Until 2011, Dr. Edzard Ernst was the head of one of the few university departments doing real, unbiased research on the effectiveness and safety of alternative medicine techniques. That's important, because you can't just dismiss weird-sounding stuff out of hand, but you also want somebody other than the practitioners of that weird-sounding stuff conducting research and analyzing the data. Now retired, Ernst recently started blogging, and I wanted to point you to his new home on the Internet. He can be a bit snarky and caustic (especially with chiropractic and homeopathy). But in general he's a fair, reasonable, and knowledgeable source on what works and what doesn't. Definitely worth a bookmark.

  • http://www.facebook.com/doyle.liamrw Liam RW Doyle

    “Do you know what they call ‘alternative medicine’ that’s been proved to work? ‘Medicine’.” — Tim Minchin

    • dragonfrog

      A catchy line, and sort of true.  But not entirely true – it has to also gain acceptance among medical practitioners, which can take a while.  When the medicine is unpatentable, it can take a very long while.

      Perhaps the most obvious example – medicinal use of cannabis as an anti-nauseant.  It’s well established to be effective and safe, but it may take a generation change in the medical establishment for it to stop being ‘alternative medicine’.

      St John’s Wort is another example where, if the current trends continue, we can probably safely think of it as ‘proven to work’ within a few years – but it will very likely remain ‘alternative medicine’ for decades.

      EDITed to add: IANA medical professional or expert by any stretch. I may very easily be subject to misunderstanding what little of the literature I have read.

      Also, what do you call ‘medicine’ from a major pharma company that has been proven not to work?  ‘Medicine,’ probably for another thirty years or so.

      Pharma companies are currently allowed to bury research results showing their drugs don’t work, and keep trying until they get results showing it works, and publish them.  Then, openly executable meta-analysis will find that “3 of the 3 published trials showed Waxaflaxicol is effective as a treatment for angry shin syndrome” – because the company that holds the patent sponsored 12 studies and only published the 3 that found efficacy.

      It’s already been proven not to work, but the proof is in a filing cabinet in the seventh sub-basement of a pharma company’s research facility (there are only 4 sub-basements on the published blueprints) – only over a few decades will the general research community get the opportunity to replicate those results, and even then a generation of doctors will have ‘known’ that it’s effective for decades.  Barring a Thalidomide-level scandal, the use of this known-ineffective medication, by doctors who firmly believe in sound evidence but don’t have the time to scour research journals, will only gradually taper off. A few years for the bogus research to make the rounds and the manufacturer to publicize them among young doctors; a generation for the secret knowledge of its worthlessness to come to light, and another generation for the doctors who don’t have time anymore to follow new research to retire.

      • dragonfrog

        Case in point:  Why is honey for cough relief “alternative medicine” and dextromethorphan cough syrup “medicine”?  Repeated clinical trials have found DM to be little or no better than placebo, but honey to be significantly better than placebo.

        Another case where the “alternative medicine” is the one that’s been proven to work, and the “medicine” is the one that’s been proven not to.

        My guess as to why – it’s in nobody’s economic interest to change that. If tomorrow everyone who uses DM for coughs switched to honey
        - major marketers of honey might see a 1-2% blip in sales over the same quarter last year. Or they might not even notice it – it might be buried by a decrease in the popularity of baklava.
        - drug companies would be in a panic – solid, reliable product lines would be rendered worthless overnight, whole manufacturing and marketing efforts suddenly crushed.
        - millions of people with sore throats would sleep better at night.

        EDIT: see eldritch_vapor’s reply below – it looks like I had misunderstood, or at least over-applied, what I had read.

        • http://www.facebook.com/Manglewood Molly Manglewood

          Can you provide any evidence for any of the claims you’re making? This is the whole point of what Edzard Ernst does – applying critical thinking to the claims of alternative medical practitioners. Too many people make wild assertions and accusations and then repeat them ad nauseam instead of providing evidence. When pressed for proof they offer anecdotes instead of data, conspiracy theories instead of clinical trials. That isn’t science, it’s propaganda.

