The quack doctors of Georgian England were shameless liars and self-publicists. If their advertisements were to be believed, no medical condition was so serious, or so trivial, that their pills and potions could not cure it. Bromfield’s Pills Against All Diseases promised to eradicate ‘Giddiness in the Head, sudden Flushings, Putrification and Stinking of the Gums, Tooth-ach, Stinking-breath and thick Vapours arising from HYPOCHONDRIA to the Midriff’. A physician in High Holborn sold medicine that would cure not only ‘Pain in the Head and Stomack’ but also red hair and freckles.1
The quacks invoked science, not faith healing or magic. And, as time went on, they took to ‘graduating themselves’ with phoney degrees and professional qualifications from institutions of their own invention.2 By the early nineteenth century, writes Roy Porter in his book Quacks, the medical profession (such as it was) found itself attacked by ‘swarms of sharp operators–untrained druggists, irregulars and itinerants, all making their pile’. They were driven out of mainstream medicine only after a long campaign by the surgeon Thomas Wakley, who used his journal, the Lancet, to attack ‘the satanic system of quackery’. Wakley was particularly angry at the way respectable bodies toyed with the ‘pest’ of bogus medicine; he described the College of Physicians as ‘vile’, the Corporation of Surgeons as ‘Bats’, and the Society of Apothecaries as ‘the Hags of Rhubarb Hall’. The Lancet specialized in revealing the secret ingredients of patent medicines and inviting readers to expose their local quacks. And, eventually, the strategy paid off, though it was not until the Pharmacy Act of 1868 that quacks were legally forbidden to sell poisons and addictive drugs to the public.3
If Wakley could come back today, what would he think? He would be astonished, of course, by the conquest of nearly every disease that had ravaged his patients. But suppose that, having absorbed the miracles of modern science, he then investigated ‘alternative medicine’. He might well ask: why, when you have achieved all this, do you still tolerate quacks? Why do millions of people buy their books and useless sugar pills? Why do you employ them in your health service? Why do your governments listen to their advice? Why is this pest taught in universities?
At the beginning of the twenty-first century, quackery is making ever deeper inroads into healthcare. An industry worth billions of pounds is built around treatments or therapies that are based on claims that can be shown to be false or for which there is no evidence. This is counterknowledge, in other words; and, like other purveyors of counterknowledge, quacks range from true believers to fraudsters. Most of them occupy territory somewhere in between and fit into Harry Frankfurt’s category of the bullshitter: someone who adopts a casual approach to the truth.
Nearly all quacks shelter under the umbrella of complementary and alternative medicine, often referred to as CAM. (Significantly, despite decades of debate, there is no agreed definition of CAM, or of the difference between ‘complementary’ and ‘alternative’ therapies.) This is a good choice of hiding place. Short of making a racist joke, there is probably no quicker way to sour the atmosphere at a London dinner party than to question the value of alternative medicine. Nonetheless, the simple truth is that most such medicine is ‘alternative’ for a good reason: it doesn’t work.
Dr Arnold Relman, a former Harvard professor of medicine and editor of the New England Journal of Medicine, elegantly dismantled the whole idea of ‘alternative’ medicine in an article for the New Republic in 1998. He wrote: ‘There are not two kinds of medicine, one conventional and the other unconventional, that can be practiced jointly in a new kind of “integrative medicine”. Nor…are there two kinds of thinking, or two ways to find out which treatments work and which do not. In the best kind of medical practice, all kinds of treatment must be tested objectively. In the end there will only be those that pass the test and those that do not, those that are proven worthwhile and those that are not.’4
Raymond Tallis, professor emeritus of geriatric medicine at the University of Manchester and a distinguished philosopher, makes a similar point: ‘Alternative medicine is the kind of medicine people took when there was no alternative; when there were no antibiotics, no steroids, no effective treatments for cancer, heart attacks, stomach ulcers.’5
Relman and Tallis are not denying the existence of grey areas; there can be a lot of confusion while we wait to see if a treatment passes the appropriate tests. Our judgement of whether it is ‘worthwhile’, whether a patient will benefit from it in some way, will often be subjective. In contrast, our judgement of whether a claim is true should be objective, based on an impartial reading of data, even if we later have to revise our judgement as new facts emerge.
Identifying bogus medical claims is usually more straightforward than identifying bogus history. You subject treatment X and treatment Y to a rigorous comparison. Where drugs or ‘natural’ food supplements are concerned, this comparison often takes the form a randomized double-blind test in which neither evaluator nor subject knows which is which. X might be a drug or food supplement you want to test, Y a sugar pill. If X beats the placebo, then scientists have to begin the tricky process of evaluating the result. If, on the other hand, it performs no better than the placebo, then you can usually say with some confidence: ‘X doesn’t work.’
Alternative and traditional medicines don’t beat the placebo; that’s why they remain alternative and traditional, rather than part of orthodox medicine. On the other hand, they may well match a placebo in effectiveness; and the placebo effect, as any GP will tell you, can be freakishly powerful. About 30 per cent of patients in clinical trials feel better after taking placebos in the form of dummy pills or saline injections. In the words of Dr Robert DeLap of the US Food and Drug Administration: ‘Expectation is a powerful thing. The more you believe you’re going to benefit from a treatment, the more likely it is that you will experience a benefit.’6
The reason unorthodox medicines, supplements and therapies so often match the placebo effect is simple: they are placebos. If a man takes a pill containing powdered rhino horn for erectile dysfunction (a traditional African remedy) and ends up with a rhino-sized erection, it is his brain that has done the work, not the ingredients. If, however, he gets the same result after taking Viagra, that is almost certainly because the drug sildenafil citrate has increased the blood flow into his penis. Viagra works, and Pfizer, who make it, can justifiably say so. The rhino pill manufacturers can only truthfully say that their product may possibly have a beneficial effect–but not as a result of anything that the product contains. And the same goes for the manufacturers of thousands of herbal remedies and food supplements.
The problem is that most suppliers of ‘alternative’ medicines and therapies aren’t interested in what they can truthfully claim: they are interested in what they can get away with claiming, which is a different matter. And they can get away with a lot, because so many of us have lost confidence in the safety net of conventional medicine.
Although people in the West are actually healthier than ever before, their expectations of good health are rising faster than the ability of scientists, doctors or politicians to deliver it. There has been no medical breakthrough in the last twenty years to compare with the discovery of antibiotics or the link between smoking and lung cancer. Pharmaceutical companies invest millions of pounds in drugs that have only a marginal effect on our health; according to GlaxoSmithKline, 90 per cent of new drugs work in only 30 to 50 per cent of patients.7 The British government pumps extra billions into primary care without achieving a significant rise in consumer satisfaction; overall, improvements in medical care advance inch by inch, through trial and error.
Confronted by the anxieties of the ‘worried well’, the most intellectually honest scientists and doctors–that is, those whose approach is evidence-based–are reduced to offering simple advice that works: eat plenty of fruit and vegetables, take regular exercise–and that’s about it. Individuals can take steps to reduce their risk of coronary heart disease and cancer, but ‘healthy living’ does not guarantee a healthy life. The relationship between lifestyle and health is mysterious; GPs are more sensitive than they used to be to the psychological components of illness and take these into account when making a diagnosis. But the vast majority do not attempt to micromanage the behaviour of people who already eat and exercise reasonably sensibly, because they know that it is unlikely to achieve anything.
Alternative medicine, on the other hand, recognizes almost no limits to what it can achieve. It feeds on middle-class anxieties about body image, diet, lifestyle and illness, offering healing therapies at every level from the cellular to the cosmic. The following is a list of a few well-known CAM therapies, with some indication as to the empirical foundation of their claims.
Acupuncture: Everyone ‘knows’ that this traditional Chinese practice actually works for the control of chronic pain. Or does it? In 1990, three Dutch epidemiologists analysed fifty-one controlled studies of acupuncture for chronic pain and found that the evidence was ‘doubtful’; they also found no evidence that acupuncture is better than a placebo at treating addiction.8 In 2004, scientists at the University of Heidelberg cast doubt on the usefulness of acupuncture for controlling post-operative nausea, one of the few alleged benefits supported in scientific journals. In short, the effectiveness of acupuncture other than as a placebo is still unproven.
Aromatherapy: This is the therapeutic use of essential oils from flowers, trees, shrubs and their fruits, blooms, leaves and roots. Some advocates of the ‘science’ of aromatherapy claim that the odours can revitalize cells, calm nerves, nourish the skin and boost the immune system. Not one peer-reviewed paper supports any of these claims. Essentials oils are placebos that smell nice.
Chinese medicine: the notion that the herbal remedies, massages and needle therapy of traditional Chinese medicine (TCM) constitute a parallel system of healthcare that complements Western methods is gaining ground all the time; but not as a result of peer-reviewed research data. The most recent large-scale review of randomized controlled trials of TCM, published by the British Medical Journal in 1999, found that, of nearly 3,000 trials, only 15 per cent were blinded, sample sizes were small, effectiveness was rarely quantitatively expressed, and ‘most trials claimed that the tested treatments were effective, indicating that publication bias may be common’.9 By 2007, only one Chinese-developed drug, the anti-malarial plant extract artemisinin, had received preliminary approval from the World Health Organization.10
Chiropractic: This is a form of alternative medicine that aims to improve general bodily health by manipulating the spine. It was invented in 1895 by Daniel David Palmer, a grocer and ‘magnetic healer’, who believed that 95 per cent of all diseases were caused by ‘subluxation’ (partial dislocation) of the spine.11 Traditional chiropractors still believe that most physical disease can be attributed to these subluxations. There is no scientific evidence to support this notion.
Craniosacral therapy (CST): This is based on the belief that the human brain makes rhythmic movements at a rate of 10–14 per minute, which are independent of breathing or heart rate. Diseases can be detected by aberrations in this rhythm, it is claimed. Moreover, CST therapists applying very light pressure to the head can improve the functioning of the central nervous system and bolster resistance to disease. The International Alliance of Healthcare Educators, a Florida-based charity that promotes CST, maintains that the therapy can be used to treat autism, traumatic brain injuries, learning disabilities, neurovascular disorders and post-traumatic stress disorder.12 The only snag is that the craniosacral rhythm does not, in fact, exist and therefore, unsurprisingly, CST therapists examining the same patient have detected quite different ‘rhythms’.13
Detox diets: The notion that depriving your body of various foodstuffs removes poisons from it is a fiction, and a potentially dangerous one. According to the British Dietetic Association, the word ‘detox’ is meaningless. The body contains its own ‘detoxifiers’ in the form of the liver, kidneys, skin, intestines and lungs; they don’t need any special help to do their job. Diets based on the concept are a marketing myth and often encourage people to cut out important food groups.14 Scientists at the University of Southern California have concluded that the arguments for detox diets are ‘categorically unsubstantiated and run counter to our understanding of human physiology and biochemistry’. Teenagers and pregnant women are particularly at risk from this fad.15
Homeopathy: This early nineteenth-century form of quackery teaches that substances become more powerful the more they are diluted. It has been described (with good reason) as alternative medicine’s ultimate fake; yet, as we shall see when we look at homeopathy later, it is entrenched in the National Health Service and in the past decade has been taken up by universities.
Reflexology: This massage therapy is based on the theory that each body part is reflected on the hands and feet, and that pressing on specific areas of these can have therapeutic effects in other parts of the body. There is no scientific evidence to show that such a link exists.
It’s worth noting that these and dozens of other alternative therapies are based on mutually exclusive theories about the human body. Traditional chiropractors and reflexologists have quite different ideas about how the body works. The former believe that the well-being of the whole body is essentially dependent on a spine free of ‘subluxations’. The latter believe that pressure to the soles of the feet triggers (undetectable) signals to different organs through the peripheral nervous system. Although both chiropractic and reflexology are equally useless as diagnostic tools, they are based on quite different physiological ‘charts’ and therefore contradict each other. But that does not worry most consumers of alternative medicine or, it seems, many of its providers.
CAM knows its market: its books, diets and potions are targeted at people with a short attention span who will soon be grazing elsewhere. Hence the constant need to come up with new products. Differences are played down in order to present a united front against ‘blinkered’ conventional medicine. Interestingly, you can find a similar camaraderie of counterknowledge in cult archaeology. An author who believes that Stonehenge was built by Aztecs will cheerfully recommend the work of someone who thinks it was built by the Priory of Sion, because they both recognize their real enemy as orthodox scholarship.
