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Do complementary and alternative therapies do more harm than good?

With a debate on this very issue coming up between leading figures on both sides of the CAM debate, Professor Edzard Ernst asks readers to consider whether complementary and alternative therapies do more harm than good.

With a debate on this very issue coming up between leading figures on both sides of the CAM debate, Professor Edzard Ernst asks readers to consider whether complementary and alternative therapies do more harm than good.

I urge all interested in CAM with reasonably well developed faculties of critical thinking to attend a debate at The King's College London (28 April 18:00 19:30 Lecture Theatre 1 New Hunts House Guys Campus) on this very subject. It promises to be an illuminating event.

Prof Michael Baum and Simon Singh (who is the first author of our book Singh S, Ernst E. Trick or treatment? Alternative medicine on trial. ISBN 978-0593061299. Bantam Press. London. 2008) are discussing with Prof George Lewith and Prof David Peters. There will be a vote by the audience. The ‘Prince's Foundation of Integrated Health' has already issued a press release, presumably to make sure the CAM proponents dominate the evening.

As Stephen Gordon pointed out on this blog we should not discuss safety in isolation but need to consider both the risks and benefits of medical interventions. In CAM, the benefits usually are not huge, or they are controversial, or not well documented. In essence, this means that even relatively minor risks can weigh heavily and, if risks do exist, a risk-benefit analysis is unlikely to turn out positive.

Apart from direct risks (e.g. several hundred cases of arterial dissection after upper spinal manipulations) there can be indirect risks. Think, for instance, of the fact that many CAM practitioners advise parents not to immunize their children (I hope to soon write a blog specifically on this issue in the near future). The therapy might be quite safe (e.g. homeopathy) but the therapist might not be!

I think the Foundation's involvement in the debate is telling. One gets the impression that the organisation does not think all that much of evidence. Its medical director recently stated that "the test is not whether someone has carried out a scientific trial, but whether the patient's condition improves".

What a worrying attitude this is.

If it takes hold, we have made a decisive leap in the wrong direction. It would take us back to the dark ages of medicine where doctors were quite incapable of telling whether the treatments they administered were doing more good than harm.

After applying blood letting, leeches or mercury many of their patients obviously got better. Luckily that's what many patients do, if only through the natural history of the disease. So our forefathers continued to use these heroic treatments to the detriment of their patients. Heroic refers to the patients who survived! Do we really want to return to this mind-set? I hope not.

All this is, of course, great stuff for a lively discussion. So, if you are in London, please try to attend this debate – perhaps you can even prevent that flimflam wins over rationality. Attendance is free and everyone can come.

Professor Edzard Ernst Recent posts

Don't let your practice become an evidence-free zone 15 April 09
Natural doesn't mean safe. And CAM is neither 06 April 09

So-called 'integrated medicine' is disturbing nonsense 30 March 09

Why 'belief' in complementary medicine is misguided 23 March 09

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