Here is an opinion piece I wrote for in this week’s Modern Medicine magazine. The version below is the final draft prior to some very minor typographical edits. The article also appears online at irishhealth.com, where you can also read a companion article presenting an opposing perspective on complementary medicine. Modern Medicine is published by Medmedia Publications and edited by Ken Fitzsimons.
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Last year saw the death from cancer of Steve Jobs, the entrepreneur who brought us the iPhone, a visionary credited with enhancing the lives of millions through insight and intellectual brilliance. Nonetheless, although acclaimed as a technological sophisticate, Jobs had a proclivity for the esoteric. When diagnosed with pancreatic cancer, he chose to eschew ordinary medicine and instead turned to complementary and alternative medicine (or CAM). His therapies included dietary treatments, “hydrotherapy”, acupuncture, naturopathy, and even the occasional visit to a psychic.
Many pancreatic cancers are aggressive. Ironically, Jobs had a rare form (an islet cell neuroendocrine tumour) for which ordinary medical treatments offer excellent survival rates. But by confining himself to CAM, he did not see much benefit. Instead, his tumour progressed inexorably to dangerous levels. He then had a poignant change of heart and underwent radical mainstream treatment, including pancreatoduodenectomy and a liver transplant. But it was too late. He died in October 2011, aged 56.
Steve Jobs was by no means the first famous figure to find CAM a poor substitute for ordinary medicine. Readers might remember Peter Sellers, the British actor made famous as Inspector Clouseau in the Pink Panther movies. At the age of 40, Sellers suffered a myocardial infarction that permanently damaged his heart. Ignoring advice to undergo bypass surgery, he instead visited “psychic” surgeons on a regular basis. He died in 1980, aged 54, all too predictably from a massive heart attack.
Or how about Barry Sheene? A World Champion motorcycle racer, Sheene was a boyhood hero of mine. Watching him angle his way at high speeds through dangerous bends, I felt he could defy death itself. Indeed, one of his claims to fame was having recovered so quickly from a bone-shattering crash in Daytona as to be back racing within seven weeks. In later life, Sheene was diagnosed with throat and stomach cancer. But he rejected chemotherapy. “I believe I can beat this thing with natural therapy,” he insisted, before embarking on a therapeutic diet and complementary microwaves treatment. He was dead within months.
CAM uptake is not confined to celebrities. While statistics vary, consumer organisations and public health bodies advise that a very large portion of society, perhaps even the majority, have at one time or another turned to CAM. Usually, such treatments are marketed as being “safe” or “organic” or “pure”, but in reality a very simple principle applies to all therapeutic endeavours. Any treatment that purports to change the functioning of the human body will certainly carry some risk of adverse side-effects; if a procedure genuinely has no side-effects at all it will be because it is doing nothing to change any element of how your body is affected by illness.
In the main, consumers (and sometimes medical professionals) believe that at least some CAM therapies have been shown to be efficacious. However, this is not the case. For most CAM treatments research on efficacy is practically non-existent, while for the more common approaches (such as acupuncture, chiropractic, and homoeopathy) the jury is still very much out. Indeed, this is what makes such treatments “complementary” or “alternative” in the first place: despite thousands of published studies, there is still no firm biological evidence to support their claims to be “medicinal” in the mainstream sense of the term.
Obviously, CAM is extremely dangerous when it discourages people with life-threatening illnesses from receiving proper treatment. As well as celebrity cases, coroners have dealt with a multitude of ordinary citizens who have met similarly tragic ends. I think even the most ardent CAM proponent would agree that advocating CAM for terminal illness is both reckless and immoral (but nonetheless, it continues to happen).
But what’s so wrong about recommending CAM for minor illnesses or symptoms, or as a fall-back for when ordinary medicine has no effective solution (such as in many cases of chronic pain)?
Well, apart from wasting money and time, and raising false hopes for a “cure”, the widespread pushing of CAM is akin to the active promotion of scientific illiteracy and the nullification of consumer scepticism. And this certainly does come with costs, what some social scientists call “the costs of misinformation”.
CAM treatments have failed their scientific road-tests. When CAM proponents tell consumers that this doesn’t matter, they are indirectly encouraging people to be suspicious of evidence-based arguments of all kinds. It is little different from urging citizens to reject the evidentiary case on climate change or the historical evidence for the Holocaust.
Commentators sometimes accuse science and scientists of “arrogance”. However, I can think of few claims more arrogant than that of CAM proponents who assert that their particular experiences, anecdotes, and personal judgements are more valuable than information that is accumulated objectively.
If evidence doesn’t matter, then what does?
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