- Herbal remedies, vitamins, minerals, and “natural” products – many of which are sold as over-the-counter dietary supplements
- Chiropractic manipulation
More than one-third of the adults and 20–40% of children in the United States have reported using CAM. These treatments are widely perceived as “natural” and therefore considered to be intrinsically safe. Unfortunately, CAM products and techniques have caused serious harm to many people.
Dietary Supplements/Herbal Remedies
Although the perception is that “dietary supplements” – including herbal remedies, vitamins, minerals and other natural supplements – are safe, many of these products have been shown to have severe side effects with frequencies comparable to those of typical pharmaceuticals. For example, herbal remedies kava and valerian both have been linked to severe liver damage. Even vitamins at doses not much above recommended levels have shown harmful effects (for example, increased cancer risk).
In the United States, dietary supplements are not regulated in the same manner as medications. These supplements are not required to prove safety or efficacy. Since the passage of the Dietary Supplement Health Education Act of 1994, they may be banned by FDA only if there is concrete evidence that they cause harm. The legal definition of dietary supplements is fairly narrow and clear. In practice, the definition is interpreted in a sufficiently elastic way that substances such as melatonin and DHEA (dehydroepiandrosterone) qualify and are sold as supplements, yet these substances clearly have risks similar to many other substances which are regulated as drugs.
Because regulation and oversight is lacking for these types of products, negative effects can sometimes be attributed to either the inadvertent contamination of or sometimes the intentional addition of other substances to the herbal therapies. Some examples:
- Many traditional Asian remedies contain very significant amounts of heavy metals including lead, mercury and arsenic, and have caused unintended poisoning with these metals.
- A 6-week-old infant developed diarrhea after being given ‘gripe water’ (a traditional British/Irish remedy for respiratory symptoms in children) contaminated with a disease-causing germ during the manufacturing process.
- Many herbal remedies have undisclosed mainstream pharmaceuticals added, presumably, as a way of increasing potency. However, those medications can have risks or interactions with other medications someone might be taking. For example, a non-prescription Chinese medicine for hypertension turned out to contain several potent prescription blood pressure medicines.
It is unclear whether the problems or adverse effects of physical or body-based CAM, such as chiropractic manipulation or acupuncture, are a result of improper technique or would have occurred even if the practitioner performed the therapy exactly according to the intended method. Numerous instances of injuries to arteries or the spinal cord have been reported in connection with chiropractic manipulation. Even a technique as seemingly benign as massage can lead to serious problems.
In other cases, it is clear that the adverse effects are a result of error or poor technique. A 9-year-old boy died after the wall of his heart was pierced by an acupuncture needle placed in the upper abdomen.
Finally, the use of CAM treatments can have grave consequences if the patient forsakes known effective mainstream medical treatments and the CAM treatment is not effective. For example, a German report documented three instances in which children with insulin-dependent diabetes were advised by CAM practitioners to stop taking their insulin in favor of various alternative treatments. All three children died of diabetes within days of discontinuing their insulin. Many CAM practitioners advise against immunization, instead recommending chiropractic or other CAM, with the expected consequence that some children develop serious vaccine-preventable infections.
Evaluating CAM Therapies
How do we know if a given CAM therapy is safe? We should apply the same standards as for conventional therapies: empiric evidence resulting from methodologically sound controlled trials, or in the absence of controlled trials, statistically rigorous analysis of existing data is the only way to demonstrate safety.
The Mayo Clinic has provided a plethora of consumer-focused information about CAM, not just what it is, but how to evaluate treatment options, practitioners, and claims. If you are considering use of a CAM product or technique, I have high-spotted some of their key points for consideration:
- Please talk with your doctor before trying CAM, especially if you are already taking other medications or have a chronic condition. As I discussed above, some supplements can contain other drugs that could cause an adverse reaction.
- Be skeptical about claims unless you can find documentation of successful outcomes from large, high-quality clinical trials in peer-reviewed journals.
- Be careful, cautious, and thorough with information you find online. Older studies you uncover which claim success may have been debunked at a later date. Maintain your skepticism in the face of sales jargon – if something were actually a “miracle cure,” we would all be using it.
- Select a CAM practitioner carefully. Talk to your doctor, local hospital, medical school, or health department about licensure, accreditation or recommendations. Check the national association websites for a list of certified practitioners in your area.
Natural Causes: Death, Lies and Politics in America’s Vitamin and Herbal Supplement Industry, Dan Hurley, 2006, Broadway Books, New York.