Pseudoscience pretends to be science, but uses theories that are obviously unscientific or bogus. In the 21st century we aim for rational, unbiased evidence-based medicine as the gold standard for Good Medical Practice, and pseudoscience is at the opposite end of that spectrum. This article will not talk about the medical practices that have not met the gold standard of evidence-based medicine, but are still rational and scientific in their approach. As medicine is a rapidly evolving field, sometimes we cannot wait for the proper evidence based on randomised, double-blind placebo controlled studies. Some of these studies will never be done because it might not be ethical to do them, because to do some of these studies properly it might mean withhold a life-saving treatment from study participants (the Helsinki Declaration). As clinicians we can rationalize how a theory works and, assess whether it makes “scientific sense”, and we develop anecdotes through our own experiences. In this article I will talk about the medical practices at the other end of the spectrum - Pseudoscience, Irrational, Fringe, Alternative, or Quackery – those medical practices that are so much out of the realm of common sense, that even though they use some scientific terms to explain the theories, they simply “do not make any sense”, and when they have been put to the gold standard tests (randomised double-blind placebo-controlled) they fail miserably.
Alternative medicine is any healing practice “that does not fall within the realm of conventional medicine” In some cases it is based on historical or cultural traditions, and usually not based on unbiased scientific theories. Richard Dawkins, the British scientist and very vocal skeptic once stated that “there is no alternative medicine. There is only medicine that works and medicine that doesn’t work.”I am of the opinion that if a medical treatment starts off as “Alternative” and has been scientifically proven to work, it should –or will - be upgraded to “conventional medicine”. The term “alternative medicine” is generally used to describe practices used independently or in place of conventional medicine. The term “complementary medicine” is primarily used to describe practices used in conjunction with or to complement conventional medical treatments. Alternative medicine is frequently grouped with complementary or integrative medicine and placed under the umbrella term Complementary and Alternative Medicine (CAM). (Some of my more skeptical colleagues would refer to this as SCAM.) CAM is also referred to as ‘Natural Medicine’, ‘Non-conventional medicine’ and ‘holistic medicine’. Some of the practices included in CAM are Acupuncture, Ayurveda, Biofeedback, Chiropractic medicine, Herbalism, Homeopathy, Hypnosis, Meditation, Naturopathy, Traditional Chinese Medicine, and Yoga. There is no place for CAM in diagnosing allergies, and if the method of diagnosis is faulty, how can you know what you are treating? I am all for patients having an outlet to be heard by an empathetic listener and I am even open to the idea of prescribing supplements for their placebo effect, and I am very much for supplements prescribed for deficiencies that are diagnosed scientifically. However, allergy patients need to be aware of what CAM is providing and they must be made aware that natural remedies are not entirely harmless. They can cause allergies and they can even have toxic effects on the body. In this article I will specifically talk about the “bogus alternative practice” in New Zealand that uses bogus methods to diagnose and treat allergies. This article is not about being negative towards CAM in general.
The Medical Council of New Zealand, made a Statement to doctors who practice CAM or refer patients to CAM practitioners on CAM in March 2011: “No person may be found guilty of a disciplinary offence under the Health Practitioners Competence Assurance Act 2003 ( the Bill intended to protect the health and safety of the public by establishing processes to ensure that health practitioners are competent to practice) merely because that person has adopted and practiced any theory of medicine or healing if, in doing so, the person acted honestly and in good faith”. However, practitioners of CAM who choose to be ignorant of science and are brainwashed into believing that their practice is effective and not dangerous, is “acting honestly and in good faith”. The medical council went on to say that they endorse the statement made by the Medical Practitioners Disciplinary Tribunal, which said: “There is an onus on the practitioner to inform the patient not only of the nature of the alternative treatment offered but also the extent to which that is consistent with conventional theories of medicine and has, or does not have, the support of the majority of practitioners…”. I strongly suspect that the majority of the practitioners of CAM are in breach of that statement. Another point made by this statement was that: “In assessing patients you must…reach a diagnosis by using a diagnostic system demonstrated by appropriate research methodologies to have high level of accuracy and proven benefits to patients”. Hair Analysis, Muscle testing, iridology, and measuring IgG levels in the blood are examples of tests widely used in New Zealand by CAM practitioners that have never been demonstrated by any appropriate research methodology to have any level of accuracy or benefit in diagnosing allergies. Finally, the medical Council document states: “In treating patients and in engaging in health promotion, you must ensure that the treatment is efficacious, safe and cost effective”. None of the CAM practiced in New Zealand, as far as treating allergies is concerned, live up to all three of these criteria. Most of them live up to none.
