Alternative or just a placebo?

Published on Monday 9 February 2009 20:44

WHEN conventional medicine fails to provide relief for illness, many people find themselves asking: "What else is out there that could possibly help me?"

Often the answer they come up with is complementary therapies, such as herbal medicine, acupuncture, reflexology, homeopathy and aromatherapy.

But opinion on such treatments remains divided. Some term them "quack medicine", while others highlight the benefits seen by many patients using these therapies.

What is clear is that scientific evidence on these treatments is still severely lacking – a fact shown in a report published today by the Arthritis Research Campaign. The study found that, for those complementary medicines where research was available, results were mixed. Many provided no effect, while others showed some benefit.

For every new piece of research heralding a success in complementary medicine, it seems another will find no effect at all.

Some experts have suggested that further research will unravel complementary therapies, confirming they do not work – and in some cases are actually dangerous.

In the latest study, researchers led by Professor Gary Macfarlane, of Aberdeen University, looked at 40 complementary medicines used to treat arthritis. Such treatments are thought to be used by more than 60 per cent of patients with the conditions – many of whom spend hundreds of pounds on pills and supplements.

Out of 21 medicines used to treat rheumatoid arthritis, 13 (62 per cent) had little or no effect on the condition, including supplements such as selenium, willow bark and flaxseed oil.

The researchers found no treatments were highly effective against fibromyalgia – a common pain disorder.

But complementary treatments appeared more effective against osteoarthritis, with only six out of 27 medicines found to have little or no effect, although only one treatment, capsaicin gel, received the top rating of five out of five.

Another worrying finding was that a quarter of the compounds assessed had common or serious side-effects. One treatment – thunder god vine – was given a "red" classification, meaning patients should carefully consider the side-effects before starting treatment.

But there were many more medicines used by arthritis patients for which the researchers could find no published data at all to assess whether or not they worked.

Prof Macfarlane said he was not surprised by the lack of data, because of the shortage of funding for such studies. "When we take conventional medicines, we do so in the knowledge that they are safe for most people and that their effectiveness has been demonstrated," he said.

"We should expect to have the same information available for complementary medicines. Patients will often make their own choice of complementary medicines, and sometimes spend a considerable amount of money."

One patient who knows the financial cost of complementary medicines is Margaret Fisken, from Aberdeenshire. After being diagnosed with rheumatoid arthritis at the age of 40, she spent about 200 on treatments including blackcurrant seed oil, rose hip, ginger and glucosamine.

She said: "Someone said to me, 'I hear such and such works – you should try it'. I didn't find that anything worked at all."

Mrs Fisken said the only treatment that worked for her was conventional drugs. Indeed, most of those who practise complementary medicine point out that they do not suggest people shun more orthodox treatment – they stress that their therapies are complementary to standard treatment, not alternative, as they are often termed.

Kush Kumar, the chairman of the Complementary Therapists Association, said: "We are not trying to be an alternative to mainstream medicine. If someone was in severe pain, I wouldn't suggest they go for a pamper session. They should see a doctor or go to A&E. We want to work alongside the rest of the NHS to promote wellbeing."

But critics are concerned that many patients are putting too much faith into these therapies, whether they are herbal remedies, such as those assessed by ARC, or hands-on treatments like acupuncture, massage and aromatherapy.

Edzard Ernst, a professor of complementary medicine at the Peninsula Medical School, said: "There is so much information out there on alternative medicines. If you do a search on the internet you will find 40 million websites on the subject. But 99.9 per cent of these websites are misleading. Some are even dangerous."

Prof Ernst said much more rigorous research was needed on complementary therapies so patients were not misled, but people were now starting to question these treatments more. He said: "There is a bit more scepticism in the public and patients about alternative therapies compared with ten years ago."

Prof Ernst is critical of a new register set up for those practising complementary healthcare, which he believes will add credibility to unproven therapies. The Complementary and Natural Healthcare Council (CNHC) was set up through the Prince of Wales' Foundation for Integrated Health, which was given 900,000 from the Department of Health.

It has recently opened its register for those providing massage and nutritional therapies, with plans to include other techniques, such as reflexology and Reiki.

Some critics have branded it "OfQuack", because of the questions that still hang over these practices, but Maggie Dunn, the co-chairwoman of the CNHC, laughed off this label. She said: "Our argument would be if people really do have this view that complementary therapists are all quacks, isn't there even more reason to regulate their practice and make sure they follow codes of conduct and ethics?"

But Prof Ernst questioned whether such a register of practitioners would do any good. He said: "They just need to prove they have some knowledge of the therapy they practise. They don't need to prove these therapies do not harm and certainly don't have to prove they do any good."

In response, Ms Dunn pointed out that the same could be said of the medical profession and its own register. She said: "The General Medical Council does not regulate medicine; it regulates doctors. Psychiatry is not regulated, but psychiatrists are. We are no different to that."

With one in five people in the UK now estimated to be using complementary therapies, research will continue to seek out those most likely to be effective. But if the results continue to contradict each other the answers could be a long way off.

AT A GLANCE

THE Arthritis Research Campaign report looked at the evidence available on 40 complementary medicines. These are some of the findings:

&#149 Capsaicin gel: herbal medicine extracted from chilli peppers. The researchers concluded: "Results evaluating its role in treating patients with osteoarthritis indicates that it has no major safety problems and can be effective in reducing pain and tenderness in affected joints." Effectiveness score: 5 (out of 5). Safety classification: Green.

&#149 Thunder god vine: traditional Chinese herbal medicine. The researchers concluded that, although studies were scarce, "it appears that thunder god vine may be effective in treating symptoms of rheumatoid arthritis, but there are serious safety concerns". Effectiveness score: 3. Safety classification: Red.

&#149 Homeopathy: based on the theory "treating like with like", using dilutions of an active substance causing similar symptoms. The researchers concluded: "Trials which investigated the role of these remedies in osteoarthritis and rheumatoid arthritis yielded inconsistent results." Effectiveness score: 1. Safety classification: Green.