Complementary and alternative medicine provides what sociologists call a ‘plausibility structure’ for the myriad unproven medical claims that come under its umbrella. In the world of CAM, cranial osteopaths, Native American shamans and Chinese herbalists can all claim to tap into a nebulous ‘wisdom’; and to attack the empirical basis of this wisdom is regarded as narrow-minded or bad manners.
The growing influence of CAM in Western society can be illustrated by looking at two manifestations of bogus medicine: homeopathy and nutritionism. The former dates back 200 years, the latter less than a couple of decades; both of them fall into the category of counterknowledge.
Homeopathy involves giving sick patients very small doses of substances called ‘remedies’ which are supposed to produce the same or similar symptoms of illness in healthy people if given in larger doses. This seeks to stimulate the body’s defence mechanisms and processes in order to prevent or treat illness. That, incidentally, is the short definition of homeopathy given by the US National Center for Complementary and Alternative Medicine.16 Yet even this thoroughly sympathetic body (funded by the American taxpayer) cannot avoid making homeopathy sound like nineteenth-century quackery, because that is exactly what it is.
The principles of homeopathy were devised by Samuel Hahnemann (1755–1843), a German physician who believed that chronic diseases were manifestations of a suppressed itch. His ‘law of infinitesimals’ stated that the smaller the dose of the ‘remedy’, the more powerful the effect. Homeopathic potions dilute the original substance (a herb or mineral) so completely that it disappears. My local chemist, for example, sells homeopathic sulphur tablets marked ‘30C’: that means that the proportion of sulphur to the inactive substance is 1 to 100.30 That’s why there is no mention of sulphur in the ingredients on the container: the pill doesn’t contain any.
Admittedly, modern homeopaths spend a lot of time engaging in a form of psychotherapy with their patients, asking them about the emotional stresses in their lives in order to refine their diagnosis. Also, inevitably, they embroider their theories with references to quantum physics. But the core teaching of homeopathy has remained the same for 200 years. Bishop William Croswell Doane (1832–1913), the first Episcopalian bishop of Albany, New York, summed it up as follows:
Stir the mixture well
Lest it prove inferior,
Then put half a drop
Into Lake Superior.
Every other day
Take a drop in water,
You’ll be better soon
Or at least you oughter.
The poet and physician Oliver Wendell Holmes (1809–94), addressing a class of graduating medical students in 1871, warned them against ‘that parody of medieval theology’ represented by the doctrine of dilutions. Even in the nineteenth century, sensible people knew that homeopathy was as scientifically rigorous as reading tea leaves.
Let’s stick with that analogy. Imagine that the art of tea-leaf reading, known as tasseography,17 was held in high regard by members of the British royal family; and that, thanks to royal patronage, at the beginning of the twenty-first century the National Health Service was funding five hospitals based around the supposed diagnostic power of tea leaves. Then imagine that, despite indisputable evidence suggesting that such power does not exist, six British universities were offering degrees in tasseography.
Substitute homeopathy for tasseography, and the picture is accurate: five hospitals, six university degrees, all of them built on a foundation of antiquated but thriving pseudoscience. One of the reasons it is thriving is the royal family’s support for homeopathy, which dates back to the 1830s.
The current Prince of Wales has founded a charity, the Prince’s Foundation for Integrated Health, which tells the public that homeopathy is ‘used to treat chronic conditions such as asthma; eczema; arthritis; fatigue disorders like ME; headache and migraine; menstrual and menopausal problems; irritable bowel syndrome; Crohn’s disease; allergies; repeated ear, nose, throat and chest infections or urine infections; depression and anxiety’.
The distinguished pharmacologist Professor David Colquhoun of University College London points out that the foundation gives no indication as to whether these treatments work. ‘That is just irresponsible,’ he says. ‘And to describe pills that contain no trace of the substance on the label as “very diluted” [as the foundation does] is plain dishonest.’18 To put it bluntly, Prince Charles is abusing his constitutional position to foist bad science on his future subjects.