Examples of Alternative medical Practices in New Zealand that diagnose and treat (or influence) allergic patients based on pseudoscience:
- The anti-vaccine movement
- Hair Analysis
- Muscle Testing
In countries like New Zealand, where there is an increase in a medical condition, like allergies, when the number of Allergy experts, have not increased proportionally, that gap is often filled by Alternative or Fringe practitioners. Frustrated, desperate allergic patients want someone, anyone to listen to them, and take their complaint seriously; the one thing most of these alternative practitioners are very good at. Proponents for Alternative medicine, might ask what is wrong with patients having a “good listening ear”? To mention a few things wrong, I will start with four: Firstly, it leads to a false sense of hope, as some of these practitioners sometimes offer a “cure”, which even in the best hands is very rare in modern medicine. Secondly, it is misleading, as patients are often put on very strict diets based on bogus tests results and the truly allergic trigger is often not identified. Thirdly, it is expensive, as some of these bogus tests cost up to $500, and the results often identify some “deficiency in the body” , which supports an ongoing sale of various “natural” supplements (aka “snake oil”). Lastly, and most importantly, it can have life-threatening consequences in truly allergic patients if a food allergy to peanuts, nuts or one of the foods that can cause anaphylaxis, is misdiagnosed and wrong advice is given.
The history of Quackery in Medicine
Quackery is nothing new to Medicine. In a letter to the British Medical Journal, dated Oct. 30, 1858, FJ Brown M.D., wrote: “ Sir, - Allow me to send you a few observations on quackery and homeopathy in particular. …those persons who resort to quackery seek relief from suffering without regards to the means used. …A large class of the diseases termed neuros is benefited by an appeal to the imagination of the patient; but I contend that it is immoral to act deceitful to sick men, and as such to deceive men in good health. I fully believe that it is immoral to deceive children and lunatics, although some persons differ with me on this question.”
In 1903 a German Society for the Repression of Quackery was founded in Berlin. Among the members of the Society were a large number of laymen as well as medical practitioners. The object of the Society was to “enlighten the public mind as to the harm done by quackery to public health, and to the proper care of the sick. The society also proposes to take part in the meetings of quacks, in order to confute their arguments and expose their misstatements. A weekly journal is to be founded, in which misdeeds of the quacks will be published and brought to the notice of the police authority. Around the same time, in a letter to the BMJ date June 10, 1911, a General Practitioner, George Dudley, made an appeal to the British Medical Association to “…make a move to persuade the Government to introduce new legislations to amend the Medical Act so as to protect members of the profession against quackery of all kinds”. Also in the UK, The historical Aspect of Quackery published in the BMJ in 1927, AJ Clark, Professor of Pharmacology at the University of Edinburgh wrote: “The term quack simply means one who pretends to knowledge or skill that he does not possess, and the fact that this term has come to signify in popular usage a pretender to medical knowledge indicates that clearly that there is something about cure of disease that particularly attracts both delusion and imposture” He identified greed as one of the motives that drives the quack to prey upon human suffering. One comment made by Clark, which seemed like a surprising view for that time, was “…there is a considerable amount of evidence to indicate that while the medical profession has become more scientific and more successful; it has become increasingly unpopular with the masses.” That is the comment that I would make of modern (21st century) medicine, in contradistinction to medicine in 1927, when the ignorance of the causes and mechanisms of diseases allowed more room for quackery.
Why is medical quackery accepted – and possibly growing in acceptance - by patients in spite of the lack of efficacy?
With advances in technology and the widespread use of the internet as the first port of call for medical information, it is much easier for medical charlatans to flourish, and some of the claims on some of these websites are very believable for the desperate patients, which happen to be gullible. Apart from filling a gap in the provision of allergy health care in New Zealand, quackery exist and is probably growing through the internet, because those who perpetuate quackery are taking advantage of ignorance about conventional allergy diagnosis and treatment in the general population. But to be fair, some of these practitioners are ignorant themselves and have been brainwashed by their trainers. Also the pride of these practitioners come into play, because once they have endorsed or defended a “cure”, and has invested time and money in it, they will be reluctant to admit that it is ineffective. Therefore some practitioners are fully aware of the ineffectiveness of their practice and are acting fraudulently.
As medicine makes remarkable advances, and more and more lives are saved by using modern drugs, people are becoming aware of all the possible side effects from pharmaceutical drugs. Therefore a fear of side-effects from pharmaceutical drugs is forcing patients to choose non-drug alternatives to treat their ailments. Many of these bogus practices will make claims on the internet of “cures”, “non-drug therapies”, and “natural treatment”, all of which are very appealing to many patients. So, desperate patients are looking for “safe”, “natural” and hopefully “cheaper” treatments. Some of the ongoing costs for Alternative Allergy treatments are anything but cheap.
