1. Patients launch $1.27 million crowdfunding campaign for ME/CFS gut microbiome study.
    Check out the website, Facebook and Twitter. Join in donate and spread the word!
ME/CFS and the Magic of the Canine Factor
There's been plenty of research indicating that having pets is good for your health. I never really noticed any particular benefits to having cats, though that may have had more to do with my cats. They've been fairly indifferent to my presence and we've shared a live-and-let-live...
Discuss the article on the Forums.

BMJ Blog: Edzard Ernst: The “natural” equals “safe” fallacy

Discussion in 'Other Health News and Research' started by Firestormm, Aug 26, 2012.

  1. Firestormm

    Firestormm Guest

    Messages:
    5,824
    Likes:
    5,982
    Cornwall England
    First appeared on MEA Facebook 25 August 2012

    Edzard Ernst: The “natural” equals “safe” fallacy

    15 August 2012

    "Things that are natural must be safe—this fallacy is deeply ingrained in our minds; it almost seems that, as human beings, we are hard-wired to believe this myth.

    An entire industry has developed around this claim: from toothpaste to wine, from dog-food to hand-cream, products are deemed to be better if they carry the label “natural.” One sector which clearly thrives on this fallacy is alternative medicine (AM).

    Much of the popularity of AM can be explained through our attraction to all things natural; according to its proponents, AM is natural; and, by definition, this means that it is devoid of risks—not like those nasty, synthetic, chemical prescription drugs, which are a major cause of mortality!

    This false logic convinces not just patients and consumers, it also seems to have bowled over large sections of the popular press and many politicians. Despite its popularity, the notion is obviously wrong and seriously misleading.

    The first thing which any critical thinker must notice is the disarmingly simple fact that by no means all types of AM are natural. What, for instance, would be natural about an acupuncturist sticking needles into patients, a chiropractor forcing vertebral joints beyond the physiological range of motion, a homeopath endlessly diluting his remedies, or a colonic irrigationist pushing a tube “where the sun don’t shine.”

    The closer we look, the more we realise that, in AM, natural is little more than a false label which might be good for PR, but which frequently does not coincide with reality.

    The next thing we cannot fail to observe is the indisputable fact that an entirely risk-free therapy does not exist—and this, of course, applies also to those forms of AM which have the reputation of being entirely safe.

    Homeopathic remedies, for instance, are usually as devoid of active molecules as they are of direct adverse effects. But this does not mean that homeopathy cannot do any harm! In fact, any ineffective treatment that is used for serious conditions will inevitably cause substantial harm, if it replaces effective therapies.

    Other forms of AM have been associated with considerable direct risks. Chiropractic manipulations, for instance, have been linked to numerous serious complications such as stroke and death.

    Similarly, herbal remedies can cause adverse effects through the toxicity of their ingredients or through interactions with synthetic drugs.

    Colonic irrigation has led to electrolyte-depletion and gut perforation. Aromatherapy may cause allergic reactions, etc, etc.

    But, on the whole, AM is relatively safe, i.e. it causes less problems than conventional treatments, enthusiasts would insist. This argument may well be true but, if employed to promote AM, it is nevertheless misleading.

    Firstly, we need to point out that, in AM, the post-marketing surveillance systems of conventional medicine do not exist.

    It is therefore conceivable, perhaps even likely that adverse-effects of AM are simply not being picked up. In this case, our impression of AM’s relative safety would not be entirely correct.

    Secondly, we should remind ourselves that the value of a treatment is not determined just by its safety; there are many safe yet useless interventions as well as harmful yet useful therapies.

    The worth of any given treatment is determined by the question whether it generates more good than harm. If a treatment is ineffective, even the smallest risk might tilt the risk-benefit balance into the negative.

    If another treatment is burdened with serious adverse-effects but its actions could save a life, it might still be highly useful.

    The conclusion from all this could not be simpler: the assumption that “natural” equals “safe” is wrong. In the realm of AM, it is widely used for promotional purposes—and that is wrong too, so much so that it can endanger the health of those who fall for this fallacy."

    Edzard Ernst is emeritus professor of complementary medicine at the Peninsula Medical School, Exeter.

    Comments to the blog are welcomed. You might like to check out Tom Kindlon's reply re: exercise for example.
     
  2. Tito

    Tito Senior Member

    Messages:
    300
    Likes:
    407
    And one often hears that the opposite of 'natural' is 'chemical' ... (instead of 'articicial')
    The whole 'natural=safe' is a marketing concept such as the 'five-a-day' etc. but because science is not properly taught (if at all) in schools these marketeers have wonderful days ahead of them...
    Generally speaking the idea that nature is 'good' is deeply ingrained in us since childhood. Animals are presented to children as sweet and innocent (teddy bears, etc.) and people rarely perceive how vicious these animals are.
     
  3. alex3619

    alex3619 Senior Member

    Messages:
    7,722
    Likes:
    12,638
    Logan, Queensland, Australia
    This article is correct in part, but conflates issues together in a misleading way. Nobody ever said acupuncture was natural for example, why subtly associate it with "unnatural"? Natural does not mean safe, obviously. The most dangerous things known to man are all natural - from pathogens and toxins to supernovas. If this is targeting "natural is safe", then fine, its a fallacy. However he goes further than that. There is a subtle implication that natural is unsafe. As always, it depends on the therapy, the patient, and how the therapy is used. Based on incidence of iatrogenic harm (medical inflicted), alternative medicines are orders of magnitude safer than conventional medicine. Of course that doesn't mean they can do everything. If I got run over by a semi-trailer, I would want a top surgeon and all the gizmos at their disposal, not a naturopath. If however I wanted to improve my diet to help with disease, I wouldn't even think of asking most doctors - their knowledge of nutrition is far worse than many patients.

    If this is an argument that alternative medicine is overhyped, he is right. What he fails to realize is that conventional medicine, and medical practitioner capability, are systematically overhyped.

    Bye, Alex
     
    Delia, mellster, SOC and 3 others like this.
  4. In Vitro Infidelium

    In Vitro Infidelium Guest

    Messages:
    646
    Likes:
    280
  5. alex3619

    alex3619 Senior Member

    Messages:
    7,722
    Likes:
    12,638
    Logan, Queensland, Australia
    Hi IVI, my argument stems from low hospitalization rates from alternative medicine. Drugs cause a lot of damage. Over the years I have read some surveys on this, although some of the time this has been from alternative medical practitioners and I have not been in a position to check the facts. If you want to argue the opposite, please cite some studies comparing numbers, not anecdotal accounts.

    One issue with alternative medicine is its not one discipline. Its many, including quacks and charlatans. However, conventional medicine has a huge proportion of borderline (and over the border) quackery too - much of psychiatry is entirely justified by unsubstantiated theory.

    Arguing about alternative health practitioners who harm large numbers of people, or who are quacks, is not a way to convince anyone. The worst and most excessive cases of those I am aware of are all qualified doctors including surgeons. So many have died or been harmed by these people. There have been several scandals about this in my state for example, and not one about alternative medicine. Now that might be a numbers game if far more were using conventional medicine than alternative medicine, but I think its heading toward the other way around.

    Have you heard of serial killer alternative practitioners? I haven't. I have heard of serial killer medical professionals though. Arguing from extremes does not get to the cause of the issues - plenty of people are criminals, its not an argument about the discipline but about people.

    I am fully aware of some alternative medicine claims that I would not support (and no I wont list them, some are used by people here on this forum and I do not want foist my opinion on them). There are branches of alternative medicine that I would not use.There is no substitute for doing a little research, just as you should not use a surgeon without checking their qualifications. Qualifications count. The risks from harm from alternative medicine largely come from less qualified people from what I can see.

    Most of this contrary data in the links given are anecdotal cases. Again, two can play that game. I can easily (but it would require a lot of time) get you lists of thousands harmed by conventional medicine. Hundreds of those would be local. Indeed, why not start with the majority of those with CFS, ME, fibro, MCS or GWS - say tens of millions of people? And thats just the beginning. I don't have a formal study to hand, but I will do a quick search after I write this to see if any harms have been compared statistically.

    Many of the items listed as adverse effects from alternative medicine are either obvious, or are things that would be obvious with minimal research. If the practitioner were qualified they would know this. Even if there were lots being harmed by this, it would just make an argument for better qualificatoins. These days naturopathy has a university degree here.

    I see no reason to consider alternative medicine to be more harmful than conventional medicine. It does need to be considered within its limitations though.In light of everythign I have seen and read over decades, natural medical approaches are much safer. This is not however an argument that they are generally more effective - how effective they are varies a lot, and many I regard as completely useless (literally applied magic). However I consider some modern psychiatry reliant on applied magic too.

    Let me cite some historical examples though. Psychiatry last century practice lobotomies, colonectomies, teeth removal and massive drug doses to cure insanity. I don't quite recall the numbers here, but we are talking hundreds of thousands. Conventional medicine had antiarrhythmic drugs and Vioxx. Both caused death. People might be aware of Vioxx, but the deaths from that pale to insignificance compared to how many were killed with antiarhythmia drugs. Thats just one class of drugs too.There is some evidence now of long term brain damage from antidepressants. Safe? Not really, its just that sometimes the risks are outweighed by the benefits.

    Now I do agree that many herbal medicine products, particularly from some parts of Asia, can be contaminated. So can any manufactured product, though medicinal drugs typically have high standards. Natural supplements sold here in Australia are subject to strict controls by the same agency that controls drugs - any contamination and the entire factory chain can be shut down. This has happened.. Herbs etc. from India can be contaminated with heavy metals, sure, but the chance of getting faulty or fraudulant drugs from Asia is also high. So it pays to qualify where the suspect supplement comes from.

    Similarly some of the compaints mentioned stem from what amounts to malpractice. A naturopath with a cancer patient who does not insist on conventional medicine in conjunction is asking to be sued, if not charged with a crime. Similarly the entire Laetrile saga in the middle of last century, where it was claimed Laetrile was a cure for cancer, was dealt with by multiple criminal proceedings, including murder if I recall correctly.

    So if your argument is there are quacks in alternative medicine, I agree. I think there are lots of quacks in conventional medicine too. Until medicine cleans up its act, which I see no signs of, this will continue.

    Finally, there is the issue of what is alternative medicine. Many who are considered to use alternative medicine are actually doctors who use off label drugs, or use non-standard tests, or who prescribe supplements. Thats all quackery according to some health fraud activists. Yet most doctors do some or all of these things from time to time .. am I to conclude that most doctors are practicing alternative medicine and its not safe?

    One last point, was thalidamide alternative medicine?

    Bye, Alex
     
    Delia likes this.
  6. alex3619

    alex3619 Senior Member

    Messages:
    7,722
    Likes:
    12,638
    Logan, Queensland, Australia
    The wikipedia is not a good or reliable source, but its easy to find. Look up iatrogenic harm:
    http://en.wikipedia.org/wiki/Iatrogenesis

    On order of 200,000 (actually over) are harmed per year in the USA alone. Now some of those would be alternative medicine effects, what percentage is not listed.

    The "Whats the Harm" website lists six hundred thousand harmed globally over decades. If we presume the US figure represents one fifth of world amounts, for simplicity as it leads to a million, then over the same time frame thirty million have been harmed from conventional medicine ... easily. There is a one to two order of magnitude difference right there.

    I am still looking for a more careful study to give a better picture.

    Bye, Alex

    I don't know how reliable this is, but here are some statistics:
    http://www.ourcivilisation.com/medicine/usamed/deaths.htm

    This source is unknown, so I cannot assess reliability.
     
  7. alex3619

    alex3619 Senior Member

    Messages:
    7,722
    Likes:
    12,638
    Logan, Queensland, Australia
    Then there is this article, claiming that iatrogenic death is the third leading cause of death in the USA - and they do not include alternative medicine here, or don't appear to:
    http://www.yourmedicaldetective.com/public/335.cfm

    This causes nearly three times as many deaths as car accidents according to one analysis. Again, however, there is no breakdown of alternative medicine.

    Here is an abstract with a direct comparison based on malpractice lawsuits, but I dont have the full paper:

    http://jama.jamanetwork.com/article.aspx?articleid=188140

    "In 2001, the FDA received 1,214 reports of adverse events regarding dietary supplements. That same year, it received more than 300,000 adverse reports about drugs. So, supplements represent less than half-of-one percent of drug adverse events using current FDA data."
    http://biotheorist.files.wordpress.com/2012/06/harm-a-compendium.pdf

    This source is again from alternative medicine I thin, so its hard to assess its realibility. Indeed, there appears to be no good data. However the huge difference in numbers is clearly apparent. They go on to make this claim:

    "According to reports from poison control centers throughout the United States, adverse reactions to drugs are more than 800 percent higher than those to dietary supplements [American Association of Poison Control Centers]."

    The cite a bunch of papers supporting this but I have not checked them. Eight times is about an order of magnitude. However, what is not clear is the percentage of alternatie supplements taken vs. drugs. Given what I see, which is biased as the ME and CFS communities take a lot of supplements, supplement usage is at least comparable to drug usage.
     
  8. alex3619

    alex3619 Senior Member

    Messages:
    7,722
    Likes:
    12,638
    Logan, Queensland, Australia
    There is a flip side to this argument too. How effective is conventional medicine compared to alternative medicine? In the case of chronic diseases, I would say its less effective, but thats subjective opinion. On the other hand for most other issues its more effective to far more effective. Efficacy, or even cost effectiveness, is a separate issue to risk.
     
  9. Esther12

    Esther12 Senior Member

    Messages:
    5,387
    Likes:
    5,902
    The safety of alternative medicine stems from the fact that it's largely just a range of placebos. Homoeopathy is a pretty safe treatment, and I'm not surprised the Royal Family are fans, given the exciting range of quacks they'll have had trying to make money from treating them with things likely to be actively harmful over the years.

    Sometimes nothing is better than something.

    I see that as more reason to fight to improve mainstream medicine rather than any reason to value alternative medicine though.
     
  10. alex3619

    alex3619 Senior Member

    Messages:
    7,722
    Likes:
    12,638
    Logan, Queensland, Australia
    Hi Esther12, in the long term I agree with you - the good things from alternative medicine need to be tested and incorporated into conventional medicine. This is happening, just very very slowly. The big reason is money - you can't patent traditional therapies.

    Many alternative medicine treatments just don't work, that is also not in dispute. More importantly, they don't work on all people. How many of us here have tried treatment X or treatment Y and found no benefit? How many thousands have we spent? The same applies to drugs though. Until ME is understood every drug is an experiment and might require the placebo effect to work - conventional medicine is in the same boat as alternative medicine for the most part with regard to ME. Those practitioners who practice cutting edge medicine are "alternative" because the other doctors haven't caught up - but at least they have some science to back their treatments, such as Myhill's mitochondrial studies.

    Bye, Alex
     
    SOC likes this.
  11. Esther12

    Esther12 Senior Member

    Messages:
    5,387
    Likes:
    5,902
    I'm pretty dubious about anyone making money from treating CFS.

    Effective treatments can come from alternative medicine, and there are problems with 'mainstream medicine', but for myself, I don't think I'd spend my time or money on anything that didn't have a good evidence base for efficacy - and that would almost inevitably lead to it['s acceptance as mainstream medicine.
     
    Firestormm likes this.
  12. barbc56

    barbc56 Senior Member

    Messages:
    1,578
    Likes:
    973
    Thanks for this article Firestorm. Ernst is a very interesting person.

    @Alex, a couple of references you might find helpful are:

    Trick or Treatment by Edward Ernst and Simon Singh.
    This book shows the scientific data behind many alternative treatments. Guess what, a few actually work!! The authors also go into how the sientific method. It's a fascinating read.

    One interesting fact in the book is that the first person to collect data to prove a hypothesis was Florence Nightengale, who later developed ME/CFS.

    Another good source is the following internet site:

    http://whatstheharm.net/

    One of the responses to what's the harm if people try AM is that people may delay legitimate medical treatment thinking that AM will cure them.

    Before anyone asks, no conventional medicine is not perfect, but the odds are certainly better!

    Barb C.:>)

    ETA I see someone mentioned What's the harm. I missed that.
     
  13. Don Quichotte

    Don Quichotte Don Quichotte

    Messages:
    97
    Likes:
    190
    You can't compare AM to conventional medicine.

    The reason is that AM is not regulated in any way and conventional medicine is. No doubt that the regulatory process is far from perfect and can be improved, but no conventional physician can decide that he/she starts treating patients with a certain medication because they have reasons to believe it will work (this can only be done within the constraints of a clinical trial which has to be approved by an independent committee), whereas AM practitioners can do that with no problem.

    The other reason is that conventional medicine constantly criticizes itself and dynamically changes. The studies you cite regarding iatrogenic damage which were published in leading journals, are an example of that. conventional medicine is constantly concerned not only with benefit, but also with potential harm.