        • eldritch_vapor

          I was surprised by your assertion that dextromethorphan doesn’t work for cough suppression, because I have used it in the past (usually in some kind of sustained-relief capsule I think) with success.  Not as powerful as codeine, but effective.

          So I did a bit of googling, and I found that there was a paper in 2004 showing that it was no more effective than placebo *in children*: http://www.ncbi.nlm.nih.gov/pubmed/15231978 .  This is weird, so I looked for papers citing that study, and here’s something that explains it:

          http://www.coughjournal.com/content/1/1/7

          Worldwide paediatricians advocate that children should be managed differently from adults. In this article, similarities and differences between children and adults related to cough are presented. Physiologically, the cough pathway is closely linked to the control of breathing (the central respiratory pattern generator). As respiratory control and associated reflexes undergo a maturation process, it is expected that the cough would likewise undergo developmental stages as well. Clinically, the ‘big three’ causes of chronic cough in adults (asthma, post-nasal drip and gastroesophageal reflux) are far less common causes of chronic cough in children. This has been repeatedly shown by different groups in both clinical and epidemiological studies. Therapeutically, some medications used empirically for cough in adults have little role in paediatrics. For example, anti-histamines (in particular H1 antagonists) recommended as a front-line empirical treatment of chronic cough in adults have no effect in paediatric cough. Instead it is associated with adverse reactions and toxicity. Similarly, codeine and its derivatives used widely for cough in adults are not efficacious in children and are contraindicated in young children. Corticosteroids, the other front-line empirical therapy recommended for adults, are also minimally (if at all) efficacious for treating non-specific cough in children. In summary, current data support that management guidelines for paediatric cough should be different to those in adults as the aetiological factors and treatment in children significantly differ to those in adults.

          • dragonfrog

            Interesting, thanks for pointing that out.

            Personally, I have quit using dextromethorphan – for me, it doesn’t touch any cough I would bother to medicate with anything stronger than mint tea.  It is however extremely effective at giving me nosebleeds.

        • http://david-colquhoun.myopenid.com/ David Colquhoun

           I’m afraid you have been misinformed about honey. It too is no better than placebo.  Sadly the university’s PR people chose to spin the result. You can read about it at http://www.dcscience.net/?p=209

          The fact of the matter is that there is no such thing as a cough suppressant.  None of them work.

          • Antinous / Moderator

            Actually, Vicodin works quite nicely.

            The problem with that study is that, looked at in a different way, the three treatments were gooey syrup, gooey syrup and nothing. If they had found a different way to deliver the dextromethorphan that didn’t precisely replicate the gross physical qualities of honey, the results might be different.

          • dragonfrog

            Good point. The results:
            - nothing: no effect
            - gooey syrup (sugar + dextromethorphan): no effect
            - gooey syrup (honey): effective

            seem to allow several interpretations:

            - gooey syrup-ness itself helps reduce coughs, dextromethorphan worsens them by an equal amount, and honey is nothing special
            - gooey syrup-ness itself has no effect on coughs, nor does any other property of honey, the placebo effect helps, and dextromethorphan worsens by an equal amount
            - gooey syrup-ness itself has no effect on coughs, neither does dextromethorphan, but some other property of honey helps
            - gooey syrup-ness worsens coughs, dextromethorphan and/or placebo help by an equal amount, and some other property of honey helps by more than enough to offset its gooey syrup-ness

            If I’m not mistaken, that could have been corrected by using:
            - nothing
            - placebo (sugar syrup)
            - placebo (something other than sugar syrup)
            - honey
            - sugar syrup with dextromethorphan

      • Jonathan Badger

        Where to begin? St John’s wort has been tested again and again — and no, it doesn’t work. 

        • Snig

          Like most SSR modulators, it works for some people.  Everyone’s mileage varies.  Quoting quackwatch is lazy, they only present one side of the issue. Wikipedia is more balanced.

