Alternative therapies - trick or treatment?

16:28 20 April 2005

One in 10 of us opt for complementary care each year and thanks to the endorsement by celebrities such as Madonna, alternative therapies have a lot to answer for.

But as we spend 1.5 billion a year on these treatments, are we being short changed?

Professor Edzard Ernst, an expert in complimentary medicine brings you his expert's view of the most popular alternative therapies:

Osteopathy

What is it?
Manual therapy frequently involving spinal mobilisation for musculoskeletal problems, such as back pain.

Does it work?
The most authoritative review is inconclusive as to the benefit for back pain compared with other treatments available for this condition. There is no evidence to support its use outside of musculosketal conditions such as in tackling asthma.

Is it safe?
Less adverse effects than chiropractic methods due to a gentler technique.

Conclusion
The benefit of osteopathy is not well-documented. Its risks seem to be less than those for chiropractic care.

Massage therapy

What is it?
Manipulation of the soft tissues on the body surface using pressure and traction.

Does it work?
Massage is effective for conditions such as constipation, back pain, anxiety, depression and stress.

Is it safe?
Although not entirely devoid of risks, serious adverse effects are very rare.

Conclusion
For a range of conditions the benefits of massage outweigh its risk.

Yoga

What is it?
A practice from India including muscular stretching, breathing exercises and meditation.

Does it work?
There is good evidence to show that yoga enhances general health and reduces cardiovascular risks.

Is it safe?
When practised prudently, there is little evidence of risk.

Conclusion
Regular yoga exercises can do more good than harm for general health, eg for cardiovascular health.

Herbal medicine

What is it?
The use of plants or parts of plants or extracts thereof for medicinal purposes.

Does it work?
Yes and no. Many studies show that certain herbal medicines are effective in treating certain conditions (eg St John's Wort for treating depression and Echinacea for the common cold). Many herbal medicines have exaggerated benefits - such is the case with Ginseng, Aloe Vera and Lavender.

Is it safe?
Some herbal medicines are toxic or they interact with synthetic drugs. Many, however, seem to be quite safe.

Conclusion
For some herbal remedies the benefit clearly outweighs the risks. For many others, the evidence is insufficient. Whether the benefits of treatments by UK traditional herbalists outweigh the risks is not certain. Flower remedies are thought to only successful at a placebo level and otherwise are a waste of money.

Chiropractic therapy

What is it?
Manual therapy frequently involving spinal manipulation (often using extreme movements of the spinal joints) for musculoskeletal problems, chiefly back pain.

Does it work?
The most authoritative review of the evidence concludes that "there is no evidence that spinal manipulative therapy is superior to other standard treatments for patients with acute or chronic low back pain"

Is it safe?
Serious adverse events, such as strokes and blood clots (sometimes fatal) are regularly reported. Chiropractors insist that they are rare but the evidence to support this claim is not conclusive.

Conclusion
The documented benefits of chiropractic do not seem to outweigh its potential risks. Regular exercise and taking ibuprofen is cheaper and just as effective.

Aromatherapy

What is it?
Use of essential oils from plants for medicinal purposes, usually with application through gentle massage, to treat ailments such anxiety, tension and headaches.

Does it work?
Studies show relaxing effects which are probably short-lived but can be helpful in supportive care for seriously ill patients, such as cancer sufferers. There is no evidence to support the treatment of specific diseases.

Is it safe?
Some people may develop allergies against essential oils but otherwise there are few risks.

Conclusion
Likely to be useful in palliative medicine and supportive care but antibiotics are far more effective.

Homeopathy

What is it?
Homeopaths use highly diluted remedies according to the "like cures like" principle - ie they would use a remedy which causes headaches in order to cure a headache.

Does it work?
The evidence is very conflicting. One summary concluded that the effects of homeopathy are not totally due to placebo. But many subsequent reviews of the trial data were far less optimistic.

Is it safe?
Being very dilute, homeopathic remedies have few side-effects but homeopaths expect an aggravation of patients' symptoms in about 20% of all cases.

Conclusion
The benefits of homeopathy are by no means undisputed. There are, however, few serious risks.

Reflexology

What is it?
Manual therapy of applying pressure to specific areas, usually on the sole of the foot, in order to influence the function of distant organs.

Does it work?
Even though several encouraging studies, on balance, the totality of the data does not strongly support the effectiveness of reflexology.

Is it safe?
No serious adverse effects conceivable from treatment with reflexology.

Conclusion
Apart from a short-lived relaxing effect, the benefits of reflexology are not well-documented. However, the treatment seems to be safe.

Acupuncture

What is it?
Part of traditional Chinese medicine involving insertion of needles in acupuncture points on the skin. Originally aimed at balancing "life forces" but science offers neurophysiological theories for its mode of action.

Does it work?
Not as a cure-all, but for some conditions there is evidence that it works such as in cases of nausea and knee osteoarthritis.

Is it safe?
Serious adverse events on record but rare. Minor problems occur in 7-11% of all patients.

Conclusion
For some, benefits outweigh the risks.

Hypnotherapy

What is it?
The induction of a trance-like state for therapeutic purposes, for use in treating phobias, pain, addiction and anxiety.

Does it work?
Hypnotherapy is effective for conditions such as anxiety, insomnia, pain and hypertension. However, its treatment for helping patients stop smoking has been brought into question.

Is it safe?
Recovering repressed memories can cause problems and so can the "false memory syndrome". The few damages are psychological over physical.

Conclusion
Hypnotherapy is effective for a range of conditions but not always entirely free of risks.

Nutritional therapy

What is it?
A very broad spectrum of treating medical conditions through modification of diet.

Does it work?
Some diets clearly work and are standard conventional therapies. Whether "alternative" diets (eg Gerson diet for cancer) are effective is doubtful.

Is it safe?
Extreme diets lead to malnutrition, which can be serious, even fatal.

Conclusion
No good evidence that "alternative" diets do more good than harm.

Magnet therapy

What is it?
The use of magnetic fields from static magnets worn on the body, usually to treat pain.

Does it work?
Its effectiveness is not proven. Magnectic fields are used in medicine in MRI scanners and healing fractures but these static fields are not proven to ease any pain except at a placebo level.

Is it safe?
The magnets themselves are thought to be safe but as this treatment is self-administered there is a danger of missing experts' diagnosises therefore losing time to treat serious illnesses.

Conclusion
There is no evidence for benefit. Always see a doctor first.