What's The Harm?

CAM proponents aggressively market their approaches with the assurance, often absolute and without qualification, that their methods never cause harm. And perhaps the most common response to critiques of CAM from people who consider themselves mildly skeptical of it but who do not have strong opinions about it is "Well, it probably doesn't work, but at least it's harmless." So it appears that the notion CAM is safe, whether effective or not, seems widely established. Unfortunately, it's often not true. Any therapy that has any actual influence on the body's processes will also have the potential for unintended effects, some of which may do harm. And even therapies which have no effect, such as homeopathy, can be indirectly harmful in delaying diagnosis or real treatment.

The following links and articles are resources illustrating some of the harm CAM methods can do, directly and indirectly. It is by no means comprehensive, and it certainly is not a scientific assessment of the risks and benefits of any particular therapy. The purpose is simply to make it clear that it is by no means difficult to find evidence of harm caused by almost any CAM therapy, so when we evaluate these approaches we must balance any possible benefits they have against any possible risks, regardless of the exaggerated claims for safety their proponents often make.


General CAM Use:

Association between CAM use and decreased success of IVF in Holland.

Association between CAM use and decreased survival in cancer patients in Norway.

General collection of anecdotes about people harmed, directly or indirectly, by CAM use.

SBM-- Risks of various CAM therapies.

Qual Assur Health Care. 1990;2(2):111-7.

Helena M. Verkooijen, Gérald M. Fioretta, Elisabetta Rapiti, Hervé Bonnefoi, Georges Vlastos, John Kurtz, Peter Schaefer, André-Pascal Sappino, Hyma Schubert, and Christine Bouchardy. Patients’ Refusal of Surgery Strongly Impairs Breast Cancer Survival. Ann Surg. 2005 August; 242(2): 276–280.

Kurian Joseph, Sebastian Vrouwe, Anmmd Kamruzzaman, Ali Balbaid, David Fenton, Richard Berendt, Edward Yu and Patricia Tai. Outcome analysis of breast cancer patients who declined evidence-based treatment.World Journal of Surgical Oncology 2012, 10:118.

Lim A, Cranswick N, South M. Adverse events associated with the use of complementary and alternative medicine in children. Arch Dis Child. 2010 Dec 22. [Epub ahead of print]

Belladonna poisoning from homeopathic teething remedy

Han E, Johnson N, Delamelena T, Glissmeyer M, Steinbock K. Alternative therapy used as primary treatment for breast cancer negatively impacts outcomes. Ann Surg Oncol 2011;Jan 12 [Epub ahead of print].


Acupuncture

Cho YP, Jang HJ, Kim JS, Kim YH, Han MS, Lee SG. Retroperitoneal abscess complicated by acupuncture: case report. J Korean Med Sci. 2003 Oct;18(5):756-7.  

Choo DC, Yue G Acute intracranial hemorrhage in the brain caused by acupuncture. Headache 2000 May;40(5):397-8.

Chung SJ, Kim JS, Kim JC, Lee SK, Kwon SU, Lee MC, Suh DC. Intracranial dural arteriovenous fistulas: analysis of 60 patients. Cerebrovasc Dis 2002 Feb;13(2):79-88

Cole M, Shen J, Hommer D. Convulsive syncope associated with acupuncture. Am J Med Sci 2002 Nov;324(5):288-9

Ernst E, Sherman K. Is acupuncture a risk factor for hepatitis? Systematic review of epidemiological studies. J Gastroenterol Hepatol. 2003 Nov;18(11):1231-6.

Am J Med 2001 Apr 15;110(6):481-5

Ernst E. Deaths after acupuncture: A sytematic review. Int J Risk and Safety in Med 2010;22(3):131-6. 

Iwadate K, Ito H, Katsumura S, Matsuyama N, Sato K, Yonemura I, Ito, Y. An autopsy case of bilateral tension pneumothorax after acupuncture. Leg Med (Tokyo). 2003 Sep;5(3):170-4.  

