Alternative therapies are increasingly mainstream. That means headaches for scientists—and no cure in sight
Three dozen doctors-in-training recently sat in a conference room in Tucson. Arizona sunshine streamed through open French windows. On the floor were votive candles and peacock feathers, symbols of healing. It was the closing ceremony in a month-long course at the Centre for Integrative Medicine at the University of Arizona, promoting the notion that doctors should use alternative treatments alongside conventional ones. Speaking to the students was Andrew Weil, a doctor and campaigner who heads the centre.
Dr Weil is a diminutive Santa Claus with a not-so-diminutive brand. He writes books and sells products (such as the Dr Andrew Weil for Origins™ Mega-Mushroom Skin Relief Soothing Face Lotion, for $61). Profits go to his foundation. On this occasion he was in his role as teacher, explaining the importance of nutrition in keeping patients well. That is a doctor's task, he said, not merely treating the sick.
Few in mainstream medicine would disagree with such an approach. But Dr Weil continued by saying that evidence-based medicine, at its worst, “is exactly analogous to religious fundamentalism.” He urged the students to promote integrative medicine. Together, they would be the future of American health care.
They are well on their way. By one recent count four in ten American adults use some form of alternative therapy. If Dr Weil's flourishing business and other programmes are any indication, these will grow even further. For six decades double-blind, randomised, placebo-controlled trials have helped doctors to sort science from opinion and to sift evidence from anecdote. Now those lines are blurring.
The evidence for alternative treatments varies wildly. Some herbal remedies broadly meet the test of mainstream medicine. St John's Wort has anti-depressive effects (though quite how it works is not completely clear). Chinese herbs may improve chemotherapy for colon cancer. Acupuncture can relieve nausea and some types of pain—though for other ailments it seems no more effective than a placebo, according to Edzard Ernst, who led the study of alternative medicine at Exeter University. Homeopathy is more controversial. Believers say substances which in large quantities may cause symptoms of illness can cure them in highly diluted form, thanks to an imprint left on the water. Sceptics deride both that claim and the principle behind it.
An example is Oscillococcinum, a homeopathic treatment for flu symptoms made with extract of duck heart and liver. Once diluted 100-fold—with the process then repeated another 200 times—it purportedly gains healing properties. Boiron, a French firm that makes this and other such products, had revenues of €523m ($681m) in 2011. Whatever the scientific arguments (or lack of them) for such treatments, the commercial ones are striking.
Powerful supporters have helped the cause. King George VI helped to ensure that homeopathy would be part of Britain's newly created National Health Service (his grandson, Prince Charles, is also a fan). Royal Copeland, an American senator and homeopath, saw to it that the Food, Drug and Cosmetic Act of 1938 authorised homeopathic products. Sixty years on another senator, Tom Harkin, helped to set up the National Centre for Complementary and Alternative Medicine (NCCAM) at the world's leading medical-research outfit, the National Institutes of Health (NIH).
The $1.5 billion that taxpayers have devoted to NCCAM has brought meagre returns. In 2009 Mr Harkin said it had “fallen short” and bemoaned its focus on “disproving things” rather than approving them. But it has spawned a new generation of research outfits. The University of Maryland's Centre for Integrative Medicine has received $25m from the NIH for research. Separately it offers treatments such as reiki, in which a healer floats his hands over the patient's body.
In 2003, with NIH funding, Georgetown University created a master's degree in alternative therapies. The University of Arizona offers training in them for medical students and a two-year distance-learning course for doctors and nurses. The Consortium of Academic Health Centres for Integrative Medicine now has 50 members.
Such trends have vocal opponents. In Britain and Australia, horrified scientists are fighting hard against the teaching of alternative therapies in publicly funded universities and against their provision in mainstream medical care. They have had most success in Britain. David Colquhoun, a pharmacology professor at University College London, has shamed some universities into ending alternative courses. The number of homeopathic hospitals in Britain is dwindling. In 2005 the Lancet, a leading medical journal, analysed the evidence and declared “the end of homeopathy”. In 2010 a parliamentary science committee advised that “the government should not endorse the use of placebo treatments including homeopathy.” But the NHS still provides it, albeit to the modest tune of £4m ($6.3m) a year.