The Placebo effect is a real and very powerful psychological response to all treatments. A placebo is a biologically inactive treatment that is used as a sham or simulated medical intervention. All treatments, including sugar pills, with no known pharmacologic effects, will also have an added effect on the person’s perception of their illness. This belief in the treatment will in turn have a therapeutic effect, leading to improvement in the patient’s condition. This is known as the placebo effect. Recent research has shown that placebos (biologically inactive treatments) can actually produce biological changes that begin the body's healing process. It is a well known fact that blue tranquilizer pills have better effects than red pills, even with the same stuff inside. Other research has found that patients do better with a caring doctor who takes time with them, compared to a non-caring doctor who is a poor communicator, even if they are both given the same placebo. Placebo has a very high rate of activity. In several studies the effectiveness of the placebo is 55-60%, when compared to the active medication, irrespective of the potency of these active medications.
A study in the journal Psychosomatic Medicine found that psoriasis patients who were alternately treated with a pharmaceutical skin cream and a placebo improved just as much as patients given up to four times as much of the real drug. Another study involving research in Parkinson's disease patients showed that their brains released dopamine (an important chemical neurotransmitter in the brain) in response to placebo treatment. The dopamine release triggered a series of other changes throughout the brain, resulting in improved health for these patients. In a recent study of a new kind of chemotherapy 30% of the patients in the control group – the group given the placebo – lost their hair.
The regression fallacy states that certain “self-limiting conditions” such as warts and the common cold will almost always improve regardless of the treatment given. In the case of the common cold, improvement almost always occurs within 1 week. Often a patient will associate the recovery with the use of the alternative treatment, when the recovery was inevitable. The bogus practitioner treatment will make your cold last one week instead of seven days! One should also be wary of the practitioner who tells the patient to “take these herbs for your hay fever until the end of summer, after which you will be cured.” She would be more honest to add “…until next spring”.
Allergy Tests using Pseudoscience, “Quackery” or “Magical thinking”
Applied Kinesiology (AK) or “muscle testing” is the study of muscles and the relationship of muscle strength to health. In AK the patient’s arm strength is tested after test substances are placed in the patient’s arm (or mouth). AK is not the same as kinesiology or biomechanics, which is the scientific study of movement. AK was developed from kinesiology by an American Chiropractor in 1964. However, it is interesting to note that position statements put out by both the American Chiropractic Association and the Danish Chiropractic Association do not endorse AK to be legitimate or effective.
AK testing is purely subjective relying solely on the practitioner assessment of muscle response. Studies have shown test-retest reliability, inter-tester reliability, and accuracy to be no better than chance correlations. Also a review of peer-reviewed studies published in Chiropractic & Osteopathy reports that “when AK is disentangled from standard orthopaedic muscle testing, the studies evaluating unique AK procedures either refute or cannot support the validity of AK procedures as diagnostic tests”
Naumbudripad’s Allergy Elimination Technique (NAET) is based on the notion that allergies are caused by “energy blockage’ that can be diagnosed with muscle testing and permanently cured with acupressure and or acupuncture techniques.
Electrodermal skin testing (Vega testing) alleged that a computerized galvanometer can be used to detect supposed “energy imbalances” caused by allergies if the allergenic substances are held in the hand.
Commercial Hair Analysis
Hair analysis is the test in which a sample of the person’s hair is sent to a lab for measurement of mineral content and diagnosis of allergies.
The ability to diagnose allergic disease was studied in 9 fish allergic and 9 control subjects, who provided specimen for blood and hair for testing. All fish allergic subjects had previously been shown at Guy’s Hospital in London to have a positive skin prick test to fish. The specimens were submitted as duplicate samples to five labs that offered a commercial service for diagnosing allergies from hair testing. All 5 labs were not only unable to diagnose fish allergy but also reported many allergies in apparently non-allergic subjects and provided inconsistent results on duplicate samples from the same subject. This study should remove any shred of doubt that hair analysis is completely useless in diagnosing allergies.
Statement on complementary and alternative medicine, Medical Council of New Zealand, March 2011, www.mcnz.org.nz
Haas, Mitchel, et al, Disentangling manual muscle testing and Applied Kinesiology: critique and reinterpretation of a literature review. Chiropractic & Osteopathy15:11(2007-2008)
Brown FJ, Quackery in Opposition to the truth British Medical Journal Oct. 30, 1858
Clark A. J. The Historical Aspect of Quackery, The British Medical Journal, Oct. 1, 1927. Pg 589
Sethi T J et al How reliable are commercial allergy tests? Lancet Jan 10; 1(8524): 92-94, 1987