Alternative therapies: an expert's view

Alternative therapies: an expert's view

Tuesday February 15, 2005
The Guardian

Osteopathy
What is it?
Manual therapy frequently involving spinal mobilisation for musculoskeletal problems, such as back pain

Ernst's verdict
Does it work?
The most authoritative review is inconclusive as to the benefit for back pain compared with other treatments available for this condition

Is it safe?
Less adverse effects than chiropractic due to a gentler technique.

Conclusion
The benefit of osteopathy is not well-documented. Its risks seem to be less than those for chiropractic

Massage therapy
What is it?
Manipulation of the soft tissues on the body surface using pressure and traction

Ernst's verdict
Does it work?
Massage is effective for conditions such as constipation, back pain, anxiety, depression and stress

Is it safe?
Although not entirely devoid of risks, serious adverse effects are very rare

Conclusion
For a range of conditions the benefits of massage outweigh its risk

Yoga
What is it?
A practice from India including muscular stretching, breathing exercises and meditation

Ernst's verdict
Does it work?
There is good evidence to show that yoga enhances general health and reduces cardiovascular risks

Is it safe?
When practised prudently, there is little evidence of risk

Conclusion
Regular yoga exercises can do more good than harm for general health, eg for cardiovascular health

Herbal medicine
What is it?
The use of plants or parts of plants or extracts thereof for medicinal purposes

Ernst's verdict
Does it work?
Yes. Many studies show that certain herbal medicines are effective in treating certain conditions (eg St John's wort for depression). Whether the UK traditional herbalists' approach of prescribing individualised herbal mixtures to patients is effective is far less certain

Is it safe?
Some herbal medicines are toxic or they interact with synthetic drugs. Many, however, seem to be quite safe

Conclusion
For some herbal remedies the benefit clearly outweighs its risks. For many others, the evidence is insufficient. Whether the benefits of treatments by UK traditional herbalists outweigh the risks is not certain

Chiropractic
What is it?
Manual therapy frequently involving spinal manipulation (often using extreme movements of the spinal joints) for musculoskeletal problems, such as back pain

Ernst's verdict
Does it work?
The most authoritative review of the evidence concludes that "there is no evidence that spinal manipulative therapy is superior to other standard treatments for patients with acute or chronic low back pain"

Is it safe?
Serious adverse events, such as stroke (sometimes fatal) are regularly reported. Chiropractors insist that they are rare but the evidence to support this claim is not conclusive

Conclusion
The documented benefits of chiropractic do not seem to outweigh its potential risks

Aromatherapy
What is it?
Use of essential oils from plants for medicinal purposes, usually with application through gentle massage

Ernst's verdict
Does it work?
Studies show relaxing effects which are probably short-lived but can be helpful in supportive care for seriously ill patients, such as cancer sufferers

Is it safe?
Some people may develop allergies against essential oils but otherwise there are few risks

Conclusion
Likely to be useful in palliative medicine and supportive care

Homeopathy
What is it?
Homeopaths use highly diluted remedies according to the "like cures like" principle - ie they would use a remedy which causes headaches in order to cure a headache

Ernst's verdict
Does it work?
The evidence is very conflicting. One summary concluded that the effects of homeopathy are not totally due to placebo. But many subsequent reviews of the trial data were far less optimistic

Is it safe?
Being very dilute, homeopathic remedies have few side-effects but homeopaths expect an aggravation of patients' symptoms in about 20% of all cases

Conclusion
The benefits of homeopathy are by no means undisputed. There are, however, few serious risks

Reflexology
What is it?
Manual therapy of applying pressure to specific areas, usually on the sole of the foot, in order to influence the function of distant organs

Ernst's verdict
Does it work?
Even though several encouraging studies, on balance, the totality of the data does not strongly support the effectiveness of reflexology

Is it safe?
No serious adverse effects conceivable from treatment with reflexology

Conclusion
Apart from a short-lived relaxing effect, the benefits of reflexology are not well-documented. However, the treatment seems to be safe

Acupuncture
What is it?
Part of traditional Chinese medicine involving insertion of needles in acupuncture points on the skin. Originally aimed at balancing "life forces" but science offers neurophysiological theories for its mode of action

Ernst's verdict
Does it work?
Not as a cure-all, but for some conditions there is evidence that it works (eg nausea, knee osteoarthritis)

Is it safe?
Serious adverse events on record but rare. Minor problems occur in 7-11% of all patients

Conclusion
For some, benefits outweigh the risks

Hypnotherapy
What is it?
The induction of a trance-like state for therapeutic purposes

Ernst's verdict
Does it work?
Hypnotherapy is effective for conditions such as anxiety, insomnia, pain and hypertension

Is it safe?
Recovering repressed memories can cause problems and so can the "false memory syndrome"

Conclusion
Hypnotherapy is effective for a range of conditions but not always entirely free of risks

Nutritional therapy
What is it?
A very broad spectrum of treating medical conditions through modification of diet

Ernst's verdict
Does it work?
Some diets clearly work and are standard conventional therapies. Whether "alternative" diets (eg Gerson diet for cancer) are effective is doubtful

Is it safe?
Extreme diets lead to malnutrition, which can be serious, even fatal

Conclusion
No good evidence that "alternative" diets do more good than harm

Shiatsu
What is it?
A type of acupressure used in Japan where acupuncture points are stimulated by external pressure, usually applied manually by the therapist

Ernst's verdict
Does it work?
There are very few studies and therefore its effectiveness is not proven

Is it safe?
Few serious adverse effects are on record

Conclusion
There is no evidence for benefit and thus the risk-benefit balance is not positive

· Edzard Ernst is professor of complementary medicine at the Peninsula Medical School at the Universities of Exeter and Plymouth