THE CORE OF OUR BOOK HAS FOCUSED ON ONLY FOUR OF THE MAIN ALTERNATIVE therapies (acupuncture, homeopathy, chiropractic therapy and herbal medicine), but we have also evaluated many other therapies, which will be discussed in this section. We have devoted a page to each one, in which we address key issues, such as how did the therapy start, what does it involve, is it effective and is it safe? Despite the brevity of the sections, we have rigorously examined the scientific evidence for and against each therapy in order to reach our conclusions. You can also find more information about each alternative therapy in The Desktop Guide to Complementary and Alternative Medicine: An Evidence-Based Approach, a detailed reference book edited by Edzard Ernst, Max H. Pittler, Barbara Wider and Kate Boddy. This book also contains references to all the research that leads to the conclusions in this appendix.
Anybody considering alternative medicine as a mode of treatment, including all the therapies that follow, should take into account five pieces of advice. First, if you are thinking of using any form of alternative therapy for a particular condition, then we strongly recommend that you first consult and inform your GP – the treatment that you have chosen might interfere with any ongoing conventional therapies. Second, do not stop your conventional treatment unless your doctor advises that this is sensible. Third, bear in mind that alternative therapies can be expensive, particularly if they involve long-term consultations, so make sure that there is evidence to support the efficacy of a therapy before investing significant sums of money in its claimed benefits. Fourth, all therapies can generate placebo effects, but this alone is not enough to justify their use. Fifth, remember that every treatment carries risks, so make sure that the risks are outweighed by the benefits.
Included in this section are our evaluations of:
Alexander Technique
A process of relearning correct postural balance and coordination of body movements.
Background
Fredrick M. Alexander was an Australian actor whose career was threatened by a recurring loss of voice. Doctors were unable to diagnose any problem with his throat, but Alexander noticed that his silence was linked to his poor posture. In the early twentieth century he developed a cure for his problem which focused on relearning correct posture.
Alexander teachers encourage their patients to move with the head leading and the spine following. These patterns of movement and posture are rehearsed repeatedly with a view to creating new motor pathways and improving posture, coordination and balance. Essentially, the mind is taught to modulate the autonomic nervous system through regular, supervised exercises.
The Alexander technique quickly became popular with performing artists. It was then noted that, apparently, it was also useful for a wider range of medical conditions. Today Alexander teachers claim that it is effective for treating asthma, chronic pain, anxiety and other illnesses.
Alexander teachers instruct their clients in a series of one-hour exercise sessions. They guide the process of relearning simple postures and body movements through a gentle, hands-on approach. As plenty of repetition is needed, 30–100 such sessions are usually required to master the technique. This obviously demands a considerable level of commitment from the client, in terms of both time and money.
What is the evidence?
Very little research has so far been conducted on the Alexander 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 of proven effectiveness. There are no serious risks associated with this method.
Conclusion
Alexander technique is not well researched, so the evidence is not conclusive. It might generate benefit for some health problems, provided patients are sufficiently committed and wealthy.
Alternative Diagnostic Techniques
Diagnostic methods not used in conventional medicine but employed by practitioners of alternative medicine.
Background
Before administering a treatment, alternative therapists will often assess the patient’s condition using a variety of diagnostic techniques. Some of these are entirely conventional, but others are not. Some of the more unusual diagnostic techniques are specific to a particular therapy. These are therefore discussed in the relevant sections of this book. The following list includes many of those diagnostic methods that are used in several disciplines:
What is the evidence?
In nearly every case, these methods and the concepts behind them are not plausible, so their ability to diagnose accurately must be treated with great scepticism. Moreover, when these methods have been rigorously tested, the most reliable results of such investigations show that they are not valid. Finally, they typically fail the test of reproducibility, which means that ten practitioners generate ten different results.
Conclusion
Alternative diagnostic techniques are dangerous as they are likely to generate false diagnoses. They can be misused by fraudulent practitioners to cause unwarranted fears in patients and to convince them to pay for ineffective or harmful treatments of conditions they did not have in the first place.
Alternative Diets
Regimented plans of eating and drinking with health claims that are not in line with accepted knowledge.
Background
In alternative medicine, unsubstantiated health claims are being made for dozens of special diets. Many of these are ‘flavour of the month’ approaches. To name but a few: Ama-reducing diet (Ayurvedic diet to burn off accumulated ama, which are supposed toxins); anthroposophic diet (lactovegetarian food with sour-milk products); Budwig’s diet (fruit, juices, flaxseed oil and curd cheese); Gerson diet (fresh fruit juices, vegetables, supplements, liver extracts and coffee enemas to cure cancer); Kelly diet (anti-cancer diet including supplements and enzymes); Kousmine diet (anti-cancer diet with ‘vital energy’ foods, raw vegetables and wheat); macrobiotic diet (aimed at balancing yin and yang); McDougall diet (vegetarian diet, low fat, whole foods); Moerman diet (anti-cancer lactovegetarian diet with added iodine, sulphur, iron, citric acid and vitamins A, B, C, E); Pritikin diet (vegetarian diet combined with aerobic exercise); Swank diet (low amounts of saturated fat to combat multiple sclerosis).
Each of these diets has its own unique concept and is promoted for specific circumstances. Some must be followed long-term, others only until the condition in question is cured. Alternative diets are promoted by a range of alternative practitioners and health writers, and via the internet.
What is the evidence?
Clearly one would need to assess each diet on its own merits, yet little data has been gathered on any of those mentioned above or in general. Where evidence does exist, it is usually seriously flawed. For instance, the Gerson diet is relentlessly promoted as a cancer cure, but the only positive evidence comes from an analysis which is now widely accepted to be fatally flawed and which should therefore be ignored.
Several alternative diets can lead to malnutrition, particularly in seriously ill patients for whom it is important to consume a balanced diet with sufficient calorie intake. Feeding a highly restricted diet to a cancer patient, for instance, hastens death and reduces quality of life. Some proponents of these diets make patients feel guilty if they cannot follow their often tedious regimens. This can further reduce quality of life.
Conclusion
Alternative diets are burdened with the risk of malnutrition and have not been shown to be effective for any condition. Our advice is to stay well clear of them.
Alternative Exercise Therapies
Approaches that employ regular movements for improving health and wellbeing, and which are not normally used in conventional healthcare.
Background
The health benefits of regular exercise cannot be valued highly enough. Knowledge about exercise developed in all cultures, so unique exercise regimens emerged in different parts of the world and are often embedded in the specific concepts about health and disease of that region. Examples are t’ai chi (China) and yoga (India). Both include meditative aspects, need to be practised regularly and place a strong emphasis on disease prevention and wellbeing.
In addition to these traditional forms of exercise, there are modern variations on the theme. An example is pilates, developed relatively recently by Joseph Pilates (1880–1967). This approach integrates breathing, proper body mechanics and strengthening exercises, as well as stabilization of the pelvis and the trunk. It is estimated that there are now over 10 million people who practise pilates worldwide.
Exercises are best learned in small groups and then have to be practised regularly – once or twice a week, or even daily.
What is the evidence?
Although there is far less research into alternative exercises than into common sports or physiotherapy exercise, some encouraging conclusions have started to emerge. For example, yoga, which encompasses a whole lifestyle including diet and meditation, has been shown to be effective in reducing cardiovascular risks.
T’ai chi has also been studied quite thoroughly. It improves balance, prevents falls in the elderly, enhances cardiovascular fitness, increases joint flexibility, prevents osteoporosis in post-menopausal women and improves quality of life in patients suffering from chronic heart failure. There is, however, no significant evidence that alternative exercise therapies convey any additional benefits compared to many forms of conventional exercise.
Conclusion
Regular exercise, whether exotic or conventional, is undoubtedly good for our health and wellbeing. A well-trained, experienced tutor is important, as alternative exercise therapies can carry the sort of risks associated with any exercise that puts the body under strain.
Alternative Gadgets
An increasing number of alternative gadgets are being promoted with promises of health benefits for those who buy them. These gadgets have little in common except that the theories behind them conflict with mainstream science.