Kirchgatterer A, Schwarz CD, Holler E, Punzengruber C, Hartl P, Eber B  Cardiac Tamponade Following Acupuncture. Chest 2000 May;117(5):1510-1511

Laing AJ, Mullett H, Gilmore MF. Acupuncture-associated Arthritis in a Joint with an Orthopaedic Implant J Infect 2002 Feb;44(1):43-4

Nambiar P, Ratnatunga C. Prosthetic valve endocarditis in a patient with Marfan's syndrome following acupuncture. J Heart Valve Dis 2001 Sep;10(5):689-90

Peuker E  Case report of tension pneumothorax related to acupuncture. Acupunct Med. 2004 Mar;22(1):40-3.

Saw A, Kwan MK, Sengupta S. Necrotising fasciitis: a life-threatening complication of acupuncture in a patient with diabetes mellitus. Singapore Med J. 2004 Apr;45(4):180-2.

Sun CA, et al. Transmission of hepatitis C virus in taiwan: prevalence and risk factors based on a nationwide survey. Sun J Med Virol 1999 Nov;59(3):290-6

Witt CM, Pach D, Brinkhaus B, Wruck K, Tag B, Mank S, Willich SN. Safety of acupuncture: results of a prospective observational study with 229,230 patients and introduction of a medical information and consent form. Forsch Komplementmed. 2009 Apr;16(2):91-7. Epub 2009 Apr 9

Woo PC, Leung KW, Wong SS, Chong KT, Cheung EY, Yuen KY. Relatively alcohol-resistant mycobacteria are emerging pathogens in patients receiving acupuncture treatment. J Clin Microbiol 2002 Apr;40(4):1219-24

Woo PC, Lin AW, Lau SK, Yuen KY. Acupuncture transmitted infections. British Medical Journal 2010;340:c1268.

Yamashita H, Tsukayama H, White AR, Tanno Y, Sugishita C, Ernst E. Systematic review of adverse events following acupuncture: the Japanese literature. Complement Ther Med 2001 Jun;9(2):98-104


Chiropractic:

SBM--Neck Manipulation:Risk vs Benefit

SBM--Chiropractic's Pathetic Response to Stroke Concerns

SBM--Chiropractic and Stroke: Evaluation of One Paper

SBM--Chiropractic and Stroke 

Albuquerque FC, Hu YC, Dashti SR, Abla AA, Clark JC, Alkire B, Theodore N, McDougall CG. Craniocervical arterial dissections as sequelae of chiropractic manipulation: patterns of injury and management. J Neurosurg. 2011 Dec;115(6):1197-205. Epub 2011 Sep 16.

Vitamins & Supplements

:

Vitamin C can interfere with chemotherapy. 

Vitamin E can increase cancer risk.

Vitamin E not useful for prevention for prostate cancer and can increase risk of congestive heart failure.

Vitamin E supplements increase risk of hemorrhagic stroke 

Vitamin E supplements may increase risk of heart attacks and stroke

Vitamin E increases risk of prostate cancer

Vitamin supplements may associated with overall increase in mortality and no benefit in preventing gastrointestinal cancer. 

Omega-3 Fatty Acids may increase risk in ventilator patients with acute lung injury

Mursu J, et al. Dietary supplements and mortality rate in older women: The Iowa Women’s Health Study. Archives of Internal Medicine. 2011;17(18):1625-33.

Widespread Failures in Quality Control of Dietary Supplements


Herbal Preparations, Including Ayurvedic and Traditional Chinese Medicine (TCM) Herbs:

Aliye Uc, MD, Warren P. Bishop, MD, and Kathleen D. Sanders, MD, Camphor hepatoxicity. South Med J 93(6):596-598, 2000,

Angers RC, Seward TS, Napier D, Green M, Hoover E, Spraker T, O'Rourke K, Balachandran A, Telling GC. Chronic wasting disease prions in elk antler velvet. Emerg Infect Dis. 2009 May;15(5):696-703.

Angkana R, Lurslurcharchai L, Halm E, Xiu-Min L, Leventhal H, et al. Use of herbal remedies and adherence to inhaled corticosteroids among inner-city asthmatic patients. Annal Allerg Asthma Immunol 2010:104(2);132-138.

