Part 4 Alt Med Skeptics I
Part 4 Alt Med Skeptics I
For the purpose of this article, “Alt Med Skeptics” will be defined as alternative medicine proponents who simultaneously criticize the faults in scientific funding and mainstream medicine, while also championing alternative therapies that have not been subjected to the same standards of evidence as those treatments and drugs that they criticize have.
I completely understand that the positions discussed in this article could upset and even enrage some of my friends, distributors, and customers. As I have stated in other articles, I am not “deaf to my audience,” but I also simply cannot justify sacrificing intellectual honesty, and as such, compromising my personal ethics and morals to avoid potentially offending some current or potential customers. In pursuing to break down what is wrong with medical and health skepticism, I must address the significant issues on both sides of the fence. I cannot, with any modicum of honesty, criticize one side and excuse the other. Doing so would exacerbate the very issue I am wishing to address.
Communication and philosophy regarding health and medical sciences in the United States have developed much like its political landscape: into a binary system where few or no concessions are given to the other side. Over time, complex opinions regarding the state of medical and health sciences have become drowned out, and the chasm separating opinions has continued to grow. As I discussed last week, mainstream skeptics are often doing more harm than good. They’re fueled by “alt med” practitioners, many of whom are skeptics in their own right, with a personal mission to discredit and debunk everything the “alt med skeptics” say, no matter the cost. It begs the question: is every position put forth by “alt med” skeptics equally ludicrous? Assuredly not. Some of their positions are completely logical, while others are mind-numbingly obtuse, hypocritical and inconsistent, and that’s if they aren’t downright fraudulent. Let’s take a look at what they get right, pointing out the hypocrisies in each stance when relevant.
Corporate & Financial Influence on Science & Policy
Corporations can influence research – this is an irrefutable fact. There are all sorts of ways in which data can be manipulated to show a result beneficial to the funder. Privately funded science should be rightfully scrutinized. As a society, we have witnessed the power that large-scale “bad science” can have on consensus and interpretation of results. For example, the tobacco industry sowed confusion and doubt into the negative effects of cigarette smoke for decades. Unfortunately, large multinational corporations often have budgets far larger than researchers interested in looking for deleterious health consequences from corporate- produced products deemed safe. These corporations can churn out numerous replicative studies, overshadowing the work of researchers looking to investigate any potential harm. This is a problem we need to be aware of as a society.
Unfortunately, many “alt med” skeptics use this line of thought to discredit everything they see fit, regardless of any hard evidence to the contrary. If there is no evidence, it is just a matter of time, or so they say, until the world wakes up – just like it did with big tobacco. This is an unwinnable argument if you play their game, but fortunately, we don’t have to play by their rules. It can be acknowledged that situations such as what happened with the tobacco industry, where corporations influence the course of research, have happened in the past, but that doesn’t mean that all situations will always follow this trajectory.
When it comes to evaluating evidence of the effectiveness or benefits of a product or technology predominantly studied by an industry, several things need to be considered:
- Are the findings from corporate research even slightly controversial by experts in the relevant field (excluding the “alt med” skeptics)
- How large is the group of researchers crying foul? Is it a sole voice or a sizable group?
- Are others in the field hesitant to express firm opinions or are they ridiculing the mavericks as having ludicrous positions?
- If there is contradictory evidence demonstrating harm, what is the quality of this evidence? Are the studies sound or are there significant methodological flaws? Have the results of contradictory studies been thoroughly debunked by researchers outside of the corporate landscape?
- If there is contradictory evidence, how was that evidence funded, and what is the track record of the team conducting the research? Do they even specialize in this research area?
Each situation is independent of the other. Because something has happened in one industry, it does not mean another industry will automatically operate the same way. Each specific claim needs to be evaluated based on the existing evidence.
Further, as I have previously discussed in my article on private vs. public funding in science, there are alarmingly high numbers of public researchers who confidentially admit to have altered their own data due to specific publication and funding pressures, independent of a corporate funding source: such as the notions of “publish or perish”, the lack of ability to get negative findings published in good journals, and the desire to secure tenure or additional grant funds. Moreover, researchers also tend to bury negative results at disturbing rates. This is why replication of study results is key, ideally by multiple teams. If one team, or company, is churning out all the data, it isn’t truly replicated. This standard needs to be upheld by both private and public research.
“Alt med” skeptics often give a pass to research by private companies regarding either natural compounds having a benefit or artificial ingredients being hazardous, even when there is a severe conflict of interest present, and the research itself is full of methodological flaws. Often, “alt med” skeptics fail to scrutinize research that supports their favourite treatments, or positions on dangers, due to their own vested financial interest, a “pass” that seriously hurts their credibility and arguments.
