Buy a packet of cigarettes in the U.K. (something I can happily say I've never done), and it will be emblazoned with dire warnings of what smoking can do to your health. I wonder if alternative health products should carry a similar warning?
At first sight, this sounds outrageous. After all, we all know that tobacco is bad for you, while alternative remedies are intended to do good. And they're often natural, which surely means that they are okay?
In a recent article in the Guardian newspaper, oncologist Ranjana Srivastava described a consultation with a patient who was undertaking a whole raft of alternative treatments as well as her chemotherapy. When the patient was asked why the therapies appealed to her, she replied "Because they are natural. They heal your body from the inside, and they guarantee results."
Other reasons for going the alternative route are sometimes given. A while ago, a local free magazine, Swindon Link published an article encouraging readers to donate to a fund collecting thousands of dollars for a young woman who wanted to take an alternative Vitamin C treatment for her cancer. I emailed the magazine, questioning their fundraising for a treatment with no proven clinical value. Their response was, "Yes, but it raises hope, it might work and it doesn't do any harm."
So let's take each of the arguments standing in the way of a health warning on alternative therapies. They are natural, they might work, they raise hope and they don't do any harm.
The "natural" part is easily dealt with. Cancer is natural. For that matter, tobacco is a natural product, and was originally sold as a health remedy. There were several Elizabethan madrigals dedicated to the benefits of tobacco, including a jolly number by Thomas Weelkes, which included these lines:
Head and brains,
Back and reins,
Joints and veins,
From all pains
It doth well purge and make clean.
It sounds remarkably like an advertisement for a product from a health store. Even the most cynical of us reacts well to a word like "natural" when compared with "artificial." But that is all it is -- a word. A marketing ploy. Nature is indeed very pleasant -- except when it isn't. There's plenty that's natural that is bad for us. That's why we like to be tucked up in our artificial beds, in an artificially heated artificial house, rather than shivering in the natural snow, out in the open under a natural tree. Many of the most deadly poisons (ricin, for example) are natural. Saying something is natural tells us nothing about its qualities, beneficial or otherwise.
How about "they might work"? A small number of alternative medicines, notably herbal remedies, certainly have an effect. But when they do work, it is because they contain active chemicals -- drugs. And we continue to learn a lot from these complex "natural" chemicals. But taking them in the form of an herbal remedy is the worst way to do so, for two reasons.
First, herbal medicines rarely come with the kind of information sheet you get with all properly licensed drugs. And that can be a problem. St John's Wort, for instance, a popular herbal treatment, has shown benefits in helping with mild depression -- but just like a real medication, it can have side effects from stomach pains to dizziness. And it reduces the effectiveness of a number of other medications, including HIV and cancer drugs. This is clearly potentially dangerous, because we tend to assume a "natural" herbal product has no side-effects.
Secondly, a proper drug will be given in a specific dose and won't contain lots of other substances with unknown effects. Herbal products contain a whole mix of active chemicals, not just the one you want. And the dosage can vary hugely, even in a good quality product. And that's something you can't be sure of getting. In 2015, the New York Times described a test undertaken by U.S. authorities on herbal supplements from four major national retailers. Around 80 percent of the products contained none of the herbs on the label, and some included dangerous contaminants. These weren't from backstreet operators, but from big stores.
Many other alternative remedies are nothing more than a placebo -- having the same effect as a sugar pill. Homeopathy is a good example. There are several problems with this popular treatment. The original basis was totally unscientific -- it's sympathetic magic. Samuel Hahnemann, who developed the concept in the 18th century, decided that consuming a dilute solution of a substance, often poisonous, which caused bad responses, would cure illnesses that produced the same effects.
Then there's that dilution. A typical dilution for a homeopathic product is "30 C." This means the original substance has been watered down by a factor of 100, 30 times in row. (That makes the chance of a single molecule of the active ingredient being left in the medicine a million trillion trillion times less likely than you are of winning the U.K. lottery jackpot with a single ticket.) Better homeopaths recognize this, but say that water has a "memory," which retains the ability to act as if the substance were present.
However, there is no evidence for this "memory" and, as the Australian Council Against Health Fraud has pointed out , it is strange that water's memory is so selective. How does it know to remember the homeopathic cure, but not the various bladders the water has passed through in the past and all the other chemicals that have been in it and then diluted out of it on its way to the final place of use?
There have been many, many trials of homeopathy, and the good quality studies show no benefit above that of a placebo. That's not the same as "no effect at all." A placebo can make you feel better, and reduce the impact of pain -- but it has little impact on an illness.
So what about "gives hope and does no harm"? There's a moral judgment here. Perhaps it is acceptable to give someone a false hope. Isn't it a bit like holding the hand of someone who is dying and saying, "It'll be fine," to make them feel better, even though you know it won't be? Technically that too is false hope. But it's very different from raising thousands of dollars to send someone to undergo a treatment whose only known benefit is fattening the wallet of the practitioner. That's not just false hope, it's significantly worse.
As for "does no harm," it is certainly true that most alternative therapies, acting as best as placebos, aren't of themselves dangerous. But this doesn't make it right to spend large amounts money on something that is no more beneficial than a sugar pill. And in some cases, there is a positive danger.
When a patient opts to take alternative therapies in place of a medical treatment, they are increasing their risk of suffering or death. No medical treatment is 100 percent certain, and some people recover from life-threatening illnesses with no treatment at all, so would appear to have been saved by an alternative therapy. But there is no doubt that choosing alternative medicine over a proven medical treatment is statistically doing harm.
So, should alternative therapies carry a health warning? I don't see why not. For instance, a homeopathic remedy could say something like:
WARNING -- contains no active ingredients. If taken in place of medical treatment could result in harm or death
Would that be so wrong?
 Quoted in Singh, S. and Ernst, E. (2008). Trick or treatment. New York: W.W. Norton, p.118.
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