How the WHO is misleading the public about so-called alternative medicine (SCAM)

Yesterday, I posted the account of a WHO summit on so-called alternative medicine (SCAM). I deliberately abstained from any comment. Yet, the arguments put forward do certainly deserve some critical evaluation. In particular, I feel that this paragraph needs discussing:

The WHO says its Summit on Traditional Medicine is essentially about repeating this sifting process for traditional remedies used in other parts of the world. It aims to apply rigorous scientific analysis to all them in order to properly assess their claimed benefits and potential harms. By 2034, it says, it will publish a definitive list of which traditional treatments work – and which don’t. “Working on traditional medicine doesn’t mean we will use shortcuts or endorse things that are unproven,” Dr Sylvie Briand, the WHO’s Chief Scientist, told The Telegraph at the conference in New Delhi. The aim was first to document what traditional treatments existed around the world “and then see what could be more useful to address the disease of this century”.

To many readers such words (which are voiced regularly) might seem entirely reasonable. Yet, they clearly are not! So, let me pick them apart.

Applying rigorous scientific analysis to all SCAMs in order to properly assess their claimed benefits and potential harms. This plan looks fine – but only if you know little bit about the subject:

• It is obvious that not every nonsensical idea merits proper assessment. Many can be rejected out of hand by simply using common sense. A Peruvian man’s piercing ululation, for instance, might not require scientific testing – or, to put it bluntly, testing nonsense will result in nonsense and is a waste of money.
• It is a demonstrable fact that many other SCAMs have already been assessed properly and most have been found wanting. In my recent book, for example, I have evaluated 202 SCAMs and found only a handfull that pass muster. The problem for the WHO and other such organisations or individuals is not that the evidence is unavailable, but that they elect to ignore it.
• And that leads to a further important point. What the WHO and other organisations or individuals call “to properly assess” might not coincide with what scientists would consider a critical evaluation of the best available evidence. As we have seen with depressing regularity on this blog, biased assessments inevitably result in false-positive conclusions.

By 2034, the WHO will publish a definitive list of which traditional treatments work and which don’t. This might look encouragingly ambitious but it is not. On the conreary, it is discouragingly naive and totally impossible. Let me use just one of the many hundred SCAM modalities, acupuncture, to explain this in more detail:

• There are dozens of different types of acupuncture, e.g. traditional, Western, Korean, Japanese, needle, ear, body, scalp, tongue, electro, etc., etc.
• Acupuncture is touted as a panacea; this means each form of acupuncture would need to be tested in clinical trials of thousands of different conditions.
• Moreover, there are uncounted different treatment schedules with acupuncture.
• Even if rigorous, one trial can never enough for a firm verdict. To make sure that the result of one single trial is not a fluke, we need several independent replications.
• Combining all these imponerabilities would require thousands clinical trials and many decades before one could claim that one has established that this form of acupuncture works for this condition, and that form of acupuncture does not.
• In case the eventual verdict for acupuncture for any given condition is negative, some clever dick would surely emerge and claim, “but, of course, you did not do the test correctly! So, your verdict is mistaken”
• Add to this the fact that hundreds of different SCAM modalities exist and most of them claim to be a cure-all, we would not need a decade but several centuries to arrive at the embarrassingly naive aim of the WHO.

Considering these problems, I fear, that the ‘WHO Summit on Traditional Medicine’ might be full of good will [to be entirely honest, I am not even sure that this is true!] but this and similarly ignorant, naive and promotional initiatives certainly are leading us up an expensive, wasteful and dangerous garden path.

PS

Oh, I almost forgot!

To criticize is easy, some will say.

Why does Ernst not show us how it should be done properly?

How do we arrive at a point where we can say: THIS SCAM WORKS FOR THIS CONDITION, AND THAT SCAM DOES NOT?

The proper way of achieving this goal is to do what we do in all medicine and remember that the onus of proof lies on the shoulders of those who make the therapeutic claim. In other words, if acupuncturists claim that a certian type of acupuncture can effectively treat asthma, for example, let them come up with the evidence! Until the evidence is on the table, the claim should be viewed as unproven which means the treatment cannot be recommended.

Simple!