Berberine. Inbaraj JJ, Kukielczak BM, Bilski P, Sandvik SL, Chignell CF.   Photochemistry and photocytotoxicity of alkaloids from Goldenseal (Hydrastis canadensis L.) Chem Res Toxicol 2001 Nov;14(11):1529-34

Booth JN 3rd, McGwin G. The association between self-reported cataracts and St. John's Wort. Curr Eye Res. 2009 Oct;34(10):863-6.

Burkhard PR, Burkhardt K, Haenggeli CA, Landis T. Plant-induced seizures: reappearance of an old problem. J Neurol 1999 Aug;246(8):667-70

Chung-Hsin Chen^, Kathleen G. Dickman^, Masaaki Moriya, Jiri Zavadil, Viktoriya S. Sidorenko, Karen L. Edwards^, Dmitri V. Gnatenko, Lin Wu, Robert J. Turesky, Xue-Ru Wu, Yeong-Shiau Pu, Arthur P. Grollman. Aristolochic acid-associated urothelial cancer in Taiwan. Proceedings National Academy of Sciences, April 2012. Panax ginseng: A Systematic Review of Adverse Effects and Drug Interactions. Drug Saf 2002;25(5):323-44 Drug Saf 2002;25(5):323-44

Cupp MJ  Herbal remedies: adverse effects and drug interactions. Am Fam Physician 1999 Mar 1;59(5):1239-45

Debelle FD, Vanherweghem JL, Nortier JL. Aristolochic acid nephropathy: a worldwide problem. Kidney Int. 2008 Jul;74(2):158-69. Epub 2008 Apr 16.

Emery DP, Corban JG  Camphor toxicity. J Paediatr Child Health 1999 Feb;35(1):105-6

Ernst E Adverse effects of herbal drugs in dermatology. Br J Dermatol 2000 Nov;143(5):923-

Fugh-Berman A Herb-drug interactions. Lancet 2000 Jan 8;355(9198):134-8

Huang WF, Wen KC, Hsiao ML. Adulteration by synthetic therapeutic substances of traditional Chinese medicines in Taiwan. J Clin Pharmacol. 1997 Apr;37(4):344-50

Kutz GD. Herbal dietary supplements: Examples of Deceptive or questionable marketing practices and potentially dangerous advice. General Accounting Office. May 26, 2010.

Lai MN, Lai JN, Chen PC, Tseng WL, Chen YY, Hwang JS, Wang JD. Increased risks of chronic kidney disease associated with prescribed Chinese herbal products suspected to contain aristolochic acid. Nephrology (Carlton). 2009 Apr;14(2):227-34.

Lawrence JD.  Potentiation of warfarin by dong quai. Page RL 2nd, Pharmacotherapy 1999 Jul;19(7):870-6

Means C.  Selected herbal hazards. Vet Clin North Am Small Anim Pract 2002 Mar;32(2):367-82

Nizsly N, Grizlak B, Zimmerman M, Wallace R. Dietary Supplement Polypharmacy: An Unrecognized Public Health Problem? eCAM 2010 7(1):107-113

Norred CL, Finlayson CA Hemorrhage after the preoperative use of complementary and alternative medicines. AANA J 2000 Jun;68(3):217-20

O'Connor A, Horsley CA. Yates, KM "Herbal Ecstasy": a case series of adverse reactions.  N Z Med J 2000 Jul 28;113(1114):315-7

Pittler MH. Ernst, E Risks associated with herbal medicinal products. Wien Med Wochenschr 2002;152(7-8):183-9

Poppenga RH. Risks associated with the use of herbs and other dietary supplements. Vet Clin North Am Equine Pract. 2001 Dec;17(3):455-77, vi-vii

Pies R  Adverse neuropsychiatric reactions to herbal and over-the-counter "antidepressants". J Clin Psychiatry 2000 Nov;61(11):815-20

Prakash S, Hernandez GT, Dujaili I, Bhalla V. Lead poisoning from an Ayurvedic herbal medicine in a patient with chronic kidney disease. Nat Rev Nephrol. 2009 May;5(5):297-300.

