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Why would anyone use an
unproven or disproven therapy?
A personal view
Edzard Ernst
Peninsula Medical School, Universities of Exeter & Plymouth, 25 Victoria Park Road, Exeter EX2 4NT, UK
E-mail: Edzard.Ernst@pms.ac.uk
In my job, professor of complementary medicine, I
meet many clinicians who do the strangest things,
for instance, administer unproven or disproven
treatments (UDTs). I have often asked myself:
why? For many years, I have been pondering this
seemingly simple question, and gradually I be-
came convinced that there is not one single reason
but at least four themes that we need to consider.
Desperation is clearly one of them. In fact, it is the
one that clinicians tend to offer most readily: ‘For
many patients there is no treatment that is
evidence-based,’ they claim thus justifying their
use of UDTs. When I then question which con-
ditions they might be referring to, the response
tends to be more hesitant. Eventually the argument
turns out to be that ‘many patients suffer from
undiagnosable conditions’.
I have always been puzzled by this claim,
mainly because it does not portray my own
impressions or recollections of being a clinician.
Undiagnosable patients do, of course, exist but
they are not in the majority. Even if I accept that
many patients belong to this category, I remain
sceptical. In particular, I wonder whether these
patients are truly undiagnosable or perhaps only
not properly diagnosed, and whether there really
is no evidence-based treatment to help them – not
even to alleviate symptoms regardless of any diag-
nosis. Furthermore, I ask myself whether some of
these undiagnosed patients really require medical
treatment at all, considering the risk of medicaliz-
ing what might only be minor reductions of well-
being. Crucially I am puzzled why these clinicians
tend to administer UDTs to so many of their
patients – even to those that do have a well-
established diagnosis. In any case, I question
that one uncertainty (unidentified diagnosis) can
be eliminated by adding a further uncertainty
(unproven therapy).
Belief is another powerful reason for using
UDTs. In complementary medicine, belief su-
premely reigns over evidence. As an example, con-
sider the physician who uses spiritual healing
despite the fact that there is overwhelming evi-
dence disclosing it as hocus pocus.
1
But belief in a
therapy clearly can overpower even the most solid
evidence. This is perhaps understandable – we are
all only human. But it is also regrettable. Medicine
has been dominated by dogma for centuries, and
progress was made only when science replaced
creed.
2
If we allowed our beliefs to get the better of
us, I fear, we would be regressing back towards the
dark ages. I am therefore convinced that replacing
evidence with belief is a disservice to our patients.
Incompetence is, in my experience, a third and
common reason for using UDTs. Some clinicians
seem to find it difficult to discriminate between
scientific evidence and promotional pseudo-
evidence. Medical schools have in the past not
always been the best places for acquiring the skills
of critical thinking, and institutions for educating
other healthcare professionals (e.g. the colleges
training practitioners of complementary medicine)
may well be worse. Many aspects of clinical medi-
cine are, of course, hugely complex and often hard
to comprehend. It is undoubtedly easier to adopt
the simplistic concepts of, for instance, ‘energy
healing’ which do not require any detailed under-
standing of pathophysiology, pharmacology, et
cetera.
Disappointment is another prominent reason for
employing UDTs. Many healthcare professionals
get disillusioned with the current healthcare busi-
ness, the dominance of ‘big pharma’, the lack of
time and empathy they are able give to their
patients, and so on. Some of these clinicians there-
fore feel the need to look elsewhere and are some-
how able to find entirely new realms of healing.
DECLARATIONS
Competing interests
None declared
Funding
None
Ethical approval
Not applicable
Guarantor
EE
Contributorship
EE is the sole
contributor
Acknowledgements
None
PODIUM
J R Soc Med 2009: 102: 452–453. DOI 10.1258/jrsm.2009.090136
452 by guest on February 14, 2016jrs.sagepub.comDownloaded from
These seem to make patients happy and might
even render life as a clinician more satisfying. It
seems to matter little that, in this fantasy world,
drugs are replaced by vague concepts of ‘energy’
and diagnostics are substituted by intuition. What
should, however, matter to any responsible clini-
cian is that, in this fantasy world, patients are not
treated with the most effective treatments avail-
able to them.
Comment
‘A consideration of the careers of the outstanding
charlatans furnishes some clues to the factors upon
which their success has depended. The common
type is that of a man of unusual force of personality
who in virtue of an imperfect education and ill-
balanced judgment has acquired the profound be-
lief that some direct inspiration has made him
independent of the slow advance of science and
has endowed him with semi-miraculous powers
of healing.’
3
This 80-year old quote by AJ Clark is
as true today as it was then. An over-reliance of
belief, combined with ‘ill-balanced judgement’
and ‘imperfect education’, are core reasons for
using UDTs. Clark adds a further dimension when
pointing out that ‘outstanding charlatans’ usually
are gifted with an ‘unusual force of personality’.
Users of UDTs are thus often able to attract a large
and loyal flock of followers. But popularity is no
substitute for effectiveness, and conviction and
charisma only render the promoters of UDTs more
dangerous than they already are.
References
1 Ernst E. Distant healing – an “update” of a systematic
review. Wien Klin Wochenschr 2003;115:241–5
2 Wootton D. Bad Medicine: Doctors Doing Harm Since
Hippocrates. Oxford: OUP; 2006
3 Clark AJ. The historical aspect of quackery. BMJ
1927;2:589–90
Why would anyone use an unproven or disproven therapy? A personal view
J R Soc Med 2009: 102: 452–453. DOI 10.1258/jrsm.2009.090136 453
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