‘Homeopathy is to medicine what astrology is to astronomy,’ says Michael Baum, professor emeritus of surgery at University College London. ‘It’s witchcraft–totally barmy, totally refuted, and yet it’s available on the NHS.’19
Moreover, homeopathy enjoys cross-party support. In 2007, a House of Commons early day motion seeking to protect NHS expenditure on homeopathic hospitals was supported by MPs from all the major parties; a Conservative spokesman said that homeopathy was ‘valuable’ and should form part of a ‘patient-led’ health service.20 In other words, if there is enough demand for treatments based on a complete fiction, then the taxpayer should subsidize them.
The Labour government, meanwhile, has encouraged the spread of homeopathy and other CAM remedies to Northern Ireland. In February 2007, Peter Hain, the secretary of state, pumped £200,000 of public money into making homeopathy, acupuncture and massage more available to NHS practices in Londonderry and Belfast. Colquhoun commented: ‘Peter Hain used to be something of a hero to me. In the 70s his work for the anti-apartheid movement was an inspiration. Now he has sunk to promoting junk science. Very sad.’21
Homeopathy has been available on the NHS since it was set up in 1948. It is only in the last ten years, however, that publicly funded British universities have started offering courses and BSc degrees in homeopathy. The existence of these degrees was not widely known until a special report in the journal Nature appeared in March 2007. The report’s author, Jim Giles, discovered that two of the six universities offering homoeopathy degrees, the University of Central Lancashire and the University of Salford, refused to discuss them or even reveal the content of the courses. Professor Colquhoun has experienced the same problem and is trying to use freedom of information legislation to extract the details.
The Nature report also found that ‘academic’ homeopaths are actively resisting the best mechanism to test their propositions, the randomized double-blind clinical trial. ‘Trying to do what I do in that context didn’t work very well,’ said Clare Relton, a homeopath conducting research at the University of Sheffield. She believes that homeopathy is scientific, but that double-blind tests in which the patient knows there is a chance of receiving a placebo break down the necessary trust. She and other homeopaths prefer to rely on ‘more qualitative methods, such as case studies and non-blinded comparisons of treatment options’.22
How can a university get away with offering a degree in 200-year-old quackery? Part of the answer is that homeopathy is taught alongside other varieties of medical counterknowledge that act as camouflage; the universities in question also teach aromatherapy, acupuncture, traditional Chinese medicine, herbal medicine, reflexology, osteopathy, therapeutic bodywork, naturopathy, Ayurveda, shiatsu and qigong. ‘None of these is, by any stretch of the imagination, science,’ wrote David Colquhoun in Nature, ‘yet they form part of BSc degrees. They are not being taught as part of cultural history, or as odd sociological phenomena, but as science.’23
Perhaps the most important example of the blurring of the boundaries of medical science is the rise of the media nutritionists. Advice on nutrition used to be dispensed mainly by registered dieticians–state-registered members of the British or American Dietetic Associations with proper science degrees. Dieticians know a lot about the effect of various foods on the human body, and it is precisely because they are aware that the links between diet and mortality rates are so tenuous that their advice is so simple and unexciting. Their basic message is the same as that of doctors: eat a balanced diet with lots of fruit and veg.
Then at some point in the 1990s the new nutritionists arrived–on daytime television, in health food stores, in the health sections of bookshops, and, as the phenomenon gathered pace, in supermarkets, the tabloid newspapers, the best-seller lists and on prime-time TV. These diet specialists belong to the world of complementary and alternative medicine, but there is nothing ‘alternative’ about their marketing skills.
