We tend to think of alternative medicine as a colourful array of therapeutic methods. However, this ignores the fact that alternative practitioners also use a range of diagnostic tools which would bewilder every conventional physician. These alternative diagnostic methods have grown out of the different traditions of alternative medicine and are therefore are extremely diverse. Yet they have in common that they have either not been validated or, in case they have been tested, they have been found to be invalid.
Non-validated diagnostic methods run an unacceptably high risk of producing false positive or false negative diagnoses; with invalid methods, the risk turns into certainty. A false positive diagnosis is a diagnosis that the patient in question is, in fact, not suffering from. Such a scenario is, of course, a most welcome ‘carte blanche’ for every charlatan; it enables him or her to cash in on treating something that is not even there. A false negative diagnosis is much more dangerous; it means missing an existing disease, and that might even threaten the patient’s life.
In addition to false positive and false negative diagnoses, we also encounter invented diagnoses. By this term I mean conditions that are pure fantasy and have been invented by practitioners mostly in order to keep the cash flowing into their bank accounts. Chiropractors, for instance, go on about ‘subluxations’ which are a complete myth, and acupuncturists speak of yin or yang deficiencies which have no basis in reality.
More than 20 years ago, I published a review evaluating the evidence for or against alternative diagnostic techniques entitled ‘Which craft is witchcraft?’. Its conclusions are as true today as they were then: ‘…alternative’ diagnostic methods may seriously threaten the safety and health of patients submitted to them. Orthodox doctors should be aware of the problem and inform their patients accordingly.
Fifteen years after the publication of my paper, Prince Charles published his book Harmony: A New Way of Looking at Our World. It covers, among many other topics, the subject of alternative diagnostic techniques. This is what His Royal Highness tells us about them:
I have also learnt from leading experts how we can understand a great deal about the causes of ill health through more traditional methods of diagnosis — for example, through examination of the iris, ears, tongue, feet and pulse, very much the basis of the Indian Ayurvedic system.
This is not to say that modern diagnostic techniques do not have a role, but let us not forget what we can gain by using the knowledge and wisdom accumulated over thousands of years by pioneers who did not have access to today’s technology. In fact, an over-reliance can often mean that the subtle signs of imbalance revealed by the examination of the eyes, pulse and tongue are totally missed.
Including the fruits of such knowledge, gleaned over 8,000 years of studying the relationship of the human body to the rest of Nature and to the Universe, can but only provide an extra, valuable resource to doctors as they seek to make a full diagnosis. Why persist in denying the immense value of such accumulated wisdom when it can tell us so much about the whole person — mind, body and spirit? Employing the best of the ancient and modern in a truly integrated way is another example of harmony and balance at work.
When he talks about ‘the subtle signs of imbalance revealed by the examination of the eyes’, Charles is referring to iridology, of course. Iridologists diagnose diseases or susceptibility to diseases by analysing the colour pattern of a patient’s iris. This method has repeatedly been put to the test, and, in 1999, I published a systematic review of the evidence which concluded that ‘the validity of iridology as a diagnostic tool is not supported by scientific evaluations. Patients and therapists should be discouraged from using this method.’
And when Charles talks about ‘the subtle signs of imbalance revealed by the examination of the feet’, he might think of the diagnostic technique some reflexologists employ when palpating the feet of their patients to draw conclusions about inner organs. In 2000, we put this method to the test. Eighteen adults with one or more of six specified conditions were identified from primary care records. Two reflexologists, blinded to the patients’ conditions, examined each patient’s feet and rated the probability of each of the six conditions being present. The results revealed that reflexology is no good at distinguishing between the presence and absence of any of the six conditions. Inter-rater reliability scores were very low and provided no evidence of agreement between the examiners. We concluded that, ‘despite certain limitations to the data provided by this study, the results do not suggest that reflexology techniques are a valid method of diagnosis’.
Given that the evidence for alternative diagnostic techniques is either negative or absent, why does the heir to the throne advocate using them? He must be aware that he has considerable influence; in fact, it would not be unreasonable to assume that this is precisely why he goes to the trouble of writing a book. So, does he not know that publishing nonsense about medicine endangers the health of those who believe him? Why does he call disproven diagnostic tools ‘valuable’? The answer, I assume, is that he does not know better.
There would be nothing wrong with Charles’s ignorance, of course. He is not a medic — if he were, this quackery might get him struck off the medical register. He does not need to know such things. But, if he is ignorant about certain technicalities, should he write about them? At the very least, when giving such concrete medical advice about diagnostic methods, should he not recruit the expertise of people who do know about such matters?
In Charles’s defence, I should mention that he did ask several physicians for help with his book. In the above-cited paragraph, he even stated that he ‘learnt from leading experts’. Two of those whose assistance he acknowledged in his book Harmony are Mosaraf Ali and Michael Dixon. I cannot help feeling that this reflects poorly on all three individuals: Ali and Dixon for not advising Charles more responsibly. And Charles for not recruiting better advisors.
Anyway, Charles is, of course, entitled to find new ways of looking at our world — with or without ‘leading experts’. But personally I would prefer it if he could look at diagnostics (and other medical issues) in a way that does not endanger the health of his subjects.
Edzard Ernst, emeritus professor at the University of Exeter, is the author of A Scientist in Wonderland and the awardee of the John Maddox Prize 2015 for standing up for science. He blogs at edzardernst.com.