A CONTEMPTUOUS editorial in the British Medical Journal in
1980 said
that alternative medicine 鈥渙ught to be as extinct as divination of the
future by
examination of a bird鈥檚 entrails鈥�. By 1993, however, the BMJ鈥檚
attitude
had softened, and it admitted that 鈥渃omplementary practitioners deserve credit鈥�
for the importance they placed on the quality of life and the subjective
symptoms of disease.
The medical establishment has been forced to recognise the benefits of
alternative medicine through the sheer number of people who use it and for whom
it works. In the US, visits to complementary therapists now outnumber those to
orthodox family doctors. In Britain, around five million people regularly use
alternative therapies, and the number of practitioners is increasing by an
estimated 10 per cent a year. 鈥淓ven many conventional doctors are becoming
receptive,鈥� says David King of the British Complementary Medicine Association.
鈥淪ome will refer patients [to alternative therapists] for particular conditions
if they find that conventional medicine has not helped.鈥�
Sales of herbal remedies have increased dramatically in recent years.
Disillusioned with conventional medicine and its perceived emphasis on
potentially dangerous drugs and high-tech interventions, people are turning to
acupuncture, osteopathy, herbalism and other 鈥渘atural鈥� treatments which, they
believe, are safe and free from side effects.
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Safety scares
However, two recent studies by Edzard Ernst, director of the Centre for
Complementary Health Studies at Exeter University and the world鈥檚 first
professor in the discipline, suggest that such beliefs may be misplaced
and that
some complementary medicines can indeed cause severe side effects (
Nature, vol 381 p 361). The first study, a poll of 386 readers of The
Guardian, found that 23 per cent had suffered adverse side effects from
manipulation, acupuncture, homeopathy or herbal remedies. The effects included
pain, fatigue and dizziness with manipulation treatments such as chiropractic
and osteopathy; aggravation, needle trauma and mental effects with acupuncture;
and digestive problems with homeopathy and herbal remedies.
In the second study, also by Ernst, a questionnaire was sent to every
general
practice in Devon and Cornwall. Of the GPs that replied, 38 per cent said they
knew of patients who had experienced problems with complementary medicine,
and a
few doctors reported cases of misdiagnosis by manipulation therapists that had
led to bone fractures or neurological damage.
Some alternative therapies have gone seriously wrong. A 40-year-old
woman was
killed in May last year when an acupuncture needle pierced her heart, and in
September a 32-year-old Nottingham man died after taking Chinese herbal
medicine. Other cases include a man who suffered a fatal stroke following
spinal
manipulation and two people who died from anaphylaxis鈥攁 catastrophic
allergic reaction鈥攁fter taking royal jelly. Serious, nonfatal adverse
effects have included miscarriages brought on by aromatherapy; autoimmune
disease and kidney or liver failure associated with herbal concoctions; and
dangerous interactions between patent remedies and prescription drugs.
However, hard statistics on the real risks of complementary medicine do not
exist because the complementary medicine business鈥攁part from osteopathy
and chiropractic鈥攊s largely unregulated. