21. Introduction to Alternative Healthcare

This following sections will consider complementary and alternative medicine or CAM, looking at various types, their philosophies and objective evidence about them.
This introductory chapter will include:

If you wish to go directly to any of the above headings, click on the title in blue above.

We shall examine the demand for “complementary and alternative medicine” or CAM and also regulation of practitioners. Homeopathy, acupuncture, manipulation, reflexology, and herbal remedies will all be scrutinised as well as chelation therapy and hypnosis. There will also be a brief look at some other forms including aromatherapy, crystal therapy, magnetic healing, reiki, iridology and traditional Chinese medicine. These forms of treatments will be examined to see how an objective analysis of their results holds up. Where possible there will also be an examination of the underlying philosophy. This introduction is a general overview of complementary and alternative medicine. Specific modalities are covered in the following chapters.

Conclusions about complementary and alternative medicine are at the end of the last chapter in the section, called Other Modalities of Complementary and Alternative Medicine

The Demand for Complementary and Alternative Medicine

There was a House of Lords Select Committee Report on CAM in November 2000.1House of Lords. Complementary and alternative medicine. There was also a subcommittee of the Royal College of Physicians set up to examine certain aspects of CAM. They reported in Clinical Medicine in 2003,2Complementary medicine: evidence base, competence to practice and regulation formerly the Journal of the Royal College of Physicians.

According to a report from 2001, in the UK, 47% of people have used complementary and alternative medicine (CAM) at some times in their lives and 10% use some form of CAM each year.3Use and expenditure on complementary medicine in England Users tend to be older, female and less than 10% was purchased by the NHS. At the time, at least 10% of hospital physicians used CAM as part of their clinical practice.4Attitudes to and use of complementary medicine among physicians in the United Kingdom A survey conducted in 2001 estimated that one in two general practices in England offered their patients some access to CAM.5Trends in access to complementary or alternative medicines via primary care in England I suspect that current figures are rather lower.

Alternative therapies, including herbs, vitamins, and supplements, contribute to an industry with a worldwide turnover of billions of pounds each year. The American Society of Clinical Oncology conducted a survey in 2017 and repeated it again in 2018.6Cancer Opinions Survey The results varied depending on age. Younger people aged between 18 and 37 were much more likely to believe that there is a benefit with the use of alternative therapies compared with older people. They found that 21% of people over the age of 72 believed that these agents could cure cancer without conventional therapies. Only 15% say they talk to their doctors about the role or the use of these alternative therapies. This was an American survey, but I wonder of a British one would be very different.

When people have serious diseases such as cancer or HIV infection, they are often so desperate that they will take any hope that is offered to them, and this includes CAM. They think that at the very least, if it does no good, it will do no harm. They may well be wrong. Parents of children with autism are also vulnerable to exploitation as scientific medicine does not offer a cure.

Just over half (56%) of men with prostate cancer in a large American study reported using complementary and alternative medicine (CAM), and the study also found that use of these products has been increasing in recent years (1996–2016).7Trends in Complementary and Alternative Medicine Use among Patients with Prostate Cancer. Multivitamins and omega-3 fatty acids were commonly used, and vitamin D use increased dramatically from 2006–2010 compared with 2011-2016. An American study, involving more than 30,000 participants found that, for the general population, taking dietary supplements does not reduce the mortality risk from either cardiovascular disease or cancer.8Association Among Dietary Supplement Use, Nutrient Intake, and Mortality Among U.S. Adults: A Cohort Study However, the study also found that taking high-dose calcium supplements appeared to increase the risk of dying from cancer. This study is of concern, as not only are all the CAM treatments and dietary supplements useless, but the increasing popularity of vitamin D supplements may be counterproductive.

They call it “complementary” rather than “alternative” suggesting it should be used alongside scientific treatments, but they may interfere with medication or wound healing

Recently, I had reason to see some information from a cancer charity in East Anglia called The Big C. Although they were not portraying this as an alternative to normal treatment, I was unhappy to find that it was offering prostate cancer sufferers reflexology and reiki. The first is reviewed in the chapter Reflexology and Reiki in the chapter Other Modalities of Complementary and Alternative Medicine. Both are fanciful in supposed method of action and useless, although probably not harmful unless they seduce patients to abandon scientific treatment. What patients need is evidence-based medicine, not quackery, especially when they have serious diseases.

Patients with breast cancer fare no better. A Portuguese professor and senior breast surgeon told an international conference in 2019 that many treatments, including popular herbal teas, may interfere with the healing of wounds after surgery. These include feverfew, garlic, ginger, ginseng, hawthorn and horse chestnut. She said that patients with breast cancer were particularly likely to resort to topical creams because the disease frequently metastasises (secondaries) to the skin, causing discomfort and distress. She added that there is a huge number of herbal products available but the evidence for their efficacy is nil and that patients often do more harm than good.

If alternative therapies prevent people from accessing effective treatments or if they interfere with medication, they do harm

The chairman of the conference said, “One of the downsides of the digital revolution is that it is now easy for people to access information, not all of which is reliable. This can create confusion and even inform poor decisions. This includes the setting of so-called complementary or alternative approaches for skin metastases. Patients need to recognise that all opinions are not equal and there is still a vital role for experts, which includes the patient’s personal care team.” I have not given a reference here as it is not freely available.

