souls’ you patronising self appointed er.. let’s be polite and call you an ‘expert’. We all make our choices and we dont need nanny John to help us to decide.
            If you actualy read my posts you will see that I am not against evaluation of CAM AEs.
            Evaluation has to be made in context with the millions of consultations on a risk benefit evaluation basis. Millions say they get benefit from CAM and that doesnt change because nanny John or anyone else disagrees. Nor is there any evidence that millions are ignoring conventional treatment.
            You can only find the odd case from millions and millions of consultations after trawling through google. That is not an evaluation of risk.
            To evaluate risk there would have to be accreditation and reporting of AEs
            Either that or ban it. No government would open that can of worms and drive it all underground. Then there would be no prospect of reporting AEs.

          • @ Dendra

            “To evaluate risk there would have to be accreditation and reporting of AEs
            Either that or ban it.”

            Exactly – I am glad to hear that you actually agree. And why is it that NO SCAM practice actually does anything of the sort?
            They all quite pointedly refuse to institute any kind of AE reporting mechanism – which indicates:
            1) lack of professionalism
            2) lack of ethics
            3) lack of morals
            4) fear of the results
            5) putting pursuit of financial gain above patient safety
            6) putting religious like faith in their SCAM above scientific truth and honesty
            7) failure to offer genuine informed consent

            What you also miss by a mile in your “millions say they get benefit from sCAM” is that truth is not a popularity contest. If the majority of the world’s population believed that the earth was flat that would not somehow make it so!
            That millions may believe that homeopathy works does not make them any less misguided.

            70 million Americans voted for an imbecile ex-reality TV star whose actions lead to appalling deaths and carnage and who has arguably been promoting treason on live TV. An idiot who suggested injecting bleach and nuking hurricanes – yet 70m Americans believe he’s the greatest! Popularity doesn’t prove a thing!

            You complain about nannying – (and btw I am something of an “expert.” I am a medical doctor and have been studying SCAM for over 40 years.) But it’s a commonly accepted principle that people don’t always know or do what’s in their own best interests. Often as a group our inclinations lead us astray or our knowledge is deficient – or special interest groups may try to lure us into activities that can damage our health or deprive us of money fraudulently (or both.)
            Think the tobacco industry – or SCAM.

            That is why there are agencies and organizations set up to try to counter-balance some of this. Standards about truthfulness in advertising, standards about pollution, safety of products sold, food quality and safety etc
            This is always a battle between interests keen to compromise on safety/truth in order to maximise profit and those trying to do the opposite. It is often unsatisfactory.

            But in the case of SCAM it is largely an unregulated free-for-all where SCAMmers can make up all sorts of truth-free advertising and fake “information” and sciency sounding pseudoscience. They can profit from the fact the the public in general know very little about SCAM or science and are easily misled by promises of “natural” and “gentle” and “ancient” and various forms of mystical and other forms of mumbo-jumbo.

            The fact that all of this is “self-regulated” means that practitioners of nonsense are being judged by other believers of nonsense which always results in results that are nonsense. How can any practitioner of nonsense be adjudged to have breached any standards when the standards of his “profession” are not based in reality to start with and when no genuinely sane and medically trained person would have treated a patient in this way to start with?
            Truly it means that the lunatics are running the asylum.

            Despite what you say there is ZERO evidence that any SCAM is doing anything to begin a reporting scheme for AEs.
            There is no evidence that SCAM regulatory bodies are doing anything more that being essentially anything more than members’ clubs.
            At present SCAM is in the position of selling their wares and providing misinformation to the public in a situation very akin to the Tobacco Industry in the past. Totally unnecessary vitamins, supplements, chiropractic adjustments, inactive homeopathic nostrums, implausible acupuncture “treatments”, worthless iridology, baseless Bio–resonance testing, nonsensical live-blood analysis, idiotically impossible cranio-sacral therapy, the daft Reiki, the hilariously fatuous Tong Ren…….I could go on and on.

            All of these are being foisted upon a naive and unwary public – who need protecting in the same way they would from a fake bank, a car manufacturer selling dangerous cars, a toy maker selling toys made from lead, a company selling gas cookers that explode and so on.

            Or are you suggesting that the market place should be a free-for-all for everybody -and that buying anything should be a lottery? Cars would be untested potentially lethal machines with no brakes and faulty steering? Just take your chances!
            If your gas cooker leaks it’s just one of those things. If the bank steals your money that’s just tough.

            Because that’s pretty much the way it works for SCAMs and that’s what you’re advocating for it to stay. Nobody has the right to try to educate the public because it’s “nannying” – or rather it might frighten off the punters.
            Wouldn’t do for the truth to get out would it?
            If the marks began to learn that all those placebos might not actually have anything at all in them they might not really be so happy after all……….

