Wednesday, December 30, 2009

Alternative medicines: Promising cure or dangerous quackery?

A recent editorial in the British Medical Journal takes the medical establishment of the UK to task for not taking a firmer stand against the quackery of many types of alternative medicine. The situation in the US may even be worse.

Though widely available and used around the world, alternative medicines frequently lack evidence supporting their effectiveness, and often lack biologically plausible theories for why they should work. Since they receive relatively little study, and few regulations, they can occasionally be harmful.

The classic example of a nonsense cure is homeopathy, the idea that medicines containing no medicine can cure disease. None of the relatively few studies that have compared them to placebos (sugar pills) have found any convincing evidence that they work. The idea that taking a medicine containing nothing will help you also lacks scientific rationality.

A common misconception is that because they are “natural”, alternative medicines such as herbal supplements are safe. Bu they can have very real effects, though not always good ones. Kava kava is a root-extract that can help calm anxiety, but also destroys your liver. It is no longer available in the EU, and carries warnings in the US. St Johns wort is an herb that has been shown in several randomized trials to be an effective treatment for mild to moderate depression. And several commonly used medications, including aspirin and flu-fighting Tamiflu, are based on or contain natural ingredients. Alternative treatments often lack the same quality control as established medicines, meaning you can’t be sure that the pills contain what the label promises (or that they don’t contain some other substance that may cause harm.)

Alternative medicines are generally not taken as seriously as mainstream pharmacology, and even when studied the results may not receive the same degree of scrutiny. In some cases, the scientific background supporting safety and effectiveness of naturally-based substances is itself suspect. The principle ingredient in a recently withdrawn weight-loss supplement, sold as Hydroxycut in the US, is widely available, and backed by numerous published studies. (About 20 cases of liver-poisoning were linked to Hydroxycut, but since only an estimated 1% of such adverse reactions are reported, it's possible that there were closer to 2000 livers harmed.) But a closer look at the evidence supporting the ingredient’s safety and efficacy finds some possible shortcomings: Standard conflict of interest declarations that are the norm in scientific publications were not provided in most cited studies. As a result, readers may not be aware that the research was supported by the manufacturer of the ingredient being examined.

Your best bet? Be exceedingly careful when choosing to use a natural or alternative product, and consult with your doctor first. Seek out high quality information from reputable, non-commercial sources. Such treatments are often trusted as folk cures handed down by wise ancestors, but remember that along with wisdom, ignorance can also be handed down through the generation, and only scientific study can establish whether a treatment works.

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