The case against cure-alls
The Sydney Morning Herald
June 19, 2008

Edzard Ernst, the world's first professor of complementary medicine,
is on a mission. He wants people to know the truth about the "potions,
pills, needles, pummelling and energising" that make up the
multibillion-dollar global alternative medicine industry.

And the news is not good.

At a time when alternative therapies are rapidly growing in
popularity, promoted by princes, pop stars and more than 40 million
websites, the German-born British expert has a harsh conclusion.

"Millions of patients are wasting their money and risking their health
by turning towards a snake-oil industry."

Ernst, from the University of Exeter, started out a fan. Like many
European doctors he was trained in homeopathy and practised it for
many years. But his faith began to falter when he looked more closely
at research emerging in the 1990s on its lack of effectiveness.

For the last 15 years he has devoted his time to sifting the
scientific evidence on a plethora of complementary therapies and
remedies, to find out what works and what doesn't.

He has developed fake acupuncture needles which look and feel real to
the patient, so this ancient practice can be tested in controlled
clinical trials. And he has quizzed neurologists about unreported
cases of stroke and artery damage after neck manipulations by
chiropractors.

His detailed findings are presented in a new book, Trick Or Treatment?
Alternative Medicine On Trial, co-authored with a journalist, Simon
Singh.

It is a very timely tome, with the Federal Government considering a
toughening of requirements for Australia's $2 billion complementary
medicine industry to disclose the evidence it has about the efficacy
of its products. Tightening advertising rules and a new consumer
information website are options being considered to help people make
better informed health-care decisions.

Scientific research on alternative therapies in Australia has also
been boosted with the establishment last year of the National
Institute for Complementary Medicine, based at the University of
Western Sydney, as well as funding grants of more than $7 million this
year for three more collaborative centres and 13 new research
projects.

Many alternative practitioners develop excellent therapeutic
relationships with their patients, maximising the placebo effect, says
Ernst. And they have had few options in the past but to put their
faith in traditional usage and case studies to evaluate the benefits
of their therapies.

But he points out that since 2000, scientific studies have flooded in,
with more than 4000 clinical trials published this decade on
alternative medicine. "Now that the research is on the table we are in
a position to identify those therapies that genuinely help patients,
those that are pure quackery and those that lie somewhere in the
middle."

One of the biggest rip-offs is homeopathy, he says. A mountain of
evidence now shows it is "a bogus industry that offers patients
nothing more than a fantasy". Its basic premise - that like cures like
- has no biological basis, and its remedies are so dilute they are
unlikely to contain a single molecule of the therapeutic ingredient.

Some commonly sold remedies are so watered down it has been calculated
that consumers would have to swallow a pill with a diameter equal to
the distance from the Earth to the sun to get one molecule of
ingredient.

While no harm can come from these fake remedies, says Ernst, the risk
is that homeopaths may convince patients not to seek conventional
treatments or to avoid true medical marvels like immunisation.

Despite thousands of years of acupuncture practice in China, and a
decade of scientific research, there is also no good evidence to show
this therapy is better than a placebo for any conditions other than,
perhaps, some sorts of pain and nausea. High-quality trials of
acupuncture using sham telescopic needles are beginning to produce
results that could even overturn these positive findings.

The risks from acupuncture, such as infection or organ puncture, are
small. But this is not the case with chiropractic therapy. "The
dangers of chiropractic therapy can be serious and in some cases life
threatening," says Ernst, whose research in Britain identified 35
cases of injury after neck manipulation in a year, including nine
strokes, which otherwise would have gone unreported.

Chiropractic therapy is on a par with physiotherapy and osteopathy for
treating some back problems, but the last two are safer because they
take a gentler approach, he says. Additional claims by some
chiropractors that they can treat a range of other conditions, such as
asthma and period pain, are "beyond belief", the science shows.

Ernst says people too easily fall for the clever marketing ploy that
traditional medicines are better because they are natural. But natural
does not equate to safe, with evidence, for example, that the herb
ephedra, promoted as a slimming agent and still available over the
internet, caused severe reactions in at least 19,000 users around the
world, and killed more than 160 of them.

And it is a fallacy that conventional medicine will not readily accept
traditional remedies, he says. Fish oil to prevent heart disease and
St John's wort to treat mild depression are examples of treatments
that have emerged from traditional roots, been promoted by alternative
medicine and are now part of conventional medicine because of evidence
of their effectiveness.

Homeopathy, acupuncture, chiropractic therapy and herbal medicine are
all at the respectable end of the alternative medicine spectrum, says
Ernst. "It's shocking to think there are dozens of even more dubious
alternative therapies which make even more outlandish claims in order
to extract even more money from their patients."

The executive director of the Complementary Healthcare Council of
Australia, Wendy Morrow, says consumers in Australia can be confident
of the quality and safety of alternative medicines here because, like
pharmaceuticals, they are regulated by the Therapeutic Goods
Administration.

Most products are listed, rather than registered, which means they
cannot be recommended to treat serious illnesses such as high blood
pressure and cancer, although a company must have some evidence, for
example, from traditional use, for a product's claimed benefits.

Registered products require strong scientific evidence that they work.
And a proposal for a middle option - an optional green tick system to
identify alternative medicines for which there is some good evidence
they are effective - is being considered by the Government.

Dr Morrow says the council does not support this proposal, because
sponsors of a product can already apply for registration if they have
the evidence. "We believe it is unnecessary."

Controlled clinical trials are valuable, she says, but are "not the be
all and end all". She remains convinced that traditional use and case
studies are sufficient to establish efficacy.

Marc Cohen, a professor of complementary medicine at RMIT University
in Melbourne, also says there are problems in using scientific methods
to evaluate the work of natural therapists, many of whom provide a
valuable service of lifestyle counselling. "Most of the burden of
chronic disease is due to lifestyle factors."

There has not been a financial incentive, as with pharmaceuticals, for
alternative medicine practitioners to carry out clinical trials,
because they have not relied on patentable products. And analyses of
large numbers of studies, which Ernst relies on, only show what is
effective for most people, says Cohen. "Very few therapies work for
everyone."

But he believes there should be a government system of registration
for alternative practitioners, as for other health professionals, and
he supports the green tick idea. "There is a huge case for more
transparency, for consumers to have more information about the
products they buy."

The new funding for research is welcome, but Australia still lags

15 years behind the United States where more than $150 million is
being spent a year on complementary medicine research, Cohen says.

He also points out that Australians spend four times as much out of
their own pockets on alternative medicines as on pharmaceuticals.
"Obviously people vote with their wallets. So it's likely they do it
because they're receiving a benefit."

But it is not an argument that persuades Singh and Ernst. There are
many reasons why people believe in ineffective therapies, they say.
Conventional medicine was popular but got it wrong for thousands of
years, with deadly practices such as blood letting, until an evidence-
based approach exposed its failures.

It's time for alternative medicine to adopt the same standards, they
say. "If alternative practitioners are making unproven, disproven or
vastly exaggerated claims and if their treatments carry risks, then we
are being swindled at the expense of our own good health."

Trick Or Treatment? Alternative Medicine On Trial, Simon Singh and
Edzard Ernst (Bantam, $37.95).

This story was found at: http://www.smh.com.au/articles/2008/06/18/1213770732852.html

Copyright © 2008. The Sydney Morning Herald.