            As thousands of studies have demonstrated – people “feeling better” doesn’t actually mean they ARE any better. It’s an altered perception and a statistical quirk as has been explained on here many many times – and you STILL don’t seem to understand that.
            There are many reasons why people may feel a therapy works WHEN IT DOESN’T! I have posted on this before
            I recommend you read this link:

            https://quackwatch.org/related/altbelief/

            the excellent Barry Bayerstein has written many times on why people may often feel that something has helped them despite incontrovertible evidence that it has not.
            SCAM artists however are wedded to the belief in “personal experience” and “seeing is believing” rather than scientific evidence – which I guess is understandable as it gives them the answers they want rather than the actual truth which is far more inconvenient.

            And lastly – far more important than any evaluation of absolute risk is RELATIVE RISK. The possibility of benefit from any SCAM is nearly always ZERO. Accordingly that makes the acceptance of any risk unacceptable. Why accept any risk whatsoever when the likelihood of any gain is almost certainly zero? QED.

            Time to consider retraining.

          • “Millions say they get benefit from CAM”

            Argumentum ad populum. What counts is not what people say, but what they can show evidence for. It is CAM’s job to prove itself both safe and effective. What CAM proves over and over again is that is has no desire to do so, because to prove itself right it must first try its damndest to prove itself wrong—and that is a risk it is not willing to take.

            Which brings us to another defining (albeit non-unique) characteristic of the narcissistic mind: its pathological inability to accept, never mind acknowledge, that it could ever be wrong.

            (A defect I can relate to: as it wasn’t until I was picking up the pieces of my life for a second time that I was finally ready to admit to myself that I was in error—and that I urgently needed to fix that inability to accept my own mistakes because the consequences of denying them was killing me and hurting everyone around me too.)

            Alties simply can’t admit the possibility that they could ever be wrong, because once they open that door to self-doubt and self-correction, everything they are and believe themselves to be—the whole house of cards—comes crashing down around them. They would rather protect their personal beliefs than protect other people, because their beliefs are the foundation upon which their entire egos are built, and that ego they are not willing to let go. And if harms arise from their practise of those beliefs, well, they can just believe those injuries out of existence as well. Which is no doubt made much easier by never looking for injuries in the first place.

            Never-ending and perfectly circular indeed. But hey, it works wonderfully for them, and isn’t Them all that counts?

          • @john travis:

            All of these are being foisted upon a naive and unwary public – who need protecting in the same way they would from a fake bank, a car manufacturer selling dangerous cars, a toy maker selling toys made from lead, a company selling gas cookers that explode and so on.

            To be clear, members of the public need protecting from false representation; i.e. products that misrepresent themselves as safe and effective when they aren’t. That’s not “nannying”, that’s just society looking out for its own.

            MOPs are still free to choose SCAM over the warnings, of course, and that’s their right as individuals. It’s not parliament or courts’ job to legislate against willful human stupidity (as long as that individual’s stupidity only harms them, not anyone else).

            SCAMmers who peddle SCAM for monetary gain absolutely should be prosecuted for monetary fraud, though. If fantasy medicine is good enough for them, then fantasy payment damn well should be too. Let them be paid solely in kitten smiles and sunbeams, and that’ll sift the con artists from the true believers in no time at all.

  • “Meanwhile CAM marches on and accreditation is more likely in an ever increasing regulatory world.”

    That’s an interesting reading of the current situation re accreditation https://www.professionalstandards.org.uk/docs/default-source/publications/consultation-response/our-consultation/2020-accredited-registers-consultation/authority-consultation-on-the-future-shape-of-the-accredited-registers-programme.pdf needs to be read.

    CAM ARs make up a minority of ARs, even more so when numbers of registrants are considered. Psychological therapies make up the majority of registrants. Dealing with CAM registers costs the PSA disproportionate time and money. Fee income certainly does not reflect that.

    Any changes to eligibility/accreditation criteria would likely make it much more difficult (and expensive) for CAM registers to apply for accreditation and existing registers to maintain accreditation. There might be a situation in which the Federation of Holistic Therapists (FHT) and Complementary and Natural Healthcare Council (CNHC) are faced with the choice of de-recognising certain therapies or losing accreditation.

    The business of ARs putting its own and members’ interests ahead of those of the public has been identified as a big problem. The public health risks associated with practitioners spreading, say, anti-vaccine propaganda are well understood. The PSA have made it clear that this is incompatible with membership of an AR.

    It will be interesting to see what happens to the Society of Homeopaths (SoH) and its accreditation.

  • Well UK Homeopathy Regulations your links, are relevant to the discussion.
    It makes a change that I can consider your points seeing that some analysis and evaluation has gone into them.
    Thank you for that.

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