Celebrity-based medicine

When we went to medical school, in the 1970s and 1980s in Germany, we essentially had to adhere to “eminence-based medicine”: what our teachers preached was right, no questions asked. This has, of course, changed in a big way; today it seems everything is measured by the yardstick of evidence-based medicine. But there are notable exceptions, and complementary and alternative medicine (CAM) is one of them. It’s not that there is no evidence behind CAM — on the contrary, its evidence base is expanding rapidly1 — but the evidence is usually ignored. In the United Kingdom, even the official patient guide to CAM avoids the evidence like the plague.2 And certainly, the average consumer seems blissfully unaware of it.

After considering this for some time, we have noticed that, in relation to CAM, consumers seem to adhere to the principles of “celebrity-based medicine”. This can be summarised as: find out what form of CAM your idol currently uses, and do likewise.

The media has a strong influence on the public’s view of CAM.3 An abundance of research has also addressed the question of why people are attracted to CAM. The reasons often provided include ideas such as “philosophical congruence” or “locus of control”.1 We suggest that a desire to imitate our idols should be added to this list. Here, we aimed to collect contemporary accounts of celebrity use of CAM, to aid clinicians in determining which CAM treatments patients are likely to use.

We identified 38 celebrities, including 19 female singers or actors, who were reported to use CAM (Box). The range of reported CAM interventions is wide, with some celebrities using several types simultaneously. The most popular modality is homeopathy, followed by acupuncture and Ayurveda. Some CAM treatments (eg, Klamath Lake algae) are so “cutting edge” that even we didn’t know what they were. Finally, there are several well known CAM therapies that are noticeably absent from the list — perhaps chiropractic is currently so “uncool” that no celebrity would want to be seen emerging from a chiropractor’s office.

Of course, most, if not all, of this information is based on “gossip”. Rarely do we see celebrities endorsing a particular therapy or hear direct statements from them about CAM. In terms of promotional effect, however, this is largely irrelevant. Perhaps more unusually, denials of CAM use by celebrities also exist.4

We are not normally told in media reports what the CAM treatments in question are used for. It is thus difficult to assess whether or not the therapies are employed wisely by celebrities. Nevertheless, it is remarkable that use of many of the modalities listed in the Box is not supported by data from clinical trials. For example, there is reasonably convincing evidence that homeopathy, spiritual healing and dowsing have no demonstrated effects beyond placebo.1 On the other hand, there is some evidence that, for some conditions, acupuncture, the Atkins diet, the Alexander technique, herbalism and yoga are effective.1 For the rest of the treatments listed, the jury is still out — either the results of clinical trials are contradictory (eg, reflexology1) or not enough research has yet been conducted (eg, breathing therapy1). The latter category of CAM is certainly the largest and probably the most interesting: for many of the treatments, all that evidence-based medicine can say about them is, “there is no evidence”. This verdict can easily be twisted to mean, “it might work — if only scientists were a little more open-minded to testing it”.

Why should it be remarkable to hear that a celebrity uses a particular form of CAM? We do not normally read in the papers that an actor has taken ImodiumTM or that a singer purchased some CanestenTM. Yet, like CAM therapies, these remedies are readily available without prescription. It is thus not the celebrity value alone that renders a medical treatment newsworthy. The combination of CAM and celebrity seems crucial. This highlights the fact that lay people’s attitudes to CAM differ from their attitudes to conventional medicine. In a sense, CAM seems more responsive to fashion than does conventional medicine, and celebrities should be more aware of their influence in these matters. Thus, while mainstream health care relies on evidence-based medicine, celebrity-based medicine seems to be the current approach for CAM.