Perhaps the most persistent and annoying question promoters of science-based medicine get is, “What’s the harm?” The implication is we should just let people use their Reiki or magic potions if it makes them feel like they are doing something, as long as the treatment is not directly physically harmful. As you can see, I have been addressing it for years, including the fact that I will have to address it for years. There is also well documented real physical harm from many unscientific treatments, but even without that the harm is substantial.

As a physician I have seen first hand much of the harm that can result – such as wasted time and effort, expenditure of limited resources, the psychological harm of false hope, and delaying effective treatment. But I have also warned about the harm to our scientific, medical, and societal infrastructures. This is difficult to quantify, but what is happening is that we are allowing to thrive a multi-billion dollar industry funneling money to charlatans, quacks, con-artists, pseudoscientists, those who discount science, and conspiracy theorists. Do you think they are just taking their money and staying quiet? No. They are using some of those billions to lobby for laws to water down public protections, weaken regulations, and funnel taxpayer money into promoting their snake oil.

This multi-billion dollar industry is also engaged in a massive advertising campaign, which amounts to a disinformation campaign, for their “brand”, which is alternative, complementary, integrative, functional, whatever medicine. They have spent decades misinforming the public about the relative significance of various health risks and benefits, the nature of disease, and the trustworthiness of scientists and experts. They have been a major component in the war on expertise, and to a large extent they are winning.

So we have allowed a system to fester in our society that weakens consumer protections, weakens regulations in favor of industry, infiltrates scientific and professional institutions with pseudoscience and rank nonsense, forces government expenditure on fake medicine, and spreads conspiracy theories and distrust of professionals and experts – what could possibly go wrong? Now all of these CAM chickens are coming home to roost (well, they never actually left).

This all amounts to a massive vulnerability in our society, and there is nothing like an historic emergency to expose weaknesses and vulnerabilities in a system. Thankfully, there is also a lot of strength in our system as well, existing side-by-side with the nonsense. We still have courageous and knowledgeable experts, scientists who are rapidly studying this new virus and disease, health care workers willing to risk themselves on the front lines, and even regulators occasionally willing to speak truth to power.

But we also have snake oil peddlers coming out of the woodwork, hawking all kinds of nonsense. Many people think they are going to find some home remedy through Google, and that they will actually improve their chances of surviving this pandemic because they let someone stick them with needles, or got their back adjusted. There are people burning 5G towers because they think it’s causing the pandemic. And of course, as soon as there is a vaccine, the antivaxxers will be there to make trouble.

We also have protestors who don’t trust the experts and think they know better when to relax physical distancing. Obviously there are multiple social factors playing into all this – but the anti-science CAM movement is a huge part of it, and cannot be discounted. In a recent survey a full 12% of US adults think that the risks of vaccines are high and not outweighed by benefits. That is a minority, sure, but enough to frustrate the herd immunity that makes vaccination campaigns most effective and protect the public at large. And make no mistake – the anti-vaccine movement is closely tied to the alternative medicine movement.

Perhaps one effect of the pandemic, however, will be a renewed faith in science, and a new understanding of the dangers of allowing pseudoscience to flourish. Timothy Caufield published a great commentary in Nature making this point. He writes:

“First, we must stop tolerating and legitimizing health pseudoscience, especially at universities and health-care institutions. Many bogus COVID-19 therapies have been embraced by integrative health centres at leading universities and hospitals. If a respected institution, such as the Cleveland Clinic in Ohio, offers reiki — a science-free practice that involves using your hands, without even touching the patient, to balance the “vital life force energy that flows through all living things” — is it any surprise that some people will think that the technique could boost their immune systems and make them less susceptible to the virus?”

Exactly. Part of our pandemic preparedness has to be scientific hygiene – we need to keep pseudoscience out of our medical institutions. We have been collectively failing at that. This pandemic is being made worse, and there is a death toll, due to the conspiracy theories, distrust in experts, and the casual acceptance of blatant medical pseudoscience. Some countries accept medical pseudoscience as a matter of national policy, like China and TCM, India and Ayerveda, and Cuba and homeopathy.

Hopefully, at least, the harm is now more visible.