Background
For some entrepreneurs, alternative medicine is a highly profitable business, and there seems to be no limit to their inventiveness. They develop gadgets and claim that, if we buy and use them, our health will improve, certain illnesses will be cured or diseases will be prevented. The ideal medium for promoting these gadgets is, of course, the internet – there is no control over what claims can be made.
Examples of alternative gadgets are copper bracelets, devices that are said to shield us from electromagnetic radiation, jewellery with healing crystals, foot-baths that supposedly extract toxins from our body, etc. In many cases, the only evidence provided by the manufacturer is statements by satisfied customers and ‘experts’, providing a thin veneer of credibility. Currently there are, for instance, dozens of websites where Professor Kim Jobst promotes the ‘Q link’ as a ‘safe and effective tool that helps guard the cells of the body against electromagnetic field effects’. He also claims, ‘Emerging evidence from early clinical cellular and molecular studies of the effects of Q link on cardiovascular, immune and central nervous systems are startling,’ but this is simply not true.
What is the evidence?
The medicinal claims for these gadgets are often couched in apparently scientific language. This is to convince the consumer that the product is serious. On closer inspection, those with a scientific background can easily see their pseudo-scientific nature (i.e. the jargon is gobbledygook). The assumed mode of action of alternative gadgets is biologically implausible and no data exist to show that they have any positive health effects at all. Indeed, when devices have been tested, then the conclusion has invariably been disappointing.
The financial loss for patients is obvious, but there is also a health risk, as some people might employ these gadgets as alternatives to effective treatments. Seemingly harmless gadgets can then even hasten death.
Conclusion
A plethora of alternative gadgets exists, allegedly curing this or preventing that condition. They are not supported by science or evidence and are a waste of money at best and a danger to health at worst.
Anthroposophic Medicine
A school of medicine developed by Rudolf Steiner based on imagination, inspiration and intuition. Anthroposophic medicine is influenced by mystical, alchemistic and homeopathic concepts and claims to relate to the spiritual nature of man.
Background
Rudolf Steiner (1861–1925) created, among other things, the Waldorf schools, biodynamic farming and his own philosophy, known as anthroposophy. Applying his philosophical concepts to health, he founded, together with Dr Ita Wegman, an entirely new school of medicine. It assumes metaphysical relations between planets, metals and human organs, which provide the basis for therapeutic strategies. Diseases are believed to be related to actions in previous lives; in order to redeem oneself, it may be best to live through them without conventional therapy. Instead a range of other therapeutic modalities is employed in anthroposophic medicine: herbal extracts, art therapy, massage, exercise therapy and other unconventional approaches.
The best-known anthroposophic remedy is a fermented mistletoe extract which is used to treat cancer. Steiner argued that mistletoe is a parasitic plant which eventually kills its host – a striking resemblance to a malignant tumour which also lives off its host and finally kills him/her. His conclusion, therefore, was that mistletoe can be used to treat cancer. The concepts of anthroposophic medicine are biologically implausible.
What is the evidence?
The efficacy of mistletoe preparations remains unproven – either for curing cancer or for improving the quality of life of cancer patients. Other elements of the anthroposophical concept are not well researched, and the therapeutic concept as a whole has so far not been rigorously tested.
Mistletoe injections have been associated with a range of adverse effects. The most important risk, however, is that of discarding conventional treatments. For example, anthropospohical doctors tend to advise parents against the immunization of their children, and some cancer patients forfeit conventional treatment for mistletoe extracts.
Conclusion
Anthroposophic medicine is biologically implausible, it has not been shown to be effective, and it is unlikely to work. It can also carry considerable risks.
Aromatherapy
The use of plant essences (‘essential oils’) for treating or preventing illnesses or enhancing wellbeing.
Background
Plant oils have been used in several ancient cultures, but the birth of aroma therapy proper was not until the publication of a book entitled Aromathérapie by the French chemist René Gattefosse in 1937. Gattefosse had previously burned his hand while working in his laboratory and immediately immersed it in lavender oil. To his amazement, the wound healed quickly without leaving a scar. This experience prompted him to study the medicinal powers of essential oils.
There are several ways of using essential oils. Most commonly, the diluted oil is applied to the skin via a gentle massage, but the oil can also be added to a bath or diffused in the ambient air. If combined with a massage, aromatherapy is definitely relaxing – but it is unclear whether the effect is caused by the oil, the gentle massage or both. Aromatherapists believe that different essential oils have different specific effects. Therefore therapists individualize these oils according to their patient’s characteristics, symptoms, etc.
A consultation with an aromatherapist can last between one and two hours. The therapist will normally take a brief medical history, possibly conduct a short examination and then proceed by massaging a diluted essential oil into the skin of the patient. This process is relaxing and, for most people, agreeable. Aromatherapy is often advocated for chronic conditions such as anxiety, tension headache and musculoskeletal pain. Aromatherapists usually recommend regular sessions, even in the absence of symptoms, e.g. for preventing recurrences.
What is the evidence?
Some clinical trials confirm the relaxing effects of aromatherapy massage. However, these effects are usually shortlived and therefore of debatable therapeutic value. Some essential oils do seem to have specific effects. For instance, tea tree has antimicrobial properties. However, these are far less reliable than those of conventional antibiotics. The risks of aromatherapy are minimal, such as the possibility that some patients may be allergic to some essential oils.
Conclusion
Aromatherapy has short-term ‘de-stressing’ effects which can contribute to enhanced wellbeing after treatment. There is no evidence that aromatherapy can treat specific diseases.
Ayurvedic Tradition
‘Ayurveda’ means knowledge (veda) of life (āyus). It is one of the ancient Indian systems of healthcare and involves bringing about balance between body and mind.
Background
Ayurveda has been used in India for roughly 5,000 years. It includes individualized herbal remedies, diet, exercise (yoga), spiritual approaches like meditation, massage and other interventions. Health is perceived as a balance of physical, emotional and spiritual energies, and any deviation from health is thought to be caused by an imbalance of these elements. Treatment is aimed at re-establishing the balance through individualized prescriptions, usually of several interventions simultaneously.
Ayurvedic practitioners will take a medical history, examine the patient, diagnose the nature of the imbalance and try to restore balance through their prescriptions. There is much emphasis on lifestyle advice, but Ayurvedic medicine supplements are also prescribed frequently. A consultation might take 30–60 minutes and numerous sessions are usually recommended, often lasting up to a year. All conditions are claimed to be treatable in the Ayurvedic tradition.
What is the evidence?
The whole system of Ayurveda has not been submitted to clinical trials, but elements of it have. The results are mixed. For instance, yoga has proven benefits for cardiovascular health. A recent trial of Indian massage, however, showed no positive effects in stroke patients. Ayurvedic remedies usually contain a multitude of herbal and other compounds. Some encouraging findings exist for conditions like acne, constipation, diabetes, chronic heart failure, obesity and rheumatoid arthritis. However, in none of these cases is the evidence sufficiently strong to warrant a positive recommendation. (The evidence for specific herbal remedies is discussed in Chapter 5.)
Ayurdevic medicines have regularly been implicated for containing substances such as heavy metals. These can either be a contaminant or a deliberate addition – according to Ayurvedic belief, they generate positive medicinal effects if handled properly. In reality, however, heavy metals are highly toxic no matter how they are prepared.
Conclusion
Ayurdevic healthcare is a complex system that cannot be easily evaluated. The current evidence suggests that some of its elements are effective while many others are essentially untested, or overtly dangerous, e.g. many herbal preparations.
Bach Flower Remedies
Highly diluted plant infusions intended to cure emotional imbalances which are thought to be the cause of all human illness.
Background
The concept was developed by Edward Bach, who had worked as a micro biologist at the Royal London Homoeopathic Hospital in the early twentieth century. Inspired by the principles of homeopathy, Bach identified thirty-eight flower remedies, each one corresponding to an emotional disturbance such as depression, fear, loneliness or oversensitivity. Administering the correct remedy, he believed, would cure the emotional disturbance and consequently the physical or psychological illness. For example, heather is used to treat self-centredness and honeysuckle is an antidote for those who live in the past. Similarly, wild rose is supposedly helpful in cases of apathy, and vervain treats the opposite problem of over-enthusiasm.