Diabetes is also a disease that needs scientific treatment but a systematic review and meta-analysis found that CAM was often used by those with the disease throughout the world.9Global prevalence and types of complementary and alternative medicines use amongst adults with diabetes: systematic review and meta-analysis It concluded that there is a wide variation in the prevalence of CAM use by patients with diabetes but healthcare professionals should be aware that patients may be using it and they may not admit to it unless asked. There can be dangerous interactions between herbs and drugs and adherence to medication must be encouraged.

As CAM treatments for serious diseases such as cancer are not funded by the NHS or health insurance in other countries, people sometimes turn to crowd-funding. According to one report, 220 cancer patient campaigns have raised $1.4 Million.10Crowdfunding Homeopathy for Cancer: A Very American Thing They said that the vast majority at 186 cases or 85% of the campaigners were in the United States, with some in Canada (23 cases or 10%). The United Kingdom had 8 or 4%, with just one campaign each in Germany, Ireland, and Spain. This refers to a paper which does not have an abstract on PubMed and the full version is not available without charge. It starts by saying, “It is estimated that approximately half of all patients with cancer use complementary and alternative medicine (CAM), and its popularity is on the rise. Patients with cancer seek these alternative therapies for a variety of reasons including providing a sense of control, helping with pain, and coping with treatment. But there are clear risks associated with this trend, including concerns that desperate patients can be exploited or that the CAM treatment could be harmful, or result in an adverse interaction with conventional therapy. Indeed, a 2018 study found that use of CAM by patients with cancer was associated with a reduced chance of survival.”

Time and again we have seen that many people seem to confuse celebrity status with expertise. Celebrities endorse absurd fads and some will take them up. An article in The Times was called 11NHS boss Simon Stevens hits out at quacks, charlatans … and Gwyneth Paltrow. She was his main target for peddling nonsense on that occasion but there are plenty more candidates.

Classification of Complementary and Alternative Medicine

Complementary and Alternative Medicine (CAM) can be classified in a number of ways. One is as follows:

  • Alternative medical systems such traditional Chinese medicine and acupuncture, naturopathic medicine and homeopathy.
  • Biological-based therapies including herbal remedies, special diets, and individual biological treatments.
  • Energy therapies such as Reiki, therapeutic touch, magnet therapy, Qi Gong, and intercessory prayer.
  • Manipulative and body-based systems including chiropractic, osteopathy, and massage.
  • Mind-body interventions such as meditation, biofeedback, hypnotherapy, and the relaxation response.

Evidence and Objective Analysis

Are they the wisdom of the past or the foolishness of a bygone age?

It is sometimes claimed that doctors reject CAM because they are too narrow-minded or because they see it as a threat. Conventional medicine has to be evidence based as far as possible and a number of treatments are no longer used because evidence has shown that they do not work. Far fewer tonsils are removed nowadays and a D and C for menstrual problems is confined to history. This is because of evidence. Before we accept other forms of treatment we must see that they are both safe and effective. That puts them on par with conventional medicine, which is what they say that they want.

Randomised controlled trials are the gold standard for assessing treatment. Anecdotes are useless

The double-blind randomised placebo-controlled trial is the gold standard for assessing the value of interventions and so it should be with CAM. To read more about such trials and how they are conducted, see Randomised Controlled Trials. Many practitioners argue that their treatment is tailor-made for the patient and so it cannot be subjected to such analysis. This is usually untrue. Physical treatments are more difficult to get an adequate placebo control. For medication, it should be no problem although strong tastes in herbal products may make it more difficult. One trial of a skin preparation compared a brown liquid with a strong smell of pine with a bland white cream. This is a totally unsatisfactory control. In acupuncture and manipulation there have been interesting and commendable attempts to get a suitable control and this will be discussed in the relevant chapters. It is very common to find that promotion for various forms of CAM makes claim to be scientifically based, but all too often these claims are empty.

Sometimes people claim that their favourite form of treatment is traditional and has been around for hundreds of years, and so it must be effective. They say that it has been tried and tested over time. It may have been tried but it has not been tested. Would you be happy if your doctor suggested bloodletting and purgatives? Why not? It was used for many centuries. It was a logical form of treatment based on the theories of Galen who was regarded as the ultimate authority for a great many centuries. We now know that Galen was wrong but only because his theories have been put to the test. Heavy metals such as bismuth and lead were used to treat disease. Would you buy face cream containing arsenic or lead? It was very popular in centuries past.

Many of the theories behind CAM are implausible at best. Each will be considered in its own section. That does not mean that the treatment is ineffective. We know that penicillin works by interfering with the synthesis of the bacterial cell wall. If we thought that it disrupted bacterial DNA and this is entirely wrong, that would not stop it from working. Therefore judgement must be based on the controlled trials.

Psychoanalysis is based on dogma rather than refutable evidence. It can involve regular sessions over many years and this keeps the practitioners in business and presumably their subjects are happy to keep parting with their money. It has waned in popularity and no longer seems to be part of mainstream psychiatric practice. As it is not amenable to scientific scrutiny it will be discussed no further.