A similar push in Australia has proved futile so far. In January a group of dismayed academics, doctors and scientists urged universities to renounce courses in alternative medicine. The universities' leaders have yet to budge, although a leaked paper from the National Health and Medical Research Council describes homeopathy as “unethical” and baseless.
The future for the alternative-therapy industry looks particularly bright in America. NCCAM continues to pay for research. Josephine Briggs, its director, says she is neither for nor against alternative treatments; she just wants to test which ones work and which do not (she is also interested in the effect of medical rituals). But Steven Novella, a vocal critic at Yale University, argues that the centre's very existence fuels the cause. “People say, ‘The government is researching that, so it has got to be legitimate',” he complains.
Supporters of alternative medicine have two additional forces in their favour. Conventional health care has some clear failings. As Dr Weil points out, America's health-care system excels at treating sick patients but is miserable at keeping them well. The pharmaceutical industry struggles to create good, long-term treatments for pain and other chronic conditions. Many doctors are hurried or come across as unsympathetic. Alternative practitioners spend time with patients, asking about not just their medical histories but their lifestyles. They may emphasise nutrition and exercise. Many such treatments, especially the hands-on ones, are soothing. It is unsurprising if patients feel better.
Second, arguments that insist on evidence and scientific rationales work only with those who think that these are all that matters. Many providers of alternative therapy say it is inherently unsuited to double-blind randomised trials.
The study of placebos does not jar with orthodox medicine. Harvard University (which employed Henry Beecher, inventor of the randomised trial) has now created a new programme in “Placebo Studies and the Therapeutic Encounter”. Ted Kaptchuk, its director, is studying how patients respond to sham treatments, as well as the importance of patient's faith in a treatment. In a paper in the New England Journal of Medicine last July he described an experiment with asthma inhalers. The real ones improved patients' lung function by 20%, compared with 7% for the alternatives: a dummy inhaler or acupuncture. But patients judged the effectiveness of the three therapies to be about the same.
The worries about the ethics of prescribing a placebo are real. But so are fears that alternative therapies may do harm—for instance, by tempting patients to shun real medicine. Steve Jobs, the founder of Apple, died from cancer last year after having first favoured acupuncture and fruit juices over conventional treatment. Misplaced faith has its costs.
A homeopathic remedy is recalled—for containing medicine
By C.H., New York, March 28, 2014
Homeopathic remedies claim to cure all kinds of ills, from fever to depression.
Exactly how they heal has always defied conventional scientific logic, as their “active” ingredient is present in such small amounts as not to be active—the more diluted the substance, according to homeopaths, the more powerful it becomes. American regulators allow the sale of homeopathic products, but do not require them to meet any standard for efficacy. That serves manufacturers well, as most homeopathic remedies consist of sugar or water.
This month, however, a company called Terra-Medica got in trouble with American regulators. The firm’s problem? Containing medicine. Terra-Medica’s Pleo products are supposed to ease digestion, colds and fungal infections, as well as prevent viruses and treat their symptoms—an impressive list, no doubt. The Food and Drug Administration (FDA) announced on March 18th that Terra-Medica would recall 56 lots of its Pleo products. The FDA had found these to contain penicillin or derivatives of it.
Homeopathic remedies do bring some tiny benefit: they are as effective as a placebo. If they contain actual pharmacological ingredients, however, they might do real harm. Americans spent $2.9 billion on homeopathic medicines and $170m on visits to homeopathic practitioners, according to a national survey in 2007.
