“It’s dressed-up quackery isn’t it?” magistrate Daniel Reiss said.

“That’s one view, your honour,” the prosecutor replied.

That is a good summary of pretty much all alternative medicine. Practitioners have gotten very good at dressing it up, enough to even fool academics who aren’t paying close attention. But in the end, it’s all quackery.

The quote above refers to a recent case of a Sydney Chinese herbalist, Yun Sen Luo, who was arrested and charged with manslaughter in the death of 56 year old client he was treating. He advised the diabetic woman to go off her diabetes medication, ultimately resulting in her death. The charge is gross negligence.

The success of alternative medicine over the last few decades has been in convincing the world that what they offer is a genuine alternative to real medicine. They have rebranded it as complementary, and the integrative, but it’s all the same – using unproven, fanciful, or even disproven treatments instead of real medicine. They justify the substitution by appealing to nature, distracting with hand-waving pseudoscientific jargon, appealing to antiquity, or straight-up lying. In the extreme they weave complex conspiracy theories about the medical establishment to scare people away from real medicine.

This case is just one example, but it’s not atypical. The core problem is that we have a practitioner who is practicing medicine without a license, and without the requisite medical knowledge, training, and experience. The con is that if you simply call what you do “alternative” you can get away with it (until you kill someone – and even then, sometimes).

Herbalism is an interesting example because herbs are drugs. They are drugs that have been poorly studied, they are not purified or quantified, they often contain multiple active ingredients, have variable doses, bioavailability, interactions with other drugs, and effects on the body. They are frequently contaminated, substituted, and counterfeited.

Imagine if a doctor said to you, “I am going to prescribe you this concoction of drugs. I am not sure whats in it or at what doses, but it’s natural, so what the heck.”

The appeal to antiquity is perhaps the most pernicious deception. Often, uses of specific herbs are not as old as claimed. Echinacea, for example, was not used by Native Americans to treat the flu or other infections. That was a claim made up in the 19th century by a snake oil salesman for marketing purposes.

In any case, a long history of use without scientific investigation is no guarantee of safety or effectiveness. Blood letting survived for a couple thousand years based on common experience.

Throwing out your real medicine is also not the only risk. Some Chinese herbs are toxic to the kidneys, for example. Unlisted ingredients can cause allergies, heavy metal contamination can cause toxicity, and the herbs themselves can interfere with prescription drugs or be toxic to the kidneys or liver.

Remember, the only difference between an effect of a drug and a side effect is the desirability. All effects are pharmacological, and we try to purify drugs, tweak them, and study them to find a specific dose range in which there is a desirable effect with tolerable side effects. This does not happen by accident. The probability of getting this sweet spot effect from herbs, with all their variability, is negligible.

One common response to this point is that, “Well, drugs are dangerous and cause side effects too.” Of course they do – that’s my premise. And herbs are drugs. That’s why they have to be used carefully. Often cases like Vioxx are brought up, a drug that increase the risk of heart attacks in at-risk patients and had to be taken off the market. This effect of Vioxx would not have been discovered without study, however. An herb can have the same or worse effect but fly under the radar, because no one is doing large rigorous clinical trials to track possible negative effects.

The risk of direct harm from herbs is probably (but not entirely) mostly small, but that is only because dosing is on the low side and bioavailability (how much drug actually gets into your body) can be very low. This is not a defense, however, because (as I stated above) effects and side effects track with each other. If there are few side effects because of low bioavailability, then there is likely low effects too. You can’t have it both ways. If you increase the dose or absorption in order to get a beneficial effect, then the risks scale up too.

Herbalism is based mainly on magical thinking and ignorance of pharmacology. Those herbs with useful chemicals that can be exploited pharmacologically become actual drugs. At the very least they are studied in purified and standardized forms, and occasionally may have some modest benefit. But because the industry is so poorly regulated, you cannot apply these studies to the real world. You essentially have no idea what you are really buying when you purchase an herbal product.

This case of alleged manslaughter also is a reminder of a major risk that goes beyond the herbs themselves – the herbal and supplement industry is all about self-empowerment. They want you to be your own doctor by using their products. Obviously for minor self-limiting symptoms, over-the-counter treatments are fine. But we need to carefully study the effect of making drugs available OTC, how they will be used, and carefully regulate their marketing.

I find that the marketing of herbs and supplements often go over the line, and encourage a level of self-treatment that is risky. (Just search on “herbs” and “diabetes” or “cancer” and see what results you get.” But further, when someone hangs up a shingle and proclaims themselves to be a health expert, we are in a different realm. They may be using worthless homeopathic potions, or dubious herbs, or some other “alternative” treatment, but this is all just “dressed up quackery.” They may be able to call themselves “doctor” and will have the trappings of professionalism, but there is nothing behind it.

Unless there is a science-based standard of care and a mechanism of enforcement, these are just fake doctors exploiting a public who falsely believes they would be protected by the law and regulations. Not any more. The snake oil salesmen have won.