Flower remedies (‘Bach Flower Remedies’ is a brand name) are produced by placing the fresh flowers into spring water. Subsequently brandy is added to make up the actual remedies, which are similar to homeopathic remedies in that both are usually so dilute that no pharmacological action is conceivable. Also both schools claim to work through some sort of ‘energy’ transfer. However, homeopaths are adamant that flower remedies are fundamentally different: succussion (or shaking) is not part of the process of making flower remedies, and their prescription does not follow the ‘like cures like’ principle.
Flower remedies can be bought over the counter, but proponents argue it is best to consult a trained therapist. The therapist would identify the patient’s underlying emotional imbalance, which, in turn, determines the choice of remedy. Flower remedies are also often recommended to healthy individuals with a view to preventing illness.
What is the evidence?
Several rigorous trials of flower remedies are available. None of them shows that this approach is effective beyond placebo in curing disease or alleviating symptoms. As the remedies are highly diluted, adverse effects are not likely.
Conclusion
Flower remedies are based on concepts which contradict current medical knowledge. The trial data fail to demonstrate effects beyond a placebo response. Therefore flower remedies are a waste of money.
Cellular Therapy
The use of human or animal cells or cell extracts for medicinal purposes.
Background
In conventional medicine, organs or cells are sometimes transplanted from one person to another, e.g. bone-marrow transplantations or blood tranfusions. This is entirely different from cellular therapy as used in alternative medicine, sometimes also called ‘live cell therapy’ or ‘cytotherapy’.
In 1931 the Swiss surgeon Paul Niehans had the idea of injecting preparations from animal foetuses into humans for the purpose of rejuvenation. This concept seemed plausible to lay people and many influential individuals who could afford this expensive treatment became Niehan’s patients. When it emerged that Niehan’s Frischzellen Therapie (fresh cell therapy) was dangerous – thirty deaths had been reported by 1955 – his preparations were banned in several countries.
Meanwhile several similar cellular treatments had emerged, particularly on the European continent. Examples include ‘Thymus’ therapy (injection of the extracts from the thymus gland of calves) or ‘Ney Tumoin’ (protein extracts from calves or cows) or ‘Polyerga’ (protein extracted from pig spleen) or ‘Factor AF2’ (extract from spleens and livers of newborn sheep). These preparations are usually injected by doctors (non-doctor therapists are not allowed to give injections in most countries) who claim that they have anti-cancer properties, stimulate the immune system or simply regenerate organs or rejuvenate the body in a general sense.
What is the evidence?
Thymus therapy has been extensively researched as a cancer treatment. The totality of this evidence does not show the approach to be effective. Other preparations have either generated similarly negative results or have not been submitted to clinical trials. However, it is known that any treatment that introduces foreign proteins directly into the bloodstream can lead to anaphylactic shock, the most serious type of allergic reaction. If this condition is not treated adequately and immediately, it can result in death.
Conclusion
The seemingly plausible principle of cellular therapy continues to appeal to the rich and super-rich. None of the claims of cellular therapy are, however, supported by scientific evidence, so these treatments are both dangerous and a waste of money.
Chelation Therapy
The infusion of chemical agents which bind to other chemicals into the bloodstream for the purpose of removing toxins and for treating diseases caused by arteriosclerosis.
Background
Chelation therapy started as a branch of conventional medicine to remove heavy metals and other toxins from the body by introducing powerful chemical agents, which bind to the toxins and are subsequently excreted. This conventional form of chelation therapy is indisputably effective and often life-saving. In alternative medicine, chelation therapy is used in very different ways and has two main applications.
First, alternative therapists use chelation to remove toxins, but the source of these toxins is unclear. For example, they may attempt to remove mercury which allegedly leaked from dental fillings or vaccines. There is, however, no evidence to suggest any toxicity from these sources. Thus chelation therapy is employed to fix a non-existing problem.
Second, chelation therapy is used for eliminating calcium ions from the blood, based on the notion that calcium deposits in the arterial wall are responsible for arteriosclerosis which, in turn, is seen as the cause of heart disease, stroke, peripheral arterial disease and other conditions. Consequently, alternative chelation therapists insist that their treatment is helpful for coronary heart disease, stroke prevention, peripheral vascular disease and a range of conditions from arthritis to osteoporosis.
Alternative chelation therapists usually advocate a whole series of treatments. In total, this can cost the patient thousands of pounds.
What is the evidence?
The claims that chelation is effective for coronary heart disease, stroke or peripheral arterial disease is based on outdated scientific theories. Chelation therapy has been tested repeatedly, but these clinical trials fail to demonstrate effectiveness. Serious adverse effects, including deaths due to electrolyte depletion, have been associated with chelation therapy. In 2005 two children, one with autism, suffered cardiac arrest and died after chelation.
Conclusion
Chelation therapy, as used in alternative medicine, is disproven, expensive and dangerous. We urge patients not to use this treatment.
Colonic Irrigation
Use of enemas for ‘cleansing the body’ sometimes herbs, enzymes or coffee are added to the water which is administered via the rectum.
Background
The notion that we are poisoning ourselves with toxic intestinal waste products from ingested food seems plausible to many lay people and is therefore widespread. It forms the basis for a range of alternative approaches which allegedly free the body of such ‘autointoxication’. One of them is colonic irrigation, or colon therapy as it is also called. The popularity of this treatment can be explained through its apparently logical concept and through its continuous promotion by the popular media and certain celebrities.
A treatment session involves partial undressing, insertion of a tube via the rectum and receiving considerable amounts of fluids via this route. The fluid is later extracted and, on closer inspection, appears to be loaded with ‘waste products’.
This visual impression helps to convince patients that colonic irrigation achieves what it claims: the elimination of residues that the body is best rid of. Treatment might last for approximately 30 minutes and long-term therapy is sometimes advised, with weekly or twice weekly sessions. Colonic irrigation is promoted as a treatment for gastrointestinal disorders, allergies, obesity, migraine and many other chronic illnesses.
What is the evidence?
Enemas have an undoubted role in conventional medicine. The use of colonic irrigation as employed in alternative medicine is, however, an entirely different matter. None of the waste products of our body ‘poison’ us; they are eliminated through a range of physiological processes, unless we are suffering from severe organ failure.
There is no reliable clinical evidence that colonic irrigation does any good at all and some evidence that it causes serious harm by, for example, perforating the colon or depleting our body of electrolytes.
Conclusion
Colonic irrigation is unpleasant, ineffective and dangerous. In other words, it’s a waste of money and a hazard to our health.
Craniosacral Therapy (or Cranial Osteopathy)
The gentle manipulation of the skull and sacrum to facilitate unrestricted movement of the cerebrospinal fluid.
Background
William G. Sutherland, who practised as an osteopath in the 1930s, became convinced that our health is governed by minute motions of the bones of the skull and sacrum. These subtle rhythms, he believed, are fundamental to the self-healing processes of our bodies. Craniosacral therapy aims at restoring the rhythmic motions when they are restricted. This is claimed to help with a range of conditions, particularly in children: birth trauma, cerebral palsy, chronic pain, dyslexia, headaches, learning difficulties, sinusitis, trigeminal neuralgia and many others. Today, craniosacral therapy is practised by several alternative therapists, including osteopaths, chiropractors, naturopaths and massage therapists.
A consultation with a craniosacral therapist would include a detailed manual diagnosis, so the first session may last one hour or longer. Subsequent therapeutic sessions, during which the therapist gently manipulates the skull and sacrum, would be shorter. A typical treatment series might involve six or more sessions.
What is the evidence?
Conventional wisdom has it that, during early childhood, the bones of the skull and the sacrum fuse to form solid structures. Even if minute motions between these bones were possible, they would be unlikely to have a significant impact on human health. In other words, craniosacral therapy is biologically implausible.
The little research that exists fails to demonstrate that craniosacral therapy is effective in treating any condition. Moreover, therapists struggle to give consistent diagnoses for the same patient, probably because they are attempting to detect a non-existent phenomenon. Mothers bringing their children to a therapist are sometimes impressed by the positive reaction. This is likely to be a relaxation response caused by the gentle touch and calming manner of the therapist, but these effects are usually shortlived. There are no conceivable risks, but if severely ill children are treated with craniosacral therapy instead of an effective treatment, the approach becomes life threatening.
