Monday, 7 December 2009

Right For All The Wrong Reasons

Nursing Times has an article by Fiona Mantle warning of the dual dangers of consumer magazines giving advice on complementary and alternative medicine (CAM) and of self-diagnosis. But all is not as it seems.

Mantle looked at 15 UK consumer magazines for one month and found 150 articles on CAM. She accepts that this is a small study but 150 articles in one random month are at least an indicator of the state of play. The British public spends £1.6bn a year on CAM so why would magazines not want in? That's a lot of potential advertising revenue and no one ever lost money by giving the public what they want. Mantle says that the majority of CAM articles are by contributors 'whose key remit appears to be new product placement'.

Of these articles, '131 remedies were proposed by contributors with no medical qualifications'; 95 were on ingested herbal remedies, 25 on nutritional supplements, 10 on homeopathic remedies and 20 on essential oils.

Occasionally, she says, there are warnings to consult doctors, but not always. Even worse, of the five contributors who were medical doctors, not one of them highlighted any potential herb/drug interaction 'with two prescribing liquorice without any reference to existing cardio pathology, diabetes or hypertension'.

Mantle is particularly concerned about a self-help leg massage feature for 'heavy legs' that 'failed to offer any contraindications in relation to varicose veins, previous or suspected DVT or localised dermatological conditions'.

So far, so good.

The World Medical Association states that individuals have primary responsibility for using OTC products, but if they choose to self-medicate, they should be able to:
  • Recognise the symptoms they are treating

  • Determine that their condition is suitable for self-medication

  • Choose a suitable product

  • Follow the directions for use

That's quite a leap of faith to take in your own abilities and a lot of trust to place in a magazine article - not to say dangerous, stupid, gullible, desperate (add your own adjectives...). Mantle is quite right to caution against it.


There's a bit of a twist in the tale.

Amazon describes her: 'Fiona has been a nurse health visitor and teacher for over 30 years and started the first CAM introductory course for nurses in 1999. Since then she has taught in a number of universities, written exclusively on CAM in the nursing press, contributing chapters to a variety of books and has spoken at national and international conferences. She holds the Diploma in Applied Hypnosis from University College London and has qualifications in reflexology, homeopathy and is a Registered Bach Practitioner.'

Reflexology, homeopathy and Bach Flower remedies. Ah. OK.

In other articles for Nursing Times, she has described reflexology as 'a fascinating system that maps and treats human organs through pressure points on the feet, face, ears, hand and back' and homeopathy 'has a wide range of applications for both acute and chronic conditions'. She has written A-Z of Complementary and Alternative Medicine: A guide for health professionals: A Practical Handbook, an article about CAM in the treatment of post natal depression (PND) and much else.

While she is cautious in her tone - aware of interactions, for example - there is no doubt for her that CAM works.

Her good advice against self-diagnosis or treatment and her objections to magazines advising readers on products begins to look more like a call for the public to see 'proper' CAM practitioners. Does she belong to the Prince Charles camp, supporting regulation to save the public from 'bogus' CAM therapists?

It would be interesting to know what she thinks about the recent cross-party inquiry into the NHS spending money on homeopathy, which concluded that it is an unethical and dubious use of public money. A spokesman for Boots said: "I have no evidence to suggest that [homeopathic remedies] are efficacious. It's about consumer choice and a large number of our customers think they work." Mantle would no doubt object to these remedies being sold over the counter to poeple who read about them in a mag - but not to them being dished out on the NHS.

She promotes the use of many kinds of CAM by the NHS. That's the NHS which is already struggling to pay for treatments that are proven to work and for enough properly trained staff. This is part of a letter she wrote to The Journal of Holistic Nursing:

This looks like a good example of out-quacking the quacks. It's a bit like a medium saying that yes, a lot of people who say they are psychic really aren't, but I am. She's not saying - don't read these magazines and don't self-treat with CAM because there is little or no evidence that most of it works any better than a placebo.

She's saying - don't trust them, trust me.

Surprisingly enough, I don't.


  1. It's an interesting post but I think, 'Don't trust them, trust me,' is an unfair summary of her article.

    Clearly, her background suggests she believes that CAM can be efficacious in certain circumstances when prescribed by trained professionals. The issue she's taking is that CAM is being dangerously misrepresented by the media, which she's right about, as you note.

    She is also arguing for CAM practitioners to be more responsible for the advice they give - which is a great thing. I'm right behind her argument here, because part of the responsibility is to tell people that the only evidence for the efficacy of these treatments is anecdotal and not in any way scientific.

  2. The trouble is, she herself believes in homeopathy, Bach remedies and reflexology so she should be taking her own advice. While I agree with her broader points, her advice is somewhat tainted for me by her own position.