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Health risk or the real heal?
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Complementary medicine: Health risk or the real heal?
A controversial book questions the value of complementary medicine, says Jane Alexander.
Disillusioned: authors Professor Edzard Ernst, top, and Simon Singh, above, say complementary treatments can be a waste of money and dangerous to some users' health Photo: PAUL GROVER; REX FEATURES
Do you receive reiki or put your feet in the hands of a reflexologist? Have you ever tried crystal therapy? Does an acupuncturist give you a needle? In short, are you one of the estimated 5.75 million people in Britain who visit a complementary health practitioner?
If so, according to Professor Edzard Ernst and Simon Singh, authors of Trick or Treatment , you're not only potentially wasting your money, you could be putting your health at risk.
''Millions of patients are wasting their money and risking their health by turning towards a snake-oil industry,'' they say.
Unsurprisingly, practitioners of complementary medicine have been less than ecstatic about the authors' stance. The British Chiropractic Association (BCA) accused Singh of libel over an article he wrote in The Guardian .
The BCA claimed he was, in effect, accusing chiropractors of knowingly supporting bogus treatments. The Court of Appeal has ruled that Singh can use the "defence of fair comment" in the ongoing dispute.
While Singh is a science writer and documentary maker, Ernst is Professor of Complementary Medicine at Exeter University. Qualified as a conventional doctor, he consequently trained in homoeopathy and practised this and other therapies.
However, as he looked at the research, he became ''increasingly disillusioned''.
His main complaint is that, according to his reviews of the available research, it simply doesn't work. If people get better, they do so because of the placebo effect or by sheer coincidence.
Homeopathy, Ernst says, ''makes no scientific sense''. He also claims it can be dangerous because it can prevent patients seeking medical attention for serious ailments.
Acupuncture, he continues, is also fundamentally unproven by clinical trials. In addition, if wrongly performed, Ernst says it can cause infection and that needles might even puncture a nerve or an organ.
Chiropractic also comes in for a panning (you can understand why they took umbrage). Ernst expresses concern if patients are being X-rayed unnecessarily, and adds: ''patients can also suffer dislocations and fractures". Herbs, he concedes, can have physiological effects and a few, such as St John's wort, Devil's claw, echinacea, garlic, ginkgo and horse chestnut, do respond well in trials.
However, he points out that herbal treatments have side-effects and that some herbs interact badly with conventional medicine.
The 50 per cent of doctors who refer patients to therapists of unproven treatments receive a lambasting, with Ernst suggesting that they are either ignorant, lazy or desperate.
Prince Charles, a long-term advocate of complementary health, also gets an earful. ''The Prince of Wales ought to start listening to scientists, rather than allowing himself to be guided by his own prejudices.'' Ouch.
It's based on science, so surely Ernst must be right? Well, not everyone agrees that it's that simple. Prof George Lewith is Professor of Health Research at the University of Southampton - hence in the same business as Ernst.
While Lewith firmly believes that complementary medicine ''should be trialled and tested'', he expresses concern about the scientific basis of Trick or Treatment.
''Synthesising one or two rather inadequate trials and coming to a negative conclusion is a very limited and often inaccurate way to look at clinical evidence,'' Lewith says. ''The honest answer when we have inadequate evidence is that we don't know. Ernst routinely spins 'don't know' into 'doesn't work' by implication and this theme tends to run through Trick or Treatment .''
So are these therapies safe after all? ''If we applied the same scientific rules used in Trick or Treatment to surgical intervention, we would probably never agree to let a dentist or indeed any surgeon ever approach us,'' Lewith says with a shrug.
''All medicine needs to be aware that it should operate safely and honestly, but Ernst and Singh seem to be waging some sort of religious war against complementary medicine.''
The book does seem curiously slanted. Ernst mentions in passing that some forms of complementary health do produce measurable results - osteopathy, massage therapies, yoga and autogenic therapy fare reasonably well, for example.
Yet the praise is faint.
There was also little acknowledgement of why some patients seek natural therapies in the first place.
While pharmaceutical drugs are extensively tested in the manner Ernst approves, they are scarcely devoid of side-effects. Also, many people seek help for issues that conventional medicine finds difficult to treat.
Research shows that the most common ailments seen by complementary practitioners are musculoskeletal problems, stress, anxiety and depression. Interestingly, these are all conditions that respond well to the therapies which were given grudging applause in Trick or Treatment.
The bottom line? It seems the jury is still out.
Trick or Treatment? Alternative M edicine on Trial by Simon Singh and Edzard Ernst is published by Corgi (
PROF ERNST LIKES...
Autogenic training "An economical self-help approach."
Massage "Improves wellbeing in most patients."
Meditation "Can be useful for many people."
Osteopathy "The osteopathic approach is effective for back pain."
Leech therapy "Some evidence shows this treatment reduces the pain of osteoarthritis."
PROF ERNST DISLIKES...
Bach Flower remedies "Flower remedies are a waste of money."
Colonic irrigation "Unpleasant, ineffective."
Crystal therapy "Based on irrational mystical concepts."
Reiki "Has no basis in science."
CAN MEDITATION HELP DEPRESSION?
The effectiveness of meditation as a treatment for depression is supported by research. A study at the University of California, Los Angeles, of Transcendental Meditation (TM), shows that this form of meditation can reduce the symptoms of depression by 50 per cent over a 12-month period.
It isn't cheap to learn (between
The UCLA study didn't compare TM with other forms of meditation but you can achieve equally impressive benefits with less cost.
Try mindfulness, a technique developed at the University of Massachusetts Medical School. The Mental Health Foundation would like to see courses in this effective self-help treatment run by the NHS.
Meanwhile you can learn it from Wherever You Go, There You Are by Jon Kabat-Zinn (Piatkus)
I thank Jane Alexander for a pretty balanced article.
Professor Ernst managed to get in his usual sensational dig at Chiropractors.Patients should certainly not be X-rayed unnecessarily. However, Chiropractic is a regulated profession and practitioners should abide by the Health & Safty Executive & The Ionising Radiation Regulations 1999.
Professor Ernst sensationally states that "chiropractic patients can also suffer dislocations and fractures". Should Ernst the scientist not state the frequency of these events. Should he not then compare this risk with another therapy often used for back pain such as anti-inflammatory medication? I have been in practice for 20 years and have not seen such an injury. And a word of warning for Jane Alexander: please check the Professor's studies. Make sure his studies are robust and actually involve Chiropractors! The 'trick' is to use other manipulators and then apply those findings to Chiropractors.
Thank you for including the balanced thoughts of Prof George Lewis. Although Prof Ernst and Dr Singh at times speak sense, over the years Ernst, in my opinion, has strayed too far from the truth for someone in such an important and influencial position.
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