Raman P, Patino LC, Nair MG. Evaluation of metal and microbial contamination in botanical supplements. J Agric Food Chem. 2004 Dec 29;52(26):7822-7

Ruschitzka F, Meier PJ, Turina M, Luscher TF, Noll G  Acute heart transplant rejection due to Saint John's wort. Lancet 2000 Feb 12;355(9203):548-9

Saper RB, Phillips RS, Sehgal A, Khouri N, Davis RB, Paquin J, Thuppil V, Kales SN. Lead, mercury, and arsenic in US- and Indian-manufactured Ayurvedic medicines sold via the Internet. JAMA. 2008 Aug 27;300(8):915-23.

Shad JA, Chinn CG, Brann OS Acute hepatitis after ingestion of herbs. South Med J 1999 Nov;92(11):1095-7

Smolinske SC J Am Med Womens Assoc 1999 Fall;54(4):191-2 Dietary supplement-drug interactions.

Tachjian A, Maria V, Jahangir A. Use of herbal products and potential interactions in patients with cardiovascular disease. J. Am. Coll. Cardiol. 2010 55: A32

, Wang JD, Lo TC, Chen PC. Increased mortality risk for cancers of the kidney and other urinary organs among Chinese herbalists. J Epidemiol. 2009;19(1):17-23. Epub 2009 Jan 22.

Zhang SY, Robertson D. A study of tea tree oil ototoxicity. Audiol Neurootol 2000 Mar-Apr;5(2):64-8

Kidney failure from aristolochia in TCM herbals preparations.

Lead, mercury and arsenic in herbal preparations.

Lead in TCM preparations.

Lead in ayurvedic preparations.

Lead in herbal preparations.

Tea Tree Oil Can be toxic to cats.

Toxic metals in Brazilian herbal preparations.

Contamination of herbal products with undisclosed pharmaceuticals.

Widespread contamination of supplements with undisclosed toxins and parmaceuticals

Unpredictable levels of coumarin in cinnamon bark, even within the same tree, pose risk of liver damage

Anecdotes and Victims Groups:

General collection of anecdotes about people harmed, directly or indirectly, by CAM use.

Anecdotes of people who suffered illness or death from vaccine-preventable illnesses because they were not properly vaccinated.

Victims of Chiropractic Abuse

Chiropractic Treatment and Stroke

A tragic story about a young women suffering needlessly yet unwilling to give up on useless therapy.

Yet another cancer patient suffering needlessly chasing false promises and useless treatments

Anti-Vaccine Activism:

A site which collects government reports of the incidence of vaccine-preventable illnesses to illustrate the danger of inaccurate and hysterical information provided by anti-vaccine activists such as Jenny McCarthy.

Anecdotes of people who suffered illness or death from vaccine-preventable illnesses because they were not properly vaccinated.

A homeopath and is wife let their 9 month old daughter die of a treatable skin condition rather that use real medicine.

Books:

Natural Causes: Death, Lies and Politics in America's Vitamin and Herbal Supplement Industry by Dan Hurley.A detailed look and the politics, economics, and risks of the dietary supplement, vitamin, and herbal medicine industries

Trick or Treatment: The Undeniable Facts about Alternative Medicine by S. Singh and E. Ernst
An outstanding review of many CAM practices from and evidence-based perspective which includes assessment of the risks, particularly for acupuncture, homeopathy, chiropractic, and herbal medicines.

The Desktop Guide to Complementary and Alternative Medicine: An Evidence-based Approach Edited by E. Ernst, M. Pittler, B. Wider An exhaustive and authoritative review of the evidence and risks for many CAM treatments, including detailed references.

Coon JT, Ernst E.

Vazquez Hernandez, M. Hurtado Gmez, MF. Blanco, JR. The influence of alternative medicine in highly active antiretroviral treatment. Farmacia Hospitalaria 2009;33(1):31-6.

Yang HY

Ernst, E. Soo Lee, Myeong. Choi, Tae-Young. Acupuncture: Does it alleviate pain and are there serious risks? A review of reviews. Pain. 2011;152:7555-764.

Ernst E, White AR. Prospective studies of the safety of acupuncture: a systematic review.

Lim A, Cranswick N, South M. Adverse events associated with the use of complementary and alternative medicine in children Archive of Disease in Childhood. 2010: