Wednesday 10 July 2019

Tortoise Take • Opinion

First, do no harm

The well-being and alternative-medicine industries are damaging our health. They must play by the rules

By Matthew d’Ancona

In September, Gwyneth Paltrow’s lifestyle company, Goop, was fined $145,000 in California over phoney claims that its vaginal eggs “balance hormones, regulate menstrual cycles, prevent uterine prolapse, and increase bladder control”. A month later, Goop was reported to National Trading Standards and the Advertising Standards Authority in the UK, over 113 alleged breaches of advertising law. But such quibbles did nothing to dissuade Paltrow’s ardent followers from shelling out £1,000 a ticket to attend Goop’s “Wellness Summit” in London in June.

Humility is essential to authentic science: the recognition that humanity is surely only in the foot-hills of intellectual discovery. The besetting sin of alternative medicine has been to make absurdly inflated claims for itself and to resent scrutiny. But such therapies only deserve to be taken seriously – at all – when they pass such tests. As the comedian Tim Minchin has said: “You know what they call alternative medicine that’s been proved to work? Medicine.”

It is a cornerstone of the scientific revolution – and one worth defending – that, in healthcare, the only treatments and interventions that should be trusted are those that have been subjected to randomised, double-blind, placebo-controlled testing.

As time-consuming and expensive as this process is, it is the only reliable means of establishing reliably whether a particular protocol works, and of protecting patients from toxic side-effects.

The champions of alternative therapies often cite stories of miracle cures brought about, they claim, by prodigious quantities of carrot juice or rebalanced chakras. But correlation is not causation. And – more importantly – the plural of anecdote is not data.

Nonetheless, the rise of the “wellness” industry – and the pseudoscience that underpins it – remains prodigious.

It is often argued that the alternative medicine industry is merely ridiculous rather than actually harmful. Take, for instance, the claim of homeopaths that water molecules have an ill-defined “memory” of the active remedial ingredient into which they have come into contact – and that, in a preposterous paradox, the greater the dilution, the greater the alleged therapeutic effectiveness of the prescribed liquid.

But such absurdity is a distraction from the real-life damage that the proliferation of such bogus “cures” is now causing.

According to a landmark study published last year in the academic journal JAMA Oncology, collating evidence from almost 1,300 patients, those who used complementary treatments were more than twice as likely to die at any point during the nine-year study – usually because they refused to complete courses of conventional therapy.

It is a poignant tragedy that this should be so, precisely at the moment when advances in oncology – especially CAR T-cell therapy, immunotherapy, and the algorithmic prescription of bespoke drug protocols – mean that, with the correct treatment, cancer will soon be, at worst, a chronic rather than a terminal illness.

Why is the resistance to conventional medicine so strong? In his posthumously-published book Snake Oil, the journalist John Diamond – who died of cancer – correctly identified a form of individualist arrogance embedded in alternative medicine: “[it] tells us that our personal well-being is entirely in our own hands, that we can all have anything we want – perfect health, freedom from anxiety – if we want it enough and are willing to take the steps to make it happen.”

Diamond’s book was published in 2001. Since then, public confidence in institutions – including the medical establishment – has plummeted, a process dramatically accelerated by the digital revolution and social media.

The contention that governments are in league with big pharmaceutical companies against the best interests of humanity is now mainstream. Absurdly, it has become almost a badge of honour to be shunned by the medical profession. Since its first appearance in the Lancet in 1998, Andrew Wakefield’s claim that there was a potential link between the measles, mumps and rubella vaccine and the rising incidence of diagnosed autism has been comprehensively discredited, and Wakefield himself has been struck off. Yet his pernicious theory has never been more influential (witness the success of his 2016 film, Vaxxed: from Cover-up to Catastrophe and the Trump administration’s opportunistic interest in the “anti-vaxx” movement.)

Again, this is not only a theoretical debate between post-truth and evidence-based research. The declining uptake of infant vaccines has contributed to the completely avoidable return of measles as a serious threat to public health:

In a landmark Atlantic article on the return of measles to the US, Peter Beinart identifies four interacting reasons for the failure of parents to vaccinate their children:

  • Medical amnesia. They have forgotten that measles used to kill more children than drowning does today.
  • “A broader forgetting.” The rise of anti-Semitism and rehabilitation of economic nationalism reflect fading memory of, respectively, Nazism and trade wars.
  • The bogus confidence of the amateur. The internet and alternative health movement has encouraged the delusion that expertise has been relocated from the professions and institutions to the individual.
  • Declining trust in government as the arbiter of truth.

This convergence of social forces has been turbocharged by celebrity culture and the depressing fact that fame now competes successfully with legitimate medical expertise. The US model and TV presenter, Jenny McCarthy, whose son has autism, has proved a powerful advocate for the anti-vaxx movement. Challenged to produce her medical credentials, she said: “The University of Google is where I got my degree from.”

If Goop and companies like it do not want to be seen as part of a continuum that stretches from their shiny products to the darker recesses of the anti-vaccination movement, they need to subject themselves to much greater scrutiny and stop claiming that they offer authentically medicinal treatments – until scientific research proves that this is so.

We have long passed the point when this assault on public health can be shrugged off as a matter of “lifestyle choice”. In the case of cancer treatment, it is morally intolerable that so many patients seem to believe that useless placebos can save their lives. To be effective, meanwhile, vaccination depends upon “herd immunity”: that is, a level of uptake so high that the illness ceases to spread.

To date, the UK government’s response to the cult of pseudoscience has been half-hearted. It is depressing to note, for instance, that public money is still spent on homeopathic prescriptions: a relatively small sum that nonetheless suggests a lack of urgency.

The UK Health Secretary, Matt Hancock, is right not to rule out compulsory vaccination – a drastic measure, to be sure, and one that would raise legitimate concerns about civil liberties, parental rights, and the proper limits of state power. But the option must remain on the table, if only to make clear what is at stake. Behind the celebrity smiles, the infantile conspiracy theories and the pretty, over-priced products, this is now a matter of life and death.