Conclusion
There is no convincing evidence to demonstrate that craniosacral therapy is effective for any condition. Prolonged treatment series are expensive and unnecessary.
Crystal Therapy
The use of crystals such as quartz or other gemstones, for the purpose of ‘energy healing’.
Background
Crystal therapists claim that crystals can move, absorb, focus and diffuse healing ‘energy’ or ‘vibrations’ within the body of a patient. This, in turn, is said to enhance the self-healing ability of the patient. Illness allegedly occurs when the individual is misaligned with the ‘divine energy’ that is ‘the foundation of all creation’. The approach is not in accordance with our understanding of physics, physiology or any other field of science. Crystal therapy therefore lacks scientific plausibilty.
A treatment session typically involves the fully clothed patient lying down. The therapist then intuitively identifies problem areas such as blockages of energy flow and places crystals over them to restore flow or re-establish balance. One treatment typically lasts for 30–60 minutes.
Crystal therapy is normally used by patients as an addition to conventional treatments. It is employed in the treatment of virtually all medical conditions, for improving the quality of health in individuals or for disease prevention. Therapists sometimes use crystal wands as part of aura therapy in order to cleanse a patient’s aura.
Patients who believe in crystal therapy will often buy their own crystals and carry them about their person in order to treat minor conditions. Although healing crystals can be relatively cheap, healing crystal jewellery sometimes costs several hundred pounds.
What is the evidence?
There is no evidence that crystal therapy is effective for any condition. The positive effects experienced by some patients are almost certainly due to expectation, relaxation or both.
Similarly, there is no evidence that the carrying or wearing of crystals is effective for any condition. If used as an alternative to life-saving treatments, crystal therapy would be life threatening, but there are no conceivable direct risks in this approach.
Conclusion
Crystal therapy is based on irrational, mystical concepts. There is no evidence that it is effective for any medical condition.
Cupping
A treatment that emerged independently in several cultures. A stimulus is applied to certain points of the body surface by attaching cups that generate suction.
Background
Cupping is an ancient treatment that has been practised in places such as China, Vietnam, the Balkans, Russia, Mexico and Iran. Essentially, the air in a glass cup is heated over a flame and the cup is then swiftly placed on the skin. As the air in the cup cools down, a vacuum develops which creates suction. This is visible as the skin and its underlying soft tissue are partly sucked into the cup. Sometimes the skin is lacerated beforehand, and the suction then draws blood from the cutaneous microcirculation. This form of cupping was popular in connection with blood letting in Europe.
In traditional Chinese medicine, cupping can be used as one of several ways of stimulating acupuncture points. Hence, Chinese cupping has the same underlying philosophy as acupuncture.
Cupping is used to treat a variety of conditions, such as musculoskeletal problems, asthma or eczema. Some practitioners even claim to treat conditions such as infertility, influenza and anaemia. Usually it is employed in combination with other therapies. The actual treatment lasts about 20 minutes and repeat sessions are usually advised. Cupping is practised by a range of alternative practitioners including naturopaths, acupuncturists and chiropractors.
What is the evidence?
The only controlled trial of cupping did not demonstrate the effectiveness of this therapy in reducing pain. However, the cupping procedure and its visible aspects (e.g. skin being sucked into the cup as if by ‘magic’) are likely to generate an above-average placebo response.
When handled correctly, there are few risks. On the other hand, the sucking action can leave typical round bruises which can last for several days. There was a very public demonstration of this in 2005, when the actress Gwyneth Paltrow attended a New York film premiere wearing a backless dress and showing dark bruises across her shoulders. Also, the bloodletting version of cupping carries the risk of infection.
Conclusion
Cupping has a long history but there is no evidence that it generates positive effects in any medical condition.
Detox
Detox or detoxification is the elimination of accumulated harmful substances from the body. In alternative medicine, an array of techniques is used for that purpose.
Background
Conventional detoxification has its established place in medicine, e.g. for eliminating poisons that have been ingested or injected. The term is also used for weaning addicts off drugs or alcohol. In alternative medicine, however, detox has been hijacked and has acquired a slightly different meaning. It is suggested that either the waste products of our normal metabolism accumulate in our body and make us ill, or that too much indulgence in unhealthy food and drink generates toxins which can only be eliminated by a wide range of alternative treatments.
Detox is often recommended after periods of over-indulgence, e.g. after the Christmas holiday. It is incessantly promoted by magazines and certain celebrities. In alternative medicine, detox can mean anything from a course of self-administered treatments to a week in the luxury of a health spa. The former, for example, might consist of a mixture of herbal and other supplements or several days of dieting, which costs just a few pounds. The latter, however, can cost a few hundred pounds.
What is the evidence?
The conventional form of detoxification can be life-saving. In alternative medicine, however, detox is a scam. Supporters of alternative detox have never demonstrated that their therapies are able to reduce levels of toxins. This would be very easy to achieve, e.g. by taking blood samples and measuring blood levels of certain toxins. In any case, the human body is well equipped with highly efficient organs (liver, kidney, skin) to eliminate ‘toxins’ due to over-indulgence. Drinking plenty of water, gentle exercise, resting and eating sensibly would rapidly normalize the body after a period of over-indulgence. An expensive detox is not required to achieve this aim.
Conclusion
Detox, as used in alternative medicine, is based on ill-conceived ideas about human physiology, metabolism, toxicology, etc. There is no evidence that it does any good and some treatments, such as chelation or colonic irrigation (see separate entries in this Rapid Guide), can be harmful. The only substance that is being removed from a patient is usually money.
Ear Candles
Thin, hollow structures of wax are inserted into the ear and subsequently ignited. This generates mild suction and is supposed to stimulate energy points.
Background
Allegedly, ear candles were used in China, Egypt, Tibet, by the Hopi Indians in America, and even in Atlantis!
Ear-candling entails placing a hollow candle into the ear of the patient and lighting the far end of the candle, which then burns slowly over about 15 minutes. Thereafter, the candle is extinguished and the content of the near end of the candle is usually displayed for inspection. Many therapists inform their patients that the remnant left behind at the end of treatment is ear wax, suggesting that it has been drawn out of the ear through the ‘chimney effect’ produced by the burning candle.
Ear-candling is used for the removal of ear wax and for the treatment of hay fever, headaches, sinusitis, rhinitis, colds, influenza and tinnitus. It is even claimed candling can lead to ‘sharpening of mental functioning, vision, hearing, smell, taste and colour sensation’.
What is the evidence?
There is no shortage of anecdotes published to promote the use of ear candles. However, a series of experiments concluded that ear candles do not eliminate any substance from the ear.
A study conducted in 1996 by Spokane Ear, Nose, and Throat Clinic in America showed that a burning candle does not produce any negative pressure at all, and that the deposit is, in fact, candle wax. Indeed, the same group of researchers also demonstrated that instead of removing ear wax, ear candles leave a deposit of wax in volunteers who, prior to the experiment, had no ear wax.
There is no evidence that candling is effective in the treatment of any of the other conditions mentioned above.
Ear candles are not free of risks: burns, occlusion of the ear canal and perforations of the eardrum are on record. There are also cases of house fires resulting from candling sessions.
Conclusion
Ear candles are based on the absurd idea that this method removes ear wax or toxins from the body; it is not supported by evidence.
Feldenkrais Method
A technique aimed at body and mind integration, based on the notion that correcting poor habits of movement will improve health.
Background
Moshe Feldenkrais (1904–1984) was a physicist and electro-engineer who suffered badly from chronic knee pain. No treatment he tried helped and he thus decided to develop his own cure.
The Feldenkrais method is based on the belief that body and spirit form a fundamental whole. The founder declared, ‘I believe that the unity of mind and body is an objective reality. They are not just parts somehow related to each other, but an inseparable whole while functioning.’ Feldenkrais published his first book outlining his philosophy in 1949 – Body and Mature Behavior: A Study of Anxiety, Sex, Gravitation and Learning.
The therapy is carried out in two steps: during the ‘functional integration’ phase, the practitioner uses touch to demonstrate to the patient techniques that improve breathing and body movement. During the subsequent ‘awareness through movement’ phase, the practitioner teaches the patient to correct so-called false movements.
