Are we being hoodwinked by alternative medicine? ……Two leading scientists examine the evidence. The first of a two-part extract from Trick or Treatment: Alternative Medicine on Trial by Simon Singh and Edzard Ernst
MIRACLE CURE? Alexander Technique,……… aromatherapy and magnet therapy
Which therapies work and which ones are useless? Which therapies are safe and which ones are dangerous? These are questions that doctors have asked themselves for millennia in relation to all forms of medicine.
And yet it is only comparatively recently that they have developed an approach that allows them to separate the effective from the ineffective, and the safe from the dangerous.
This approach, known as evidence-based medicine, has revolutionised medical practice, transforming it from an industry of charlatans and incompetents into a system of healthcare that can deliver such miracles as transplanting kidneys, removing cataracts, combating childhood diseases, eradicating smallpox and saving millions of lives each year.
Evidence-based medicine is about using the current best evidence — gathered through clinical trials and other scientific investigations — to make medical decisions. Alternative medicine claims to be able to treat the same illnesses and diseases that conventional medicine tries to tackle.
We set out to establish the truth of these claims by using the principles of evidence-based medicine.
Some people will be suspicious of this, perceiving evidence-based medicine as a strategy for allowing the medical establishment to defend its own members and treatment, while excluding outsiders who offer alternative treatments.
In fact, the opposite is often true — evidence-based medicine actually allows outsiders to be heard; it endorses any treatment that turns out to be effective, however strange it may seem.
In the 18th century, for instance, lemon juice as a treatment for scurvy was regarded as implausible but the establishment had to accept it because it was backed up by evidence from trials.
We had no axe to grind — indeed Professor Ernst even practised as a homeopath for many years (as well as receiving treatment as a patient) — and we came to our conclusions based on a fair, thorough and scientific assessment of the evidence.
So what did we find? While some therapies do provide some health benefits (e.g. osteopathy), most have nothing to offer.
Many popular therapies are “effective” only because they are good at eliciting a placebo response; making the patient feel better simply because they believe the treatment will help.
You might feel that as placebos help patients, this alone justifies the use of the therapy. But any treatment that relies on the placebo effect is essentially a bogus treatment. And it’s far from cheap.
If alternative practitioners are making unproven, disproven or vastly exaggerated claims, and if their treatments carry risks, then we are being swindled at the expense of our own good health.
Too many alternative therapists remain uninterested in determining the safety and efficacy of their interventions. These practitioners also fail to see the importance of rigorous clinical trials in establishing proper evidence for or against their treatments — where evidence already exists that treatments are ineffective or unsafe, alternative therapists carry on regardless.
Despite this disturbing situation, the market for alternative treatments is booming, and the public is being misled over and over again, often by misguided therapists; sometimes by exploitative charlatans.
It is time for the tricks to stop, and for the real treatments to take priority. The same scientific standards, evaluation and regulation should be applied to all types of medicine.
If this doesn’t happen, then homeopaths, acupuncturists, chiropractors, herbalists and many other alternative therapists will continue to prey on the most vulnerable — raiding their wallets, offering false hope and even endangering their health.
WHAT IS IT? A technique for relearning correct posture and body movements. Alexander teachers guide their clients through exercise sessions using a gentle, hands-on approach. As plenty of repetition is needed, 30 to 100 such sessions are usually required to master the technique, demanding a considerable level of commitment from the client, in terms of both time and money.
DOES IT WORK? Very little research so far has been conducted on the technique. Some promising findings have emerged in terms of improvement of respiratory function, reduction of anxiety, reduction of disability in Parkinson’s disease and improvement of chronic back pain.
However, for none of these conditions is the evidence sufficient to claim that the Alexander technique is effective.
WHAT IS IT? Plant essences (known as “essential oils”) are used to treat or prevent illnesses or enhance wellbeing. Most commonly, the diluted oil is applied to the skin via a gentle massage, but it can also be added to a bath or diffused in the air.
Aromatherapists believe that different essential oils have different specific effects. Aromatherapy is advocated for chronic conditions such as anxiety, tension headache and musculoskeletal pain.
DOES IT WORK? Some clinical trials confirm the relaxing effects of aromatherapy massage. However, this is usually short-lived and therefore of debatable therapeutic value. Some essential oils do seem to have specific effects. For instance, tea tree has anti-microbial properties. However, these effects are far less reliable than those of conventional antibiotics. There is no evidence that aromatherapy can treat specific diseases.
WHAT IS IT? Chiropractors use spinal manipulation to realign the spine to restore mobility. Spinal manipulation can be a fairly aggressive technique, which pushes the spinal joint slightly beyond what it is ordinarily capable of achieving, using a technique called high-velocity, low-amplitude thrust — exerting a relatively strong force in order to move the joint at speed, but the extent of the motion needs to be limited to prevent damage to the joint and its surrounding structures.
Some chiropractors claim to treat everything from digestive disorders to ear infections, others will treat only back problems.
DOES IT WORK? There is no evidence to suggest that spinal manipulation is effective for anything but back pain and even then conventional approaches (such as regular exercise and ibuprofen) are just as likely to be effective and are cheaper. Neck manipulation has been linked to neurological complications such as strokes — in 1998, a 20-year-old Canadian woman died after neck manipulation caused a blood clot which led to stroke. We would strongly recommend physiotherapy exercises and osteopathy ahead of chiropractic therapy because they are at least effective and much safer. The dangers of chiropractic therapy to children are particularly worrying because a chiropractor would be manipulating an immature spine.
WHAT IS IT? The use of hypnosis, a trance-like state, for therapeutic purposes. Hypnotherapists treat a range of chronic conditions, including pain, anxiety, addictions and phobias.
DOES IT WORK? Dozens of clinical trials show that hypnotherapy is effective in reducing pain, anxiety and the symptoms of irritable bowel syndrome. However, the evidence is that it’s not effective to help you stop smoking, even though it is frequently promoted in this context.
WHAT IS IT? The use of magnetic fields from static magnets, which are usually worn on the body, to treat various conditions, most frequently pain. These days rapidly fluctuating magnetic fields are used in conventional medicine in high-tech imaging machines (such as MRI scanners) and for promoting the healing of bone fractures. However, alternative medicine tends to use static magnets, which create a permanent magnetic field, to treat many conditions, mostly to alleviate chronic pain.
DOES IT WORK? There is no evidence that static magnets offer any medical benefit for pain relief. As they are usually self-administered, there is a danger of missing serious diagnoses and losing valuable time for early treatment of serious diseases.
WHAT IS IT? A manual therapy which focuses on the musculoskeletal system to treat disease. Osteopaths use a range of techniques to mobilise soft tissues, bones and joints. Osteopathy and chiropractic therapy have much in common, but there are also important differences.
Osteopaths tend to use gentler techniques and often employ massage-like treatments. They also place less emphasis on the spine than chiropractors, and they rarely move the vertebral joints beyond their physical range of motion, unlike chiropractors. Therefore osteopathic interventions are less likely to injure.
In general they treat mainly musculoskeletal problems, but many also claim to treat other conditions such as asthma, ear infection and colic.
DOES IT WORK? There is reasonably good evidence that the osteopathic approach is as effective as conventional treatments for back pain, but there is no good evidence to support the use of osteopathy in nonmusculoskeletal conditions.
People with severe osteoporosis, bone cancer, infections of the bone or bleeding problems should confirm with the osteopath that they will not receive forceful manual treatments.
LOOK BEFORE YOU LEAP:-
*Advice for anyone considering alternative medicine:
*Consult and inform your GP — the treatment might interfere with any ongoing conventional therapies.
*Do not stop your conventional treatment unless your doctor advises that this is sensible.
*Alternative therapies can be expensive, so make sure there is evidence to support the efficacy of a therapy before spending huge sums of money.
*very treatment carries risks, so make sure the risks are outweighed by the benefits.
Sources: THe Telegraph (Kolkata, India)