One of the most common responses to criticisms of alternative medicine is that, whether it is effective or not, at least it can’t do any harm. There is ample evidence, unfortunately, that this is not true. Any therapy with a potential benefit also has potential harms, so if CAM interventions do anything at all, one would expect some side effects. But even for those that are completely ineffective, there are risks.
Some of these risks are direct. Herbal remedies and supplements can be toxic or contain toxic contaminants (1, 2, 3). And other CAM therapies can be directly harmful, such as chiropractic (4), herbal remedies (5), and even acupuncture (6). But even for therapies that are inherently safe because they contain no active ingredients, such as homeopathy (7), there are indirect risks. Avoiding effective conventional therapies because of a false belief in the value of alternatives can lead to significant harm. A new study illustrates this in women with breast cancer.
Kurian Joseph, Sebastian Vrouwe, Anmmd Kamruzzaman, Ali Balbaid, David Fenton, Richard Berendt, Edward Yu and Patricia Tai. Outcome analysis of breast cancer patients who declined evidence-based treatment.World Journal of Surgical Oncology 2012, 10:118.
This study compared the survival of women diagnosed with breast cancer for those who accepted standard medical care and those who did not. The authors concluded:
A total of 185 (1.2%) patients refused standard treatment…The 5-year overall survival rates were 43.2% (95% CI: 32.0 to 54.4%) for those who refused standard treatments and 81.9% (95% CI: 76.9 to 86.9%) for those who received them. The corresponding values for the disease-specific survival were 46.2% (95% CI: 34.9 to 57.6%) vs. 84.7% (95% CI: 80.0 to 89.4%).
Women who declined primary standard treatment had significantly worse survival than those who received standard treatments.
Of the women who declined care, 54% pursued some form of alternative therapy instead, and overall 5-year survival for this group was 57.4% (95% CI: 42.7 to 72.1%).
It is important not to over interpret these results. To begin with, the number of women who refused standard treatment was very small, which suggests that most understand the value of conventional therapy for this disease. And of those who refused treatment, many may have done so for reasons having nothing to do with their beliefs about conventional versus alternative therapies. There are many perfectly sound reasons for choosing not to pursue treatment depending on the extent of disease, the chances of benefit and harm from therapy, and personal circumstances and values. No clear reason was given for almost half of the women who refused, so it is impossible to know whether or not CAM played any role in their decision or their outcomes.
And choosing CAM instead of conventional therapy may not have been the only reason for the difference in survival between women who did or did not have standard treatment. Women who were sicker, had more advanced disease, or had other diseases as well may have been less inclined to pursue therapy, and also more likely to die sooner than women with a better chance of a good outcome with standard treatment.
And women who pursued CAM therapy instead of standard treatment did do slightly better than women for whom no reason for refusing traditional care was given (57.4% 5-year survival versus 43.2% 5-year survival). This would make sense if women who refused all care, even CAM, did so because they had more aggressive or advanced disease or other health problems.
However, there is no question that women who chose standard treatment did far better than those who choose CAM. The difference in 5-year survival between CAM (57.4%) and standard care (81.9%) was huge and unequivocal. And while the specific CAM used was not known in each case, overall there is no reason from these data to believe CAM in general has anything like the efficacy of conventional breast cancer treatment. If there is some form of CAM that performs as well as conventional care, no one has yet presented the data to show this, so claims that this is a legitimate alternative and that refusing standard care is a reasonable choice for women who want to treat their disease are not supported by any evidence and are, in fact, contradicted by the evidence of this and other similar studies (8, 9)
This is yet another study which emphasizes that importance of not substituting unproven alternative therapies for science-based medical care. While investigating the possibility that some plausible alternative therapies may have benefit is reasonable, choosing CAM over standard care is not and is likely to result in real harm.