Complementary and Alternative Medicine: Science, Pseudoscience, and Ethics - PowerPoint PPT Presentation

View by Category
About This Presentation

Complementary and Alternative Medicine: Science, Pseudoscience, and Ethics


Complementary and Alternative Medicine: Science, Pseudoscience, and Ethics Martin Donohoe, MD, FACP Karen Adams, MD, FACOG Herbal Remedies - Disclaimer More than ... – PowerPoint PPT presentation

Number of Views:938
Avg rating:3.0/5.0
Slides: 60
Provided by: phsjOrgw
Learn more at:


Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Complementary and Alternative Medicine: Science, Pseudoscience, and Ethics

Complementary and Alternative Medicine Science,
Pseudoscience, and Ethics
  • Martin Donohoe, MD, FACP
  • Karen Adams, MD, FACOG

  • What is CAM?
  • Philosophies of CAM and Western medicine
  • Recognizing Quackery, Pseudoscience and Bogus
  • Risks and Benefits of Herbal Remedies
  • Why Herbs are Not Regulated
  • Conclusions and Recommendations

What is CAM?
  • Any health care intervention not offered by
    traditional Western physicians
  • E.g., chiropractic, massage, acupuncture,
    homeopathy, distance healing, therapeutic touch,
    Reiki therapy, aromatherapy, herbs/nutraceuticals

  • Some are recommended by physicians for certain
    conditions or people
  • Chiropractic, massage, acupuncture, aromatherapy
  • Proven benefit e.g., acupuncture for certain
    types of chronic pain, chemotherapy-induced
    nausea and vomiting guided imagery to reduce
    stress of surgery in children and adults

No Such Thing as CAM
  • Good medicine
  • Scientific
  • Evidence-Based
  • Quality Control
  • Peer Reviewed
  • Humanistic and Caring

No Such Thing as CAM
  • Bad Medicine
  • Non-scientific
  • Poor or No Quality Control
  • Non-Peer Reviewed
  • Impersonal, Uncaring

CAM is Not Unique in Its Emphasis on
  • Humanistic health care
  • Empathy and Compassion
  • Emphasis on healing the mind and body /
    recognizing the powerful links between the two

CAM is Not Unique in Its Emphasis on
  • Care involving family, friends, religious
  • Care emphasizing the whole patient or the
    provider-patient relationship

CAM Versus Western Medicine
  • These attributes are the characteristics of
    quality medicine and public health, yet have been
    co-opted by the CAM movement

Dont get sCAMmed by CAM
  • Some CAM is without benefit, some harmful
  • Therefore, it is important to be able to
    recognize quackery, pseudoscience and bogus

How Quackery Harms
  • Economic harm individual costs
  • Direct harm
  • Medical e.g., cyanide toxicity from laetrile,
    electrolyte imbalances from coffee enemas,
    quadriplegia from cervical spine manipulations
  • Psychological e.g., unjustified guilt,
    distortion of perspective

How Quackery Harms
  • Indirect harm
  • E.g., delay in seeking care
  • Harm to Society
  • Perpetuates pseudoscience, puts other
    contemporary and future patients at risk

Warning Signs of a Bogus Scientific Discovery
  • The discoverer pitches the claim directly to the
  • The discoverer says that a powerful establishment
    is trying to suppress his/her work
  • The scientific effect involved is always at the
    very limit of detection
  • Evidence for a discovery is anecdotal

Warning Signs of a Bogus Scientific Discovery
  • The discoverer says a belief is credible because
    it has endured for centuries
  • The discoverer has worked in isolation
  • The discoverer must propose new laws of nature to
    explain an observation

Characteristics of Pseudoscience
  • Indifferent to facts
  • Looks only for evidence supporting hypothesis
  • Indifferent to criteria of valid evidence
  • Relies heavily on subjective validation
  • Depends on arbitrary conventions of human
    culture, rather than on unchanging regularities
    of nature

Characteristics of Pseudoscience
  • Avoids putting its claims to meaningful tests
  • Often contradictory
  • Deliberately creates mystery where none exists,
    sometimes by omitting important details
  • Does not progress
  • Attempts to persuade with rhetoric, propaganda
    and misrepresentation

Characteristics of Pseudoscience
  • Appeals to false authority, emotion, sentiment,
    or distrust of established facts
  • Extraordinary claims and fantastic theories
  • Often described by an invented vocabulary of
    words with ambiguous meanings
  • Relies on anachronistic thinking
  • Appeals to vanity, fear, magical thinking or

Characteristics of Pseudoscience
  • Relies on anecdotes and testimonials
  • Products often claim to be effective against a
    wide range of unrelated diseases
  • Quick, dramatic results promised for one-time
    therapies frequent re-treatments/maintenance
    treatments required for ongoing therapies

