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Although the popularity of many complimentary therapies may be widespread, it is not
generally based on a broad understanding of what these therapies can offer. Complimentary
medicine seems to be largely taken on trust. Given its popular status, there is a somewhat
surprising and possibly troubling lack of research on the subject. To a large extent even
the most basic questions remain unanswered. Which complementary therapies are effective? Are
they as safe and natural as claimed? More complex issues are even more difficult to resolve.
Do complementary therapies promote health or prevent illness? Could they reduce medical
expenditure? Is there a "scientific basis" for their action?
Much more research into complementary therapies is
Different types of clinical trials, originally devised to test pharmaceutical drugs and
treatments in conventional medicine, are now being used to investigate complementary
therapies. A controlled clinical trial compares at least two groups of patients:
an experimental group that receives the treatment, and a control group that does not.
This does not necessarily determine whether a procedure or medication "works", however,
since any treatment, even taking a medical history, tends to have therapeutic effect. To
take this into account, the placebo controlled clinical trial was devised, in which
both groups are given seemingly identical treatments, but the treatment of the control
group is inactive (See Placebo Response). For the treatment to be
deemed to have worked, patients in the experimental group must perform significantly better
than those taking the placebo. Researchers also try to include as many people as possible
in the trial to balance out any personal factors, such as one patient being more ill than
another, and to reduce the likelihood of therapeutic benefits being attributed to chance.
Further risks of bias are ruled out by assigning patients at random into both groups, and
the randomized controlled trial has been the gold standard in scientific research
since the 1950s. Taking this one step further, the ultimate type of research trial is the
"randomized double-blind" study, in which neither the patient nor the practitioner knows
if the treatment is real or a placebo. The aim of this method is to ensure that nay
improvement in the treated group has not been influenced by individual attitudes, such as
a practitioner's strong belief in the efficacy of a treatment.
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Clinical trials are sometimes evaluated with what is known as a systematic review or
meta-analysis, in which the results of a number of trials are combined. Small trials
that remain inconclusive themselves may, when linked with trials that are designed better,
yield more significant results. In complementary medicine, there are few possibilities for
meta-analyses until more trials of therapies are available, but in the 1990s several reviews
of this type did produce evidence that homeopathic treatments, acupuncture and manipulative
therapies have clinical benefits.
There is little incentive for commercial funding of
The use of randomized controlled trials to investigate complementary therapies can be
problematic. Critics point out that randomization neglects a patient's right to choose,
and that the success of complementary therapies depends to a great degree on the knowledge,
skills, and attitude of the practitioners. In many cases - particularly for mind-, body-,
and movement-oriented therapies - treatment is more complex than a simple administration
of pills, and it can be hard to select a "blinded" control treatment. How do you give a
placebo massage, or even placebo acupuncture, not to mention placebo psychotherapy?
Clinical trials also contradict the desire of many patients to participate in the healing
process, a vital factor in many complementary therapies.
The Evidence & Research cited in the therapies and diagnostic sections:
is based on the best scientific research available: the 1,500 randomized controlled trials
(not all double-blind) on the database of the Research Council for Complementary Medicine
in the UK, which has worked with the Office of Alternative and Complementary Medicine of
the National Institutes of Health in the US. The findings suggest that some complementary
therapies can be analyzed in this way and may be clinically effective, but there is a lack
of research. Researchers in conventional medicine have yet to show great interest in
complementary medicine, nor have complimentary practitioners had much interest in research.
Much of the research so far has been by health care providers practicing complementary
therapies.
Unlike drug trials, funding for complementary medicine research is scant. Drug companies
are not likely to invest, since there are few financially attractive patents to acquire;
most herbal remedies, for example, have been in use for centuries. Nor do complementary
practitioners wanting to carry out research have the backing of universities, hospitals,
statisticians, and full-time research staff - all elements that create a research environment
for conventional medicine. As complementary therapies develop their own professional
bodies and academic groups, the facilities to carry out research will grow and coherent
programs will develop.
Ailments studied in conventional research may not be representative of those commonly
treated by complementary medicine. Postoperative nausea, for example, has been studied
because it can be easily gauged and a hospital-based researcher has access to a large
number of patients, but it is not a condition for which complimentary therapies are often
used. Chronic fatigue syndrome, on the other hand, is often helped by complementary
medicine, but is unlikely to be treated in hospitals and cannot be quantified easily.
It will always be difficult to make general statements about the efficacy of complementary
medicine, because therapies differ so much, and because so much depends on the approach
and skill of the practitioner. Even if a definite statement could be made about one
therapy, it might only apply to one condition; for example, a therapy shown to be effective
for irritable bowel syndrome may not be proved to work for any other ailment.
Adapting research conclusions into practical knowledge is also far from simple. For
example, a placebo controlled trial of homeopathy might find this therapy more effective
than a placebo for migraines, but it fails to indicate whether homeopathy would be more
effective than another approach for the same condition. There are scientifically rigorous
ways of researching complementary therapies that take account of individuality and
relationships, but they are often more complex than randomized controlled trials.
It is important to not that many conventional treatments - most surgery and physiotherapy,
for example - have never been subjected to clinical trials. Moreover, only a quarter of
studies reported in leading medical journals are estimated to be based on randomized
controlled trials. If complimentary and mainstream medicine are to integrate more closely,
and new approaches are to be evaluated, thorough research is needed, and a way to apply
clinical trials must be found.
Finding a scientific explanation for the principles behind many complementary therapies
is one of the most difficult issues. For example, there is no anatomical basis for the
existence of acupuncture meridian, nor a biochemical explanation of how homeopathic remedies
could work. Although the use of acupuncture in conventional pain management took a great
leap forward when it was discovered that endorphins (a body's natural opiate, a
morphine-like substance produced naturally by the body to relieve pain) could be released
during treatment, this kind of research depends on high technology, and there is limited
funding.
"If the present popularity of complementary medicine is to be more than yet another
passing fashion, it is essential to cultivate an atmosphere of constructive criticism,
informed debate, and balanced views... those who are inspired by an attitude of constructive
criticism will surely turn out to be the true champions of complementary medicine."
A placebo (from the Latin for "I will please") is an inactive medication or treatment given
to a patient in place of a genuine drug or medical technique. In clinical trials, new
treatments are tested against a placebo, which may be a sugar pill or meaningless procedure.
Because patients expect it to work, the placebo may have a therapeutic effect. This is in
fact the self-healing response, which conventional doctors often dismiss because placebos
are not an intervention. However, it is highly significant that, when given a placebo,
around 30% or people in clinical trials feel much improvement; some researchers say this
can rise to as much as 90%. The opposite also appears to be true - patients receiving
insensitive treatment from practitioners often feel worse - a "nocebo" effect. How a
treatment is given, by whom, and in what setting, is clearly important, but little is
understood about the physical and psychological processes involved. All treatments,
however, particularly surgical procedures, do have a large placebo component. Immune
system research has shown how patients' expectations and feelings can influence healing
processes, and the mind/body relationship in all illness, especially long-term disease,
has a major effect on the outcome of health problems.
needed. Some conventional research methods, however, are not
ideally suited to evaluating the benefits of these therapies
because they do not take into account the patient's participation
in the healing process.
research into herbal medicine due to the lack of profitable
patents to acquire, since many plant remedies have been used
for hundreds of years and are widely available.
Touch & Movement Therapies
by Professor Edzard Ernst of the University of Exeter; UK: Complementary
Medicine: An Objective Appraisal
An Explanation of Holistic Medicine
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