          • http://www.sunshinenaturalhealing.com/ George

            Thank you! Quackwatch over exaggerates one tiny potentially untrue story into epic proportions. It amazes me that anyone quotes their crap.

        • dragonfrog

          Except for the studies that found it does work – unless you think the BMJ and Cochrane Review are outlets for quackery.
          http://www.bmj.com/content/313/7052/253
          http://www.ncbi.nlm.nih.gov/pubmed/18843608

          I’m certainly not asserting it can now safely be considered effective.  It had been my impression that the overall trend was toward it being useful in some cases; maybe I’m mistaken though.

          I do stand by what I’m saying overall though – maybe St. John’s wort will in the end be roundly understood to be ineffective, and it will be some other treatment or herbal medicine currently in the ‘alternative’ arena that will eventually amass enough studies underlining its efficacy.  Whatever that thing is, it will take a long time for it to become ‘medicine’ in popular perception.  In the same timespan, some widely-hyped new pharmaceutical will likely come out, be labeled ‘medicine’, be broadly used, new studies will gradually be done that undermine the initial drug-company-sponsored studies, eventually the body of evidence will overwhelmingly show it’s worthless – and it will still be ‘medicine’ in the popular perception for a long after that.

          To be perfectly clear though – IANA doctor, pharmacist, nurse, or any other kind of medical expert.

          • Jonathan Badger

            You don’t get how science works. You can’t just use a paper supporting X out of context to support the idea that X is scientifically accepted because you can find individual papers supporting nearly any position you would like — that’s what Creationists and global warming deniers do. You have to take a look at the consensus opinion, which is pretty clearly not in favor of St. John’s Wort. And while, yes, there have been examples of marginalized scientific ideas becoming generally accepted, those are rather far and few between.

          • Snig

            He cited two meta-analyses, both from mainstream medical and science based institutions.  He gets how science works.  Consensus was that surgery and opiates were better than conservative care for back pain, consensus was that stress caused ulcers, consensus used to be prefontal lobotomies not being that bad idea.  Science like the meta-analyses eventually changed consensus.  You cited a highly biased blog. 

          • dragonfrog

            St. John’s wort is completely beside the point I’m trying to make.

            I don’t think I’m even arguing for “marginalized” scientific ideas – I’m talking about un- or under-studied ideas.  There are thousands of plant-based medicines used in thousands of corners of the world.  Most of them are probably ineffective, or perhaps make you feel subjectively better without actually addressing the condition they are traditionally used for (caffeine is a nice pick-me-up even if it doesn’t help my cold go away faster, for example)

            Studying any one of them to the standard we would expect of scientific medicine is an enormously expensive undertaking – is it any wonder most of them have been studied only lightly, if at all, when most of them will probably be duds, and the ones that are found to work can’t be patented?

            When that occasionally does happen, the public perception is mostly based on the fact that for as long as I remember, treatment X has been unproven, ‘alternative’, assumed-quackery-by-default. If scientific consensus emerges that it works, it takes a long time to overcome the first impression based on the fact that for years the only one recommending you use it was your aunt who also talks away warts.

            Meanwhile, a new drug comes out that has no public history, because it was only synthesized 20 years ago, and marketed as Makeyawelltrafin 4 years ago – the first impression is makes is as ‘reputable medicine’ – there is no cultural memory of buying it in funny-smelling herb shops in Chinatown. If scientific consensus emerges that it’s worthless, the first impression is hard to dispel.

          • Antinous / Moderator

            that’s what Creationists and global warming deniers do.

            Cherry-picking favorable studies? That’s also a rather popular practice among pharmaceutical companies.

          • http://david-colquhoun.myopenid.com/ David Colquhoun

             What the trial show is the St John’s Wort works as well as SSRIs.  Since the negative trials that were hidden by GSK were revealed it turns out that SSRIs are no better than placebo for mild/moderate depression.  Therefore St John’s Wort doesn’t work either.

