Paracelsus' poison

Paracelsus' poison

Still no good evidence that most complementary medicine works

The complementary medicine industry has been quick to respond to an opinion piece by Cassandra Wilkinson in The Australian newspaper on the lack of evidence for many complementary medicines, and particularly complementary medicines for children.

Alan Bensoussan of the National Institute of Complementary Medicine claimed in a follow-up letter to the Australian that complementary medicines included many well-established medicines (scroll down for the letter). He claimed that these well-established complementary medicines include medicines that prevent spina bifida in newborns, osteoporosis in the elderly, macular degeneration, cognitive decline, and childhood bronchitis.

Except, well, they don’t. You can search for clinical trials of complementary medicines for the above complaints that show them to be “well-established” and you will come up empty handed. You will find one or two studies suggesting that there might be a beneficial effect of some complementary medicine (see here for the inconsistent evidence for Ginkgo and macular degeneration), but nothing “well-established”.

Similarly, a search of systematic reviews, which look at the overall evidence from multiple studies, turns up nothing, although one treatment for osteoarthritis (not osteoporosis) glucosamine, might be beneficial in some patients. This is hardly “well-established” though.

If you go to the web site of the National Center for Complementary and Alternative Medicine and look up “bronchitis” you get the following “There is not enough evidence to support the use of any complementary health practices for the relief of asthma”. If you look up cognitive decline, you get a page that shows all current complementary therapies either do not help (and this includes the favoured herb, Gingko) or have not enough evidence.

So where does Alan Benoussan’s claim come from? Some clarification comes from an article in Pharmacy News, where Steve Scarff, regulatory and scientific affairs director of the Australian Self Medication Industry, also claimed that there is a growing evidence base to support the use of complementary medicines. Mr Scarff used as examples of clinically-supported complementary medicines “calcium and vitamin D for osteoporosis, omega-3 fish oil for heart disease, folate for pregnant women in preventing spina bifida, iron supplementation for anaemia, and evidence to support St John’s Wort for depression”.

One problem here, all but one (St. John’s Wort) of these are conventional medicine, not complementary medicine. It was conventional medicine that researched the physiology, did the clinical trials and developed the therapies and approaches, not complementary medicine (calcium and vitamin D for osteoporosis (note that this is not “one size fits all” medication), omega-3 fish oil for heart disease, folate for pregnant women in preventing spina bifida). Just because you sell vitamin pills doesn’t mean you get to appropriate the hard work of medical researchers and clinicians.

“Complementary” use of vitamins is usually use of high dose vitamins, such as high dose vitamin C for colds and flu’s (which doesn’t really work) or high dose antioxidant vitamins (high dose fat soluble antioxidant vitamin are actually associated with slightly worse outcomes and in some cases a slight increase in death). And vitamin supplementation of healthy, non-vitamin deficient people also has no benefit.

St. John’s Wort does have a modest anti-depressant effect (although very variable due to wide differences in composition). It also has significant side effects and very serious interactions with conventional medicines, so is not recommended for therapy. People have died because of it. Information on the side effects of St. John’s Wort from points of sale are generally very poor and most consumers will be unaware of them (see also here)

The claims from the National Institute of Complementary Medicine and the Australian Self Medication Industry does nothing to address the issues brought up in the opinion piece, namely that there is no evidence that complementary medicine works for children and that between 70-90% of complementary medicines surveyed did not meet regulatory requirements (71% had manufacturing or quality problems). As well, complementary medicine sponsors drag their feet when asked to remove non-compliant medicines (see here and here).

This is what the National Institute of Complementary Medicine and the Australian Self Medication Industry should be dealing with, not claiming the work of conventional medicine as complementary medicine.