CAM or SCAM?

The first thing I should say about alternative medicine is that there's no such thing. There is an alternative to medicine and it is widely promoted, but the existence of a valid alternative to medical science is as likely as the existence of alternative physics or alternative engineering. Every time there is a significant rise in petrol prices a flurry of people offering methods to run cars on water appears, but generally these people are politely ignored and referred to as kooks or quickly identified as charlatans and run out of town. Sometimes one will appear with a magic fuel efficiency increaser which attracts millions of dollars of investment and allows the inventor to, for example, buy some sporting teams, but these are the exceptions. Defying and denying the fundamental laws of physics or chemistry are seen as a signs of an unsound mind – car manufacturers and energy suppliers aren't rushing into perpetual motion research. People who deny the fundamental principles of engineering don't get to build bridges and commercial aircraft.

Things are different in medicine, because apparently there anyone can have an opinion about what happens and can offer acceptable solutions and treatments for medical problems, and the reason that all of these alternatives are suppressed is simply turf and income protection by Big Pharma and its minions, the medical societies, journals and doctors. Consistency of argument is not a strong point for many altmed supporters, and I will return to this later, but one example is how someone can complain about suppression of alternatives and then shortly afterwards claim that the money freely spent on alternative medicine in Australia is many multiples of that spent on conventional pharmaceuticals. The equation is somewhat biased by including such things as vitamins, massage and exercise at the gym as "alternatives" while leaving out the billions of dollars spent by the Pharmaceutical Benefits Scheme. I assume that this is an honest oversight, because I have seen the claim made by senior academics in university quackery departments, sorry, departments of complementary medicine, and one must not assume that they are being dishonest.

Anyone looking around without a conspiracist mindset might fail to detect the suppression of alternative medicine. I am going to pay some attention to the three big ones – the filler of pharmacy shelves, homeopathy, and those staples of all private health insurance plans, chiropractic and acupuncture.

Homeopathy

Apart from iridology, homeopathy is probably the most ridiculous form of alternative medicine. It is based on two principles. One is the Law of Similars, which states that the appropriate treatment for a set of symptoms (homeopathy only deals with symptoms, not any underlying pathology) is something which can produce those symptoms if administered in large enough doses. This raises the obvious problem that the cure could be worse than the disease, so what makes it all good is the Law of Infinitesimals, which says that the lower the dose of treatment the better it works.

Homeopathic preparations generally come in two forms, X and C. A 10X preparation is made by taking a 10% concentrated solution of something, taking 10% of the volume, mixing it with 90% solvent, shaking it in a special way known as succussion and then repeating the process nine more times. The final "medicine" contains .00000000001 concentration of active ingredient. For a C preparation, replace 10% by 1% in the process above. A 20C preparation therefore has forty zeroes after the decimal point. I was once challenged by a homeopath to test 200C belladonna on myself to see what happened. The concentration in this case has 400 zeroes to the right of the decimal place. To put that into some sort of perspective, if there was one molecule of active ingredient in our entire universe the concentration would contain less than 100 zeroes.

Did homeopathy ever make sense? Well it probably did in the late 18th century when it was invented because it allowed the 80% of patients who recover without treatment to avoid the purges and other treatments that were the tools of the doctors of the day. Real medicine has moved on since then and the progression of work by Dalton, Gay-Lussac, Avogadro, Brown, Franklin, Cannizaro, Einstein and Langevin should have completely buried the idea of infinite dilution, but there it is, right there in pharmacies. By the way, even by the rules of homeopathy those bottles and packets of stuff in the pharmacies are fraud, because homeopathic preparations must be individualised to the specific patient and prepared fresh to treat their symptoms. Retail sales of ready-mixed products do make money, though, so perhaps this is justification. While most retail homeopathic products contain nothing but water or lactose, I have seen one which provided more value to the consumer. It was a bottle of Flower Remedy on sale in my local pharmacy. This is based on cheap brandy, not water, and in this case was selling for only $1,595 per litre.

Chiropractic

There is a popular misconception that chiropractors are some sort of back pain specialists. If your chiropractor confines himself to treating lower back pain by massage and manipulation then he is not really doing chiropractic. The fundamental principle of chiropractic is that all dis-ease (note the hyphen) is the result of subluxations of the spine causing pressure on nerves and therefore inhibiting the transmission of the signals which allow the innate intelligence of the body to heal itself. Everything is caused by subluxations (which chiropractors have trouble reliably identifying on x-rays) and everything can be fixed by removing these annoying misalignments. And I mean everything – as examples, if you pick up any magazine aimed at new parents you will find advertisements for chiropractors who can treat bed wetting, asthma, ADHD and colic. My favourite chiropractic treatment for children, however, is the one for the ear inflammation otitis media. I am not sure how adjusting the spine can affect signal transmission in nerves which do not pass through the spine, but what would I know? I haven't been to chiropractic school.