          • dragonfrog

            Sorry, no.

            http://www.bmj.com/content/313/7052/253

            “Results: Hypericum extracts were significantly superior to placebo (ratio = 2.67; 95% confidence interval 1.78 to 4.01) and similarly effective as standard antidepressants (single preparations 1.10; 0.93 to 1.31, combinations 1.52; 0.78 to 2.94).”

  • ChickieD

    There’s a book with a similar slant – Snake Oil Science – http://www.amazon.com/Snake-Oil-Science-Complementary-Alternative/dp/0195383427/ref=sr_1_1?ie=UTF8&qid=1350481452&sr=8-1&keywords=snake+oil+medicine

    I thought the book was worth reading for the explanations of issues with testing alternative medicine. The second half of the book kind of slams alternative medicine, whereas I thought that the fact that the placebo effect brings real relief was something that ought to be investigated further and deserving of much wonder. If it is true, as the author stated, that we can treat pain without any drugs but simply by performing effective ceremonies, it seems like we should be ALL OVER that.

  • awjt

    I’m a huge science-in-medicine guy.  I *do not* subscribe to any magical thinking and hate homeopathy.  Most chiropractic therapies are crap.  Unproven, and some possibly even are damaging.  That said, in working with the data on Chiropractic care vs. traditional back care, Chiro has its place.   Look, traditional back care is see your primary care doc, get some meds, lie in bed, try to move around and stretch, and if it gets really bad, surgery.  How is that better than seeing a Chiro 2-3x per week, they adjust you, maybe give you a little heat, cold, electro-stimulation, massage, range-of-motion therapy, and you get better just as fast at half the cost?    So I don’t see how you can just dismiss alternative medicine out of hand, when the traditional, allopathic treatments are no better.

    • BDiamond

       How about I go to a trained physical therapist/masseuse and save even MORE money?

      • awjt

        I dunno.  Honestly, don’t know.  Do what you feel is right.  The thing is, traditional medicine for back pain is no better, and that’s been proven in clinical trial after clinical trial.

        When I have back pain, I rarely see a Chiro and never my family doc. I just go get a massage, tough it out for the first few days and then increase my activity level and I’m back to normal. I don’t know what I’ll do if it got to be a bigger problem.

        The massage actually costs me more because it’s not covered under my plan. But chiro is, and so is traditional.

      • Snig

        Why do you assume it’s cheaper?  In this study at least, chiro was cheaper:
        Journal of Occupational and Environmental Medicine, April 2011, Vol. 53 Is. 4, p: 396-404

        There’s nothing wrong with seeing a massage therapist, in an ideal world it should be covered by insurance.  It’s often a helpful intervention.  They tend, in the US to have months vs. years of training compared to a PT or a chiro, so quality varies widely, and they are much less trained in diagnosis. 

      • Antinous / Moderator

        Where I live, PTs and masseurs charge as much as chiropractors, sometimes more. And they don’t do adjustments.

        I went from years of frequent, severe neck and sacral pain to rare, mild neck and sacral pain after three months of seeing a chiropractor. That was 12 years ago. I’m sorry that it doesn’t fit your narrative, but it works.

    • Antinous / Moderator

      Chiropractic works. Physicians refer their patients to chiropractors. Insurance companies pay for it. It’s almost universally accepted by physicians who actually see patients. If a chiropractor is also promoting woo, that’s not chiropractic.

      • awjt

        Yes. Chiros are unconstrained which therapies they can use.  Traditional allopathic primary care docs have a greatly reduced pallette of modalities they can use to treat patients.  If you are seeing a GOOD chiro, they are apt to give you the USEFUL therapies.  If you are seeing a weirdo, they wave the crystals and light the incense.  But they both call themselves Chiropractors, both have the same licenses, and all their therapies are sanctioned by the ACA.  It’s caveat emptor with Chiros.  But there is no doubt that, overall, they work.  And their stuff works just as well as traditional medicine.  Notice that we are NOT talking about appendicitis.  We are talking about back pain…  not even back fracture… just pain.

