Health: Hidden truths behind healing hands

Complementary medicine is a boom industry, but media hype has often exaggerated the benefits and ignored a lack of hard scientific evidence to support its claims.

WHEN, five years ago, I was appointed as Britain's first (and still only) Professor of Complementary Medicine, I noticed the lively media interest in the subject.

Much of what was being reported on the subject seemed to stem from an extreme 'pro' or an extreme 'contra' position. I decided then to stay out of "media battles" and focus on discussions in scientific publications. Now I am about to make an exception to this rule.

Why? The reason is simply that, in my view, the debate has gradually become ill-informed, misleading and seriously unbalanced.

Three examples can be given to substantiate this view: over the last eight months we have seen a Channel 4 television series Natural Born Healers; a Sunday Times series by Hazel Courtney (Health Journalist of the Year) "What's the Alternative"; a five-part supplement "Healing. A-Z Guide to Complementary Medicine" in the Times.

All three major media events rely heavily on reporting anecdotes of miracle cures in support of what I feel compelled to call a seriously biased view.

So, what is wrong with anecdotes? My grandmother smoked 20 cigarettes per day all her adult life and never had lung cancer. Does that mean that smoking does not cause lung cancer? No, it does not.

Anecdotes are uniquely uninformative, even dangerous when it comes to generalisable matters of health.

Historically, in medicine, we have struggled to get away from testimonials or anecdotes. Exactly 50 years ago, the randomised controlled trial* was introduced as the gold standard to find out whether a given therapy is effective or not.

With this tool, we are now able to differentiate between specific therapeutic effects and non-specific (e.g. placebo effects, natural history of the disease) effects and can furthermore determine whether one particular treatment is better than another.

Testimonials or anecdotes, as produced so often by those who promote complementary medicine, are a significant step backwards in our endeavour to approach the truth.

If we accept them in support of complementary medicine and reject them for orthodox medicine we would de facto have introduced double standards into the evaluation of healthcare.

And what is wrong with promoting complementary medicine?

Nothing at all, except that promotion of this type should be based on reliable evidence and not on anecdote.

Promoting medical treatments differs significantly from, for instance, promoting the sale of cars. But, even if you were about to buy a car, you would probably rely on evidence.

The two questions you would be likely to ask (both in relation to a car and a given therapy) are, does it work and is it safe? Testimonials (of car dealers, customers or therapists) will not take you far in finding reliable answers.

It is simply common sense that, with health matters, one ought to be doubly cautious and extra critical.

The recent press coverage of complementary medicine is neither. It dulls our common sense to follow emotion rather than reason, testimonials rather than science.

There are, of course, those who claim that complementary medicine is special, so special that it defies testing through science.

I suspect this argument is the result of misconceptions as to what science is about. If, in the present context, science means the evaluation of treatments through randomised controlled trials, the notion that science cannot be applied to complementary medicine is false. In the area of complementary medicine, about 1,000 scientific studies have been published world-wide. This, I think, should be sufficient evidence to show that complementary medicine can be tested scientifically.

And what are the results of these studies? Invariably they are complex and prohibit generalisations.

They show that some complementary treatments are effective for certain conditions; they show that some treatments are not effective. They show that for some treatments the evidence is contradictory and insufficient for a final verdict.

They show that some complementary therapies are not entirely free of side effects. And they show that some complementary therapies have not been properly evaluated at all (see below).

Thus there never will be simple and reliable messages such as those recently favoured by British media.

But does the attitude of the media matter at all? Biased media coverage of complementary medicine, as increasingly seen in Britain, may cause serious damage on several levels. Paradoxically, perhaps, it will damage complementary medicine itself.

Giving the impression that most of complementary medicine is well- established hinders the planning, funding and execution of urgently needed research. Misguided media reports could also turn out to be damaging to our society at large.

Last week the Prince of Wales hosted a conference in London on the integration of complementary medicine into the NHS. If integration comes before proper evaluation, there is a very definite danger of financial loss to our already squeezed healthcare budgets.

Most importantly, biased media coverage has a real potential for harming the consumer. He or she may be led to believe that a given type of therapy is safe and effective while the truth could be that, at present, we actually do not know that.

Complementary medicine is certainly a "hot" subject. It is also too important to be misused by those who merely want to "warm their hands". If we are to progress in this area, we must not allow any bypassing of rigorous research. We need to fill in the substantial gaps in our present knowledge.

The very minimum would be to make sure that the benefits of a given complementary treatment for a given medical condition outweigh the risks. To achieve this aim, we need an open-minded approach, expertise, co-operation, time, funds and last, but not least, responsible support from the press.

* These are studies where patients are allocated at random to two or more groups treated by different methods, and subsequently compared in terms of pre-defined clinical outcomes.

The author is Professor of Complementary Medicine at the Postgraduate Medical School, University of Exeter

The diagnosis is... misleading

1. Examples of effective complementary treatments (1)

* St John's Wort (hypericum), used in herbal medicine, alleviates the symptoms of mild-to-moderate depression and is associated with fewer short- term side effects than conventional drugs.

* Acupuncture reduces back pain, dental pain and nausea (e.g. morning sickness).

* Ginkgo biloba, a herbal treatment, delays the clinical deterioration of patients with Alzheimer's disease.

2. Examples of forms of complementary medicine that have been shown to be ineffective (1)

* Acupuncture is no better than a sham as a help in smoking cessation or reduction of weight.

* Iridology, diagnosis through the study of the iris, is not a valid diagnostic tool

* Chelation therapy, a vitamin infusion to cleanse the body of toxins, has been shown to be no better than placebo for circulatory problems in the leg.

3. Examples of complementary treatments where, contrary to general beliefs, the evidence is inconclusive or insufficient (1)

* Chiropractic treatment has not convincingly been shown to be more effective than conventional treatments for acute or chronic low back pain (nor for any other medical condition).

* Acupuncture has not convincingly been shown to be effective for arthritis or asthma.

* Hypnotherapy has not convincingly been shown to be more useful than standard therapies as an aid for smoking cessation.

4. Examples of complementary therapies which are associated with serious health risks.

* Chiropractic treatment can result in vascular damage (e.g. stroke) in an unknown number of cases.

* Acupuncture has been associated with serious internal injuries (e.g. collapsed lungs) and infections (e.g. hepatitis).

* Chelation therapy, colonic irrigation, certain diets (e.g. macrobiotic) have been linked to serious complications.

* Several herbal remedies are know to be toxic and can cause liver damage, others (e.g. Ayurvedic and Chinese remedies) have repeatedly been found to be contaminated with toxic substances.

5. Examples of therapies for which, so far, virtually no clinical trials have been carried out.

* Flower remedies/essences

* Shiatsu

* Crystal therapy

* Shark cartilage

* Rolfing (a deep form of massage guided by the contours of the body)

(1) based on recent overviews of clinical trials in which patients were randomly allocated to treatment with the therapy or with placebo.