A further pass is given to considerable influence on “alt med” therapies and the silencing of scientists by powerful figures, such as the public feud between Prince Charles and Prof. Edzad Ernst, the department head of the first “School of Complementary Medicine” at the University of Exeter in the UK, the first such academic position in the world. Having left a prestigious position as Chairman of Physical Medicine and Rehabilitation at the University of Vienna, Prof. Ernst sought to use scientific methods to investigate alternative therapies. These were subjects he had a soft spot for, before the evidence demonstrated otherwise. Due to his repeated,
negative findings, and refusal to tow the line to serve financial and political influences, Prof. Ernst was repeatedly threatened in an attempt to silence him, had his funding cut, and received numerous peer attacks, as well as public attacks from staff and allies of Prince Charles.
In his memoir, “A Scientist in Wonderland”, Prof. Ernst discussed the politics of academia and the resistance from complementary and alternative medicine practitioners to his research. Specifically, he had refused to participate in teaching lectures and helping with the course work on a new “integrative medicine” post-graduate degree, specifically on homeopathy, a subject which he had thoroughly debunked, despite the program being pushed by Prince Charles himself and funded by Nelsons. On p. 161, Prof. Ernst poses the following question:
“Why were my peers seemingly bent on constraining me and making life increasingly difficult for me?”
He answers this question by stating the following:
“This was by no means a trivial question and, on reflection, the most plausible answer, in my view, was that the results of my research were a thorn in the flesh of powerful interests operating in the background. Our critical analyses of alternative medicine, once acclaimed locally, nationally, and internationally, seemed no longer wanted.”
This is just one prominent example where powerful proponents of alternative medicine silence truth, or attempt to obfuscated the truth, due to personal belief or financial gain. It is important to note that as of 2019, the dietary supplement market is estimated to be worth $123 billion dollars worldwide, while the Complementary and Alternative medicine market is estimate to reach about $300b by 2027. Further, the organic food industry is projected to be worth $323b by the end of 2024, and the ambiguous, functionally useless and legally meaningless term "natural" is projected to generate $192b annually by 2023. Clearly, there is a lot of “big business” on this side of the fence, so why is the skepticism of financial and corporate influence only directed to mainstream medicine and the pharmaceutical industry? Any financial or political influence that silences the truth is worthy of criticism and should be fought.
Never Enough Evidence
With regard to many “hot” topics, “alt med” skeptics will concede there will “never be enough” evidence to change their mind. Such conviction does not represent critical thought and is analogous to religious belief. It is indefensible to simultaneously prop up inadequate evidence of harm under the guise of scientific proof, while simultaneously disregarding the evidence existing to the contrary, and admitting that there could never be enough evidence to sway their opinion.
Further, many of these “alt med” skeptics love to talk about the molecules they endorse and the science behind them, even when the science is flawed, inadequate, and often, has not been conducted in humans. They will endorse these “favoured” molecules on the one hand, while simultaneously these “alt med” skeptics claim there is never enough evidence for effectiveness or benefits of drugs and technologies developed by what they deem “big industry.” However, for the molecules they profit from, also developed and typically researched by the industry,
even a morsel of evidence is sufficient. According to this logic, for some reason, smaller businesses are less likely to be influenced by financial gain? It doesn’t make any logical sense.
“Alt med” skeptics often confidently assert that the FDA in the USA is a captured agency, meaning that the agency serves corporate interests above public interest, namely safety. There is a legitimate argument here, but it is far more complex than argued by the proponents. Specifically, some of the main flaws of the FDA include the following:
The FDA is seriously understaffed and outgunned. Teams of specialists in one specific area will work on a filing, presenting the strongest evidence they have to a few or one FDA officer working on the clock to assess the portfolio. Communication in the interim is permitted, meaning for any concerns or questions the FDA officer has, responses will likely quickly overwhelm, inundate, and pacify them.
-FDA officers often do not treat their work with the FDA as long-term careers, but rather, aim to gain experience and understanding of the framework in order to utilize the industry, either as a consultant or by working directly for one of the companies they are meant to enforce. Meaning, many will lack incentive to dig deep into the companies that one day may be their source of income.
-The FDA commissioners tend to come from industry before they accept the helm and go back to industry after they leave. They are rarely promoted from within the agency.
