Sunday 20 August 2017

Alternative therapies: What's fact, what's fiction

How many times have you visited an acupuncturist because a colleague said it eliminated their back pain, or ingested a queer substance because you didn't fancy seeing your GP again that month? Alex Meehan on whether the different therapies we dabble in are safe for our health

Acupuncture
Acupuncture
Dr Ciara Kelly

Many of us have turned to an alternative medical practitioner at some point or another, whether it was for a bad back, allergies, trouble sleeping or even indigestion. But just how effective are these therapies, and are well-intentioned customers throwing good money after bad by using them?

The answer, according to medical science, would seem to be yes. But for many people their local acupuncturist, chiropractor or reiki healer is a valuable resource. So who do you believe, a friend who reports a great experience with a faith healer or a scientist who says there's no reliable evidence?

"Word of mouth is a very strong factor and people read a lot into it. The pitfall of course is just because someone tells you that something worked for them doesn't mean they are right," said Brian Hughes, professor of psychology at NUI Galway.

"Often because of the placebo effect people will feel better after a treatment than if they hadn't gone. But that doesn't mean the treatment worked."

A placebo is something that seems like a medical treatment but isn't. In experiments when people are secretly given inert tablets with no active ingredients, they often report an improvement in their condition anyway. This shows that belief in a treatment can have a real effect on whether it actually is effective.

Because of this people often ask 'what's the harm'? Surely if a person feels better after a treatment does it really matter if the therapy really works?

"The thing to remember is that the placebo effect can only go so far - it's largely superficial. If you have a pain or are fatigued then that might go away as a result of the placebo effect, but if you have a serious infection or an actual physical defect like a cancerous growth or inflammation, that's not going to be treatable by the placebo effect, it needs direct medical attention," said Hughes.

This is an opinion that Dr Ciara Kelly agrees with. The GP and Newstalk presenter believes that complementary therapies can have their place, but as it's an unregulated industry and patients need to be wary of the advice they're given.

"I've no problem with alternative therapies being used to complement medical treatment of patients, however over the course of my medical career, I have seen many occasions where very poor advice has been given by people who work in that area," she said.

"You have to remember that this area is entirely unregulated and that can be very bad for patients. Treating vulnerable people is a very responsible position to be in and it's my view that every person that does that - across the board whether they work in medicine or whether they work in an alternative area - should be properly trained, regulated and accountable.

"Otherwise it leaves people vulnerable to charlatans or simply ignorance."

One reason why people who have alternative treatments sometimes report an improvement in their conditions is 'regression to the mean', a statistical term that describes the fact that most people who are sick will get better on their own eventually, even if they do nothing about it.

Interestingly, people often seek out medical help when their symptoms are at their worst. Because of the life cycle of minor illnesses and injuries, this means that even if they didn't visit a doctor or therapist, they'd start to feel better soon anyway.

This improvement can combine with the placebo effect to make someone start to feel better soon after a treatment, which is then attributed to the therapy.

"Most alternative medical practices have been found to have no more effect than emotional support and none of them have been demonstrated to change the body in ways that make it well following an illness," said Hughes.

"When you talk to a neighbour or friend who swears by some therapy, you have to remember you're only hearing one person's point of view. That view can be skewed because it's a self-selecting sample. You're hearing from someone who more than likely found the therapy worked for them and as a result went back several times," he said. "You're not hearing from someone who didn't like it or for whom it didn't work."

To eliminate this kind of bias, when scientists want to test a new medical treatment or a new drug, they conduct double blind, randomised controlled trials. For example, in a group of 1,000 people, 500 are randomly selected to be given a treatment or drug and 500 are randomly selected to be given a placebo.

Neither the people administering the test nor the people receiving the treatment know who has the real treatment and who has the placebo. When the trial is over it's possible to say how effective the treatment is by comparing the control group with the real group.

"When you talk to a large number of people who have had a therapy over a course of time, you can develop a more statistically meaningful indication as to whether it works or not. That's been done for all these practices and the picture is very clear - these treatments don't work and don't have any more effect than short-term emotional support," said Hughes.

"There's value to be gained from all sorts of non-medical supports - everything from friendship and social networks to exercise and meditation can have a positive effect. But nobody would claim that these activities are changing the body medically the way a drug or surgery would.

"The issue with therapies like homeopathy is whether that's sufficient grounds to encourage their use. After all, alternative remedies aren't free - they're run as businesses and you have to pay for them," he said.

Ireland's favourite  therapies - what's the evidence?

Acupuncture

Acupuncture is based on traditional Chinese medicine and involves the insertion of needles into specific points on the body to alleviate pain or help treat medical conditions. Based on centuries' old ideas, the theory is that there is an energy force, termed Qi or Chi, that flows around the body and that ill health is caused by disruptions to that flow.

Inserting needles can help correct the flow of energy and as a result restore health. There is no scientific evidence to support this hypothesis and repeated studies have disproved the effectiveness of acupuncture.

Aromatherapy

Aromatherapy is the use of essential oils and plant-based materials to alter mood using pleasant smells. Oils can be inhaled, vapourised into the air, applied topically or used in massage. There is no evidence that aromatherapy works as a medical treatment but its use can be beneficial as a relaxation aid and in reducing anxiety.

Cognitive Behavioural Therapy (CBT)

Cognitive behavioural therapy is a type of psychotherapy which teaches people to recognise and reassess negative patterns of thought about the self and the world in order to alter unwanted behaviour, or treat mood disorders such as depression, anxiety and insomnia. CBT is scientifically recognised as being effective, and in the case of depression can be as successful as the use of antidepressant medication.

Homeopathy

Homeopathy is an alternative medicine created in 1796 on the theory that 'like cures like', that a substance which causes the symptoms of a disease in a healthy person can cure similar symptoms in sick people. Treatments typically involve using homeopathic preparations - extreme dilutions of substances in water or alcohol until there is almost no trace of the original substance left. Homeopathy is not supported by evidence.

Meditation/Mindfulness

Meditation is a combination of deep breathing, relaxation and turning the attention inwards while anchoring the attention in the present moment. Mindfulness is a similar practice, with a deeper emphasis on focusing on the here and now, discouraging practitioners from spending too much time dwelling on the past or anticipating the future. Both practices have been found to reduce stress, increase a sense of well-being and even improve creativity.

- Alex Meehan

Irish Independent

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