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Unscientific Medicine: What’s The Harm?

Any promoter of science-based medicine often faces the question: “What’s the harm?” What is the harm if people try treatment modalities that are not based upon good science, that are anecdotal, or provide only a placebo benefit? There are generally two premises to this question. The first is that most “alternative” placebo interventions are directly harmless. The second is that direct harm is the only type worth considering. Both of these premises are wrong.

The pages of Science Based Medicine (SBM) are filled with accounts of direct harm from unscientific treatments: Argyria from colloidal silver, death from chelation therapy, infection or other complications from acupuncture, burns from ear candleing, stroke from chiropractic neck manipulation — the list goes on. You can read anecdotal accounts of such harm on the website, whatstheharm.net.

Of course, as we often point out, harm and risk is only one end of the equation — one must also consider benefit. It is the risk-benefit ratio of an intervention that is important. But generally we are talking about interventions that lack any evidence for benefit, and therefore any risk of harm is arguably unacceptable.

But perhaps the far greater harm comes from indirect causes. I was reminded of this with the publication of a study looking at flu vaccine uptake in nine countries. They found that among older individuals who did not get the flu vaccine there was an increase in negative attitudes toward the vaccine, but also there was an increase in the use of traditional unscientific interventions. Cause and effect here is likely to be complicated. People who rely upon folk remedies may feel that they do not need the flu vaccine. Also, those who do not trust in the vaccine may then seek out alternatives. It is likely also true that the subculture of “alternative” medicine simultaneously fosters both a belief in unscientific treatments and a mistrust of mainstream science-based interventions.

The study authors conclude:

The hypothetical framework can be used to guide healthcare providers in developing strategies to foster normative beliefs of older people in vaccination, provide effective action cues and promote vaccine access.

“Normative beliefs” is a technical way of referring to the fact that promoters of “alternative” modalities tend to foster bizarre and unscientific beliefs in the public. Dubious treatments are often marketed with false notions about biology, physiology, and anatomy. It turns out, the iris of the eyes do not contain a functional map of the body (nor does the bottom of the foot). There is no human energy field or biofield or chi. Acupuncture points have not basis in reality. Magnets do not attract the iron in our blood. And toxins do not build up in our tissues, causes most diseases.

The consequences of fostering incorrect notions about human physiology and the nature of health and disease are difficult to measure or quantify, but they should not be ignored as a significant source of indirect harm from unscientific treatments.

The marketing of unscientific treatments often involves warning potential customers away from mainstream medicine, or at least downplaying the effectiveness of science-based treatments or overstating their risks. One does not have to look beyond any pro-CAM website to see articles scaring the public off science-based treatments side by side with advertisements for unscientific alternatives. The internet is unfortunately full of commercialized websites working directly against efforts to create “normative beliefs” in the public.

Belief in ineffective treatments and mistrust of science-based treatments may lead to delay in effective treatment and worse outcomes. In addition they create financial harm, which is increasingly important as health care costs rise. Financial harm can be extreme in cases of the desperation caused by serious illnesses. Tens of thousands of dollars are spent, for example, to send one patient to a fraudulent stem cell clinic. This financial harm is not limited to the patient or their family, as often such treatments are funded by charity from extended family, friends, and colleagues.

There is further psychological harm from creating false hope. I have personally seen the crushing effects such false hope can create when reality finally sets in. This can also significantly delay the process of psychologically dealing with a serious illness, which further affects important decision making about care. Wasting time of worthless treatments can also rob the terminally ill of precious time spent with loved ones.

Further, the allure of unrealistic treatments diverts scarce resources (hospital space, research time and money) away from more fruitful modalities.

Conclusion

The ripple effect of harm that flows from  unscientific medical beliefs is multifarious and significant, but often neglected by those who are not familiar with the phenomenon. “What’s the harm” is therefore a question we will have to answer frequently and for the foreseeable future.

*This blog post was originally published at Science-Based Medicine*


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One Response to “Unscientific Medicine: What’s The Harm?”

  1. Marya says:

    Dear Dr. Novella,

    Once again I have to agree with some of your premises, but disagree with your misguided leaps of illogic. I agree that if a modality has not been proven effective, the only way it should be left alone to be used by the public is if it has been shown to be safe. Alas, the risk-benefit equation is an individual choice, and we cannot impose our quantitative bottom line on it. Your assertion that scientific medicine is being eschewed because of acceptance of alternative modalities is as flawed as maintaining that a rain dance brings on rain. I know you said the relationship was complicated, but let’s be honest: you think that CAM acceptance is killing allopathic medicine.

    Now, let’s get on to “proof” in science-based medicine. As you well know, while we do have evidence for efficacy and safety of some modalities, many are grandfathered without any science. Even those that are shown to have acceptable efficacy and safety profiles as mandated by the FDA, are arguably (and many do argue) not all that. There is an important concept in clinical science of heterogeneous response to treatment, HTE, which I have addressed extensively on my blog. I did not make it up, it is very real, and it is this phenomenon that makes it difficult to predict how an individual will respond to a particular intervention. This confounds much of what we think is God’s own word on what is supposed to work in allopathic medicine.

    Finally, do you really think that agents that are approved based on a 2-week prolongation of median survival in a desperately ill population of patients are used because of their supposed scientific merit? I would have to argue that there is a lot of subcortical emotional thinking that goes into these decisions. Can you really prove to me that a 2-week increase in median survival is not tantamount to placebo effect, aka type I error, even if there is a power calculation? Yet this is science-based. I think if I had a horrible disease, I might opt for acupuncture in hopes that it might make me feel better in the weeks I have left rather than rely on this kind of “science” to prolong my mysery by 2 weeks.

    Bottom line, we need to appreciate that none of the science is all that straightforward. Let us not dumb down the arguments and create false dichotomies. If we do, no one wins.

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