Alternative medicine is no alternative

It doesn’t work and may kill people

In science, we must be prepared to question everything, also deeply held beliefs, using logic and scientific methods. If we do this, the whole field of alternative medicine, also called complementary medicine, falls apart. There is no commonly accepted definition which might delineate alternative medicine from other treatments, and logically, it does not even seem possible.^1,2 Most definitions simply say it is not presently considered part of conventional medicine. This can be translated into: It does not work. Because, if it did, we doctors would be happy to use it and would not call it alternative.

HC Andersen: The Emperor’s New Clothes

I analysed this area when I was asked to write a chapter about alternative medicine in the general textbook of medicine used by medical students in Denmark¹ because they felt there was a need for such a chapter. I also wrote a chapter about it in my book about surviving in an overmedicated world.² Our prescription drugs are so dangerous and so much overused that they are the leading cause of death, with psychiatric drugs alone being the third leading cause of death, after cardiovascular diseases and cancer.³ Therefore, when I lecture about this, I am often asked: “What’s the alternative?”

My reply is simple: The alternative to drugs is no drugs. We would have much healthier and more long-lived populations if we took fewer drugs. Unfortunately, doctors, other health professionals, and patients are under heavy influence of the pharmaceutical industry^4,5 and find it very difficult to do nothing, even though we know that a good surgeon is one who knows when not to operate.

In this article, I shall discuss the general principles and findings. In the next two articles, I shall demonstrate that none of the most popular alternative remedies have any effect and that spinal manipulation, acupunture and surprisingly, even homoeopathy, can be lethal – albeit very rarely compared to prescription drugs;⁶ and that the Cochrane review of praying for people to cure diseases is a pillar of shame for Cochrane.⁷

Quite often, we should let nature take its course because our bodies and minds have a great capacity for self-healing. In other cases, we might prefer a non-drug intervention that has documented effects, for instance, psychotherapy for mental health issues.⁵

Many patients and some doctors are attracted by the irrationality of alternative medicine, which I assume is related to the propensity human beings have for religious beliefs and rituals. When I sit at a dinner table, I try to avoid talking about alternative medicine, but people can become very agitated when I gently tell them that I am not interested in this. It is like telling a religious fanatic that I do not believe in gods and do not wish to discuss it.

Once, my tablemate was very tenacious and just wouldn’t accept my excuse that I knew too little about Chinese herbs to say anything of value about them. I tried to start a conversation with another person, but the man would not let me go and did not have a modicum of politeness. He ultimately played his trump card: “Don’t you agree that Chinese herbs must be good for people, because the Chinese have used them for thousands of years?” to which I responded: “They have also used bamboo as a building material for thousands of years. If I were an engineer, would you then have told me to use bamboo to build road bridges?” For the rest of the evening, he didn’t look my direction.

Herbal medicine is called natural medicine in some countries. It is defined as medicinal products whose active ingredients are naturally occurring substances in concentrations not

significantly greater than those in which they occur in nature. However, there is nothing “natural” about natural medicine, and in the evolutionary battle for survival, many plants have developed toxins that can be deadly, both for humans and other animals.

Some of the diagnostic methods are really “alternative.” It makes no sense to make a diagnosis by looking people in the eyes (iris analysis), examining the patient’s “aura,” recording the propagation of the vibrations from a tuning fork placed on the knee, or analysing the mineral content in a person’s hair.⁸

A stereotype in the criticism of medicine is that it is reductionistic, whereas alternative medicine is described as holistic even though it offers the greatest simplifications. A wide variety of diseases are reduced to having singular explanations. Imbalances in clients’ energy systems or small vertebral misalignments called subluxations in their spines get the same treatments, such as rubbing the soles of their feet or physical manipulations. Or homoeopathy is used for headache, irrespective of whether it is caused by a brain tumour or influenza.

Some practitioners have psychological insight and may help clients suffering from stress, undue perfectionism, low self-esteem, anxiety, sadness and depression, but this is due to their human qualities. It has nothing to do with the use of alternative diagnoses or treatments.

The explanations about causality that alternative therapists use to support their claims of positive effects are often speculative and have no connection with reality. In 1964, American magician James Randi promised a reward of one million dollars to anyone who, under agreed upon, controlled circumstances, could prove pseudoscientific postulates, for instance, the alleged mechanism of action for the effects of reflexology, homoeopathy, acupuncture and chiropractic healing (apart from the effects on back and joint pain).⁹ During the next fifty years, over a thousand people tried, but all failed, and the challenge was terminated.

The most popular treatments are those involving bodily contact, which is easily understood from an evolutionary perspective. Apes and monkeys spend quite some time grooming each other which is important for the social cohesion and for maintaining the hierarchy,¹⁰ and we humans probably miss that kind of physical proximity. In addition, some alternative therapists are good listeners and they tell their customers how unique they are.

Some people have realised that their doctors cannot cure them and are desperate to try anything, making them vulnerable to exploitation by all sorts of quacks and fraudsters like German businessman Matthias Rath who sold large doses of vitamins against HIV in South Africa and claimed that nutritional supplements could prevent cancer and heart disease and cure all forms of cancer.¹¹

“The worried well” are good customers. They are often told that something is wrong with their energy systems; that they have a lack of certain minerals or vitamins; that they are being poisoned with all sorts of substances and therefore need special treatments like intestinal cleansing; or that they need peculiar diets.

Today, we know so much about the human body, and its physiology and pathophysiology, that alternative therapists cannot be excused for speaking mumbo jumbo to their clients. No “cleansing” is needed, because the liver and kidneys take care of toxic substances, and there is no good evidence that dental fillings with amalgam leads to health problems, or that some people suffer from multiple chemical sensitivities.

Immunisation of the research hypothesis

Alternative therapists often claim it is not possible to investigate the effects of alternative medicine in randomised trials. They say that the research setup changes the natural treatment situation and that the results are unreliable because the patients cannot benefit from the placebo effect.

In the theory of science, this approach is called immunisation of the research hypothesis. It means that, regardless of the experimental results obtained, believers will be unaffected and will continue claiming with equal conviction that their treatments are effective.

Moreover, the evidence we have does not support this view. First, comparisons between patients who received a treatment in a randomised trial and patients who received the same treatment outside the trial showed similar effects.¹²

Second, the placebo effect is small or non-existent. When Asbjørn Hróbjartsson and I reviewed 234 trials where a placebo intervention was compared with an untreated control group, we did not detect any clinically important effects of placebo in general.¹³ In certain settings, placebo seemed to have influenced patient-reported outcomes, especially pain and nausea, but we could not distinguish between true effects and biased reporting. An untreated control group cannot be blinded, and the patients who know they are not being treated may be disappointed about that.

Another, very common misconception is believing that if you cannot blind a treatment, you cannot study it in a randomised trial. But blinding and randomisation are two different methods, and the patients can be randomised to two treatment groups which are then compared. When blinding is not possible, e.g. for surgery, psychotherapy or reflexology, the treatment effects can be evaluated by someone who is unaware of the treatments the patients received. Or we can use objective outcomes that cannot or are unlikely to be influenced by lack of blinding, e.g. survival or return to work.

Serious alternative therapists have long acknowledged that the potential effects of their remedies must be investigated in randomised trials, and there are thousands of such trials.

“It cannot hurt” is a false argument

A common argument for using alternative medicine is that it cannot hurt. However, we treat people because we hope to help them, not because we hope we will not harm them, and the argument is wrong for several other reasons.

First, fraud is very common. When patients attending a dermatology clinic in England reported using herbal creams with good effect for atopic eczema, the doctors asked them to submit the creams for analysis, and it turned out that 20 of 24 creams contained potent corticosteroids.¹⁴ Corticosteroids surely work but have many irreversible harms, e.g. thinning of the skin and easy bruising.

The fraud is not only related to secretly and illegally adding substances with known effects. The opposite also occurs, that listed ingredients are missing. In 2015, four US retailers were selling fraudulent dietary supplements.¹⁵ The authorities had run tests on popular store-brands of herbal supplements at Walmart, Walgreens, Target and GNC and found that approximately four out of five of the products contained none of the herbs listed on their labels. In many cases, the supplements contained little more than cheap fillers like rice and house plants, or they contained substances that could be hazardous to people with food allergies.

Second, the ingredients can be toxic. Textbooks on alternative medicine describe some treatments that have outright dangerous ingredients. Liver failure and deaths have occurred after ingestion of Chinese herbal tea containing wild germander.¹⁶ To be killed after a cup of tea is something we mostly hear about when Russian dissidents are not liked by Putin. There was radioactive polonium in Alexander Litvinenko’s tea¹⁷ whereas in Salisbury, the Russian murderers smeared the nerve poison Novichok on a door handle.¹⁸ Sergei Skripal and his daughter Yulia survived while a British mother of three died.

Third, patients are often exposed to curious regimens with strict injunctions about what to eat and drink, or they are treated with mineral mixtures or large doses of vitamins, even though such regimens can be deadly. A review of the placebo-controlled trials of antioxidants showed that beta-carotene and vitamin E increase mortality.¹⁹ We need vitamins and essential minerals, e.g. zinc and copper, to make our enzymes work, but if we get too much, we might die. The human body is far more complicated than alternative practitioners are aware of and it is well adapted to the environment.

Fourth, many alternative practitioners advise against life-saving vaccines. A 2002 survey showed that 31 of 77 homoeopaths and 3 out of 16 chiropractors advised against giving one-year old infants a vaccination for measles, mumps, and rubella (MMR).²⁰ Since they knew they participated in a study, their advice in their daily practices might be even worse.

In my next article, I shall document that manipulation of the spine, massage, reflexology, acupuncture, healing, craniosacral therapy, and homoeopathy don’t work whereas manipulation of the spine, acupuncture, and – strangely enough – homoeopathy, can be deadly in rare cases.⁶

References

1 Gøtzsche PC. Alternativ behandling. In: Ove B, de Muckadell S, Haunsø S, Vilstrup H, red., Medicinsk Kompendium. 18 udg. København: Nyt Nordisk Forlag Arnold Busck 2013:2789-98.

2 Gøtzsche PC. Survival in an overmedicated world: look up the evidence yourself. Copenhagen: People’s Press; 2019.

3 Gøtzsche PC. Prescription drugs are the leading cause of death. And psychiatric drugs are the third leading cause of death. Mad in America 2024;April 16.

4 Gøtzsche PC. Deadly medicines and organised crime: How big pharma has corrupted health care. London: Radcliffe Publishing; 2013.

5 Gøtzsche PC. Deadly psychiatry and organised denial. Copenhagen: People’s Press; 2015.

6 Gøtzsche PC. None of the most popular alternative remedies are effective. And it can be deadly to believe that they work. Substack 2026;Feb (in press).

7 Gøtzsche PC. Praying for others to cure diseases. Cochrane review of intercessory prayer is a pillar of shame for Cochrane. Substack 2026;Feb (in press).

8 Gøtzsche PC. Rational Diagnosis and Treatment. Evidence-Based Clinical Decision-Making, 4th edition. Chichester: Wiley; 2007.

9 James Randi Educational Foundation. One Million Dollar Paranormal Challenge. 2006.

10 Lawick-Goodall J van. In the shadow of man. Hugo and Jane van Lawick-Goodall. 1971.

11 Gøtzsche PC. The Chinese virus: Killed millions and scientific freedom. Copenhagen: Institute for Scientific Freedom; 2022 (freely available).

12 Vist GE, Bryant D, Somerville L, et al. Outcomes of patients who participate in randomized controlled trials compared to similar patients receiving similar interventions who do not participate. Cochrane Database Syst Rev 2008;3:MR000009.

13 Hróbjartsson A, Gøtzsche PC. Placebo interventions for all clinical conditions. Cochrane Database Syst Rev 2010;1:CD003974.

14 Ramsay HM, Goddard W, Gill S, et al. Herbal creams used for atopic eczema in Birmingham, UK illegally contain potent corticosteroids. Arch Dis Child 2003;88:1056-7.

15 O’Connor A. Alternative medicine: What’s in those supplements? New York Times 2015;Feb 3.

16 Mostefa-Kara N, Pauwels A, Pines E, et al. Fatal hepatitis after herbal tea. Lancet1992;340:674.

17 Watson R. Litvinenko: A deadly trail of polonium. BBC 2015;July 28.

18 Harcombe C. “Many lethal doses” of Novichok used in poisonings. BBC 2024;Nov 13.

19 Bjelakovic G, Nikolova D, Gluud LL, et al. Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases. Cochrane Database Syst Rev 2012;3:CD007176.

20 Schmidt K, Ernst E. Aspects of MMR. Survey shows that some homoeopaths and chiropractors advise against MMR. BMJ 2002;325:597.