The problem of ‘information inoculation’

While the risk from alternative therapies may seem small, I worry that it will rise along with the growth of misinformation online

It’s probably fair to say that, for many sceptics, trashing alternative medicine is a treasured hobby. This is partially understandable because there is so much great material to work with. Sometimes it’s a grand, although fake, heritage like the old homeopathic remedy that contains one molecule per 30,000L of water (a ‘30X concentration’). Sometimes it’s the veneer of scientific respectability, like chelation of heavy metals to cure heart disease. And sometimes, like in the case of coffee enemas, they’re just a bit odd.

But many of the reasons sceptics laugh at these practices are the same things that make them so appealing. These treatments come with a narrative (‘an ancient recipe’), a moral (‘cleanse yourself of toxins’), and a grandeur (‘your new life begins tomorrow’) that people simply do not get from subcutaneous clexane, despite its many evidence-based charms. So they are popular, with over a quarter of the Irish general population using alternative remedies and higher figures across Europe and the US. They are more popular again among Irish patients with cancer and viral hepatitis.

This popularity has provoked pushback. There is a generation of pop science writers and broadcasters who have made their name with dramatic takedowns of shady alternative medicine evangelists. While this sparks joy for their fans, it raises the question: Does engaging in these discussions achieve much?

That depends, firstly on whether these practices cause much harm, and secondly whether scientists and doctors can convince believers to change their minds.

On harm, some treatments are clearly a bad idea. Chiropractic has been studied in a systematic review of systematic reviews (they exist), which found it offered no benefit for anything. Instead, it’s consistently linked with frequent mild harms and rare serious ones (like vertebral artery dissection). We can also say goodbye to colonic irrigation and ozone therapy at this point.

Other alternative approaches delay effective treatments. I have seen a handful of patients from oncology clinics over the past few years go abroad for alternative therapies and miss out on the opportunity for cure or major benefit. While we know how many cancer patients use alternative medicine, there is only a little evidence on how often it harms them in this way. A US study looked at 280 cancer patients who chose alternative medicine instead of conventional therapy and compared them to 560 cancer patients who went the conventional route. It found a 2.5 times greater risk of death for the alternative group.

But it’s also clear that most patients are neither getting involved with the riskier alternative treatments nor are they leaving conventional treatments behind. Usually, they are pursuing some fairly benign practices, like reflexology and vitamin supplements, alongside their standard therapy. Most report feeling better. While my inner purist wants to kick up a fuss, I have also learned that the best doctors I know are able to pick their battles and this is not one of them.

What about the serious situations though, when a patient is choosing Gerson therapy instead of cancer surgery? What are our chances of changing their minds?

It’s said that Ireland has a culture of deference to medical advice and I think that, compared to the US, this is largely true. Many people do not question much (this comes with problems of its own, which is another day’s discussion).

For those patients who want to forge their own path, though, I have found that sometimes there is little that will change their mind. Forensic review of medical evidence, confidential conversations with nurses they trust, meeting with patients in the same situation, or serious warnings about the potential consequences: Nothing seems to make a difference.

Some will argue that, at this point, patient autonomy dictates that we step back: People are free to make these decisions. This is true, but it’s really upsetting to see patients left in this situation. Is there any way to avoid this?

There is some hope for the practice of ‘information inoculation’. Analogous to vaccination campaigns, this approach involves pre-emptive communication to strengthen the mind’s ‘immunity’ against misleading arguments. People are warned first that there are deceptive promises circulating on social media and elsewhere online. Then, they are presented with some common gambits from the world of alternative medicine (for example, ‘this ketogenic diet will starve your cancer of nutrients’) followed by explanations why this is false (in this example, there are too many reasons to count).

Also analogous to vaccination, this will be of little help after the harm has happened, when someone has developed firm beliefs. Rather, this would be an approach taken at first cancer diagnosis among all patients, to reduce the risk of misleading information gaining traction later.

While the risk from these alternative therapies may seem small at present, I worry that it will rise in parallel with the growth of misinformation on social media and deepening mistrust of anything that represents establishment thought. With this in mind, there may come a time when prevention is worth much more than dealing with the consequences of these false cures.