A name that will appear on many papers and systematic reviews about CAM is E Ernst.12Profile in The Guardian Professor Edzard Ernst was born on Germany in 1948 and qualified in medicine there. He came from a family of doctors and his family doctor was a homeopath. He saw that as a normal part of medicine. In Germany, homeopathy and other forms of CAM tend to be used freely and uncritically. He was trained in acupuncture, herbalism, homoeopathy, massage therapy, autogenic training, and spinal manipulation and he worked at a homeopathic hospital. Autogenic training is a relaxation technique first introduced by German psychiatrist Johannes Heinrich Schultz in 1932. In 1988, he became Professor in Physical Medicine and Rehabilitation at Hannover Medical School and in 1990 moved to head the department at the University of Vienna. He moved to the University of Exeter as the first ever Professor of Complementary Medicine in 2002.

Professor Edzard Ernst

He performed many systematic reviews in the field and wrote extensively on the matter. He also helped to develop the “stage dagger” retracting acupuncture needle for placebo control, as will be explained in the section on acupuncture. He is regarded by many practitioners of CAM as fundamentally antagonistic to them. This he denies. 13The alternative professor He says that he just wants to put their remedies to the test that other treatments face. He has published vast numbers of papers including many systematic reviews. He has even published systematic reviews of systematic reviews.14A systematic review of systematic reviews of homeopathy Many fall short of the necessary strict methodology. Many other authors are also concerned about the lack of hard evidence for CAM. 15Exposing the evidence gap for complementary and alternative medicine

Prince Charles’ private secretary accused Edzard Ernst of having breached a confidentiality agreement regarding the 2005 Smallwood report of the role of complementary and alternative medicine in the NHS. He was strongly criticised for disclosing the report’s contents before they had been fully reviewed and published. The Smallwood Report was commissioned by The Prince of Wales’ Foundation for Integrated Health. It had commissioned them to conduct a study of the cost-effectiveness of complementary and alternative medicine (CAM). Christopher Smallwood was an economist. According to the BBC, the report covers the “Big Five” complementary and alternative therapies in the form of osteopathy and chiropractic, acupuncture, homeopathy and herbal medicine.16Charles study backs NHS therapies It seems to suggest that CAM treatments are cheaper than conventional medicine, but the BBC says that the report does not say that wider use would bring huge savings to the NHS.

Even this report, commissioned by Prince Charles, casts doubt upon the effectiveness of homeopathy. Regardless of how cheap an intervention may be, if it is ineffective, it does not offer value. Edzard Ernst wrote an article in the British Journal of General Practice casting doubt upon the value of the report.17The ‘Smallwood report’: method or madness? The narrative of the report seemed to prefer anecdotes and stories to hard evidence, and perhaps we can see some royal influence on this line of inquiry.

According to Wikipedia, an interesting source but to be treated with care, after being subjected to a “very unpleasant” investigation by the University of Exeter, the university “accepted his innocence but continued, in his view, to treat him as ‘persona non grata’. All fundraising for his unit ceased, forcing him to use up its core funding and allow its 15 staff to drift away.” He retired in 2011, two years ahead of his official retirement. There are allegations that he was forced out by royal pressure and the unique department was closed.18Prince Charles ‘silenced’ professor over row on complementary medicine He is now Professor Emeritus which is a title of respect given to professors who have retired. Not all retired professors are given this accolade. He continues to write in academic journals, the media including The Guardian and on his own website.19Edzard Ernst. Official Site

Writers who advocate CAM often claim to be promoting a discipline based in science, but a closer look usually shows that they are most uncritical. There is often paranoia and inference of conspiracy theories by scientific medicine to ignore or deride them. Too often there is no valid scientific evidence about the effectiveness of their treatment and it does not have any rational explanation. That is not to say that all CAM is necessarily rubbish. We shall see how it fares in the test.

Regulation

Regulation of such practitioners causes concern. The House of Lords Select Committee was very keen20House of Lords Regulation of CAM but little is done or planned. There are a number of voluntary regulatory authorities but at the time of writing only osteopaths and chiropractors have any statutory regulation. It is estimated that there are about 1,000 of each in the UK compared with an estimated 14,000 healers, 7,000 aromatherapists and 5,000 reflexologists. There are an estimated 50,000 CAM practitioners compared with 38,000 GPs in the UK. The committee recommended that “It is our opinion that acupuncture and herbal medicine are the two therapies which are at a stage where it would be of benefit to them and their patients if the practitioners strive for statutory regulation under the Health Act 1999, and we recommend that they should do so. Statutory regulation may also be appropriate eventually for the non-medical homeopaths.” It accepts that a single regulatory authority would be inappropriate to cover all forms of CAM as they are too diverse although an Institute for Complementary and Natural Medicine21Institute for Complementary and Natural Medicine exists and claims to have a register.

Who sets and enforces standards?

However, having a register is entirely different from enforcing standards. In 2011 the British Acupuncture Council supported regulation for its 3,000 members but none was imminent.22British Acupuncture Council. Statutory regulation for acupuncture A number of practitioners of acupuncture are doctors or physiotherapists who already have a system of regulation. Herbal medicine will get regulation.23European Herbal & Traditional Medicine Practitioners Association. Statutory regulation in the UK. The European Herbal and Traditional Medicine Practitioners Association welcomes the move but the Independent Herbalists UK is opposed, saying that it will reduce their freedom. They accuse those in favour of regulation of “dirty tricks and misinformation.”