        • http://burntheflag.ca Jardine

          For Canadians, there’s a good indicator. If their degree is from a Canadian school, they’re less likely to be a whack job. The Canadian schools don’t seem to teach their students that adjusting the back can cure cancer and give you superpowers. They’re only concerned with the back and neck. If a Canadian went to the US to learn, that likely means they subscribe to the nutty bullshit or they weren’t smart enough to get a slot here.

    • http://maggiekb.com/ Maggie Koerth-Baker

      If you’ve read much of the analyses that Ernst and his team have done you’ll find that they separate chiropractic into two general branches: The people who claim to treat your back pain, and the people who are lying to you. 

      This is part of why I like Ernst. It’s his work that does show that, when it comes to something like lower back pain, there is some value to chiropractic sometimes. It’s when chiropractic claims to be able to treat everything from ear infections to allergies that he starts coming down on them hard. That, and the fact that British chiropractors tried (and failed) to sue a journalist who has collaborated with Ernst for libel, simply because that journalist pointed out that there was no evidence chiropractic could do 9/10ths of the stuff it claims to do. 

      • http://maggiekb.com/ Maggie Koerth-Baker

        I’d also add that, when I had a lot of recurrent, severe lower back pain, my “allopathic” doctor pointed out that they keep having to stop clinical trials for back pain treatments (lots of different treatments … chiropractic, surgery, drugs, you name it) because the control of regular, moderate exercise seems to work better than the treatments. 

        That was 2008. I’ve had something like four serious bouts with back pain since then (at the time, I was running like four a year). All of those line up with times I stopped exercising regularly. 

        • http://david-colquhoun.myopenid.com/ David Colquhoun

           Actually the Bronfort report shows that even for low back pain chiropractic works no better than any other manipulative therapy (that leaves open the question whether any of them work),

          So far better to got to a physical therapist (physiotherapist in UK).  They don’t deal in nonsensical ideas like “subluxation” (or occasionally kill you by violent neck manipulation). 

          • awjt

            That’s why I just pony up for a massage.  At least the massage feels realllllllly good and I walk away feeling like somebody did something.  But as I said before, I don’t know what I’d do if I face a major back problem, and don’t mean to minimize or suggest anything for other people.

  • http://www.facebook.com/profile.php?id=1935419 Steve Higgins

    This is actually the best source of how homeopathy works I’ve ever seen. Very very informative.

    http://www.howdoeshomeopathywork.com/

  • eldritch_vapor
  • http://twitter.com/pvandck Peter Vintner

    Would be good if the phrase “alternative medicine” were abandoned altogether. It is a meaningless marketing phrase. If it works it is medicine, and if it doesn’t work then it isn’t.
    The whole idea of “alternative medicine” is predicated on the convenient but demonstrably false notion that it isn’t used because “evil” or some such other bad parties are suppressing it. This is an alternative reality, which is actually a much more appropriate description for what passes as “alternative medicine”.
    Anything passing itself off as medicine that has not been shown to incontrovertibly work is not medicine. It cannot honestly be labelled “alternative medicine” either (nothing can). It is simply fraud. And medical fraud is big business, hence the need for evidence (not anecdotes or patient satisfaction surveys) where claims of efficacy are made.

    Evidence consist of actual documented case studies of incontrovertible efficacy or cure. In other words, real people, real cases, real diagnoses, real blinding, randomisation and controls in trials, real analysis and real, complete and unedited results.
    The reason for continuing with the dishonest label of “alternative medicine” is that where such robust evidence exists it doesn’t support claims of efficacy. If claims of efficacy were supported by the evidence it would rightly and simply be called medicine.