The Economist explains why homeopathy is nonsense
By C.H., New York, April 1, 2014
Visit any health shop and you are likely to see them: packages of homeopathic remedies claiming to cure whatever ails you, from coughs and fever to insomnia and asthma. Flip the package of medicine, however, and you may be confused by the listed ingredients. Some claim to contain crushed bees, stinging nettles and even arsenic, as well as sugars such as lactose and sucrose. Americans spend some $3 billion a year on homeopathic medicines. What are they thinking? The history of homeopathy—literally, "similar suffering"—dates to the late 18th century. Samuel Hahnemann, a German doctor, was unimpressed by contemporary medicine, with good reason. Doctors used leeches to let blood and hot plasters to bring on blisters, which were then drained. In 1790 Hahnemann developed a fever that transformed his career. After swallowing powder from the bark of a cinchona tree, he saw his temperature rise. Cinchona bark contains quinine, which was already known to treat malaria. Hahnemann considered the facts: cinchona seemed to give him a fever; fever is a symptom of malaria; and cinchona treats malaria. He then made an acrobatic leap of logic: medicines bring on the same symptoms in healthy people as they cure in sick ones. Find a substance that induces an illness and it might treat that illness in another.
Hahnemann then decided that ingredients should be diluted and shaken repeatedly, a process called "potentiation". The smaller the amount of the active ingredient, the more powerful the medicine would become, he believed. Homeopathic remedies use various bits of terminology to convey their supposedly potency. One common designation is "NC", where C signifies that a substance is diluted by a ratio of 1:100 and N stands for the number of times the substance has been diluted. So a dilution of 200C would mean that one gram of a substance had been diluted within 100 grams of water, with the process repeated 200 times. At this dilution not a single molecule of the original substance remains. Most homeopathic pills are made entirely of sugar. However, the pills are supposed to retain a "memory" of the original substance. This is bunk. Studying homeopathy is difficult, points out the world’s biggest funder of medical research, America’s National Institutes of Health (NIH), because it is hard to examine the effects of a medicine when that medicine has little or no active ingredient. Researchers can neither confirm that the medicine contains what it claims to nor show the chemical effect of the diluted medicine within the body. The most comprehensive review of homeopathy was published in 2005 in the Lancet, a medical journal. Researchers compared trials of homeopathic and conventional medicines. In the bigger, well-designed trials, there was "no convincing evidence" that homeopathy was more effective than a placebo, they found. Meanwhile, in similar trials of conventional drugs, medicines showed specific clinical effects.
As the NIH dryly notes: "several key concepts of homeopathy are inconsistent with fundamental concepts of chemistry and physics."
The last four reports on homoeopathy are from The Economist.
When defenders of homoeopathy or sincere inquirers ask me about reports that homoeopathy actually works, I summarise my reply as follows, and The Economist backs me on my position:
1. The patient experiences what is known as "The Placebo Effect". The person may feel an improvement in his condition with the concerned and detailed holistic questioning directed at him by the homoeopath (as compared to the impersonal approach of conventional medicine).
In Appendices 1 and 2 of the fourth chapter of his book A MAGICKAL HERBALL COMPLEAT, Pino Longchild provides the herbalist/homoeopath two sets of questions to be put to the subject before the diagnosis and prescription of remedies. See http://ephesians-511.net/docs/A_MAGICKAL_HERBALL_COMPLEAT-PINO_LONGCHILD.doc.
2. Time heals. The recipient of the remedies may be cured in seven days, or if not, in a week’s time.
3. There are genuine medicines incorporated into the homoeopathic preparations.
Homeopathy is witchcraft, say doctors
By Laura Donnelly, Health Correspondent May 15, 2010
Homeopathy is "witchcraft" and the National Health Service should not pay for it, the British Medical Association has declared.
Hundreds of members of the BMA (British Medical Association) have passed a motion denouncing the use of the alternative medicine, saying taxpayers should not foot the bill for remedies with no scientific basis to support them.
The BMA has previously expressed scepticism about homoeopathy, arguing that the rationing body, the National Institute for Health and Clinical Excellence should examine the evidence base and make a definitive ruling about the use of the remedies in the NHS.
Now, the annual conference of junior doctors has gone further, with a vote overwhelmingly supporting a blanket ban, and an end to all placements for trainee doctors which teach them homeopathic principles.
