CANCER HERBAL REMEDIES
The biggest category in the US report is described as ‘non-vitamin, non-mineral natural products’. These are presumably herbal remedies of various sorts – as already noted, this excludes the expenditure of around $23 billion on vitamin supplements and minerals such as selenium. A further $4.1 billion is spent on techniques that focus on mental wellbeing with or without a component of exercise – yoga, for example. Clearly, it is debatable whether these really belong here as the individual’s motivation is clear – it makes them feel good. As this clearly is a benefit in itself, I do not think further discussion is necessary. The same applies to the $0.2 billion spent on relaxation techniques.
Most of the remainder is either grouped as practitioner costs ($11.9 billion) or homeopathic medicine $2.9 billion (it’s not clear whether this reflects the ‘medicines’ themselves or the total cost including practitioner fees). Either way, this is an astonishing sum to have been spent in a society as litigious as the USA. For a practitioner of conventional medicine, the route to a licence is long and heavily policed. Any licensed drug will have been through stringent approval procedures to demonstrate efficacy, safety, and fitness for purpose. Thus both the practitioner and products used are heavily regulated. Step outside the rules and stringent penalties apply both to practitioners and sellers of medicines and devices. Failure of either to perform to the expected standard will result in legal and often financial penalties. In conventional medicine, a drug company cannot legally sell a treatment for, say, asthma without evidence that it works a reasonable amount of the time.
For the most alternative and complementary medicines, no such tests apply in most countries. Regulation is either absent or internal to the ‘speciality’. No tests of efficacy apply to, for example, homeopathic medicines. Why the practitioners of these specialities are not subject to these basic rules is a mystery. Even if different rules applied, in other walks of life to charge for a good or service on the basis that it has certain properties will be subject to legal penalty if the item does not fulfil the advertised function.
The truth is that the purveyors of these remedies appear to believe that they work and their patients do likewise. Alternative and complementary therapies are therefore in reality more akin to religion than science, and this goes a long way to explaining their apparent immunity to the law, as religion itself enjoys the same degree of legal privilege in most countries. Furthermore, there is a well-known phenomenon observed in clinical trials called the ‘placebo effect’. Patients in blinded trials where some are taking dummy pills called placebos will often experience the beneficial effects (and bizarrely, sometimes the minor side effects) expected from the active drug. This effect is often substantial and is in many ways highly desirable – there is clearly no risk of serious drug-related adverse events. The body is healing itself. Clearly, therefore, if the alternative ‘practitioner’ and the patient collude in a belief that a treatment works, it often will. Does this mean it is an honest practice? In my opinion, it does not – I believe these remedies should be subject to the same tests of efficacy as any other product, whether medicinal or not.
Furthermore, it is not the case that no harm is done by an ineffective product – it depends on how it alters the treatment of the patient. Clearly, if, say, homeopathy is used for a minor, self-limiting condition such as soft tissue injury, then no long-term harm is likely. If it is used in place of a standard therapy for cancer, AIDS, or tuberculosis (as some of its proponents advocate), then clearly deterioration can occur while the patient is forgoing some more effective therapy.
The gold standard way to assess any medicine, conventional or otherwise, is in a controlled trial. These are widely used to assess conventional medicines but have also been used to test complementary or alternative medicines such as homeopathic remedies as well as with techniques like acupuncture (where the control is sham acupuncture – a needle is inserted but in the ‘wrong’ place).