Any therapy that is not supported by sound evidence showing that it generates more good than harm should not be used in routine healthcare. While many rational thinkers might agree with this categorical and seemingly harsh statement, most advocates of alternative medicine would probably dispute it. They claim that alternative therapies ought to be exempt from such rigour because they are natural, gentle, safe and agreeable. Therefore, there is no reason for insisting on scientific proof. What could be wrong with a little aromatherapy, reflexology, naturopathy, homeopathy or Reiki?
Arguments like this can be persuasive; we hear them so often that many of us have started believing them. But the endless repetition of a falsehood does not make it a truth. Yes, alternative treatments are often natural, gentle, safe and agreeable, but they can also be harsh, risky and painful. What is more, they can even be deadly.
Take Paida, or ‘slapping therapy’, for instance (Paida in Chinese means to pat and slap your body). Hongchi Xiao, a Chinese-born investment banker, popularised this treatment several years ago and has since earned good money from it. Based on the principles of traditional Chinese medicine, it involves slapping the body surface with a view of stimulating the flow of the life energy ‘chi’. As a result, patients acquire bruises that make them look like the victims of serious domestic violence. Proponents of slapping therapy believe that this ritual restores health and eliminates toxins; in fact, they claim that the bruises are nothing but the toxins coming to the surface.
The treatment might not be all that effective — I know of not even a single clinical trial showing that it works — and it is certainly not agreeable. But how can it be harmful or even deadly? The answer is simple: if slapping therapy, homeopathy, or any other bizarre and useless intervention is being employed as a replacement for treating a serious condition, it instantly and inevitably becomes life-threatening.
Recently, it was reported that a woman from East Sussex died after receiving slapping therapy; other fatalities have been documented previously. The latest victim had been suffering from diabetes and was led to believe that Paida was an effective treatment for her condition. Consequently, she discontinued her medication, a decision which eventually killed her.
Yes, this was an extreme case, but such tragic instances are by no means as rare as alternative medicine fans would want us to believe. Deaths after apparently harmless alternative treatments are being reported with depressing regularity. However, much more often, the resulting harm is not fatal, simply because the conditions treated are not life-threatening. People try alternative therapies mostly for benign diseases such as arthritis, insomnia, back pain, migraine and allergies. In such cases, the ineffectiveness of the treatment does not lead to disaster, but it nevertheless causes unnecessary expense and prolongation of suffering. Thankfully, fatalities are rare, but less serious harm is a very common problem.
The principle is the same: apparently harmless but useless treatments become dangerous not because of the direct adverse effects of the intervention but because they are far too often recommended as a replacement of an effective therapy. In other words, quacks and quackery harm by neglect.
Yet we live in a time where we are constantly being told, for instance by ‘experts’ like Prince Charles, that we ought to be respectful towards ancient traditions of healthcare. I am all for respect towards other cultures, but in medicine there should be limits when it comes to translating respect into action. I do not see any benefit in either respecting or implementing ancient, obsolete notions of life energies, meridians, toxins and other disproven assumptions of alternative practitioners. They originate from a pre-scientific era and have been disproven. They do not belong in modern treatment manuals but in the history books of medicine.
I think that our tolerance of demonstrably false assumptions in medicine is wrong. There are far too many fatalities suggesting that my intolerance is correct.
Edzard Ernst, emeritus professor at the University of Exeter, is the author of Homeopathy: The Undiluted Facts and the awardee of the John Maddox Prize 2015 for standing up for science. He blogs at edzardernst.com.