Dr Tom Dolphin, deputy chairman of the BMA's junior doctors committee in England told the conference: "Homeopathy is witchcraft. It is a disgrace that nestling between the National Hospital for Neurology and Great Ormond Street [in London] there is a National Hospital for Homeopathy which is paid for by the NHS".
The alternative medicine, devised in the 18th century by the German physician Samuel Hahnemann, is based on a theory that substances which cause symptoms in a healthy person can, when vastly diluted, cure the same problems in a sick person.
Proponents say the resulting remedy retains a "memory" of the original ingredient – a concept dismissed by scientists.
Latest figures show 54,000 patients are treated each year at four NHS homeopathic hospitals in London, Glasgow, Bristol and Liverpool, at an estimated cost of £4 million.
A fifth hospital in Tunbridge Wells in Kent was forced to close last year when local NHS funders stopped paying for treatments.
Gordon Lehany, chairman of the BMA's junior doctors committee in Scotland said it was wrong that some junior doctors were spending part of their training rotations in homeopathic hospitals, learning principles which had no place in science.
He told the conference in London last weekend: "At a time when the NHS is struggling for cash we should be focusing on treatments that have proven benefit. If people wish to pay for homoeopathy that's their choice but it shouldn't be paid for on the NHS until there is evidence that it works."
The motion was supported by BMA Chairman Dr Hamish Meldrum, though it will only become official policy of the whole organisation if it is agreed by their full conference next month.
In February a report by MPs said the alternative medicine should not receive state funding.
The Commons science and technology committee also said vials of the remedies should not be allowed to use phrases like "used to treat" in their marketing, as consumers might think there is clinical evidence that they work.
In evidence to the committee, the Royal Pharmaceutical Society of Great Britain said there was no possible reason why such treatments, marketed by an industry worth £40 million in this country, could be effective scientifically.
Advocates of homoeopathy say even if the effect of the remedies is to work as a placebo, they are chosen by thousands of people, and do not carry the risks and side effects of many mainstream medicines.
A survey carried out at England's NHS homeopathic hospitals found 70 per cent of patients said they felt some improvement after undergoing treatment.
Crystal Sumner, chief executive of the British Homeopathic Association (BHA), said attempts to stop the NHS funding alternative medicines ignored the views of the public, especially patients with chronic conditions.
She said: "Homeopathy helps thousands of people who are not helped by conventional care. We don't want it to be a substitute for mainstream care, but when people are thinking about making cuts to funding, I think they need to consider public satisfaction, and see that homoeopathy has a place in medicine."
She said junior doctors' calls for an end to any training placements based in homeopathic hospitals ignored the lessons alternative medicine could provide, in terms of how to diagnose patients.
Estimates on how much the NHS spends on homoeopathy vary. The BHA says the NHS spends about £4 million a year on homeopathic services, although the Department of Health says spending on the medicines themselves is just £152,000 a year.
Two weeks ago, a charity founded by the Prince of Wales to promote alternative medicines announced plans to shut down, days after a former senior official was arrested on suspicion of fraud and money laundering. The Prince's Foundation for Integrated Health said its plans to close had been brought forward as a result of a fraud investigation at the charity.
George Gray, a former chief executive of the organisation, and his wife Gillian were arrested by Scotland Yard officers last month in an early-morning raid on their home in North London.
Woman faces negligence charges in connection with son’s death
By Sherri Zickefoose, Calgary Herald
The family of a Calgary woman facing criminal charges in connection with the death of her seven-year-old son say they’re in shock over the allegations of neglect. The boy, Ryan Alexander Lovett, died last March after suffering from a strep infection which kept him bedridden for 10 days.
Police allege his mother, Tamara Lovett, 44, chose to treat the bacterial infection with homeopathic herbal remedies instead of taking him to a doctor. That decision likely killed the child, police say.
“It was a belief system in homeopathic medicine that contributed to this death,” acting Staff Sgt. Mike Cavilla said.
“It should absolutely serve as a warning to other parents. The message is simple: if your child is sick, take them to the doctor.”
