Medical harm

What it is

Physical harm arising when spiritual or metaphysical belief interferes with medical care. It takes several distinct forms, and lumping them together produces bad reasoning about all of them.

• Replacement — treatable illness left untreated because an alternative approach is used instead of medicine
• Delay — conventional treatment postponed while something else is tried, in conditions where time changes the outcome
• Interference — substances that are not inert interacting with prescribed medication
• Practice injury — harm from the practice itself: prolonged fasting, extreme breathwork, intensive retreat, entheogens in the wrong person
• Doctrinal refusal — a sincere religious position against a specific intervention

These are not equivalent. The last is a matter of religious liberty when an informed adult makes the decision for themselves, and becomes a legal and ethical problem chiefly where children are concerned. The others are mostly about information and pressure.

Where it came from

The tension is old, but its modern shape dates from the nineteenth century, when medicine became effective enough that declining it started to have measurable consequences.

Christian Science, founded in 1879, holds that illness is an error of mind correctable through prayer; a series of prosecutions in the twentieth century, mostly involving children, established that parental religious belief does not override a duty of care. Jehovah's Witnesses' refusal of blood transfusion, held since 1945, has been extensively litigated and has also driven genuine clinical innovation in bloodless surgery — an honest complication, since a sincere refusal prompted medicine to improve.

The larger contemporary problem is not doctrinal refusal by organised religion. It is diffuse: wellness culture, alternative cancer treatment, and the anti-vaccination current that runs through parts of the spiritual-wellness world.

How it is used

The specific mechanisms worth knowing:

Herb–drug interaction is real and routinely underestimated. St John's Wort induces liver enzymes that reduce the effectiveness of a long list of drugs including hormonal contraceptives, some antidepressants, anticoagulants and immunosuppressants. "Natural" says nothing about safety — foxglove and hemlock are natural. This is the single most practical item on the page: anyone taking anything herbal alongside prescribed medication should tell their pharmacist, who will check it in about a minute and for free.

Intensive meditation has documented adverse effects. Research by Willoughby Britton and colleagues, including the 2017 study The Varieties of Contemplative Experience, catalogued adverse effects among practitioners — anxiety, depersonalisation, disrupted emotional regulation, and in some cases lasting impairment. These are minority outcomes and were, for a long time, not discussed by teachers who had no framework for them.

Entheogens carry real contraindications, particularly for people with personal or family histories of psychotic illness, and interactions with several classes of medication that can be dangerous.

What we can and cannot say

We can point to evidence on the central question. A 2018 study by Skyler Johnson and colleagues in the Journal of the National Cancer Institute found that patients with curable cancers who chose alternative medicine instead of conventional treatment had substantially higher mortality. The finding is about replacement, not about complementary use — a companion analysis found that patients who used complementary approaches alongside conventional treatment did no worse, except where doing so led them to refuse part of the recommended treatment.

That is the line the evidence actually draws, and it is more useful than a blanket position. Acupuncture for chemotherapy nausea, meditation for anxiety, yoga for back pain, and a community that brings meals are not the problem. Declining the surgery is.

We can say the standing rule for this site follows from that: describe what traditions believe and do, never instruct, and never let a page imply that anything here substitutes for care.

We should also say something that the sceptical literature usually omits. People do not turn to alternatives because they are stupid. They turn to them after being dismissed, rushed, disbelieved, or left in pain without explanation — and because alternative practitioners reliably offer time, attention, touch and a coherent story, which are things medicine often fails to provide and which genuinely matter. Contempt is both unkind and ineffective; it pushes people further from care rather than closer.

We cannot say every alternative approach is worthless, and this site will treat each on its own evidence. What can be said without qualification is that delay is the mechanism that kills, and that the questions worth asking are whether a practitioner will say what they cannot treat, whether they are willing to work alongside a doctor, and whether they ever discourage you from seeing one. Anyone who suggests you stop or postpone treatment has told you what they are.

Further reading

• Johnson et al., "Complementary Medicine, Refusal of Conventional Cancer Therapy, and Survival Among Patients With Curable Cancers" (JAMA Oncology, 2018) and the companion 2018 JNCI study on alternative medicine.
• Lindahl, Britton et al., "The Varieties of Contemplative Experience" (PLOS ONE, 2017).
• Your pharmacist. Genuinely — for interactions this is the fastest reliable check available.