Dr Gillian McKeith, a bossy Scottish nutritionist, has sold more than a million copies of her book You Are What You Eat, which was also the most borrowed book from British libraries in 2005–6; her hit television programme of the same name, in which ‘overeaters are trained in Gillian’s healthy ways’, has run to several series and airs in fourteen countries. Her career was going swimmingly, in fact, until she attracted the attention of Ben Goldacre, a young hospital doctor who writes the Bad Science column in the Guardian, who decided to find out more about her doctorate and discovered that it was awarded by a non-accredited American institution on the basis of a correspondence course.24
News of Goldacre’s discovery spread like wildfire, and McKeith’s career has never quite recovered from this humiliation; but most media nutritionists have not been exposed to any scrutiny and still exude plausibility. They are careful not to come across as New Age fruitcakes. They do not promise to realign our biorhythms on the astral plane; they talk about ‘The Health Remedies in your Fruit Bowl’, to quote the title of an article by Angela Dowden, registered nutritionist and former Health Writer of the Year. She says: ‘Whichever fruit you fancy, you can be sure you’ll get a healthy boost of fibre, vitamins and disease-preventive antioxidants. But fruit is also nature’s pharmacist–so by selecting carefully, your fruit bowl can become a valuable source of home remedies for minor ailments.’
Dowden gives an example. For eye-strain, take bilberries. ‘These European cousins of American blueberries contain anthocyanin antioxidants which strengthen the blood vessels supplying the retina in the eye. Bilberry extracts have been shown to treat visual fatigue caused by prolonged reading and working in dim light.’25
Dowden’s tone is so cheerful and reasonable that it seems positively rude to ask: ‘Shown by whom?’ But it’s a good question. Goldacre read this passage and worked his way through all the references to bilberries in medical journals. There was no evidence to suggest that bilberries had the slightest effect on the retina. ‘I read 84 very boring abstracts to make sure,’ he writes. He describes Dowden’s claims as ‘fairly typical media nutritionist fare–and horseshit, as media nutritionist fare usually is’.26
This ‘fare’ has not only gone down extremely well with the public; in the process, it has also pushed the boring but accurate claims of qualified dieticians to the margins. Anyone can call himself a nutritionist. Patrick Holford, founder of the Institute for Optimum Nutrition, is Britain’s most influential nutritionist. His Optimum Nutrition Bible has sold half a million copies, and he has advised the National Association of Head Teachers, the Food Standards Agency and the Prince of Wales’ Foundation. In 2007, he was made a visiting professor in nutrition at the University of Teesside. Yet his only academic qualification is an undergraduate degree in psychology from York University (though he does hold a diploma from his own institute). The barrier for becoming an ‘expert’ is set so low that the only real requirement is a talent for self-promotion.
Media nutritionists cannot easily be identified as quacks because so much of what they say seems innocuous. ‘Fruit is nature’s pharmacist,’ insists Dowden. (It isn’t, actually, but it’s a nice thought.) Instead of New Age mumbo-jumbo, they produce quasi-scientific statements about ‘the link between’ natural food supplements and various manifestations of good health. They refer confidently to clinical trials and employ many of the buzzwords used by doctors: such and such a substance is ‘rich in antioxidants, which have been shown to prevent cancer’. But what they are actually doing, most of the time, is manipulating the language and literature of medicine.
‘The scholarliness of her work is a thing to behold,’ says Goldacre of Gillian McKeith. ‘She produces lengthy documents that have an air of “referenciness”, with nice little superscript numbers, which talk about trials, and studies, and research, and papers…but when you follow the numbers, and check the references, it’s shocking how often they aren’t what she claimed them to be in the main body of the text. Or they refer to funny little magazines and books, such as Delicious, Creative Living, Healthy Eating, and my favourite, Spiritual Nutrition and the Rainbow Diet, rather than proper academic journals.’27
In an article for the British Medical Journal, Goldacre discussed media nutrionists in general: ‘The whole field is based on a small palette of simple academic errors. Food gurus extrapolate wildly, creating hypotheses from metabolism flow charts or interesting theoretical laboratory bench data, and then using them to justify a clinical intervention…Similarly, the media nutritionists extrapolate from observational data to giving ‘evidence based’ interventional advice.’28
Media nutritionists often dispense counterknowledge, and people act on their advice. Should we be worried about that? The question cannot really be separated from a broader question: how dangerous is complementary and alternative medicine in general? And there is no simple answer.
Some alternative medicine is dispensed under the supervision of medical doctors. That is a good thing, in the sense that it means that there is less danger of an alternative practitioner misdiagnosing a serious illness. But it is also a bad thing, because it shows that CAM has established a foothold in health services and universities on both sides of the Atlantic.
