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Intangible Risks of Complementary and Alternative Medicine

University of ExeterExeter, United Kingdom

To the Editor:Many cancer patients use one form of complementary medicine (CAM) or another believing that CAM is safe. Yet some complementary therapies are clearly not totally devoid of risk. For instance, acupuncture has caused deaths and other serious complications through infection and trauma, chiropractic medicine has been associated with vertebral arterial dissection after upper spinal manipulation, and herbal medicines have been associated with serious complications through hepato- and nephrotoxicity, as well as herb-drug interactions.¹ Such events are probably rare, but their exact incidence is unknown at present.

Other complementary therapies, particularly those popular in palliative and supportive cancer care (eg, acupressure, homeopathy, reflexology, and spiritual healing), might be judged as entirely free of direct risks; nevertheless they are associated with indirect risks. The most obvious of such risks is the use of complementary therapies as true alternatives to conventional cancer treatments. We recently cooperated with a nonmedically qualified CAM practitioner who noticed a brown lesion on her arm and self-medicated homeopathic remedies for months. When she was finally seen by a physician, an advanced malignant melanoma was diagnosed; tragically, she died shortly afterwards. Complementary therapists assure us that such disasters almost never happen, but I find this hard to believe. Underreporting is probably close to 100%, and very little systematic research exists in this area, yet similar cases are being reported with depressing regularity.²

A sizeable proportion of nonmedically qualified homeopaths and chiropractors advise their clients against immunization for their children.³ Such advice is potentially harmful to entire populations. In the United Kingdom, it represents a leading cause for noncompliance with immunization programs.⁴ The majority of United States homeopaths do not recommend immunization, and 9% openly oppose it.⁵ Many doctors also worry that CAM providers might interfere with their prescriptions, and preliminary evidence suggests that this does indeed happen with some regularity.⁶

Other indirect risks of CAM relate to the diagnostic methods used by come CAM practitioners. For instance, chiropractors tend to overuse x-ray diagnoses, which might unnecessarily increase the cancer risk.⁷ Other therapists use diagnostic techniques that are demonstrably invalid, for instance, iridology, reflexology, and applied kinesiology.⁸ False-negative diagnoses can obviously lead to missing time for curing a malignant disease.

Even less tangible risks relate to recommendations of some of the many lay books on CAM. Seriously ill patients could suffer real harm if they adhered to the advice issued in such books.⁹ We have demonstrated that seven of the leading books on CAM tend to recommend everything for anything, with little consensus amongst authors and even less grounding in reliable evidence.⁸ Collectively, these seven authors recommend 133 different complementary treatments for cancer! Similarly, women with breast cancer can be put at serious risk through the advice provided in health food shops.¹⁰

Perhaps the least tangible but most important indirect risk is an attitude of antiscience that sometimes emerges from CAM. Not infrequently, this seems to be promoted and sustained by the media. United Kingdom daily newspapers, for instance, tend to report significantly more favorably about matters relating to CAM compared with those of conventional medicine.¹¹

REFERENCES

1. Ernst E: Risks associated with complementary therapies, in Dukes MNG, Aronson JK (eds): Meyler’s Side Effects of Drugs ( ed 14 ). Amsterdam, the Netherlands, Elsevier Science, 2000, pp 1649-1681

2. Coppes MJ, Anderson RA, Egeler RM, et al: Alternative therapies for the treatment of childhood cancer. N Engl J Med 339: 846, 1998[Free Full Text]

3. Ernst E: Attitude against immunisation within some branches of complementary medicine. Eur J Pediatr 156: 513-515, 1997[Medline]

4. Simpson N, Lenston S, Randall R: Potential refusal to have children immunized: Extent and reason. BMJ 310: 227, 1995

5. Lee ACC, Kemper KJ: Homeopathy and naturopathy. Arch Pediatr Adolesc Med 154: 75-80, 2000[Abstract/Free Full Text]

6. Moddy GA, Eaden JA, Bhakta P, et al: The role of complementary medicine in European and Asian patients with inflammatory bowel disease. Public Health 112: 269-271, 1998[Medline]

7. Ernst E: Chiropractors’ use of X-rays. Br J Radiol 71: 249-251, 1998[Medline]

8. Ernst E, Eisenberg D, Pittler MH, et al: The Desktop Guide to Complementary and Alternative Medicine. London, United Kingdom, Mosby, 2001

9. Ernst E, Armstrong NC: Lay books on complementary/alternative medicine: A risk factor for good health? Int J Risk Safety Med 11: 209-215, 1998

10. Cook Gotay C, Dumitriu D: Health food store recommendations for breast cancer patients. Arch Fam Med 9: 692-698, 2000[Abstract/Free Full Text]

11. Ernst E, Weihmayr T: UK and German media differ over complementary medicine. BMJ 321:707

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