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This is Science Fictions with Stuart Ritchie, a subscriber-only newsletter from i. If you’d like to get this direct to your inbox, every single week, you can sign up here.

Whether you look at its information on diet drinks, aspartame, vaping, or even its early response to the Covid pandemic (“FACT: COVID-19 is NOT airborne”, said one of its tweets in March 2020), the World Health Organisation (WHO) has made a surprising number of missteps in recent years. Alas, it’s just shot itself in the foot once again.

This time, it’s about so-called “traditional” medicine. In a Twitter thread, the WHO informed us that this kind of medicine “has been at the frontiers of medicine and science”. It gave a couple of examples (the antimalarial drug artemisinin and the contraceptive pill) where important chemicals in new medicines were derived from “natural” sources that were apparently known to traditional healers.

“Traditional medicine”, the WHO tells us, is “rooted in indigenous knowledges [and] natural resources of communities”. They give a list of medical practices people around the world use that the WHO considers to be “traditional”. Here it is in full:

Acupuncture

Ayurveda

Herbal medicine

Homeopathy

Naturopathy

Osteopathy

Traditional Chinese medicine

Unani medicine

The WHO is trying to find a baby in an awful lot of bathwater here. In my mind, having read very many of the evidence summaries from organisations like the Cochrane Collaboration over the years, that list reads like a list of unscientific and pseudoscientific techniques: only because “herbal medicine” includes a vast number of different chemicals can you find a couple that might be effective, such as willow bark for treating pain – but the relevant chemical there (salicylic acid) has been made far more effective and turned into aspirin by scientific research, not “traditional” knowledge.

For other techniques, I’m not sure there’s a baby in the bathwater in the first place. For instance, I’m not aware of any strong evidence that acupuncture treats any medical conditions better than placebo. And the Indian Medical Association describes practitioners of Ayurveda and Unani medicine, among other techniques, as “quacks”, who represent a “threat to the nation’s health”.

Later in the Twitter thread the WHO notes that you should “beware of exaggerated promises” and speak to your doctor before using these types of treatments. But how can you read their initial tweets – along with their overall discussion of “traditional” medicine, including the fact they’re running a major conference on it today – as anything other than a tacit endorsement? I can’t help but read the WHO’s ambition to “catalyse ancient wisdom and modern science for the health and well-being of people and the planet” as a bias in favour of those who are holding onto discredited, pre-scientific, or pseudoscientific belief systems – and not a determination to be rigorous or sceptical.

How “traditional” is homeopathy? 

Here’s another confusing thing: in what sense are some of these medicines even “traditional”, let alone “ancient” or “rooted in indigenous knowledge”? Many of them, including so-called Traditional Chinese medicine (which was invented in the 50s by Chairman Mao), are actually much more modern ideas that are nonetheless given a “natural” gloss by their practitioners to make them seem more appealing.

The worst offender on the list is perhaps homeopathy. The techniques underlying homeopathy – taking a tiny amount of a substance that supposedly causes a symptom, diluting it with water until absolutely zero of its molecules remain, then shaking the pure water or hitting it against a Bible to make a medicine that apparently cures the symptom- were entirely devised by a German physician by the name of Samuel Hahnemann in the late 1790s and early 1800s.

If you were being ultra-charitable, you could argue that the principle of “like cures like” is traditional in the sense that it’s based on ideas of “sympathetic magic” from folkloric tales. But I don’t think arguing that it’s based on magic is particularly helpful for the credibility of homeopathy.

Needless to say, homeopathy has been shown over and over again to be ineffective in treating any medical condition. And it’s not like there might be some serendipitous discovery within homeopathy, as there might be for herbal medicine – unlike herbal medicine, where actual plants and herbs are present in the pills, in homeopathy it’s physically impossible for any active ingredients to remain in the medicine.

So even leaving aside the fact that all of the techniques the WHO described are at best extremely shaky in their evidence base, the whole point of the thread – that sometimes traditional knowledge can lead to new, effective medicines – is entirely undermined by the inclusion of homeopathy.

The WHO claims that “around 40 per cent of pharmaceutical products today have a natural product basis, and landmark drugs derive from traditional medicine” – but even if that claim is true (they don’t provide a source), you can bet your bottom dollar that none of the 40 per cent is coming from homeopathy.

 A partial backtrack 

In a tweet in response to the controversy, the WHO agreed that “the message could have been better articulated”, and clarified that by “traditional medicine” they just mean everything listed in their tweet, even if it’s not particularly “traditional”. This doesn’t really resolve anything: in mushing together all these different techniques and nodding along to their proponents’ often-erroneous claims that they’re “traditional”, they’re making medicine – already an area riven with misunderstanding, overclaiming, and bad science – even more confusing. If someone sees that the WHO has even semi-endorsed one of these techniques – or even that the WHO is taking them seriously – they’re more likely to use them. Worse, they’re more likely to use them instead of a more well-evidenced medical treatment.

And here’s the fundamental thing: as has been pointed out many times before, there isn’t really such a thing as “alternative” medicine, or “integrative” medicine, or even “traditional” medicine. There’s just medicine that works, and medicine that doesn’t. If a technique from one of these traditions is shown to be effective in good-quality research, then that’s great news. If it hasn’t – and let’s be clear, the vast majority of what the WHO is talking about hasn’t – then it should be discarded.

To put it another way: whether it comes from a big pharmaceutical company or a traditional healer using ancient wisdom, if a medicine or medical technique doesn’t have a decent empirical, scientific basis, you shouldn’t use it – unless you’re happy to waste your money, have your hopes dashed, or even risk unexpected harms.

The soft bigotry of low expectations 

Harping on the near-magical properties of medicines that draw on indigenous knowledge is, I’m afraid to say, an example of the soft bigotry of low expectations: science is not some Western entity that people from non-Western countries can’t understand. It’s something that can (and should) be applied to all empirical claims and that can be used by anyone, regardless of their background. You can have, as the WHO puts it, “respect” for people’s “local heritages, resources and rights” without claiming that ineffective, or sometimes dangerous, medical techniques are actually worth using.

In their “rowing back” tweet, the WHO stated that “Health literacy is vital for science, solidarity, and solutions”. But in blurring the boundaries between science and pseudoscience, they’re doing nobody’s health literacy – and nobody’s health – any favours.

Other things I’ve written recently

I’m just back from my holiday, so there’s nothing to report here. Normal service will be resumed next week! 

Science link of the week

You might remember the supposed “room temperature superconductor” that I wrote about a few weeks ago. I was sceptical from the start, despite the social-media hype – and now we know that the material (called LK-99) is not, in fact, a room-temperature superconductor. But there were still a few unanswered questions about exactly why the material behaved the way it did. This week, there’s a great article in Nature‘s news section that describes how scientists worked it out, finally closing the book on the whole story. 

This is Science Fictions with Stuart Ritchie, a subscriber-only newsletter from i. If you’d like to get this direct to your inbox, every single week, you can sign up here.



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