Characteristics of Pseudoscience
  • Disclaimers couched in pseudo-medical jargon
  • Claims that Western Medicine is dangerous
  • Practitioners advise, Dont trust your doctor

Characteristics of Pseudoscience
  • Claims of no side effects
  • Products claimed to be natural usually are not

Misconceptions re Cancer
Misconceptions re Cancer
Ban Dihydrogen Monoxide?
  • Iowa junior high school student science fair
  • 100 adults surveyed at State Fair

Would you sign a petition to ban dihydrogen
  • 1. It can cause excessive sweating and
    vomiting 2. It is a major component in acid
    rain 3. It can cause severe burns in its gaseous
    state 4. It can kill you if accidentally
    inhaled 5. It contributes to erosion 6. It
    decreases effectiveness of automobile brakes 7.
    It has been found in tumors of terminal cancer

Ban Dihydrogen Monoxide?
  • Results
  • 90 yes
  • 8 Get away from me kid! I dont sign
  • 2 Are you kidding - that is water!

One Reason Why Pseudoscientific Beliefs are
Common Public Education is in Disarray
  • U.S. Schools ranked lowest among western nations,
    particularly in science
  • ? funding, infrastructure decaying
  • 1/4 of U.S. Schools have no library
  • 1/4 of schools use textbooks from the 1980s or

Geographic Ignorance
  • Percent of US teens unable to locate the
    following on a map
  • United States 11
  • Pacific Ocean 29
  • Japan 58
  • United Kingdom 68

Pseudoscientific Beliefs
  • Percentage of Americans who believe at least to
    some degree in these phenomena
  • 1976 1997
  • Astrology 17 37
  • UFOs 24 30
  • Reincarnation 9 25
  • Fortune-Telling 4 14

Ignorance/Pseudoscientific Beliefs
  • Half of US citizens do not believe in evolution
    and do believe that humans and dinosaurs
    coexisted (2007)
  • 40 think scientists still generally disagree
    about evolution
  • Only 12 of U.S. Protestant pastors believe in

Pseudoscientific Beliefs
  • 37 believe places can be haunted (2007)
  • 25 believe in UFOs (2007)
  • 24 believe in astrology (2009)
  • 16 believe that people with the evil eye can
    cast curses or harmful spells
  • 14 have consulted a psychic or fortune teller

Ignorance/Pseudoscientific Beliefs
  • 22 of Americans dont know whether an atomic
    bomb has ever been dropped (2000)
  • 20 of Americans dont know the earth revolves
    around the sun (1999)
  • 18 believe in Bigfoot and the Loch Ness Monster
  • 8 of men / 18 of women believe in astrology and
    fortune tellers (2007)

Ignorance/Pseudoscientific Beliefs
  • Some states require instructors to teach
    creation science, intelligent design, and
    climate change skepticism
  • Despite politicians statements, 72 of
    Republicans believe global warming is occurring
    (92 of Democrats)

Herbal Remedies
  • 17.8 billion on herbs and supplements in 2001
  • 58 billion on pharmaceuticals
  • 12 use herbs in one year (vs. 2.5 in 1990)
  • E.g., between 1996 and 1998, 8 of normal-weight
    women and 28 of obese women used
    non-prescription weight loss products

Herbal Remedies - Disclaimer
  • More than ½ of current prescription and OTC
    medications come from plant products
  • Many herbs, in pure form, may be beneficial
  • Studies poor, no incentives for industry to
    rigorously investigate
  • Less than 0.5 of the worlds vanishing tropical
    plant species have been investigated for their
    medicinal qualities

What is All Natural?
  • Natural means eating a balanced diet, favoring
    organic, local foods, and protecting the

Gauging Risks Of Herbal Remedies
  • FDA Manufacturer may claim that the product
    affects the structure or function of the body, as
    long as there is no claim of effectiveness for
    the prevention or treatment of a specific
    disease, and provided there is a disclaimer
    informing the user that the FDA has not evaluated
    the agents
  • Multiple violations / near violations

Why Herbs Are Not Regulated By The FDA
  • 1974 (Senator William Golden Fleece Award)
    Proxmire Amendment
  • -Nutritional supplements are not drugs

Why Herbs Are Not Regulated By The FDA
  • 1994 Dietary Supplement Health and Education Act
    -supplements excluded from purity, composition,
    effectiveness and safety review
  • -supported by Orrin Hatch (R-Utah), recipient of
    169,000 from pharm and nutraceutical ind. in
    2000, more than any other Senator Utah home to
    more herbal/nutraceutical companies than any
    other state
  • Established Office of Dietary Supplements

FDA Oversight
  • 2100 scientists in 40 labs
  • 1100 investigators and inspectors
  • Monitor and inspect 95,000 businesses
  • Visit gt15,000 facilities per year
  • Collect 80,000 domestic and imported product
    samples for label checks

Risks of Herbal Remedies
  • Products unregulated/untested
  • Variable
  • collection
  • processing
  • storage
  • naming
  • purity

Risks of Herbal Remedies
  • Adulterants and contaminants include
  • Botanicals e.g., digitalis, belladonna
  • Microorganisms Staph aureus, E coli,
    Salmonella, Shigella, Pseudomonas
  • Microbial toxins aflatoxins, bacterial
  • Pesticides

Risks of Herbal Remedies
  • Adulterants and contaminants include
  • Fumigation agents
  • Toxic metals lead, cadmium, mercury, arsenic
  • Drugs analgesics and anti-inflammatories,
    corticosteroids, benzodiazepines, warfarin,
    fenfluramine, sildenafil
  • 1998 32 of Asian patent medicines sold in the
    US contained undeclared pharmaceuticals or heavy

Risks of Herbal And Naturopathic Remedies
  • Est. less than 1 of adverse reactions reported
    to FDA (vs. 10 est. for prescription drugs)
  • 19,468 adverse events reports to poison control
    centers in 1998, vs. 500 to FDA
  • Potential toxicities cardiac, CNS, liver, kidney

High Risk Users of Naturopathic Remedies
  • Elderly, pregnant and nursing women, infants
  • Poor overall health status
  • Chronic users, prescription drug users

Risks of Herbal Remedies
  • Dietary supplements containing ephedrine,
  • HTN, MI, CVA, psychosis, seizures
  • Chapparal, germander, comfrey, skullcap,
  • Hepatotoxic, carcinogenic

Risks of Herbal and Naturopathic Remedies
  • GE-L-tryptophan ? Eosinophilia Myalgia Syndrome
    (1989) 5,000 in US affected, 37 deaths, 1500
    permanently disabled
  • Ephedra - heart attacks, dysrhythmias, strokes
    and seizures
  • Garlic, gingko, and ginseng bleeding
  • Ginseng - hypoglycemia

Risks of Herbal and Naturopathic Remedies
  • Kava and valerian - potentiation of anesthetic
  • St. Johns wort - increased metabolism of many
  • ?CyA effectiveness ? transplant rejection

  • CAM is widespread some may be useful
  • Caveat emptor know how to recognize quackery
    and pseudoscience
  • Do not confuse or conflate CAM with humanistic /
    integrative / whole person care

  • Traditional medicine is not immune from bad
    science, misleading advertisements, excessive
    corporate influence, corruption and support of
    some therapies offering limited benefit.

  • Medical education and training curricula should
    include greater emphasis on professionalism,
    ethics, the humanities, public health, social
    justice, communication skills, legal issues,
    cultural and religious understanding and
    sensitivity, and bedside teaching

  • Visit lengths, which have become shorter in the
    face of financial pressures, need to be increased
    to allow more time for the development of rapport
    between doctor and patient, comprehensive
    screening, accurate diagnosis, and patient
    counseling and education

(No Transcript)
The National Center for CAM
  • Established 1998, 7 yrs. after its predecessor
    (Office of Alternative Medicine)
  • Annual budget 110 million/yr
  • Role of Iowa Senator Tom Harkin, Chairman/Ranking
    Member of Labor, Health and Human Services and
    Education Subcommittees held entire NIH budget

  • Board populated with discredited, fringe
  • Culture of fear among academics needing funding
    and universities establishing Centers of
    Alternative Medicine to not anger NCCAM and
    Senator Harkin

Unethical NCCAM Studies
  • Fringe studies of discredited and highly
    implausible techniques exploit patients and
    deplete health care resources
  • Homeopathy
  • psychic healing
  • therapeutic touch

Unethical NCCAM Studies
  • Dangerous studies with inadequate informed
    consent forms
  • E.g., decreased effectiveness of protease
    inhibitors not mentioned
  • St Johns Wort for HIV
  • Garlic for hyperlipidemia due to HAART treatment
    for HIV

  • After 20 years and about 1.6 billion,
    NCCAM-sponsored research has not demonstrated
    efficacy for any CAM method

  • Adams KE, Cohen MH, Eisenberg DA, Jonsen AR.
    Ethical considerations of complementary and
    alternative medicine in conventional medical
    settings. Annals of Internal Medicine, October
    2002 137660-664.

Contact Information
  • Public Health and Social Justice Website
  • http//