It is not just those who wish to peddle unregulated and untested medicines who oppose regulation. Some people are concerned that regulation of CAM may give it an undue legitimacy.24UK-wide consultation on CAM regulation is launched What it really needs is a strong evidence base to determine what works and what does not. Look first to the validity of the method of treatment. Then look to the validity of the person offering it.

In September 2014, the British Professional Standards Authority for Health and Social Care (PSA) announced that it endorsed a register of qualified homeopaths. This was met with an outcry from scientific health care professionals including Simon Singh.25Outcry as register of homeopaths gets official backing According to The Times, Harry Cayton, chief executive of the authority said, “It’s a matter of opinion. The people who use homeopathy have an opinion.” Science is not about opinion. It is about evidence.

Without some form of regulation those who wish to consult a practitioner in the field have little idea whether or not that person has any qualification of value. Ignore letters after a name. Some are registered medical practitioners who also practice CAM, usually acupuncture, manipulation or homeopathy. Some may assume the title of “doctor” but have no right to do so. I would have thought that this amounted to masquerading as a duly qualified medical practitioner but apparently it does not. I have no problem with people with a PhD or other doctorate degrees who use the title provided that it is a proper doctoral degree and not something bought over the Internet.

Qualifications can be fake or meaningless

No one would accuse the Archbishop of Canterbury of pretending to be a medical practitioner. However, when people assume the title to practice in a field of healthcare, this does tend to imply a qualification that they do not possess. Apparently anyone can assume the title of “Doctor” and I think that applies to “Professor” too. Chiropractors may have the qualification of DC that means “doctor of chiropractic” but it is not in any way comparable with doctorate degrees from reputable universities or a medical qualification. It is possible to get qualifications including degrees over the Internet. I have received spam offering me bachelor’s degrees, masters or doctorates without needing any study. Selling useless degrees on the Internet or elsewhere is a big business.

People may feel that CAM should be free to advertise and to attract attention but it often fails to comply with the Trades Description Act which basically says that a product must do what the claims for it say. CAM often falls severely short on this, especially with regard to evidence of efficacy. A major cause for concern is not the “worried well” or the trendy who want something different, but where valid and scientifically based forms of treatment are rejected in favour of nonsense. It is not just the unintelligent or ignorant who may fall prey to this. Steve Jobs was the founder of Apple and must have been a brilliant man, but when he received a diagnosis of pancreatic cancer, he spent six months on a macrobiotic diet before resorting to scientific medicine. That gave his cancer a further six months without treatment and it may have cost him his life.

In late 2019, The Times was highly critical of Google for permitting advertisements for substances that were not just ineffective, but dangerous too.26Google pushes quack cancer cure Miracle Mineral Solution One substance was Miracle Mineral Solution (MMS), which contains chlorine dioxide used in water purification and bleach. It has been advertised to cure cancer, autism and AIDS. Those three claims together should immediately spark scepticism and if it does work, why is it not available through conventional channels? Google displayed one advert for MMS in the form of chlorine dioxide water purification drops, which told users to add them to a bath “for a total healing detox”. The instructions added: “Basically, it will heal anything.” People with cancer can be desperate when told that they have a potentially fatal disease, but they need scientific medicine, not to be fleeced by charlatans.

This is not a medicine!

There was a similar story in early 2020. The Times exposed a clinic run by someone who said her practice was “like your GP”.27Clinic ‘advises bleach to cure autism’ She offers one-to-one consultations at £34 for 30 minutes or £60 for an hour. She is not a doctor but a podiatrist. She gave the names of two websites that sold chlorine dioxide and said that up to 20 drops a day could be stirred into a drink and given to a child with autism. When asked whether it could be administered with an enema, she recommended buying a funnel to pour it into the child’s rectum, adding: “Well, you’re tackling it from both ends, you see. I think you’ve still got to introduce it orally because you know it’s going right through the system then and you can have the pathogens in the oesophagus, and the liver and the stomach. But through the rectum, yeah, you’re getting straight into the colon.”

She says that the molecular formula for bleach is H2O2, whereas the molecular formula for chlorine dioxide is ClO2. H2O2 is hydrogen peroxide that can be used as a bleach and is often used to bleach hair. It is not to be swallowed. Household bleach has the chemical name sodium hypochlorite, with the formula NaClO. Chlorine dioxide is used as an industrial bleach.

They claim that the pharmaceutical industry is only interested in profit, but what is their motivation for pedalling fake cures to those with potentially fatal disease?

An internet search for chlorine dioxide produced the following two pieces of advice. “What are the health benefits of chlorine dioxide?” It said, “Chlorine dioxide is used to kill microbes in the bloodstream. How effective it is on any given microbial disease depends on the life-cycle of the microbe. For example, it has a 100 percent cure rate on malaria because the malaria microbe is always in the bloodstream.” A high enough concentration to kill all the malaria parasites in the blood would certainly kill the patient too. This was followed by a link to a site that advocated chlorine dioxide as a treatment for cancer. It was related to the Miracle Mineral Solution (MMS) which we have seen above.

This was followed later by “Is chlorine dioxide toxic?” This said, “Chlorine dioxide bleaching agent is a very unstable compound, it is considered extremely toxic and explosive to handle and transport. At high concentration it is a spontaneous explosive. Moreover, it is exploded by UV light, contact with mercury and organic matter, or by electric spark.”

The podiatrist is a follower of Kerri Rivera, an American former estate agent who is a prominent advocate of using chlorine dioxide to treat autism. The estate agent said, “Reporters and ‘journalists’ are not interested in the truth nor science, only opinions of so-called ‘professionals’ who have no science nor chemistry degrees. Doctors are not chemists. They rarely understand chemistry.” In the UK doctors need at least A-level chemistry to start their course which includes further chemistry. There would be similar requirements in the USA. Estate agents do not need to know about chemistry.

Most bleaches are oxidising agents. This includes hydrogen peroxide, sodium hypochlorite and chlorine dioxide. They kill micro-organisms including bacteria and viruses. They also kill normal cells in the body. The same applies to antiseptics generally. Hence, it may be useful to use an antiseptic on a possibly infected wound but do not use repeatedly or it will slow wound healing.

Chlorine dioxide has been claimed as a treatment for HIV/AIDS, malaria, autism, hepatitis A, B, and C, diabetes, Lyme disease, herpes, MRSA, multiple sclerosis, parasitic infections, dengue fever, Parkinson’s Disease, Alzheimer’s Disease and coronavirus. Donald Trump is not the only one with lunatic ideas about using bleach. It is an effective antiseptic on a surface but not to be taken internally.

A very sad story that appeared on the BBC website was called 28I lost my boyfriend to cancer ‘conspiracy theories’ It concerns a young man who had a recurrence of a Hodgkin’s Lymphoma after treatment and he feared the side-effects from further treatment. He was told he had a 50% chance of long-term cure with further therapy. Instead of discussing it with his oncologist, he researched alternatives online and believed he could cure his cancer by detoxing and completely changing his lifestyle. He relied on “thermographic scans” which are heat images of the body and advertised as being radiation free, which would be true. He took them as reassurance that the alternative treatments were working, although the NHS warns there is no evidence that thermography is an effective way to test for or monitor cancer. He thought that he was responding to the treatment but the cancer was enlarging. He was looking ill but he girlfriend used terms like, “It’s the Herxheimer’s reaction”, which means getting worse before getting better. It is seen a lot of the alternative forums. The Herxheimer’s reaction is actually what happens when a person receives penicillin for syphilis and it kills the organisms so fast that toxins are released and the patient feels ill. He had a tumour the size on a grapefruit in his stomach and three others around his body. He died at the age of 23.

Some examples of totally unfounded ways to “cure” cancer by diet.

He became immersed in forums and online communities dedicated to “curing cancer naturally” and his girlfriend and mother got sucked into it. He went vegan, tried cannabis oil and started using coffee enemas. He documented his journey on Facebook Lives and grew a huge following. When he realised he had been duped, he deactivated his social media accounts when he should have exposed the betrayal. I wonder how many know that he was victim of a scam and died as a result. I think that it is a pity that he did not continue and broadcast his devastation, anger and failing health as he died from a scam.

Conspiracy theories abounded in their world. Memes on their phones were reinforcing what they thought every day. “Cherries neutralize acidity in the body and kill cancer cells,” read one totally absurd post on Instagram. It was hope that they wanted and it made them vulnerable. It was so convincing in the way that it was written on the internet and by charismatic speakers.

Fraudsters are pedalling fake cures to people with fatal but potentially curable diseases. They are not just the worried well. The hypocrisy of suggesting that the pharmaceutical industry does not provide effective treatments because they are only interested in profits is quite dumbfounding. Anyone running a business hopes to make a profit. A doctor expects to get paid at the end of the month. That does not mean that he does not care about his patients. These people are as bad as those who scam old people of their life savings. They are psychopaths who lead people to their deaths. The Government would not tolerate financial scams, and there are plenty of them. Nor should they tolerate scams that offer false hope and take people’s lives.

Natural Healing

A term that is often used with regard to CAM is “holistic”. This means looking at the whole person and not just the disease. This is a basic feature of all forms of medical practice including conventional medicine. At least it should be. Another term is “integrated”. It can mean holistic or sometimes it implies a desire to be integrated into mainstream healthcare. Either way, it is not a term to be given much credence.

Would you accept untested treatments from the pharmaceutical industry?

A common inference is that CAM is “natural” or “nature’s healing”. Natural healing is just leaving it to get better by itself. There is nothing natural about any form of medical intervention. Doing what is not natural is part of what places us above the animals. The natural response to appendicitis is for peritonitis to develop and this may result in a pelvic abscess or death. Most people prefer the unnatural approach of surgical removal of the diseased appendix.

Claims are often made that treatments “stimulate the immune system” or “enhance the body’s natural response”. Quite how this is measured remains a mystery. There is usually some vague suggestion that the presence of antioxidants in certain foods boosts the immune system.29Natural Therapy Pages. How to Boost Your Immune System Anti-oxidants will be discussed in a later chapter on nutrition. Claims of “immune system enhancement” may appear to be supported by some pseudoscientific words possibly explaining how the immune system works but it gives no indication of how to measure its activity. The reference given30Immune system enhancement. Compassionate Acupuncture & Healing Arts even has a list of references at the end, like a scientific paper, but not one is for a peer reviewed journal. A rise in blood white cell count or changes in blood flow are not an indicator of immune activity and can be a non-specific response to stress.

There are ways of measuring immune competence as is done in research into HIV and AIDS.31Measuring immune response by flow cytometry An article from Harvard Medical School points out the need for scepticism of claims to boost the immune system.32How to boost your immune system. Harvard Health Publications. Harvard Medical School Most websites that make claims of “how to boost your immune system” simply assume that it is a good thing even in normal people and give no indication of any evidence base that either it is helpful or that it happens. None of them mention CD4 lymphocytes or any other type of measurement that an immunologist would use.

The immune system must be kept in balance. Underactivity may lead to infection. Immune surveillance is part of the prevention of cancer, taking out rogue cells before they turn malignant.33Immune surveillance of tumors However, inflammation from an overactive system, can also damage the body. Auto-immune disease can destroy organs and destruction of insulin producing cells causes type 1 diabetes34Diabetes UK, Type 1 diabetes and a number of other diseases including both an overactive and underactive thyroid gland and rheumatoid arthritis. High levels of markers of inflammation are linked to coronary heart disease. People with rheumatoid arthritis, an inflammatory autoimmune disease, have an even higher risk for coronary heart disease than diabetics.35Rheumatoid arthritis and cardiovascular disease A cascade of inflammation is what damages organs and causes death in COVID-19 infection. The immune system must be in balance and an overactive one is as bad as an underactive one. Most of these claims about immune enhancement are without foundation.

Athletes and body builders will take anything for a slight advantage

Not everything that is promoted as “natural” is quite as pure and unadulterated as may be hoped. A Chinese herbal cream for use in infantile eczema was found to contain betamethasone, better known by its trade name Betnovate.36Chinese herbal remedies may contain steroids It is a very potent steroid which should not be used in infants and should not be used on the face at any age. This cream is put on the face of infants. A few years later a paper examined herbal creams that were being used by children attending the skin department at the Birmingham Children’s Hospital. They found that the majority of the creams that they analysed contained potent or very potent steroids.37Herbal creams used for atopic eczema in Birmingham, UK
illegally contain potent corticosteroids.
This is not just very bad practice. It is illegal.

Adulteration of oriental herbal products seems quite common. The sprinters Carl Lewis and Linford Christie have both tested positive for stimulants and both blamed Chinese herbal products. Both were lucky not to be banned from their sport as a result. There is a very common and very naïve attitude among sportsmen and coaches that oriental herbs offer a safe, effective and legal means of performance enhancement. There is no evidence to support this belief. Adulteration of supplements for use in sports is a major problem and a common reason for positive drug tests.

It is impossible to cover all of CAM. It is far too varied. Instead a number of the better known and more commonly used techniques will be scrutinised. Almost every form of CAM claims on their website to be scientifically based. As we shall see, this is usually an empty claim. In criminal law we have a premise of “innocent until proved guilty”. However, for treatments we should assume “ineffective until proved effective” and “dangerous until proved safe”. There are pressures to get the NHS to embrace more CAM in response to consumer demand. There is also pressure to get it to stop funding treatments that are of limited or no value. The NHS must provide value for taxpayers’ money. If CAM is to find its way into the NHS besides orthodox medicine, it has to earn its place. This means not by the number of years that it has been around or by consumer demand but by scientific validity.

It works for me. It must be good

Many people have a medical problem that comes and goes. It may be arthritis, a painful neck or depression. It has good times and bad times. Hence it has a natural cycle of up and down. That does not necessarily mean that there is regularity in these cycles. Sometimes attacks may be more severe or more prolonged. Sometimes remissions may be longer or shorter. The fact is that there are good times and bad times.

The public are very gullible about anything called “natural”

You may find that a friend or family member has a favourite treatment that they advise you to try. It may be herbal or a “natural” remedy. It may be a nutritional supplement. It might be cod liver oil, garlic capsules, green mussel extract, a multivitamin preparation or a mineral supplement. At first you are reluctant but as the condition gets more severe you relent and give it a try. Then you improve and it appears that the treatment has worked. You were bad. You took the treatment and you improved. It must have made you better!

Is this view justified? We need to look at the natural history. This means what happens if the condition is left untreated.

As we have seen, the natural history of the condition is that it has cycles of good and of bad. Therefore, when it is bad, especially when it is very bad, the only way is up. We can expect it to get better with time. This will happen without treatment. However, if we take treatment and it gets better we attribute this to the treatment rather than to the natural progression which is to recover after a bad spell.

Like the stock market, chronic conditions have natural ups and downs

It is the same with the Stock Market. It has cycles of up and down. When it is at a low it will almost certainly get better. When it is high it is likely to fall. However, many people, especially small investors fail to appreciate this and so they do not buy when the market is down and sell when it is up but they follow the “bull” or “bear” sentiment. Provided that you do not invest in a company that goes bankrupt, buy low and sell high.

So how do we know if these treatments are any good? The answer is by Randomised Controlled Trials. This will show the difference between natural history and real benefit. Indeed, the “wonder cure” may even slow recovery but because there is recovery it is attributed to the treatment. Trying something when “the only way is up” is bound to be associated with improvement. This issue is discussed in much more depth in Snake Oil Science which is one of the books in “further reading” below.

Testimonials are useless

There are plenty of people to offer testimonials for CAM but they are no substitute for trials. Ten testimonials, even if they are genuine, may represent the few who got better whilst the other 90 were no better or even worse. They are ignored. The placebo effect is very important. This is why Randomised Controlled Trials are so important.

Further Resources

References

  1. House of Lords Select Committee on Science and Technology; 6th report, session 1999-2000. Complementary and alternative medicine. November 2000.
    http://www.parliament.the-stationery-office.co.uk/pa/ld199900/ldselect/ldsctech/123/12301.htm
  2. Lewith GT, Breen A, Filshie J, et al; Complementary medicine: evidence base, competence to practice and regulation.; Clin Med. 2003 May-Jun;3(3):235-40.
    http://www.ncbi.nlm.nih.gov/pubmed/12848257
  3. Thomas KJ, Nicholl JP, Coleman P; Use and expenditure on complementary medicine in England: a population based survey.; Complement Ther Med. 2001 Mar;9(1):2-11.
    http://www.ncbi.nlm.nih.gov/pubmed/11264963
  4. Lewith GT, Hyland M, Gray SF; Attitudes to and use of complementary medicine among physicians in the United Kingdom.; Complement Ther Med. 2001 Sep;9(3):167-72.
    http://www.ncbi.nlm.nih.gov/pubmed/11926430
  5. Thomas KJ, Coleman P, Nicholl JP; Trends in access to complementary or alternative medicines via primary care in England: 1995-2001 results from a follow-up national survey.; Fam Pract. 2003 Oct;20(5):575-7. [full text]
    http://fampra.oxfordjournals.org/content/20/5/575.long
  6. The American Society of Clinical Oncology. ASCO 2018 Cancer Opinions Survey October 2018 page 49.
    https://www.asco.org/sites/new-www.asco.org/files/content-files/research-and-progress/documents/2018-NCOS-Results.pdf
  7. Zuniga KB, Zhao S, Kenfield SA, Cedars B, Cowan JE, Van Blarigan EL, et al. Trends in Complementary and Alternative Medicine Use among Patients with Prostate Cancer. J Urol. 2019 May 15:101097
    https://www.ncbi.nlm.nih.gov/pubmed/31091175
  8. Chen F, Du M, Blumberg JB, Ho Chui KK, Ruan M, Rogers G, Shan Z, Zeng L, Zhang FF. Association Among Dietary Supplement Use, Nutrient Intake, and Mortality Among U.S. Adults: A Cohort Study. Ann Intern Med. 2019 May 7;170(9):604-613.
    https://www.ncbi.nlm.nih.gov/pubmed/30959527
  9. Alzahrani AS, Price MJ, Greenfield SM, Paudyal V. Global prevalence and types of complementary and alternative medicines use amongst adults with diabetes: systematic review and meta-analysis. Eur J Clin Pharmacol. 2021 Mar 8 [Epub ahead of print]. doi: 10.1007/s00228-021-03097-x. PMID: 33686454
    https://link.springer.com/article/10.1007/s00228-021-03097-x
  10. Crowdfunding Homeopathy for Cancer: A Very American Thing. Medscape 4 January 2019.
    https://www.medscape.com/viewarticle/907249
  11. NHS boss Simon Stevens hits out at quacks, charlatans … and Gwyneth Paltrow. The Times 31 January 2020.
    https://www.thetimes.co.uk/edition/news/nhs-boss-simon-stevens-hits-out-at-quacks-charlatans-and-gwyneth-paltrow-zh63d3qzv
  12. The Guardian. Profile of Edzard Ernst.
    https://www.theguardian.com/profile/edzardernst
  13. Boslely S. The alternative professor. The Guardian 25th September 2003.
    http://www.guardian.co.uk/science/2003/sep/25/scienceinterviews.health
  14. Ernst E. A systematic review of systematic reviews of homeopathy.Br J Clin Pharmacol. 2002 Dec; 54(6): 577–582.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1874503/
  15. Power M, Hopayian K. Exposing the evidence gap for complementary and alternative medicine to be integrated into science-based medicine. J R Soc Med. 2011 Apr;104(4):155-61.
    http://www.ncbi.nlm.nih.gov/pubmed/21502214
  16. Charles study backs NHS therapies. BBC News 5th October 2005.
    http://news.bbc.co.uk/1/hi/health/4312780.stm
  17. Ernst E. The ‘Smallwood report’: method or madness? Br J Gen Pract. 2006 Jan 1; 56(522): 64–65.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1821425/
  18. Prince Charles ‘silenced’ professor over row on complementary medicine. The Daily Telegraph. 20th January 2015.
    https://www.telegraph.co.uk/news/uknews/prince-charles/11358546/Prince-Charles-silenced-Professor-over-row-on-complementary-medicine.html
  19. Edzard Ernst. Official Site.
    https://edzardernst.com/
  20. House of Lords. Select Committee on Science and Technology Sixth Report. Chapter 5 regulation. 2000.
    https://publications.parliament.uk/pa/ld199900/ldselect/ldsctech/123/12307.htm
  21. Institute for Complementary and Natural Medicine.
    http://icnm.org.uk/
  22. British Acupuncture Council. Statutory regulation for acupuncture. 14th July 2011.
    https://www.acupuncture.org.uk/public-content/public-regulation-updates/statutory-regulation.html
  23. European Herbal and Traditional Medicine Practitioners Association. Statutory regulation in the UK.
    http://www.ehtpa.eu/statutory_regulation/in_uk/index.html
  24. Corbyn Z. UK-wide consultation on CAM regulation is launched. Times Higher Education. 5th August 2009.
    https://www.timeshighereducation.com/news/uk-wide-consultation-on-cam-regulation-is-launched/407695.article?sectioncode=26&storycode=407695&c=2
  25. Outcry as register of homeopaths gets official backing. The Times 16th September 2014.
    http://www.thetimes.co.uk/tto/health/news/article4207497.ece
  26. Google pushes quack cancer cure Miracle Mineral Solution. The Times 28 December 2019.
    https://www.thetimes.co.uk/edition/news/google-pushes-quack-cancer-cure-miracle-mineral-solution-jjjhhwg36
  27. Clinic ‘advises bleach to cure autism’. The Times 22 February 2020.
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  28. I lost my boyfriend to cancer ‘conspiracy theories’. BBC3 20 July 2020
    https://www.bbc.co.uk/bbcthree/article/72396917-47b0-4aac-856f-e213c3a0c3fa
  29. Natural Therapy Pages. How to Boost Your Immune System.
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  30. Gomer JG. Immune system enhancement. Compassionate Acupuncture & Healing Arts. 2005.
    http://www.compassionateacupuncture.com/immune-system-enhancement/
  31. Measuring immune response by flow cytometry. Drug discovery and development 3rd February 2005.
    https://www.rdmag.com/article/2007/09/measuring-immune-response-flow-cytometry
  32. How to boost your immune system. Harvard Health Publications. Harvard Medical School.
    https://www.health.harvard.edu/flu-resource-center/how-to-boost-your-immune-system.htm
  33. Swann JB, Smyth MJ. Immune surveillance of tumors. J Clin Invest. 2007 May 1; 117(5): 1137–1146.
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  34. Diabetes UK, Type 1 diabetes.
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  35. Crowson CS, Liao Kp, Davis JM, Soloman DH, Matteson EL, Nutson KL et al. Rheumatoid arthritis and cardiovascular disease. Am Heart J. 2013 Oct; 166(4): 622–628.e1.
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  36. Graham-Brown RA, Bourke JF, Bumphrey G. Chinese herbal remedies may contain steroids. BMJ. 1994 Feb 12; 308 (6926):473.[full text]
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  37. Ramsay HM, Goddard W, Gill S, Moss C. Herbal creams used for atopic eczema in Birmingham, UK illegally contain potent corticosteroids. Arch Dis Child 2003;88:1056–1057. [full text]
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Site Index