The aim is to improve everyday functions. According to Feldenkrais, behaviour is not innate, but is merely acquired. False behaviour, he thought, was ‘a groove into which a person sinks never to leave unless some physical force makes him do so’. His treatment, he was convinced, provides that force.
The therapy consists of a series of sessions usually carried out in small groups. Once the lessons are learned, the patient has to practise continuously at home. The conditions treated include musculoskeletal problems, multiple sclerosis and psychosomatic problems.
What is the evidence?
Only about half a dozen rigorous clinical trials are currently available. Their results are far from uniform. Some, but not all, results suggest that the Feldenkrais method is useful for multiple sclerosis patients. For other conditions, the evidence is even less convincing. There are no conceivable serious risks.
Conclusion
The Feldenkrais method is not well researched, and there is currently no compelling evidence that it is effective for any condition.
Feng Shui
The Chinese art of placing objects in accordance with the theory of yin and yang in order to optimize the flow of life energy, which, in turn, is thought to influence health and wellbeing.
Background
Chinese medicine assumes that all health is governed by the flow of energy (Ch’i) and the balance of yin and yang within the body, but these concepts can also be applied to the things that surround us. Feng shui consultants give advice on the position of objects in an office or home. They may, for instance, place a screen in a certain position to make sure that the energy is travelling in the right direction, or they might advise their clients to reposition their beds so that they can benefit from the right energy flow while sleeping.
Feng shui is not biologically plausible, because its basic tenets make no sense in the context of modern science. The benefit some people experience after following the advice of feng shui consultants could be due to expectation and has no physiological basis, nor is it likely to last.
Feng shui consultants do not normally claim to cure diseases, but they say that their work can improve wellbeing and prevent ill-health. Increasingly, feng shui consultants are giving advice on how to deal with the health effects of electromagnetic fields in the home, even though there is no evidence that such fields are harmful. These consultants generally charge considerable amounts of money for their services.
What is the evidence?
It would not be difficult to test some of these claims, but as yet there have been no serious studies. However, informal tests comparing the judgements of feng shui consultants demonstrate significant conflicts over their interpretation of the energy flow in any given space, which implies that their advice is based on subjective imaginings.
Therefore all we can say is that there is no evidence to show that feng shui does anything but enrich those who promote it.
Conclusion
Feng shui is based on biologically implausible concepts and there is no evidence to show that it works. A competent interior designer can probably offer equally good, if not better, advice.
Food Supplements
Substances usually taken by mouth to increase the intake of vitamins, minerals, fats, amino-acids or other natural substances in order to maintain or improve health, fitness or wellbeing.
Background
Food supplements are a relatively new invention. At present, sales are booming. Regulation of food supplements varies nationally but, generally speaking, it is very lax. Manufacturers can sell supplements without providing proof that they do any good at all, and often without sufficient data on safety.
Medical claims are not normally allowed for food supplements. This does not, however, stop the industry from cleverly conveying the message that this or that supplement is effective for treating this or that condition. Health writers, books and the internet relentlessly target the consumer with exactly that aim.
What is the evidence?
It is obvious that not all food supplements are the same, as is the case with herbal supplements, which were discussed in detail in Chapter 5. Some are likely to be useful and are supported by evidence; others are either unproven or disproven, and many supplements carry risks of adverse effects. The dangers can be due to a supplement’s inherent properties, contamination (e.g. heavy metals), or adulteration (e.g. synthetic drugs). Also, it is likely that there are many adverse effects that are not known due to lack of research and under-reporting.
Fish-oil capsules, as discussed in Chapter 6, are an excellent example of an effective supplement, because they have been proved to reduce the risk of heart disease. They may also reduce inflammation, which might make them beneficial for rheumatoid arthritis and many other conditions.
Shark cartilage, also discussed in Chapter 6, is an example of a popular supplement which has been shown to be ineffective. Although it is probably harmless, it can distract patients from seeking more appropriate treatment and it is certainly damaging for the sharks who are victims of the supplement industry.
Vitamin B6 is an example of a supplement that can be harmful in large doses. It can result in nerve damage to the arms and legs. There are several reports of people reporting such complications having taken 500mg of B6 per day.
Conclusion
Food supplements are a very broad category – too broad to generalize. Some are undoubtedly helpful in certain situations. For many others, the effectiveness is uncertain or even disproven. Adverse effects can occur.
Hypnotherapy
The use of hypnosis, a trance-like state, for therapeutic purposes.
Background
Hypnotherapy has a long history – it can be traced back to ancient Egypt – but its modern development started in the eighteenth century with the work of the charismatic Viennese scientist Anton Mesmer. He was followed in the nineteenth century by the Scottish physician James Braid.
In recent years, hypnotherapy has become recognized in several areas of healthcare. Hypnotherapists treat a range of chronic conditions, including pain, anxiety, addictions and phobias. Hypnotherapy is practised by several healthcare professionals, including psychologists, counsellors and doctors. One session lasts 30–90 minutes and, depending on the condition and the responsiveness of the patient, 6–12 sessions are normally recommended. Autogenic training is a self-hypnotic technique, which, after some instruction, can be practised without the help of a therapist.
What is the evidence?
People who are suggestible generally respond best. Dozens of clinical trials show that hypnotherapy is effective in reducing pain, anxiety and the symptoms of irritable bowel syndrome. However, according to reliable reviews by the Cochrane Collaboration, it is not effective for smoking cessation, even though it is frequently promoted in this context. There is much less research for autogenic training, but the existing evidence is encouraging for anxiety, stress, hypertension, insomnia and some pain syndromes.
Hypnotherapy and autogenic training are relatively safe, but they should not be used by people with psychoses or other severe mental problems. With hypnotherapy, the recovery of repressed or false memories can create problems, and cases of false-memory syndrome (i.e. remembering distressing events which, in reality, have never occurred) have been reported.
Conclusion
The prudent use of hypnotherapy can be helpful for some patients. Whether this is a specific effect of the treatment or a non-specific (placebo) effect is difficult to say. Autogenic training has the added advantage of being an economical self-help approach that maximizes each patient’s own involvement. Neither treatment is associated with serious risks when applied correctly.
Leech Therapy
The application of live leeches to the skin in order to treat a range of illnesses.
Background
Hirudo medicinalis is a small, black, worm-like animal. It is capable of attaching itself to humans or animals, sucking substantial amounts of blood from the skin. During this process, it increases considerably in size and finally, when it is saturated with blood, it drops off.
Leeches were used for medicinal purposes in ancient Babylon, and in more recent centuries in Europe as a mode of bloodletting, as discussed in Chapter 1. Today their only use in conventional medicine is in plastic surgery: clinical trials show that applying leeches post-operatively improves the cosmetic results of some operations.
In alternative medicine, leeches are employed for a range of conditions. Some therapists believe that they eliminate toxins from the body; others use them to treat painful local conditions such as osteoarthritis.
While sucking blood, leeches inject pharmacologically active substances into the body. Initially they inject an anaesthetic substance which enables them to bite through the skin without causing pain. Subsequently they excrete a substance that prevents blood from clotting so that they can suck blood easily. This substance is called hirudoine and is a well-researched anticoagulant. It can now be synthesized and is used widely in mainstream medicine for its anticoagulation properties.
What is the evidence?
A German group recently published a series of clinical trials which suggested that the application of several leeches over the knee eases the pain of osteoarthritis. These studies still await independent replication.
All other claims of the alternative use of leech therapy are unsupported by evidence.
If done properly, there are few risks. Many patients, however, might feel uncomfortable about leech therapy, either because of the aesthetic aspects of the treatment or the fact that, after one session, the animals are usually destroyed.
Conclusion
Leeches have a long history of medical use. There is some evidence that their use is effective in reducing the pain of osteoarthritis of the knee. There is no evidence to support their use for any other treatment performed by an alternative therapist.
Magnet Therapy
The use of magnetic fields from static magnets, which are usually worn on the body, to treat various conditions, most frequently pain.
Background
Nowadays, rapidly fluctuating magnetic fields are employed in conventional medicine in hi-tech imaging instruments and for promoting the healing of bone fractures. However, alternative medicine tends to focus on the use of static magnets, which give rise to a permanent magnetic field.