    Conventional medicine has strict rules that have to be followed. Conventional physicians are liable for their errors and many times even for less beneficial outcomes which they did not explain clearly enough as possible consequences of their treatment. A conventional physician can be sued for loss of fertility caused by treatment that saved a patient's life if he failed to document that this outcome was clearly explained to the patient.

    How many AM physicians practicing acupuncture tell you that this can be fatal? How many tell you that there can be damage to nerve endings from this procedure? How many, on the other hand tell that this is a safe procedure that can only lead to benefit?

    AM is a "wastebasket" name which includes anything that can promote health or treat existing disease and is not in the realm of conventional medicine. It can range from nutrition (which I agree is not studied enough by conventional medicine, although this is now changing rapidly) to encounters with aliens from outer-space.

    I personally prefer the term complementary medicine, which is what has been tested (to some extent) but is not considered main-stream medicine. I hope that in the future it will become part of main-stream medicine. This includes nutrition, certain herbal medications, some forms of physical therapies and possibly relaxation techniques etc.

    I think that if you look at the history of modern medicine, most harmful practices have been corrected. Many diseases which were poorly understood and not properly treated are now much better understood, have effective management approaches and are even cured.

    I think that modern medicine has become the victim of its own success. Because of the enormous accomplishments (which are now taken for granted) there are unrealistic expectations from both physicians and patients regarding its true capabilities. It's much worse than hyping, as there is no need for hyping.

    Those unrealistic expectations lead to :patients blaming their physicians for not diagnosing an extremely rare disease, patients blaming their physicians for relatively minor side-effects of medications which saved their lives, patients blaming their physicians for inevitable human errors and patients blaming their physicians for not being able to cure incurable diseases.

    On the other hand physicians blame their patients for having an illness that doesn't fit their book, they blame their patients for not responding to "effective" medications, they blame their patients for having normal emotional responses to their illness etc etc.

    And health care managers blame physicians for lack of patient satisfaction, for less than perfect medical records and documentations, for lack of efficiency (which means spending too much time with each patient), for inevitable human errors etc.

    This leads to a very expensive and very frustrating system for all involved.
     
  14. barbc56

    barbc56 Senior Member

    Messages:
    1,578
    Likes:
    973
    This is why I recommend the book Trick or Treatment. It does address alternative practices and the science or lack of science behind them.

    I would not say that most aternative medicine practioners are on the cutting edge and conventional medicine just hasn't caught up. In fact, I would say it's probably the other way around. Alternative practioners haven't caught up with science based medicine.

    As far as Myhill, don't get me started. Her tests and treatments are not reliable nor valid. But that subject is for another day, eh?

    If alternative medicine works, it's not alternative, it's just medicine.

    Barb C.:>)
     
  15. alex3619

    alex3619 Senior Member

    Messages:
    7,722
    Likes:
    12,638
    Logan, Queensland, Australia
    Much of alternative medicine does indeed have justification. A lot has been incorporated into conventional medicine. Alternative medicine is a nonsense phrase - its a catch all. Don Quichotte is correct about that. This is in part because its defined as an absence of conventional medicine. In time everything useful in alternative medicine will be incorporated in conventional medicine, but that time frame is huge - probably at least a century.

    My problem with the arguments against alternative medicine is also based on the uselessness of the phrase. Its used by very conservative people in the medical and associated industries to attack all non-conventional medicine, as defined by them. I will be discussing this in one of my two next blogs, Greenwashing. I wonder if we should not distinguish between traditional alternative medicine, and recently invented alternative medicine which has not been around long enough for anyone to understand what the impact is.

    For example, any treatment not traditionally used or supported by current medical systems is alternative. That includes treatments based on sound biochemistry. The anti-health fraud proponents have lobbied since the 1980s against a wide range of treatments. Vitamins apparently don't help people. Known poisons are good for you. These are the kinds of claims made by some. Every treatment except CBT/GET being used to treat ME, CFS or similar disorders have been attacked as unjustified alternative medicine. Sometimes this is indeed a justified claim, each and every claim has to be considered based on the specifics of the claim. There is no substitute for investigating claims.

    According to the WHO traditional medicines are the dominant medicine in many parts of the world. The WHO supports traditional medicine. Those medical practices are artforms, not science. Many modern drugs are derived from traditional herbal therapies.

    Some traditional herbal recipes however use poisonous materials. So do some traditional western herbal therapies, though mostly we have stopped using them. However conventional medicine has had a history of this too - mercury and arsenic used to be considered fantastic drugs. Radiation was considered to be good for you. What differentiates science from artform is that in time science addresses these issues, though as we know from the Tobacco and health debate, society can resist scientific enquiry for decades. Currently we face that with CBT/GET and the Dysfunctional Belief Model of CFS (DBM).

    Bye, Alex
     
    Delia and Adamskitutu like this.
  16. Hope123

    Hope123 Senior Member

    Messages:
    1,171
    Likes:
    688
    Not reading all of the above but wanted to say:

    1) Alternative medicines and practices are not tracked as consistently as allopathic medicine and treatments. For example, it's not perfect, but drug companies in the US are required many times to do what is called "Phase 4 trials" -- surveillance for ill effects of drugs after they are released widely to the general public. There is no similar mandated system for alternative treatments although some professional or research groups might do this voluntarily or out of interest - not too common though.

    2) Coming from a family with people in both allopathic and traditional medicine, I have used both but my family feels that for their area, traditional Chinese medicine, it has gotten interpreted and used in ways in the West that are outside the bounds of what certain treatments were traditionally used for and this is not always a good thing.

    3) Somewhat tangential but people need to remember that a "good" quack or charlatan never says things that are 100% fake. There is usually some true science in what they say to sell their product. It's not until one digs deeper that you find their theory/ treatments might be wrong or unsafe. I think this is the most difficult piece for non-science/ non-health-trained people to understand and even professionals can be fooled occasionally.

    A resource: http://nccam.nih.gov/health/decisions
     
    Delia likes this.
  17. mellster

    mellster Marco

    Messages:
    801
    Likes:
    180
    San Francisco
    Most people do not start so-called "alternative" treatments unless they exhausted the conventional path and nothing helped. So this is a total non-issue and totally overblown. Plus, there are plenty of remedies deemed "alternative" that have solid scientific research backing them which you can find on the web. Stick with those if you are skeptical, no problem.
     
  18. barbc56

    barbc56 Senior Member

    Messages:
    1,578
    Likes:
    973
    If there is credible research backing up an alternative treatment, it is not considered alternative but conventional. This is an important distinction as it shows why alternative and conventional mean two different things.
     
  19. Marco

    Marco Old blackguard

    Messages:
    1,400
    Likes:
    1,080
    Near Cognac, France
    This whole 'debate' reminds me of a conversation with a previous GP who told me that there was absolutely nothing he could offer me but to not even think about going near any alternative therapies.

    As previously mentioned, many millions if not billions have used traditional/alternative therapies for many centuries amounting to a vast number of individual experiments in a naturalistic setting. These therapies are not considered 'mainstream' in western medicine because they have not been 'scientifically' verified. Contrast though the value the empirical data derived from these 'natural experiments' to empirical findings from a few controlled experiments that necessarily have to reduce the number of variables to ensure replicability to the point that the experiment may have no external ecological validity.

    Personally I take N-acetylcysteine as it is cheap, well tolerated and I have found by chance that it can prevent PEM. Mainstream medicine does not recognise any disease mechanism in ME/CFS that would account for this beneficial effect.

    I probably don't have another 27 years to wait for mainstream medicine to give NAC its scientific seal of approval.

    More generally this opinion piece also reminds me of Richard Dawkins who, in his enthusiasm to debunk what he sees as the indefensible, appears to me to do so in the same dogmatic and patronising manner that threatens to make him a mirror image of those he opposes.

    A little live and let live wouldn't go amiss.
     
    Delia, natasa778 and Adamskitutu like this.
  20. Valentijn

    Valentijn Activity Level: 3

    Messages:
    6,714
    Likes:
    10,220
    Amersfoort, Netherlands
    I think alternative medicine can be safe, as long as it's done carefully. Find out what the ingredients are, what effects they're known to have, and safe dosages.

    Vitamins and supplements are things we already (should) have in our bodies. As long as you know what a safe amount is to take, there's little risk in trying them, and the possibility of benefits we're not getting from conventional medicine.
     

See more popular forum discussions.

Share This Page