Are complementary and alternative therapies worth the billions of pounds that we spend on them? And do they have the same effects as conventional medicine? The scientific community is split over whether they work. In a sceptics’ guide, Sanjida O’Connell looks at the most popular treatments and assesses their efficacy.

The Times - Tuesday July 16 2002

To the hard-bitten cynic they are moonshire merchants, snake-oil salesmen and quacks. But for every doubter there is someone who will claim that alternative therapists are the necessary antidote to the chemically addicted world of conventional medicine, an arrogant branch of science that has lost contact with the older verities of more natural forms of treatment. What is indisputable is the scale of the market for complementary and alternative therapies. According to research published this week by Datamonitor, the independent market analysts, each year some $30 billion (£20 billion) is spent worldwide on alternative and complementary therapies.

But are alternative therapies really worth the money? Do they cure people as well as conventional medicine? There is considerable dispute in the scientific community as to whether they actually work, and if so, how. It is entirely possible that complementary medicines work because we believe they will. Are we perhaps being premature by trying to introduce them into the NHS? Edzard Ernst, Professor of Complementary Medicine at Exeter University, says, “The NHS will not bend the rules. Their criteria are efficacy and safety. Alternative medicines have to demonstrate that they do more good than harm, but few treatments show this.”
In a sceptics’ guide, The Times examines a few of the most popular treatments to see whether the claims that alternative therapies make for themselves match up to the reality.

Acupuncture

What is it?

Acupuncture is one of the oldest and most commonly used alternative therapies. It originated in China more than 2,000 years ago.

What is involved?

Therapists stimulate a number of pressure points throughout the body using needles. There are 2,000 pressure points which connect to 12 main and 8 secondary pathways called meridians.

What is the theory?

Acupuncture is believed to regulate our spiritual, emotional, mental and physical balance which is influenced by the opposing forces of yin and yang. When yin and yang are unbalanced, our qi (pronounced ‘chee’), a form of energy, becomes blocked. Western scientists have been unable to explain acupuncture using Chinese philosophy since meridians do not correspond to either blood circulation or nervous pathways. No one fully understands how acupuncture works, but there is some evidence that stimulation of pressure points increases the flow of electromagnetic signals which may trigger the release of the body’s natural pain killers such as endorphins or immune cells. Natural opiods such as endorphins may also be released and brain chemistry can be altered by releasing neurotransmitters and neurohormones.

What is the evidence?

The American National Center for Complementary and Alternative Medicine (NCCAM) in Gaithersburg, Maryland, has recently supported several clinical trials into the effectiveness of acupuncture which seem to indicate that it can be effective in certain cases. Researchers at the University of Maryland in Baltimore discovered that patients treated with acupuncture after dental surgery had less intense pain than patients who received a placebo. The same team have also shown that acupuncture can reduce the pain of osteoarthritis when used with conventional drugs to a greater degree than when these drugs are used on their own. Professor Ernst says, “There is good clinical evidence that acupuncture works for osteoarthritis, migraine, dental and back pain. But there is good evidence that it does not work for some treatments, such as weight loss and smoking.”

Reiki

What is it?

Reiki is believed to have originated in Tibet thousands of years ago and is a way of healing using energy. It was rediscovered by Dr Mikao Usui, a Japanese Christian from Kyoto, Japan, in the 1800s.

What is involved?

The practitioner may manipulate the patient’s neck gently, but mainly he or she will not touch the patient, but instead holds his or her hands above the patient’s body.

What is the theory?

Reiki means ‘universal life energy’ in Japanese. Reiki is supposed to work by releasing energy from the practitioner to the patient which enhances the body’s natural ability to heal by rebalancing its energy. Practitioners claim that reiki helps patients relax, destroys energy blockages, detoxifies the system and lends people new vitality.

What is the evidence?

There have been no carefully controlled studies proving reiki’s effectiveness. Professor Ernst’s group at the University of Exeter have carried out research which indicates that reiki works no better than a placebo. He says, “People clearly benefit if they see a healer and if they believe in it, but I have considerable doubts based on the evidence.”

Reflexology

What is it?

Reflexology is the therapeutic manipulation of the hands or feet which, according to practitioners, have areas that correspond to parts of the body.

What is involved?

As well as manual manipulation by a qualified practitioner, it is now possible to buy reflexology guides and foot massagers for do-it-yourself reflexology.

