The erroneous assumptions of so-called alternative medicine: The test of time


Edzard Ernst
Edzard Ernst is Emeritus Professor of Complementary Medicine at the Peninsula School of Medicine, University of Exeter. He is the author of ten books on complementary and alternative medicine.

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So-called alternative medicine (SCAM) comprises a heterogeneous mix of treatments that have almost nothing in common:

  • Herbal medicine is fundamentally different from acupuncture.
  • Homeopathy has nothing to do with chiropractic.
  • Reflexology is different from tai chi.
  • Osteopathy has little in common with yoga.
  • Etc., etc.

Despite this heterogeneity, there are a few assumptions that underlie most of these treatments. In this series of articles, I discuss some of these common denominators with the aim of critically analysing their validity. Part one focused on the claim that SCAM treats the root cause of disease; this part looks at the notion that SCAM has stood ‘the test of time’.

The test of time

We all tend to trust time-tested methods more than new developments. The idea is that, if something has survived for many decades, it must be fine – otherwise it would have been discarded long ago. To some degree, this concept makes sense. And because it seems rational (and because it is excellent for business), proponents of SCAM like to apply it to their trade. Thus, the term ‘traditional medicine’ is often used by practitioners pointing that:

  • Acupuncture is claimed to have a history of 2000 years.
  • Faith healing was already mentioned in the Bible.
  • Herbal medicine has been used in all cultures.
  • Homeopathy has survived more than 200 years.
  • Chiropractic and osteopathy are more than 120 years old.
  • Naturopathy has ancient roots.
  • Etc., etc.

There is, of course nothing wrong with discussing the age or explaining the history of a treatment. A problem, however, arises when the argument is used to support the assumption that the treatment in question is effective and safe. Yet, this is precisely what happens (in case you doubt it, read any of the many speeches by Prince Charles on the subject).

The notion that a long history can substitute scientific evidence is not just false, it can also be dangerous. For instance, blood letting was seen for centuries as an undisputed panacea. Its widespread practice must have killed thousands more than it ever benefitted. When it was finally discovered to be ineffective, through controlled clinical trials, it was not the intervention but the then new method of the controlled trial that was doubted. Today we know that blood letting (in the form of haemodilution) helps only in very few conditions.

Ginseng root

Other examples come from the realm of herbal medicine. An Oriental traditional herbal formula containing Bupleuri radix, Ginseng radix, Glycyrrhizae radix, Pinelliae tuber, Scutellariae radix, Zingiberis rhizoma, and Zizyphi fructus is used in Japanese Kampo medicine under the name of Sho-saiko-to. It has been employed in China for 2000 years and it was generally considered to be devoid of serious side effects. Yet, case reports from Japan associated it with serious liver damage.

Even if a traditional remedy has historically been used without problems, it might not be safe today. An ancient method of preparation may originally have produced a safe remedy, but a seemingly minor change in the production process can render it unsafe. Japanese authors showed that the highly toxic aconitine alkaloids in raw tubers of Oriental Aconitum species are transformed by the traditional method of preparation into the much less poisonous benzoylaconines. But modern manufacturing techniques have rationalised the traditional production process, generating a hazardous herbal remedy.

Years ago, we had few effective drugs to take alongside traditional remedies. Today we have hundreds, and many patients do take more than one drug at a time. One therefore has to consider the complex issue of drug interactions. St John’s wort, for instance, is quite harmless when taken on its own. When combined with other drugs, however, it can cause considerable harm.

Such examples demonstrate that our intuitive trust in the ‘test of time’ is by no means always justified. A treatment which has been used for millennia is not necessarily safe, and even the longest history of usage is no evidence for effectiveness. On the contrary, arguments based on ‘the test of time’ should make us suspicious. Only 200 years ago, our understanding of how the human body functions was woefully incomplete. Most SCAMs were thus based on erroneous notions about physiology, pathology, etc. Seen from this perspective, a SCAM’s long history of use could be seen as a sign that it might now be obsolete.

The fact that a SCAM has been used for many years is therefore by no means a reliable indicator for either efficacy or safety, and ‘the test of time’ turns out to be no test at all. No doubt, for providers of SCAM, it is a welcome boost to their business. But in essence it is a dangerous fallacy that lulls consumers into a sense of security that, in reality, does not exist. The true risk/benefit balance of any therapy cannot be judged by experience; to be sure, we always need rigorous science.

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