This website is now completed, although I shall continue to do updates. The following list shows the sections or chapters. Just click on the topic in blue to go to that part of the site.

1 Introduction
2 A Very Brief History of Science And Medicine
  Fundamentals of Medical Science
3 Finding Good Medical Advice and Evidence Based Medicine
4 Randomised Controlled Trials
5 Cohort or Longitudinal and Epidemiological Studies
6 Qualitative Research
7 Basic Maths in Medical Research and Decision Making
8 How Good is the Evidence?
9 Ethics in Practice and Research
  Public Health Issues
10 Screening Programmes
11 Fake News and Vaccine Scares
12 Electronic Cigarettes (E-Cigarettes)
13 Motor Vehicle Emissions, Air Pollution and Health
  COVID-19
14 COVID-19. What You Need to Know
15 Who is at Risk from COVID-19
16 What we Must Learn from the COVID-19 Pandemic
  Nutrition
17 Basics of Nutrition
18 Exercise, Obesity and Diets for Weight Loss
19 Diets and Nutrition for Health and Fitness
20 Supplements
  Complementary and Alternative Medicine
21 Introduction to Alternative Healthcare
22 Homeopathy
23 Acupuncture
24 Manipulation of the Spine
25 Reflexology
26 Herbal Remedies
27 Other Natural Products
28 Chelation Therapy
29 Hypnosis
30 Other Modalities of Complementary and Alternative Medicine
  Some Controversial Diseases
31 Fibromyalgia
32 Chronic Fatigue Syndrome (CFS) or Myalgic Encephalitis (ME)
33 Systemic Candidiasis and Leaky Gut Syndrome
34 Mobile Phones, Masts, Wi-Fi and Electro-sensitivity
  The Environment
35 Global Warming and Climate Change
36 Alternative Energy
  Some Final Thoughts
37 Still Searching for the Age of Reason