What is the theory?

The practitioner can diagnose abnormalities by feeling the hands or feet and by massaging or pressing these areas, stimulates the flow of energy, blood, nutrients, and nerve impulses to the corresponding body zone and thereby relieves ailments in that area.
Dr Stephen Barrett, a retired psychiatrist from Pennsylvannia who is Vice-President of the National Council against Health Fraud in the States, says, “The pathways postulated by reflexologists have not been anatomically demonstrated and it is safe to assume that they do not exist.”

What is the evidence?

Professor Ernst says, “Practitioners use reflexology as a diagnostic tool and it does not work. It can be a relaxing treatment though.” A study published in Respiratory Medicine last year described 40 asthma patients who were given ten weeks of simulated reflexology and ten weeks of real reflexology. The researchers could find no evidence that the reflexology helped their asthma, neither using subjective tests, nor objective lung function tests. Practitioners claim that reflexology can cleanse the body of toxins, increase circulation, assist in weight loss, and improve the health of organs. Dr Barrett says, “There is no scientific support for these assertions.”

Iridology

What is it?
According to iridologists, the eye contains a complete map of every body part. This therapy was invented by a Hungarian physician, Ignatz von Peczely, who, during his childhood, accidentally broke the leg of an owl and noticed a black stripe appear in the lower part of the owl's eye. He may have developed his theories further during his imprisonment in 1848 at the time of Hungarian revolution and he first practiced on his mother.

What is involved?
The practitioner looks into the patient’s eye and checks their pupil’s pigmentation against iridology diagrams. Several dozen different configurations exist. Herbs are then prescribed to help the patient with their diagnosed illness.

What is the theory?

Iridologists believe that a person's health can be diagnosed from the color, texture, and location of various pigment flecks in the eye. Some also claim that the eye markings can reveal a complete history of past illnesses. However, according to Dr Barrett, “There is no known mechanism by which body organs can be represented or transmit their health status to specific locations in the iris.”

What is the evidence?

Professor Ernst recently published a review of the scientific literature on iridology but he could only find four publications which had been carried out according to correct scientific procedure. These studies suggested that iridology is not a valid diagnostic tool.
He says firmly, “Patients and therapists should be discouraged from using this method.”

Chiropractic manipulation

What is it?

Chiropractors diagnose and treat conditions that are due to mechanical faults in the joints, especially the spine.

What does it involve?

A chiropractor manipulates joints using the hands to improve mobility and relieve pain.

What is the theory?

If the spine is not functioning properly, it can cause irritation of the nerves that control posture and movement. This irritation can lead to ‘referred’ pain, pain which is felt in another part of the body. By manipulating joints, chiropractors stimulate the joint’s movement receptors which are sensors that provide feedback to the brain on where the joint is in space.

What is the evidence?

Going to a chiropractor has become almost mainstream. The British Chiropractic Association reports 90,000 patient visits a week. It is one of the most regulated of the alternative therapies, and yet of those discussed here, it is potentially the most dangerous. Manipulation of the neck can tear the fragile tissue of the vertebral artery and result in a stroke. It is difficult to determine how great the risk is or how many people have been affected: the latest figures suggest that 1 in 100,000 chiropractic patients have a stroke after neck manipulation. This February the Canadian Stroke Consortium looked at 98 severe stroke cases where the trigger was a blood clot in the vertebral artery and concluded that chiropractitioners were responsible for 38 of them.

In January this year UCLA Medical School published a report on 681 patients who were given chiropractic help when they had lower back pain. After 6 months 96 per cent of them still had lower back pain leading the researchers to conclude that chiropractic manipulation had been ineffective. Professor Ernst says, “The bottom line is that it works for a very limited number of spinal conditions and mainly in the short term.”

Osteopathy

What is it?

Osteopathy and chiropractic share a common origin in the folk traditions of bone setting, and still have much in common: many of the textbooks are relevant to both disciplines. Andrew Taylor Still founded modern day osteopathy. Like chiropractic, osteopathy is regulated, practitioners must register with The General Osteopathic Council.

What does it involve?

Practitioners use their hands to manipulate the spine. They tend to be gentler than chiropractors who are more likely to push on vertebrae directly. Osteopaths use the patient’s limbs as a lever to manipulate the spine. Some osteopaths also practice a technique known as craniosacral therapy. Practitioners place their hands on the cranium and sacrum and gently handle the bones of the skull.

What is the theory?

Osteopaths claim to treat lower back pain, neck and shoulder pain, sports injuries, repetitive strain disorders, headaches as well as pain from muscle spasm. The British School of Osteopathy states, “The osteopath believes that if the body is functioning to the best of its ability, then its own in-built healing mechanism can function effectively.” Craniosacral therapy depends on working with subtle rhythmic pulsations of the cerebrospinal fluid which allows the osteopath to correct disturbances in the neuromuscular system.

What is the evidence?

The most common adverse effects, according to the British Medical Journal, are mild pain or discomfort at the site of manipulation, slight headache, and fatigue which affects between a quarter and a half of all patients. However, this normally disappears in 75 per cent of patients within 24 hours.
But does osteopathy work? The evidence for its effectiveness is fragmentary. In the mid-nineties the Institute for Research in Extramural Medicine, Vrije University, Amsterdam reviewed 36 studies which used osteopathy to treat back pain. Only 16 of these studies examined the patients 3 months later, and in only 6 of these were positive effects observed. Two recent reviews of the medical literature have found osteopathy to be ineffective for treating severe period pain or asthma. However, two studies have been more positive: one published in 2000 in Alternative Therapies in Health and Medicine showed that osteopathy can help patients recovering from hip and knee operations if given between 2 and 5 days after surgery; in 1999 research published in the New England Journal of Medicine indicated that both osteopathy and standard medical practices helped patients with lower back pain but that osteopathy alone reduced the need for pain killers. This week one of the authors of the first review mentioned, Dr Lex Bouter, has published research in the Annals of Internal Medicine. His team’s patients suffered from neck pain and were either given physiotherapy, no help at all or some form of spinal manipulation. The latter was found to be the most effective, though Dutch practitioners give both osteopathy and chiropractic manipulation to patients as they see fit. Bouter comments, “We do not know which kind of therapy is most effective. For acute pain, manipulation does work best, but it is not spectacularly effective.”

Homoeopathy

What is it?

Homoeopathy uses dilute preparations of natural substances to treat illness according to two laws. The law of similarities states that patients are given a substance that would normally trigger an illness, but will theoretically relieve their symptoms in small quantities: a ‘like cures like’ approach. The law of infinitesimals means that the substance is most effective when it is so highly diluted that often not even an original molecule of it remains in the solution. It is thought to have begun in the 18th century using dilute preparations of deadly nightshade to cure scarlet fever.

What does it involve?

Remedies may sometimes be prescribed according to a person’s constitutional type. The ‘Nux Vomica’ is aggressive, bellicose, ambitious and hyperactive.

What is the theory?

The original substance is diluted with water and/or alcohol, and further diluted. Dilutions are designated by Roman numerals (1X is 1/10; 3X is 1/1,000). A 30X dilution means that the original substance has been diluted 1,000,000,000,000,000,000,000,000,000,000 times. Oscillococcinum, a 200C product for the relief of colds, is prepared by incubating small amounts of a freshly killed duck's liver and heart for 40 days. The resultant solution is then filtered, freeze-dried, rehydrated, repeatedly diluted, and impregnated into sugar granules. The American Physical Society calculated that if a single molecule of the duck's heart or liver were to survive the dilution, its concentration would be 1 in 100200. This huge number, which has 400 zeroes, is vastly greater than the estimated number of molecules in the universe.

What is the evidence?

NCCAM are concerned because of the sudden interest in homeopathic remedies for anthrax and small pox. Dr Stephen Straus, director of the center says, “Even though there is some doubt that these products could be effective, we cannot prove the claims to be entirely specious. However, lacking any competent evidence that they work, the claims about these products are dangerous both to the individual who uses them and to the population in general who might become infected.”

Claims about homoeopathy are equivocal. The Homeopathic Hospital in Glasgow carried out a study which was published in 2000 in the British Medical Journal. Fifty patients were treated in 4 different hospitals with either a homeopathic inhalant of an allergen or a placebo to treat allergic rhinitis. All the patients improved, and those who had the homeopathic treatment improved most, although not to a significant extent. Professor Ernst says, “The evidence for homoeopathy is extremely mixed. The jury is still out, but it would be arrogant to say that since we don’t know how homeopathic medicine works, it does not work. There are still things in Heaven and Earth that we do not yet understand.”