  • http://www.facebook.com/marko.raos Marko Raos

    In my experience, the label “alternative medicine” has nothing to do with efficacy of the treatment or its origins (traditional, experimental, nutcase) but everything to do with whether Big Pharma can patent and make money of it.
    Case in point: studies of vitamin D deficiency and its link with cancer. You can’t patent sunlight so… who cares? We saw a similar model with energy companies and alternative/renewable energy sources – again, you can’t patent sunlight… Thankfully this is beginning to change in the energy sector, and hopefully the time will come for a similar change in mainstream medicine which is, sadly, at this moment 100% profit oriented and thoroughly corrupt at the highest level (the one which provides $$)

    • http://maggiekb.com/ Maggie Koerth-Baker

      Yeaaaaah, but no. There’s a lot of alternative medicine that people can (and do) make plenty of money from. Ask Xeni about the cost of some of those wonderful, anti-Big Pharma cancer treatments. Let me tell you about expensive woo that gets peddled to ladies who can’t get pregnant or have recurrent miscarriages. 

      This is about evidence of effectiveness. (Yes, that has overlap with some of the problems and excesses of Big Pharma, but one thing at a time.) 

      It should also be pointed out that the case for Vitamin D as a wonder cure has been vastly overstated and it’s still really unclear what’s going on. 

      It should also also be pointed out that, while you can’t patent sunlight, it is pretty helpful to have somebody make (and patent) increasingly efficient solar cells. Anyway, basically, this situation is a lot messier than “alternative medicine = cheap = good and true and wonderful and suppressed by the bad guys”. The cheapest drug I’ve ever taken is generic Ritalin. 

      • http://www.facebook.com/marko.raos Marko Raos

        Oh, I’m not saying that “alternative medicine” is always cheap or effective. Of course “bad people” will always try to peddle their snake oil. However the key part of the argument is who benefits from the aforementioned snake oil? If it is Big Pharma then it’s medicine, if it’s someone else then it’s “alternative.” Washing hands before surgery was considered alternative quackery for quite a long time…
        Imo, labels such as “alternative medicine” and “conspiracy theory” should leave the vocabulary of any thinking person. The history is full of examples of effective “alternative” cures and “conspiracy theories” which turned out to be “conspiracy facts.” The easiest way to discredit something is to label it and that’s why I’m always leery of any labels, in fact, “where there is smoke…”

        • Luther Blissett

          Washing hands before surgery was considered alternative quackery for quite a long time.

          Your point being?

          Just wanted to recall that Semmelweis published about his method of hand disinfection, and the efficacy could not be disproved. And this was well before Koch identified Bacillus anthracis, before John Snow shutting down a Cholera-infected pump in London, and before Pasteur developed the germ theory of fermentation.

          It did *not* help his argument to disinfection and general hygiene that he called his colleagues “murderers”, which quite surely contributed to something which is called now “Semmelweis reflex”. But, in whole, his findings could not be disproved, and lead to the breakthrough of evidence based medicine. Which I could find summarized and condensed to nutshell-size in the very first comment.

          Just one more thing: alternative medicine is far to large a market to be ignored by “Big Pharma”. Actually, the income of “alternative” pharmaceutical companies is, well: big.

  • RevWubby

    “A useful blog for people not interested in knowing why they are still sick”

    Fixed it for you…

  • Luther Blissett

     Just to add one thing, because there was this side discussion about St.Johns Wort: this is a perfect example that herbal remedies (often used aka alternative medicine!) can be very effective – in causing drug interaction side effects. The pharmacokinetics of Hypericum are right away dangerous to people under treatment with other drugs. Someone undergoing, e.g., chemotherapy, should *ALWAYS* inform their doctors before using St. Johns Wort to “lighten up”. (cf., e.g.: DOI: 10.1046/j.1365-2125.2002.01683.x )

  • http://www.flickr.com/photos/mennonot/sets/ mennonot

    The site looks interesting, but it looks like there’s some sort of gray, semi-transparent gradient that follows me down the page as I scroll and interferes in reading. Seems like an unwise design choice.

    • dragonfrog

      Can you conveniently use Chrome as your browser?  It’s wonderful for removing awfulness from website layouts.

      In this case:
      - right-click off to the side somewhere, select “inspect element”
      - in the bottom-left panel that just opened up, click on “div-id=art-main”
      - over on the bottom-right panel, under “matched CSS rules”, look for the “background” elements, and uncheck them all
      - close the bottom panel