The single mother, who lived in a Beltline basement suite, shunned conventional treatment to follow her belief in holistic remedies.
In fact, police say there is no record of the boy ever being taken to the doctor for annual checkups or any treatment.
“We have no medical record of his entire life,” said Cavilla.
But family members say the allegations of criminal negligence may be wrong.
Grandfather Donn Lovett said the picture police were painting of his daughter relying on alternative remedies may not be accurate. “She devoted her life to that child. Ryan was beautiful, bright, happy and intelligent. I had seen Ryan the week before he got sick. I was supposed to pick him up on Monday and she said he had the flu. But then she sent a message he was looking good on Wednesday or Thursday and might be in school the next day.”
Soon, the family was summoned the emergency room for news of the boy’s death.
“His liver had been overwhelmed. The report given to me was that he died of flesh-eating disease,” said Lovett.
The family had not been aware police suspected Ryan’s mother in the death, he said.
“This was an absolute shock to us. It’s a shock to our whole family.”
Police say the woman’s friends were worried for the ailing child’s health and urged her to take him to the doctor.
“According to people that saw the child prior to the death (he) looked very ill,” said Cavilla.
The boy’s father is estranged and had no contact, police say.
The woman has an older child with another man, but does not have custody.
Police say the woman called for help from her suite in the 900 block of 17th Avenue S.W. early March 2 fearing the young boy was suffering from a seizure. The child was later pronounced dead in hospital.
An autopsy revealed he died as a result of a Group A Streptococcus infection.
After consulting medical experts and the Crown prosecutor’s office, police arrested the woman at home Friday. She faces charges of criminal negligence causing death and failing to provide the necessities of life.
In Canada, it is illegal for a parent or guardian to deny children food, shelter, care and medical attention necessary to sustain life and protection from harm.
“If you do not provide medical attention for your sick child, you will be held accountable,” said Cavilla.
“The legal requirement is that she get medical attention through traditional western medicine to deal with the illness. And in this case it was a bacterial infection that could have been easily treated with antibiotics such as penicillin.”
I reproduce this text from page 30: The worries about the ethics of prescribing a placebo are real. But so are fears that alternative therapies may do harm—for instance, by tempting patients to shun real medicine. Steve Jobs, the founder of Apple, died from cancer last year after having first favoured acupuncture and fruit juices over conventional treatment. Misplaced faith has its costs.
Some of my other files on homoeopathy and alternative medicine contain similar horror stories. An example:
Who is Ronald Rebello who wrote to the Prime Minister copy to The Examiner, Bombay’s Archdiocesan weekly, asking for "tertiary level hospitals of Ayurveda, Acupuncture, Homeopathy…"?
At the time of writing that letter, Ronald Rebello was just 21 years old. He died on February 23, 2007, aged 25. He was the son of Dr. Leo Rebello of Mumbai.
Who is Dr. Leo Rebello?
Dr. Leo Rebello is a lapsed Catholic, a leading New Ager and promoter of New Age Alternative Therapies.
Dr. Rebello wrote me that both their sons, Ronald and Robin were never subjected to any inoculations or vaccinations, and, excepting homoeopathy, have never used any allopathic medicines, under their dad's "professional" care. It is therefore very sad to hear of Ronald Rebello's 25 days of high fever which remained undiagnosed and refused to reduce, resulting in his untimely and unnecessary demise.
3. It is my sincere belief that Ronald Rebello would be alive today if his father had not denied him vaccinations, inoculations and allopathic treatment in favour of homeopathy and other dubious alternative medicines about which he has written so much in the books that he has authored. And this is the grave danger in what The Examiner is doing with issues concerning the health of its subscribers and readers:
For example, The Examiner, March 1, 2008, "Cancer Therapy" Letter to the Editor by Dr. Neville S. Bengali, the doctor recommends magnet therapy claiming that it checks cancer in its initial stages; he also suggests "a judicious co-ordination of different systems (like allopathy and/or homoeopathy with magnet therapy)."
Following such advice can prove fatal for patients.