From Quackery to Credibility
Subtitle: Unconventional Healthcare in the Era of High-Tech Medicine
Publisher: Financial Times, London
Published: 2000
Place of publication: London
Language: eng
Format: Paperback
Number of pages: 336
Description: Is it not a paradox that people are losing faith in modern medicine and pharmacology, turning instead to alternative or complementary healthcare, herbal remedies and functional foods, at a time when both medicine and pharmacology are at the peak of their effectiveness?  
 This book describes the tremendous progress in biomedicine that has provided doctors with the tools to ease suffering rather than watch patients die. It details the political and economic context in which medical practice has changed, taking into account parallel shifts in ideas about medicine, their impact on regulatory measures and the manipulation of power by parties involved in health provision. It reaches into the past to throw light on the present. And it looks at the genetic research that now promises to enlarge the frontiers of life.  
 These days healthcare entrepreneurs come and go, many of them amassing fortunes before they leave the theatre of pseudo-science. There are more than 1,300 entries on the ever-changing list of therapies offered by these self-proclaimed gurus - from absent healing and aromatherapy to healing love and healtheology, Mahikaro and Marma Science, network spinal analysis, psionic medicine, radiesthesia, rebirthing, vibrational medicine, Zen Alexander Technique and many more. A broad selection of these is covered in the report, giving modern quackery its full dimension.  
 “Don’t forget that there is something outside that has been around for 2,000 years”, advises renowned US consumer activist Ralph Nader. But the New England Journal of Medicine voiced the concerns of the international medical community by insisting that alternative therapies could not be allowed a free ride, substituting assertions, speculation, and testimonials for sound clinical evidence and following a rationale that violated fundamental scientific laws.  
 Since the end of the vitamin discovery period, there have been advances in quantifying human requirements for specific nutrients and developing practical dietary and pharmaceutical means of satisfying these requirements. Yet an unending flood of new preliminary findings or hypotheses, born mainly of the food industry’s efforts to promote foods with specific health claims, has led to public confusion. Journalists fixed on daily news agendas have encouraged the hype, and the question of how best to disseminate accurate nutrition and health information to the general public is still a matter of debate. The book explains how to avoid the pitfalls of misrepresentation and misinterpretation.  
 Among the proxies for scientific evidence in the alternative therapy sector are the ubiquitous placebo effect, a mismatch of correlation with causation and an over-emphasis on the anecdotal. Often these are a front for misdiagnosis and the failure of human logic. The question of why unproven therapies appear to work, and how the mysterious placebo can be such a powerful healer, is addressed in the report.  
 A regulatory approach to alternative/complementary therapies that is fast gaining currency is the notion of a ‘Third Way’. US experts consider Germany‘s Kommission E monographs to be a possible model for a third category of medicines alongside prescription and OTC products. The book examines the potential advantages of a system that, although far from perfect, has been proposed to the FDA as one way to tackle herbals when reviewing the contraversial DSHEA (Dietary Supplements Health Education Act).  
 Germany’s love affair with nature is put in its historical context. The book describes past and present natural and holistic remedies/theories with their roots in the German tradition, particularly homeopathy. Phrenology, Mesmerism and Naturopathy are offered as examples of alternative practices from Europe that have sought to undermine conventional medicine by borrowing the symbolic capital of science. Nor is the impact of dogmatic faith and folk remedies from the Indian and Hispano-Mexican cultures ignored.  
 Where their safety and efficacy are recognised by significant scientific agreement, functional foods and herbal supplements could emerge as significant factors in government efforts to curb national healthcare expenditure. With the advent of genetic modification, the near future could bring crops with improved nutritional value, peanuts or wheat without allergens, milk with reduced lactose and foods with enhanced ‘functional’ components, such as tomatoes with more lycopene. The public, however, has mixed feelings about science and technology, associating it with improved quality of life but concerned that it will make the world a riskier place.  
 Assessing the potential risks and benefits of functional foods means answering questions about safety and efficacy: does the product actually contain the active component and will it be effective? Is it safe at the levels likely to be consumed? Might not the product displace traditional healthy foods from the diet? Could people be spurred into self-treating serious medical conditions, neglecting or delaying professional help? Communication and consultation with the public are essential to ensure they can make informed choices from a range of alternatives. They must be allowed access to credible information and the chance to have their say in the development and application of science.  
 The book questions whether evidence-based medicine (EBM), with its emphasis on the economic aspects of healthcare, may not be aiding the renaissance of unconventional therapies And it surveys a range of other contributory factors, including:  
  Genuine concern about the adverse effects of powerful drugs, allied to the perception that conventional medicine is too harsh for chronic and non-life-threatening diseases.  
  Moves to restrain social health and welfare costs, prompting a search for affordable means of alleviating suffering.  
  Doubts over conventional medicine’s ability to maintain the flow of more and better treatment options.  
  Reduced tolerance for medical paternalism.  
  Increased interest in spiritualism as a replacement for disappearing centuries-old values.  
  The general public’s deep-rooted preference for the ‘natural’ over the ‘chemical’.  
  Health illiteracy, compounded by ‘information age’ confusion.  
  The shift in emphasis from keeping people alive to keeping them fit for longer life.  
 The measure of success enjoyed by alternative theories and products has always reflected the degree of disillusionement with the orthodox medical system of the day. But that in itself is no proof of efficacy.  
 Complementary therapies, invoking nature and its universal healing powers, are more than a current fad: they are embedded in cultural heritage and practice. Yet mysticism should not be allowed a new lease of life in matters of health. One scenario for the future of unconventional healthcare is to acquire ‘conventional’ credibility through recourse to full regulatory approvals. But this is a less likely survival strategy for the sector than others envisaged in the book: adaptation (evolution), democracy/diversity and the pendulum scenario. Also examined is the current concept of integrated healthcare in a framework of outcomes-driven therapy.  
 The book includes several case studies. Among them are :  
  The largest. Most heartless and firmly rooted racket  
 (Treating cancer)  
  Luring the manly man full of vigour  
 (Erectyle dysfunction)  
  The stubborn resistance to new medical knowledge  
 (Pink disease).  
 We are witnessing now the reinvention of the nutrition industry around a core of health and ‘functionality’. This in turn could catalyse the strategic realignment of other global businesses - pharmaceuticals, food and agriculture - around biotechnology as the defining, integrative technology base. But companies may misunderstand the nature and true potential of the emerging ‘naturals’ business. Today’s functional foods are just one step in the evolution of products that will increasingly be promoted as healthier, more nutritious, better tasting and as better insurance against disease. The long-term winners will be those companies that learn to set their sights beyond the passing trends.  
 We retain a romantic affection for the plausibility of the unproven; we warm to the scientific underdog. Yet this can lead to adventurism with consequences that we have not fully weighed. While it is easy to sympathise with emerging theories of disease prevention and treatment, we must beware of having our interests dictated by the ambitions of self-declared health priests, yellow press journalists, drugstore cowboys and commercial mavericks. Credibility matters.