Did chiropractic ever make sense? Probably not. It was "discovered" by Daniel Palmer in 1895 when he cured someone's deafness by pressing on a bulge on the person's back. Have I mentioned that the nerves between the ear and the brain don't go through the spine? Palmer's son saw the commercial potential of training schools and colleges, some even calling themselves universities. (To my eternal chagrin, the university which I attended was the first real university in the world to open a school of chiropractic.) Attempts to reform the profession and place it on a scientific basis have been strongly resisted, and chiropractors in the USA who have broken ranks have been subject to much vilification and abuse.

One aspect of chiropractic which is often overlooked its declared opposition to vaccination. Of course, if everything is caused by vertebral subluxations then vaccination is unnecessary, but the opposition goes beyond that to claims that vaccination is harmful. At a recent trade fair aimed at parents of young children I was given brochures at the stand of a professional association of chiropractors which contained serious misinformation about vaccines. You might even say the brochures contained lies. (At the same show I was told by representatives of a professional homeopathy association that they could supply me with 200C homeopathic vaccines against meningococcal disease, but only if I asked quietly because the sale of this was illegal.) At the 2000 national conference of the Pediatrics Council of the US International Chiropractors' Association an award of Hero of Chiropractic was made to a man who was in prison for the murder of a ten-week old child. The award was to recognise that the killer was just as much a victim as the dead child, because it was obviously a vaccine which had caused the intracranial bleeding and the broken ribs

Acupuncture

You can forget those nerves pinched by subluxations. According to the theories of acupuncture, illness is caused by disruption to the flow of qi (or chi) through meridians in the body. These meridians are not associated with the nervous or lymphatic systems, but are pathways through which the life force travels. They cannot be imaged, and one acupuncturist has told me that they are analogous to the lines of latitude and longitude on the Earth which let us know where we are. The analogy breaks down for me because if the flow of qi can be unblocked by the insertion of needles into points on the meridians then the lines must be more than imaginary (but convenient) constructs for mapping the geography of the body. Perhaps acupuncture meridians are more like those ley lines that connect Stonehenge to the pyramids at Giza, but I assume that acupuncturists don't want to make that comparison in case people think that they are talking nonsense.

Acupuncture can be used on animals also, and I have a model of a dog with the acupuncture points marked. There is a point on the tail called Wei Jan, which is used to treat stroke, sunstroke and gastroenteritis. Some dogs don't have tails but losing this point is not a problem as there are several other points which can treat stroke and sunstroke. Gastroenteritis is treated by needling or smoking Hou San Li (on the rear leg), which provides the added advantage of also being useful for posterior paralysis, neuralgia, paralysis of pelvic limb, intestinal spasm and colic, arthritis, febrile symptoms and dyspepsia, as well as preventing diseases and making the dog strong and healthy. I am not making this up.

Did acupuncture ever make sense? Like homeopathy, it probably did when it was first invented back in the misty past. Now that we know a lot more about what really goes on inside the human body we should be beyond relying on imaginary and undetectable lines in the body to treat anything. The most common defence I see of acupuncture is that it has been around for thousands of years, as if longevity is all that is necessary to ensure efficacy. People have believed in astrology for thousands of years, too. And ley lines.

Do they work?

All of the above treatments work. They work provided that the patient has a self-limiting or mild psychosomatic condition. They do not and can not work for the sort of things that do not get better by themselves. Proponents sometimes claim that they are simply exploiting the placebo effect, but they don't like this being translated to "they do nothing". Charging money for doing nothing could be considered to be fraud.

What's common to the three?

The common factor is that all of these three reject any idea that bacteria, viruses or allergens might have any influence on the human body. (Which is also the basis for much anti-vaccination activity.) They also ignore any part played by diet or the immune system in maintaining health. Each one has the complete answer to all you need to know to stay healthy. This leads to another commonality, which is that they have nothing in common. If subluxations cause everything then sticking needles in acupuncture points is a waste of time. If otitis media can be treated by a 30C preparation of ear wax then adjusting the connection between C2 and C3 in the neck is a (dangerously) useless practice. I mentioned above the lack of consistency across altmed believers, and these three mutually-exclusive systems illustrate it to perfection. For an altmed true believer, however, if it is an alternative to real medicine then it must be good. I once challenged a group of true believers to examine five totally contradictory guaranteed cures for cancer and say which one was believable, because they could not all be true. The universal answer I received was "All of them are true".

Does it matter?

I have been told that it doesn't matter that these things don't work because people should have the freedom to choose their treatments. I deliberately chose the most well respected forms of alternative medicine, but there is a myriad of more outlandish claims and methods out there. I have been told that they offer hope to people when real medicine doesn't have an answer, but I have stood at the bottom of the slippery slope at a cancer clinic in Tijuana and seen how far desperate people will go when someone promises them hope.

A $15,000 per week cancer clinic in Tijuana

As I said at the start, there is medicine and there is an alternative. Practitioners of alternative medicine like to use the word "complementary" to hide from reality, and now seem to refer to Complementary and Alternative Medicine, or CAM. As they like to promote dietary supplements, I prefer Supplementary, Complementary and Alternative Medicine. Or SCAM for short.

This article was published in Issues magazine in September 2008

An osteopath was not happy. My replies are in italics.