These challenges lend the possibility that some drugs or food ingredients on the market pose dangers that escape detection. This is why I have proposed that replicative work, such as the second phase III trial in drug development, should be conducted by public teams under no agreement to withhold publication, and no final decision on design by the drug company, with the university being assigned by the FDA either by lottery or rotating assignment to mitigate funding source issues. These challenges need to be taken with a grain of salt. First off, corporations putting forth portfolios have gathered the required information on safety and efficacy. However, important information can be left out. Most people need to justify and rationalize their decisions. If there is a known risk, it is typically deemed small and then ignored and concealed. However, the
losses incurred by the companies concealing information, when these small risks end up being large issues, are far more devastating than if the potential issues had been acknowledged, and properly explored, leading to the project being abandoned on day one. This likely means there
are often questions, but in most cases, the rewards far outweigh the risks, both regarding applications to public health and financially. Further, presuming this is the case, even a well-funded FDA with numerous officers on each file, none of whom are seeking private employment, would be unlikely to detect such risks, as they wouldn’t be reported in the first
Realistically, neither FDA officers nor the majority of the corporate researchers are complicit in harming the population. To do so would harm their friends, family, and the entire population. Who could live with themselves without warning those they care about? If they are warning
numerous people, what are the odds of whistleblowers not alerting the public countless times? The suggestion that thousands of scientists and regulators, most modestly paid, are all secretly acting in a way to cause harm to the population, including themselves and their loved ones, is
preposterous. Specific risks falling through the cracks is certainly the result of ignorance, sometimes wilful, but do not result from greed and malevolence. Once the product is on the market, coverups of specific risks are certainly largely motivated by fear of ramifications, at least as much and likely far more than by loss of profits.
Many “alt med” skeptics will bring up recalled drugs as an example of the FDA’s incompetence, somehow suggesting that because some drugs have caused harm and been recalled, all drugs must carry that risk, with the eventual risk being likely, not minimal. The history of drug recalls, such as the current Zantac situation and many others preceding it, is a great example of effectiveness and wins in post-market research, both from the FDA and the collective research community. If there had never been a recall, or a drug removed from market, that would be a far more frightening prospect. I suspect this is a no-win situation, as if there had never been a recall, those skeptical of pharmaceutical drugs would point out that there has never been a recall as an example of the FDA being “captured.”
This brings me to the big question on this topic:
If the FDA is so lax and pro-industry, why are “alt med” skeptics selling their own treatments, supplements and purported cures for a plethora of diseases, and not pursuing drug status? (There is a legitimate reason for this, which I have detailed in "Open Letter Regarding testimonials." However, I have not heard anyone from the “alt med” crowd stating this reason). It would certainly garner them far more earnings. Maybe money isn’t the goal, but rather, they are doing what they do out of a passion for the population’s health and wellness. If this were the case, why are the “alt med” skeptics not donating proceeds from their profits of these largely unregulated treatments to support research on the topics on which they deem themselves to be the top health priorities? (As an aside, a select few from the “alt med” community do this and seem to truly believe in their positions. I have written about this in my past articles “100 voices” and “Don’t trust the health experts” part 1.)
Some “alt med” leaders truly believe that they are better equipped to determine specific drugs’, “natural” molecules, and therapies safety and efficacy than the FDA, disregarding even the much more relaxed laws regarding supplements, cosmetics, and devices for their low standards. Others use their disdain of the FDA as an excuse to skirt, when not outright breaking, regulatory laws for their own profit, or to avoid “unnecessary costs.”
Why are some “alt med” practitioners adamant that they are to be trusted above “big corporations” and the FDA? These practitioners are also making money, and in many cases, lots of it. In fact, they earn far more than the FDA officers who may or may not be hoping for a job in the private sector, and far more than the salaried scientists and employees of corporations conducting the research and reviewing the trials. If fear of losing a job or opportunity is as powerful as these alt med skeptics suggest, wouldn’t fear of losing their customer base or reputation if one of their suggested protocols were determined to be false or harmful be as
Unfortunately, the truth is money corrupts and very few, if any, are above becoming corrupted. Intent and integrity can propel a mission forward, but in the real-world, concessions need to be eventually made. This is why checks and balances are important. Perhaps, some of these “alt med” proponents start out with noble intentions (and I believe many do), but why should we trust that they will always maintain this same level of integrity with the same honest intentions? The very argument of corruption through profits invalidates them to be above it. It takes “brass balls,” to steal a quote from “ Glenngary Glenn Ross ,” and use for my own purpose, to roll the dice on the fate of your company in the search of truth.
I repeatedly publicize the fact that we will work with researchers under no gag order to publish results or final say in methodology because I do not trust myself to maintain integrity as the business grows. This is not to say that I currently have any desire to be dishonest. I am pursuing research in this way I am because I feel strongly about it. It is because I understand as more people rely on what I am doing, and I become accustomed to certain lifestyles and reputations, my preferences and priorities will likely change. Therefore, I am attempting to safeguard my current ethics by obligating my future self. Already, as I have significant amounts of funds riding
on progress and positive outcomes. Every time I roll the dice and we proceed with another unknown trial out of my control, the emotional stress expresses itself in physical symptoms, such as dry heaving and lethargy. It takes concerted effort to snap myself out of it. It is painful, and humans tend to avoid pain and pursue pleasure.
The bottom line is, no one can be trusted. We can only trust the evidence, which we must pursue with relentless fervor. “Alt med” proponents are just as bound to financial stakes as the big industries they condemn. And, as previously addressed, so am I.