Such static magnets have always attracted the interest of physicians, but the boom in magnet therapy began in Europe in the eighteenth century. Although static magnets fell out of favour as medicine progressed, a plethora of static magnets are today again popular within alternative medicine. Their use is promoted for many conditions, most frequently to alleviate chronic pain. These static magnets are worn as wrist bands, belts, leg wraps, shoe inlays, patches, etc. Magnetic mattresses or seat covers are also available. The magnetic strength of these devices varies between 10 and 1,000 Gauss. Static magnets can be purchased through numerous outlets and, more often than not, the consumer/patient would not have had any contact with a healthcare practitioner.
Subtle effects of magnetic fields are observable, for instance, on cell cultures. The question is whether these translate into any therapeutic benefit.
What is the evidence?
Most of the clinical research on static – meaning constant field strength rather than fluctuating strength – magnets relates to pain control. Researchers at Exeter University recently included nine placebo-controlled, randomized trials in a meta-analysis. The results do not support the use of static magnets for pain relief. For other problems, such as menstrual symptoms or varicose veins, the evidence is equally unconvincing.
Static magnets are unlikely to cause direct adverse effects. As they are usually self-administered, there is a danger of missing serious diagnoses and losing valuable time for early treatment of serious diseases.
Conclusion
Static magnets are popular, and the market is booming, but it is important to realize that there is no evidence that they offer any medical benefit, and indeed there is no reason why they ought to. There is more information about magnet therapy in Chapter 5.
Massage Therapy
The manipulation of the tissues close to the body surface (e.g. muscles and tendons) using pressure, traction and vibration.
Background
Massage is as old as medicine itself; indeed, it seems to be a human reflex to rub ourselves where we feel pain. Today many variations exist; for example, classical ‘Swedish’ massage focuses on muscular structures and is popular throughout Europe. Other forms of massage treatment include:
While many massage therapies are based on a sound understanding of anatomy, some rely on unproven and unlikely philosophies. These more exotic forms of massage therapies include shiatsu, craniosacral therapy and reflexology (which are all discussed elsewhere in this appendix), as well as polarity massage (balancing positive and negative energy), trigger-point massage (pressurizing trigger points aimed at reducing local pain or influencing the function of distant organs) and acupressure (pressurizing, rather than needling, acupuncture points).
Massage is practised by specialist massage therapists, physiotherapists, nurses, alternative practitioners of all types and other healthcare professionals. They aim to treat both physical problems (e.g. musculoskeletal pain) and psychological conditions (e.g. anxiety or depression).
What is the evidence?
There is encouraging evidence that massage is beneficial for some musculoskeletal problems, especially back pain, for anxiety and depression, and for constipation. It acts, possibly, by increasing local blood flow and releasing endorphins in the brain. Adverse effects are rare.
Conclusion
Generalizing is problematic, but massage is probably effective for some conditions and improves wellbeing in most patients. The more exotic forms of massage are generally unlikely to offer any extra benefit.
Meditation
A range of techniques that direct the subject’s attention to a symbol or sound or thought in order to achieve a higher state of consciousness.
Background
Most religions have developed techniques that bring about altered states of consciousness. They may include repeating a mantra or listening to one’s own rhythm of breathing. Such rituals can lead to a deep relaxation and mental detachment. This ‘relaxation response’ can also be used therapeutically for reducing stress, which, in turn, can bring about other health benefits such as lowering blood pressure or pain control. Meditation is normally taught in a series of sessions; subsequently patients who have mastered the technique are requested to practise on a daily basis.
During the meditative state, a range of physiological functions are altered. For example, respiratory rate and heart rate are slowed, and brain activity is reduced. Proponents of meditation claim to treat conditions such as anxiety, hypertension, asthma or drug dependency.
Certain forms of meditation (e.g. Transcendental Meditation) have strong religious associations and may be part of larger systems of beliefs and practices that patients may not feel is appropriate. For example, Hinduism is the most ancient religion to advocate meditation as a spiritual practice. ‘Mindfulness Meditation’ is an approach which has been developed purely for therapeutic purposes and does not raise such issues.
What is the evidence?
Research into meditation is scarce and often seriously flawed. Truly independent evaluations are rare. Nevertheless, it seems likely that meditation offers many of the benefits associated with relaxation. Some alternative therapists suggest that meditation can have a direct impact on serious conditions, such as cancer, but there is no evidence to support such claims.
Some reports suggest that mental illnesses can be exacerbated through meditation, so patients with such problems should not use it.
Conclusion
Meditation can be relaxing and thus increase wellbeing. In this way it can prove to be useful for many people. In the absence of mental illness, it seems to be a safe form of therapy.
Naturopathy
An approach to healthcare that uses exclusively natural remedies and forces like water, heat or cold to promote self-healing.
Background
This movement began in eighteenth-century Europe, where people such as the priest Sebastian Kneipp preached the value of curing disease with the means that nature has provided. Naturopaths are convinced of nature’s own healing power (vis medicatrix naturae), a gift that all living organisms are believed to possess. In their view, ill-health is the result of disregarding the simple rules of a healthy lifestyle. Therefore much emphasis is put on a good diet, regular exercise, sufficient sleep, etc. Once an illness occurs, naturopaths employ herbs, water cures, massage, heat, cold and other natural means to cure it.
Consulting a naturopath is not fundamentally different from seeing a conventional doctor, inasmuch as a diagnosis will be made by taking the patient’s history and a physical examination. The main difference lies in the nature of the prescriptions. Naturopaths do not prescribe synthetic drugs. Their treatment usually consists of several of the treatments mentioned above plus lifestyle advice. Naturopaths tend to treat chronic benign conditions such as arthritis, allergic conditions and headache.
What is the evidence?
Even though it would be feasible to test the effectiveness of the whole naturopathic approach, such trials are so far not available. However, much of the naturopathic approach is eminently valid (e.g., healthy diet, regular exercise). Similarly, certain herbal remedies are of proven value (see Chapter 5).
On the other hand, naturopathy can carry risks, particularly if it delays a patient with a serious condition from seeking urgent conventional treatment. Indeed, many naturopaths are against mainstream medicine and advise their patients accordingly – for instance, many are not in favour of vaccination. Also, some naturopathic treatments, such as particular herbal remedies, can carry risks.
Conclusion
Many lifestyle recommendations of naturopaths are valuable, but a general judgement about the wide variety of naturopathic treatments is not possible. Each naturopathic treatment must be critically assessed on its own merits, and it is likely to be covered elsewhere in this appendix. For any serious condition, naturopathy should not be seen as an alternative to conventional medicine.
Neural Therapy
The diagnostic and therapeutic approach of using injections with local anaesthetics for the identification of health problems, treatment of diseases and alleviation of symptoms.
Background
The brothers Ferdinand and Walter Huneke were German doctors who practised during the first half of the twentieth century. They made observations regarding the local anaesthetic Novocain which led them to become convinced that injecting this drug around a ‘field of disturbance’ (Störfeld) generates dramatic effects in other parts of the body. This, they postulated, has nothing to do with the pharmacological action of the local anaesthetic, but is mediated through the autonomic nervous system.
One key event, for instance, was when Huneke injected Novocain into the skin around a leg wound of a patient who then was cured of an old shoulder pain within seconds. This type of observation was coined Sekundenphänomen (phenomenon of a cure within seconds).
The brothers Huneke claimed the ‘fields of disturbance’, often old scars, injuries or sites of inflammation, can exert strong influences throughout the body which in turn can cause problems in distant body structures. Treating a particular problem may involve injecting Novocain or other local anaesthetics into one or two sites that may be ‘fields of disturbance’. When the correct site is located, the problem is cured.
Neural therapy is particularly popular in German-speaking countries. There are also many practitioners in the Spanish-speaking world, largely thanks to its promotion in the 1950s by a German-Spanish dentist called Ernesto Adler.
What is the evidence?
Injecting local anaesthetics into an area of pain will reduce that pain – but that is a predictable pharmacological effect and not what neural therapy is about. The concepts of neural therapy have little grounding in science, and the few clinical trials that exist have not produced any convincing evidence to support neural therapy. Occasionally, the local anaesthetic drug can cause adverse reactions, but such incidents are rare.
Conclusion
Although the injection of local anaesthetics as performed by many doctors can control pain, neural therapy is biologically implausible and is not backed up by sound evidence.
Orthomolecular Medicine
The use of substances in high and specific doses which are natural constituents of the human body for the prevention and treatment of a range of conditions, including serious diseases such as cancer.
Background
‘Orth’ means correct, and orthomolecular medicine (also known as optimum nutrition) means administering doses of vitamins, minerals and other natural substances at levels that have to be exactly right for the individual patient. Proponents of this approach believe that low levels of these substances cause chronic problems which go beyond straightforward mineral or vitamin deficiency. These problems include a tendency to suffer from infections such as the common cold, lack of energy or even cancer. This means each patient is initially assessed to determine precisely which substances he or she needs. Subsequently the ‘correct’ mixture is prescribed. The hallmarks of orthomolecular medicine are the extremely high doses that are usually suggested and the individualization of the prescription.
What is the evidence?
Some of the diagnostic methods that are being used for defining the right mixture of substances are not of proven validity. For instance, hair analysis is often employed, yet it generates spurious results in this context. The medicinal claims made are neither plausible nor supported by data from clinical trials. Thus there is no evidence that orthomolecular medicine is effective.
Proponents would strongly dispute this statement and refer to a plethora of studies that show the efficacy of vitamins. After all, vitamins are substances that are vital for humans – without them we cannot survive. However, our normal diet usually provides sufficient vitamins and the treatment of vitamin deficiencies is unrelated to the specific principles of orthomolecular medicine.
In excessive doses, vitamins can cause harm. Virtually all of these substances will cause adverse effects if grossly overdosed over prolonged periods of time – and this is precisely what is recommended by proponents of orthomolecular medicine.
Conclusion
The concepts of orthomolecular medicine are not biologically plausible and not supported by the results of rigorous clinical trials. These problems are compounded by the fact that orthomolecular medicine can cause harm and is often very expensive.
Osteopathy
A manual therapy involving a range of techniques, particularly mobilization of soft tissues, bones and joints. Osteopaths focus on the musculoskeletal system in treating health and disease.
Background
The American Andrew Taylor Still founded osteopathy in 1874 – around the time when chiropractic therapy (see Chapter 4) was created by D. D. Palmer. 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, as chiropractors tend to do. Therefore osteopathic interventions are burdened with less risk of injury.
In the US, doctors of osteopathy (DOs) are entirely mainstream and only rarely practise manual therapies. In the UK, osteopaths are regulated by statute but considered to be complementary/alternative practitioners. British osteopaths treat mostly musculoskeletal problems, but many also claim to treat other conditions such as asthma, ear infection and colic.
What is the evidence?
There is reasonably good evidence that the osteopathic approach of mobilization is as effective (or ineffective) as conventional treatments for back pain. For all other indications, the data are not conclusive. In particular, the overall conclusion from several clinical trials is that there is no good evidence to support the use of osteopathy in non-musculoskeletal conditions.
Because their techniques are generally much gentler than those of chiropractors, osteopaths cause adverse effects much less frequently. Nevertheless, 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.
Conclusion
The evidence that the osteopathic approach is effective for treating back pain is reasonably sound. If, however, you receive no significant benefit then be prepared to switch to physiotherapeutic exercise, which is backed by similar evidence and which can be done in groups and therefore is more cost-effective. There is no evidence to support osteopathy for the treatment of non-musculoskeletal conditions.
Oxygen Therapy
The direct or indirect application of oxygen (O2) or ozone (O3) to the human body to treat a range of conditions, including serious diseases such as cancer.
Background
Oxygen is essential for life and has many uses in conventional medicine. For instance, if the lungs are no longer capable of taking up sufficient amounts of oxygen, the patient may be given oxygen-enriched air to breathe.
In the context of alternative medicine, however, oxygen therapy is much more controversial. Alternative oxygen therapy is practised in a variety of ways, which differ according to the way in which oxygen is administered, the type of oxygen (e.g. ozone) administered or the conditions being treated.
There are many ways to administer oxygen. For example, it can be injected subcutaneously or a patient’s blood can be drawn, exposed to oxygen and re-injected into the body. Alternatively, oxygen-enriched air can be applied to the skin, or oxygen-enriched water can be used for colonic irrigation.
The range of conditions supposedly treated by oxygen therapy includes cancer, AIDS, infections, skin diseases, cardiovascular conditions, rheumatic problems and many other illnesses.
What is the evidence?
The fact that we all need oxygen for survival does not mean that more oxygen than normal is beneficial. In fact, it is not: there is plenty of evidence that too much oxygen can be harmful to patients. And, of course, ozone is well known for its extreme toxicity.
Some of the many forms of oxygen therapy have been tested in clinical trials. The results were not convincing and it is therefore safe to say that no type of alternative oxygen therapy is supported by sound evidence. Thus the potential risks clearly outweigh the documented benefits.
Conclusion
Oxygen has a wide variety of uses in conventional medicine, but its role in alternative medicine is based on biologically implausible theories. Therefore, alternative oxygen therapy is unproven and, worse still, potentially harmful. We recommend avoiding it.
Reflexology
A therapeutic technique applying manual pressure to the soles of the feet in order to treat or prevent illness.
Background
Manual massages of the feet are usually experienced as relaxing and it is therefore not surprising that they were used in various ancient cultures. But reflexology is different. It is based on assumptions by William Fitzgerald who, in the early twentieth century, postulated that the body is divided into ten vertical zones, each represented by part of the foot. Fitzgerald and his followers developed maps of the soles of the feet showing which areas correspond to which inner organs.
Reflexologists take a brief medical history and then manually investigate the foot. If they feel a resistance in one area they are likely to diagnose a problem with the corresponding organ. The therapy then consists of a high-pressure massage at this point, which is believed to repair the function of the troubled organ and ultimately to improve the patient’s health or prevent illness.
One session may last about half an hour, and a series of treatments may consist of ten or more sessions. In the absence of any health problems, many therapists recommend regular maintenance sessions for disease prevention.
What is the evidence?
The postulated reflex pathways between a certain area of the foot and an inner organ do not exist, and the notion that resistance in one area of the foot is a reliable indicator for a problem with a certain organ (e.g. kidney) is unfounded. Hence, the technique is not biologically plausible. Moreover, several different versions of reflexology maps exist – reflexologists cannot even agree among themselves how to apply the treatment. Clinical trials have shown that reflexology has no diagnostic value. Its effectiveness in treating certain health problems has been tested repeatedly. Even though the results have not been uniform, they generally do not demonstrate convincingly that this therapy is effective. There is also no evidence that regular reflexology might prevent diseases.
People with bone or joint conditions of the feet or lower legs might be harmed by the often forceful pressure applied during treatment. Otherwise no serious risks are known.
Conclusion
The notion that reflexology can be used to diagnose health problems has been disproved and there is no convincing evidence that it is effective for any condition. Reflexology is expensive, and it offers nothing more than could be achieved from a simple, relaxing foot massage.
Reiki
A system of spiritual healing or ‘energy’ medicine which is similar to the laying on of hands.
Background
Reiki healers believe in the existence of a universal energy which they can access in order to generate healing effects in humans, animals and plants. This universal energy flows through a reiki healer’s hands when he or she places the palms upon or close to the recipient. This allegedly enhances the recipient’s own healing potential.
Reiki is popular far beyond Japan, where it was developed in the early part of the twentieth century by Mikao Usui during a period of fasting and meditation on Mount Kurama. It is used for treating all medical conditions, for improving quality of life or for preventing disease.
The concepts of reiki are contrary to our understanding of the laws of nature. The approach therefore lacks biological plausibility.
A treatment session would normally involve the fully clothed patient lying down on a massage table. Then the healer may or may not touch the client while transmitting healing energy. A session may last for about an hour and most patients would experience it as intensely relaxing.
What is the evidence?