Subject: Response to September Issue Cam or Scam
Date: Thu, 06 Nov 2008 16:44:50 +1100
From: "Mark Smith"

Hi,

I was surprised to find your article on homeopathy, acupuncture and chiropractic. I didn't realize there where people "out there" dedicated to look for anything negative related to "alternative" therapies.

Why not? Did you assume that quackery would be immune from investigation?

In fact, I would have thought that if this were the case that allopathic medicine would have been your first port of call, as the leading cause of death in the USA is from iatrogenic sources

Ah, yes – The Lie That Will Not Die. I don't know why later figures aren't available, but here are the 10 leading causes of deaths in the USA in 2005. If you have any later information you might like to let the CDC know so that they can update their web site.

• Number of deaths: 2,448,017
• Death rate: 825.9 deaths per 100,000 population
• Life expectancy: 77.8 years
• Infant Mortality rate: 6.87 deaths per 1,000 live births

Number of deaths for leading causes of death:

1. Heart disease: 652,091
2. Cancer: 559,312
3. Stroke (cerebrovascular diseases): 143,579
4. Chronic lower respiratory diseases: 130,933
5. Accidents (unintentional injuries): 117,809
6. Diabetes: 75,119
7. Alzheimer's disease: 71,599
8. Influenza/Pneumonia: 63,001
9. Nephritis, nephrotic syndrome, and nephrosis: 43,901
10. Septicemia: 34,136

http://www.cdc.gov/nchs/fastats/deaths.htm

(it is the third leading cause of death in Australia).

Australian numbers are more up to date, but again I encourage you to contact the Australian Bureau of Statistics with your later information so that they can update their web site. Here is the situation in 2006:

1. Ischaemic heart diseases – angina, heart attacks, and blocked arteries of the heart (I20-I25): 22,983
2. Strokes ( I60-I69): 11,465
3. Trachea and lung cancer (C33-C34): 7,348
4. Dementia and Alzheimer's disease (F01-F03, G30): 6,542
5. Chronic lower respiratory diseases – asthma, bronchitis and emphysema (J40-J47): 5,443
6. Colon and rectum cancer (C18-C21): 3,858
7. Blood and lymph cancer (including leukaemia) (C81-C96): 3,693
8. Diabetes (E10-E14): 3,662
9. Diseases of the kidney and urinary system (N00-N39): 3,192
10. Prostate cancer (C61): 2,952

http://www.abs.gov.au/ausstats/abs@.nsf/mf/3303.0

From what YOU say alternative medicine (I prefer to use the term complementary) has no effect (other than placebo).

I didn't say that at all. What I said was, and I quote, "All of the above treatments work. They work provided that the patient has a self-limiting or mild psychosomatic condition". Real medicines have a placebo effect as well. The objective of clinical trials is to see if the medicines have an effect greater than placebo. If all you can claim is placebo then all you can claim is nothing, so there should be no charge. Why do quacks want to charge money for things that do nothing? Surely that would be fraud.

If this was the case then at least the mortality rate would be a lot less!!!

Are you saying that the mortality rate for alternative medicines is the same as for real medicine and can be reduced? I'm pleased about that and I look forward to reading the research on how that can be achieved. A good start would be a system of reporting adverse effects.

I agree that there are charlatans out there that exploit people who will do anything to relieve their symptoms but that is not due to the professions out there, it is more related to those individuals, and it occurs in medicine also. The biggest charlatans are the pharmaceutical companies who drive the medical machine, their guinea pigs are the general public. If their product kills or maims enough people they take it off the market and repackage it as something else.

So all alternative and complementary medicines undergo extensive safety trials involving millions of test subjects to prove absolute safety before they are sent to market, do they? As an example, the day after Vioxx was withdrawn from the market I was offered a quack substitute that was guaranteed to be safe. How could this be known? (By the way – the people who suffered ill effects from Vioxx were not using it according to the clear instructions on the label, but why should that fact mean anything to the critics?)

Yet, if someone has an allergic reaction to royal jelly, the AMA wants to shut down the whole naturopathic community.

You might like to point me to the safety trials for royal jelly that were undertaken before it was sold to the public. You might also like to consider risk/benefit ratio. As the risk of allergic reaction to bee products is quite high and there are no trials or research indicating any benefit of royal jelly (except to the wealth of those selling it), the ratio is infinite. Here's something else to think about – should royal jelly be "prescribed" for someone who is also taking one of the large number of alternative products which "boost the immune system"?

By the way – the AMA has no say over who practices what in the medical field. They can express an opinion but they can't stop anyone doing anything.

I would have thought that if you were going to make comments such as you have that you would have done a little research (there is a plethora of research articles out there on the benefits of "alternative medicine") beforehand. Having said that I understand that everyone is entitled to their own opinion, even if you feel the need to spread your opinion to as many people as possible. But I would be interested to find out your opinion based on the same scrutiny of the pharmaceutical and medical industry.

And I would be interested in your explanation of how the mutually exclusive world views of chiropractic (or in your case, osteopathy), homeopathy and acupuncture can be reconciled. Do bacteria and viruses cause disease?

Mark Smith
Osteopath