Complementary therapies: what works, what doesn't
Professor Edzard Ernst, chair of Complementary Medicine at the University of Exeter, looks at what a decade of scientific research into the weird and wonderful has achieved and predicts what the future may hold
Our original plan at the department of complementary medicine was to conduct as many clinical trials as possible. However studies are expensive and funding remains at a premium, so under the circumstances I think the fact that we have conducted about two dozen clinical trials is pretty good going. We have done a lot of systematic reviews and meta-analyses and have published about 70 papers1.
Much of the research into complementary and alternative medicine is published in languages other than English. Fortunately my team is very international so we are in an excellent position to conduct such reviews. Some of the more remarkable findings of the results and systematic reviews are summarised below.
In the last 10 years, the climate of the discussions on complementary and alternative medicine has changed considerably. Our main aim is to apply the rules of science to determine the efficacy and safety of complementary therapies. Initially this caused quite a stir and even today many enthusiasts believe that a treatment that has been around for hundreds of years must be safe and effective. But the majority now accept that neither safety nor efficacy can be assumed; it must be supported by hard evidence. This climate change is not just down to us of course, but I hope our work has contributed to it in a significant way.
In 2001 we published a book specifically to inform busy GPs about the evidence for or against complementary and alternative medicine3. It was very well received. We also created the first annual scientific meeting the Annual Symposium on Complementary Health Care4. For our tenth anniversary this year we will take it to London to accommodate the 400-odd delegates expected from around the globe.
I think it was Mark Twain who said predictions are awfully difficult, particularly about the future. Given this not insignificant caveat, I predict the following.
· As researchers establish that certain therapies do more good than harm for certain conditions, so complementary therapies will become more and more integrated into routine health care.
· Funding to do this research will become available both from professional complementary medicine organisations as well as major funding bodies.
· Europe (including the UK) will hold the lead it had in this area despite the US going into alternative therapy research with massive funding.
· Experts will agree that a large amount of psychological and sociological research into attitudes, expectations and the motives of complementary medicine users or providers does not directly advance patient care. They will then do the necessary clinical research
· Practitioners will no longer feel threatened by research. Instead they will realise that without it complementary medicine will go precisely nowhere.
· Both opponents and proponents will realise that we are all working towards the same thing: better health care.
'Positive' and 'negative' findings generated in last 10 years
There is good evidence to show:
· Acupuncture is safe
· Acupuncture is effective for back pain
· Autogenic training reduces stress
· Ginkgo biloba is effective for alleviating symptoms of dementia
· Hawthorn is effective for treating heart failure
· Kava is effective for reducing anxiety
· Massage therapy is effective for a range of conditions
· Yoga normalises cardiovascular risk factors
There is insufficient evidence to show:
· Bach Flower remedies are more than placebos
· Chelation therapy is effective for cardiovascular conditions
· Chiropractic is safe
· Chiropractic is effective for neck pain
· Homoeopathic remedies are more than placebos
· Iridology is a valid diagnostic method
· Milk thistle is an effective cancer therapy
· Spiritual healing is more than a placebo
· When complementary medicine is mentioned conventional scientists will lose that arrogant smile that indicates they don't for a minute take it seriously.
Edzard Ernst is chair of complementary medicine at the Universities of Exeter and Plymouth
1. A complete list of publications can be obtained from Julie Morgan via e-mail at Edzard.Ernst@pms.ac.uk)
2. A summary of our clinically orientated research entitled 'The Evidence So Far' is available at cost price of £20.00 from Nicola Watson (via e-mail at Nicola.Watson@pms.ac.uk).
3. (Ernst E, Pittler MH, Stevinson C, White AR. The desktop guide to complementary and alternative medicine. Edinburgh: Mosby, 2001. ISBN 0 7234 3207 4: www.harcourt-international.com