Most teaching hospitals in Britain offer courses in CAM; so do some of America’s leading medical schools, including Harvard and Columbia. These courses are mostly designed to teach doctors about alternative medicine as a phenomenon rather than to persuade them of its merits, but the dividing line is a fine one. The nursing profession, too, is branching out into CAM. In America, growing numbers of nurses have endorsed something called ‘Therapeutic Touch’ (TT), which advertises itself as a form of ‘energy healing’. In TT, ‘the practitioner moves the hands with the palms facing the recipient at a distance of three to five centimetres. Gentle sweeping movements are employed to activate the energy flow.’ Utter horseshit, as Goldacre would say–and now practised not only in America but also by nurses in the publicly funded National Health Service.29
Some alternative practitioners are employed directly by health authorities. Many more are informally linked to the NHS through word of mouth: a doctor or nurse suggests that a patient try aromatherapy or reflexology because ‘it seems to work well for some people’. I first heard of cranial osteopathy, for example, when my former GP vaguely recommended it for ‘stress’. He couldn’t remember exactly how it was supposed to work.
Cranial osteopathy is almost identical to craniosacral therapy; it claims that ‘practitioners with a very highly developed sense of touch’ can detect a rhythm that pulsates through the entire body and holds the secret to good health. This is, in fact, 100-year-old quackery, dreamt up by one Dr William Sutherland at the beginning of the twentieth century. Orthodox medicine has been unable to find this rhythm; and, indeed, like CST practitioners, cranial osteopaths examining the same patient identify completely different rhythms.30
A couple of years after my GP recommended cranial osteopathy, a friend of mine, the novelist Michael Arditti, was nearly killed by it. In 2001, he developed acute stabbing pains at the base of his spine. He consulted a highly recommended husband-and-wife team of cranial osteopaths. They were charming, but firm in their diagnosis. As Arditti wrote later:
They claimed that the pain was the product of all the negative energy I had stored at the base of my spine. In my enfeebled state, I believed them. Against all the evidence, they claimed to have healed me, pronouncing me free of ‘dis-ease’ and asserting that the pain, sweats and fevers were simply the negative energy working its way through my body. In despair, I called a doctor who rushed me to hospital, where I was diagnosed with an infection of the spine between the vertebral discs. As the condition had gone untreated for so long, I had developed septicaemia. For several days, my life hung in the balance. I remained in hospital for 14 weeks. I’ve been left permanently disabled, since the bug destroyed two discs at the base of the spine.31
Is Michael Arditti a victim of alternative medicine? Interestingly, he doesn’t think so. He remains a fan of CAM. He says that the fact that he was misdiagnosed by two cranial osteopaths doesn’t invalidate other alternative therapies. That would be like damning orthodox medicine because a GP had misdiagnosed the first signs of a heart attack as indigestion (something that has happened countless times).
In my opinion, this is a misleading analogy. When a medical doctor makes a wrong assessment, that is either an honest mistake or a failure to follow diagnostic procedures. Medicine uses a methodology that furnishes doctors with the best available evidence, however incomplete or confusing it is. In contrast, practitioners of CAM can more or less make up their own rules, and its regulatory bodies serve little purpose since regulated counterknowledge is as useless as the unregulated variety. Because Arditti’s cranial osteopaths operated in the demi-monde of CAM, it was virtually impossible to sue them for medical negligence.
On the other hand, critics of alternative medicine must be careful not to fall into the same trap as CAM and turn anecdotal evidence into a looming public health crisis. Harry Petrushkin, a junior doctor at St Thomas’s Hospital in London, told me that one or two friends of his middle-class parents had suffered at the hands of alternative practitioners. But he added: ‘Out of several thousand cases I’ve encountered professionally in NHS hospitals, I can’t think of anyone who was made ill by alternative medicine.’ In 2000, a report on CAM by the House of Lords select committee on science and technology suggested that alternative medicine was most popular among the ‘worried well’; it also quoted American research showing that the best single predictor of the use of alternative healthcare was higher educational status.32
In short, the classic consumers of CAM would appear to be middle-class hypochondriacs. Occasionally they damage their health because they prefer organic snake oil to prescribed medicine, but for the most part it’s pretty safe to sniff aromatic oils, munch your way through a bowl of bilberries, or swallow sugar pills disguised as homeopathic medicine. More than safe, in fact: if the placebo effect is triggered, then the effects will be beneficial and genuinely ‘complementary’ to orthodox treatments.
