Another reason to write about alternative medicine: risk. Alternative therapies have associated risks that practitioners may not inform patients about. In part one of this series (here), I linked to research that found media coverage of alternative medicine to be positive (in some cases overwhelmingly so) and to lack discussion of the risks, benefits, and costs.
Given the reluctance of practitioners and journalists to tell people about the risks of CAM, I think it is worth taking some time to blog about them.
Physical risks to the patient
Risks depend on the therapy, but include vertebral artery dissection followed by stroke after cervical manipulation by a chiropractor, liver damage from kava, deaths associated with acupuncture, the finding that Vitamin A, beta-carotene, and vitamin E supplements may increase mortality, and remedies such as ayurvedic medicines being contaminated with heavy metals.
Chelation therapy is not an alternative treatment (if used for lead poisoning) – but its off-label use is alternative. Despite there being no scientific support for these off-label uses, some practitioners have tried chelation therapy for autism and to treat coronary artery disease. There have been deaths from such off-label use of chelation therapy.
Colonic irrigation might lead to perforation of the rectum. Alternative diets might lead to nutritional deficiencies, rickets, and stunted growth. Ear injuries may occur as a result of candling. High doses of vitamin B6 can cause nerve damage. If you see a chiropractor you may be exposed unnecessarily to X-rays.
Although serious adverse events linked to alternative therapies tend to be uncommon, you can be poisoned, punctured, and even killed by alternative medicine. If you were going to take the risk of trying a treatment that had serious (if rare) side effects, I imagine you’d want to be pretty certain that it was going to do some good. Most alternative therapies are of little or no benefit for the conditions for which they are promoted. (You can find reviews of alternative therapies for various conditions here: http://www.thecochranelibrary.com/view/0/index.html.)
Failure to seek conventional treatment
The website What’s The Harm has a number of reports of people alleged to have been caused harm by alternative medicine. In many cases, the harm resulted from people failing to seek proper medical treatment (preferring to rely on homeopathy or some other alternative remedy). Here is the section on homeopathy. Harm caused due to reliance on homeopathy and failure to take conventional treatment includes malaria, organ failure, and death. You can find similar cases on their alternative medicine page – including deaths from AIDS, seizures, and breast cancer in patients who tried vitamin pills, acupuncture, and psychic healing instead of using conventional treatments.
This is a real problem with alternative medicine – it is being offered as an alternative to effective treatments for serious conditions.
Some nutritionists advise IgG testing for food intolerance (more here: SBM, Holford Watch, Breath Spa for Kids), which costs between $150 and $350 (cached page). Some also offer tests and treatment for histadelia (£55 for a test, plus the cost of daily doses of two grams of Vitamin C, 15mg of Zinc, 5mg of Manganese, and at least 50mg of Vitamin B6 the last time I checked).
As explained in the posts I link to above, IgG tests are not useful – the presence of IgG antibodies does not indicate food intolerance. There appears to be no evidence that histadelia exists as a condition, that it can be diagnosed by a test, or that the treatments for it are beneficial. When I found nothing on Pubmed to support the claims made by those promoting tests and treatments for histadelia, I contacted some of them (Dr Kaslow and the Pfeiffer Treatment Center) to ask for the evidence that they based their claims on. Dr Kaslow advised me to contact the Pfeiffer Treatment Center and the PTC declined to respond to my emails.
In my beginners guide to chiropractic, I found that the cost of examination and treatment at the hands of a chiropractor was between £40 and £84. This page on the NHS website states that: “The cost of chiropractic varies and depends on the length of a particular chiropractic session. On average, a 30-minute session will cost £20-35 and an hour session £40-80”. Chiropractors often offer to treat conditions that there is no evidence they can successfully treat: colic, ear infections, or bedwetting to pick just three examples.
I found that Helios would charge me £4.45 for 4g of a 30C homeopathic product (X-ray tablets). A pound per gram for a ‘remedy’ that contains not a single molecule of the purported active ingredient. I checked to see if this was typical and found that Boiron USA X-ray 30C tablets could be purchased for a similar price on Amazon. These tablets contain sucrose and lactose. Now, I checked how much it normally costs to buy sugar. You can buy a 2kg bag for £3.49, or 1000 sachets for about a tenner (a penny a sachet). I don’t think I’m unreasonable in considering homeopathic products to be an expensive way to take sugar.
This is the risk that concerns me least. If people want to spend money on useless tests and treatments then that is up to them. As long as someone is pointing out that they are wasting that money. [Edit, see below comment #20 from phayes.]
Misinformation on public health issues
Advocates of alternative medicine often hold worrying positions on issues like vaccination. In surveys, chiropractors and homeopaths have revealed anti-vaccination sentiments and even advised against MMR vaccination. In this paper, Ernst found that websites for chiropractic, homeopathy and naturopathy generally did not recommend immunisation and promoted anti-immunisation attitudes (“of the 36 websites identified, only two offered advice in favour of conventional immunisation; three sites presented information that was considered neutral”).
Then there’s the nutritionist who claimed that AZT, the first prescribable anti-HIV drug, is potentially harmful, and proving less effective than Vitamin C and the vitamin pill entrepeneur who bought full page adverts denouncing Aids drugs while promoting his vitamin pills in South Africa, and sued his critics.
This risk is an important one – undermining conventional treatments for serious conditions, or public health initiatives such as vaccination, can have serious consequences. Here, for example, is what one paper says about the situation in South Africa where there was antipathy to anti-retroviral drugs such as AZT:
Demographic modelling suggests that if the national government had used ARVs for prevention and treatment at the same rate as the Western Cape (which defied national policy on ARVs), then about 171,000 HIV infections and 343,000 deaths could have been prevented between 1999 and 2007.