Faculty of 1000

Post-publication peer review

Is there an alternative?

Posted by Callum Anderson on 19 February, 2010

I read an article recently in a well-known London newspaper which raised an issue I have been thinking about for a long time. What happens when unregulated medicine actually causes more harm than good?

I won’t name names (although the original article does), but in a nutshell, a woman was prescribed pills by a practitioner of Chinese medicine containing the (subsequently banned) substance [aristolochic acid] to treat her acne. On the one hand the pills did their job, and the acne cleared up, but on the other hand they were destroying her kidneys, inducing urinary tract cancer and eventually led to a heart attack. The woman now needs dialysis treatment three times a week and is no longer able to work.

The problem here stemmed from the fact that the sale of Chinese medicine is completely unregulated, and it is pretty unlikely that a practitioner selling the pills is going to have a subscription to Mutagenesis, in which a 2002 article reported the following

It is concluded that there is significant evidence that AA is a powerful nephrotoxic and carcinogenic substance with an extremely short latency period, not only in animals but also in humans. In particular, the highly similar metabolic pathway of activation and resultant DNA adducts of AA allows the extrapolation of carcinogenesis data from laboratory animals to the human situation. Therefore, all products containing botanicals known to or suspected of containing AA should be banned from the market world wide.

And anyway, this study proved to be too little, too late. By the time the ban was in place, the woman had been taking the pills for a little over five years, and the damage was irreversible.

Now I’m not suggesting that we should blanket ban alternative therapies because of one mistake (albeit a pretty huge one). And as my esteemed colleague RPG has previously noted, many alternative remedies have active ingredients which really do work.

However, I can’t help feeling that if alternative medicine (and I use the term ‘medicine’ with the lightest touch) wants to be taken seriously, it really needs to become self-regulating, and ensure things like this can’t happen again.

What form might that regulation take? Well for a start we could insist that all practitioners of alternative medicine are registered with and accredited by their respective council. For Chinese medicine this would be The Chinese Medicine Council, UK. Secondly we need to give these independent bodies real power, the ability to blacklist practitioners and ban substances without exception, and ensure that the medicine suppliers are subject to rigorous product testing before bringing new products to market.


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