There are several clinical trials of reiki and some of their results seem to suggest that this approach is beneficial for a range of conditions. However, most of this research is seriously flawed. For instance, many of these unreliable studies compare patients who elected to receive reiki with others who had no treatment at all. Any positive outcome in such a trial is likely to be due to a placebo effect, or to the attention those patients receive, and not necessarily to the reiki intervention itself. A critical analysis of the existing evidence therefore fails to demonstrate that reiki is effective.
There is, of course, a danger that reiki is used in serious conditions as a replacement for effective treatments, particularly as reiki practitioners claim to help any type of patient. There are, however, no direct risks associated with this approach.
Conclusion
Reiki is a popular form of spiritual healing, but it has no basis in science. The trial evidence fails to show its effectiveness for any condition.
Relaxation Therapies
A range of therapeutic techniques which are specifically aimed at eliciting a ‘relaxation response’ in order to generate positive health effects.
Background
Patients experience many alternative therapies as relaxing, e.g. meditation, hypnotherapy, autogenic training, massage, reflexology. While these therapies generate relaxation as a welcome side-effect, other treatments are specifically designed to generate what is known as the ‘relaxation response’. This term describes a pattern of reactions of the autonomic nervous system producing relaxation of the body and the mind. It is reflected in changes of physiological parameters, such as reductions of brain activity, heart rate, blood pressure, muscle tension, etc.
Relaxation techniques such as progressive muscle relaxation, visualization or imagery are practised by many alternative health practitioners, doctors, nurses, psychologists, psychotherapists or sports therapists. They are used to treat a range of conditions, including anxiety, stress, headaches, musculoskeletal pain, or they are employed to enhance physical or mental performance. The techniques are usually taught in supervised sessions; once the patient is able to elicit a relaxation response, he or she is advised to practise regularly at home. This, of course, requires time and dedication.
What is the evidence?
The evidence for relaxation therapies is mixed, and depends particularly on the condition under consideration. Relaxation treatments are effective for reducing stress and anxiety. Encouraging evidence also exists for treating insomnia, hypertension and menopausal symptoms. Whether relaxation treatments are helpful for controlling pain is still controversial, and they do not seem to be effective for chronic fatigue syndrome, irritable bowel syndrome, dyspepsia and epilepsy.
For patients with schizophrenia or severe depression, relaxation might aggravate their problem. Otherwise there seem to be no serious risks.
Conclusion
Relaxation techniques are helpful for a range of conditions. They are appreciated by many, not least because they put patients in charge of their own health. There are no serious risks if used appropriately.
Shiatsu
A type of forceful massage therapy developed in Japan, consisting of the application of pressure on acupuncture points, usually with the thumbs.
Background
Shiatsu can be seen as the Japanese synthesis of acupuncture and massage. Literally it means finger (shi) pressure (atsu). It was founded by Tokujiro Namikoshi, who established the Japan Shiatsu College in 1940. At the age of seven, Namikoshi discovered the value of shiatsu when he treated his mother who suffered from rheumatoid arthritis.
The therapist typically uses his thumb to apply strong pressure on acupuncture points. Sometimes the palm of the hand or the elbow are also used. The treatment can be painful for the patient.
A shiatsu practitioner would start by making a diagnosis about the balance of the two life forces, yin and yang, so to some extent shiatsu is similar to traditional Chinese medicine. Depending on the findings, the practitioner would then apply pressure to points along yin or yang meridians. If the patient is diagnosed as having an excess of one, the therapist would tend to stimulate the other. By re-establishing balance, shiatsu practitioners believe they can treat many conditions.
As yin and yang, acupuncture points and meridians are not a reality, but merely the products of an ancient Chinese philosophy, shiatsu is an implausible medical intervention. However, like all massage techniques, it may generate relaxation and a sense of wellbeing.
What is the evidence?
There are virtually no clinical trials of shiatsu, but there is no reason to think that it is any more effective than a conventional massage.
Due to the high forces applied during treatment, injuries can occur. These range from bruises to bone fracture in the elderly with advanced osteoporosis. There are also reports of retinal and cerebral artery embolism associated with shiatsu massage applied to the neck or head.
Conclusion
Shiatsu is based on the biologically implausible theory of yin and yang. There is no evidence that it is effective for any specific conditions. Shiatsu massage therefore seems to be a waste of effort and expense, which offers nothing above conventional massage.
Spiritual Healing
The interaction between a healer and a patient for the purpose of improving health.
Background
Many different forms of spiritual healing exist: faith healing, intercessory prayer, reiki, therapeutic touch, psychic healing, Joheri healing, wart charming, etc. The common denominator is that healing ‘energy’ is channelled via the healer into the body of the patient. This ‘energy’ is supposed to enable the patient’s body to heal itself. The term ‘energy’ needs to be put in inverted commas because it certainly is not energy as understood by scientists, but rather it has a spiritual or religious basis. All attempts to detect or quantify it have so far failed.
Healers view themselves as instruments of a higher power with healing ability bestowed upon them from above. Most state that they have no idea how their treatment works, but are nevertheless convinced that it does. The patient on the receiving end often feels sensations of warmth or tingling as the ‘energy’ apparently enters the body.
Consulting a healer usually involves a short conversation about the nature of the problem. The healer then starts the healing ritual. Initially this can be diagnostic by nature. For instance, the healer’s hands may glide over the patient’s body to identify problem areas. Eventually the healing starts, and ‘energy’ is supposed to flow. Many patients experience this as extremely relaxing, while healers often feel drained after a session.
With other forms of spiritual healing, however, there is no personal contact between healer and patient. Sessions can be conducted at great distances, over the phone or the internet. Some healers offer their services for free, while others charge up to £100 for a half-hour session.
What is the evidence?
The concept of healing ‘energy’ is utterly implausible. Many clinical trials of various healing techniques are available. Some initially generated encouraging results, but about twenty of these studies are now suspected to be fraudulent. More recently, rigorous trials have emerged and shown that spiritual healing is associated with a large placebo effect – but with nothing more.
Conclusion
Spiritual healing is biologically implausible and its effects rely on a placebo response. At best it may offer comfort; at worst it can result in charlatans taking money from patients with serious conditions who require urgent conventional medicine.
Traditional Chinese Medicine
An ancient healing system which employs various treatments to restore the balance of Ch’i, the vital energy that governs health.
Background
According to Traditional Chinese Medicine (TCM), all ill-health is viewed as an energy imbalance or blockage, while optimal health is a state of perfect balance, often symbolized by the yin–yang image. The aim of any therapy must be to restore the balance or to prevent any imbalance in the first place. For this purpose, TCM offers a range of treatments, including herbal mixtures, acupuncture, cupping, massage and diet, which are all discussed in more detail elsewhere in this book. All conditions are said to be treatable with TCM.
A TCM consultation will involve diagnostic techniques, such as tongue and pulse diagnoses. Although these techniques are also part of conventional medicine, TCM practitioners make un reasonably ambitious claims about their diagnostic power. Treatment will be tailored to the individual. One session would typically last 30–60 minutes, and treatment can be long-term, if not for life.
What is the evidence?
The TCM system is complex and not easy to evaluate. Thus its various elements are usually tested separately (see acupuncture in Chapter 2, for instance). Chinese herbal medicines usually contain a multitude of herbs which are individualized according to the specific needs of every patient. This approach has recently been tested in cancer patients and shown to be no better than placebo in alleviating symptoms. In another rigorous study, Chinese herbal medicine was tested in patients with irritable bowel syndrome against a standardized herbal prescription and against a placebo. The results suggested that individualized treatment is better than placebo in controlling symptoms, but not better than a (much simpler) standardized herbal medicine.
Some individual herbs used in TCM (e.g. liquorice, ginger, ginkgo) undoubtedly have pharmacological effects; some have even provided the blueprint for modern drugs. On the other hand, some Chinese herbal medicines are toxic (Aristolchia) and others may interact with prescription drugs. Chinese ‘herbal’ preparations may also contain non-herbal ingredients (e.g. endangered animal species), contaminants (e.g. heavy metals) or adulterants (e.g. steroids).
Conclusion
TCM is difficult to evaluate. Some elements may be effective for some conditions, while other elements (e.g. cupping) are unlikely to offer any benefit above placebo. Many aspects of TCM are potentially harmful.