To grasp the real long-term danger of CAM, we need to return its central and most objectionable feature: it makes claims that are simply not true. It encourages what the House of Lords report calls the public’s ‘flight from science’ towards a simplistic, quasi-magical world view. There is a natural human tendency to extrapolate fake trends from isolated cases, and CAM exploits it to the full. For alternative practitioners and the lobbyists who write press releases, the plural of ‘anecdote’ is ‘data’. By cherry-picking research findings and twisting statistics, self-appointed health gurus play into the hands of journalists (especially those on the Daily Mail) who seem intent on dividing all foodstuffs and medicines into miracle cures and hidden poisons, thereby increasing our tendency to fads and panic. And politicians are gutless in the face of health panics, even when they suspect that ‘public concern’ (as it is presented) is based on bad science.
The worst example in recent years is the scare over the non-existent link between autism and the MMR (measles, mumps and rubella) triple vaccine given to children. In 1998, the Lancet published a paper written by Dr Andrew Wakefield and colleagues describing twelve children who developed autism and inflammatory bowel disease. The paper suggested that the autism might be the result of the bowel problem; it also speculated that, since the bowel problems flared up after the children received the MMR vaccine, the vaccine might have caused the autism.33
Wakefield, a lecturer at the Royal Free Medical School in London who trained as a surgeon in Canada, then gave a press conference in which he said that the combination of the three vaccines might overload the body’s immune system, leading children to develop the bowel disorder Crohn’s disease, linked to autism. He called for single vaccines to be provided for the three diseases because there were ‘sufficient anxieties’ over the safety of the MMR jab.34 Professor Raymond Tallis, a former chairman of the Royal College of Physicians’ ethics committee, commented: ‘To say that this was irresponsible–because the evidence in his paper fell far short of this conclusion–is the understatement of the century.’35
Wakefield’s theory has since been negated by several larger and more rigorous studies; the Medical Research Council, for example, examined the vaccination records of more than 5,000 children and found no connection between MMR and autism.36 Yet it was years before this simple truth could be heard above the babble of concerned parents, alternative health experts, tabloid columnists, celebrities and opportunistic politicians, all of them expressing their opinion that there ‘might well be’ a link.
As a result of the furore, countless parents held off giving their children the triple vaccine–a decision that had no more basis in science than the refusal of Pakistani parents to vaccinate their children against polio because they believed it was an American plot to sterilize Muslims. In 2002, the mayor of London, Ken Livingstone, advised parents to avoid the MMR jab. ‘It seems to me that a child of just fourteen months is incredibly vulnerable,’ he said. ‘I remember having all these jabs separately–often you have quite a severe reaction. Why whack them all into a child at the same time?’ Dr Ian Bogle, the chairman of the British Medical Association, accused Livingstone of ‘doing irreparable damage’ with this irresponsible statement.37 Coincidentally or not, vaccination levels in London fell and the incidence of measles rose. As Tallis points out, in rare cases measles is fatal or causes brain damage: an epidemic would kill hundreds of children. In any case, the cost to the NHS of dealing with an entirely avoidable nationwide health scare ran to millions of pounds.
The MMR panic illustrates the downside of the democratization of healthcare. The expansion of consumer choice into medicine is inevitable and often beneficial. People genuinely are empowered by, for example, the release of information about hospital mortality rates, which helps them decide where they want to be treated. It is less easy to say to what extent they benefit from the emergence of a multi-billion-pound market in placebos.
Many doctors would say that, in so far as it takes the pressure off them to treat minor ailments, and also encourages patients to take more responsibility for their own well-being, it’s on the whole a good thing. But no one is truly empowered by being given false information about his or her own health. Moreover, there is a difference between allowing consumers the freedom to make bad choices about their own treatment and allowing the boundaries of medical knowledge to be decided by the whims of the marketplace rather than by scientific research. Yet that is exactly what is happening, with worrying implications for Western society and, as we shall see in a later chapter, horrible consequences in the developing world.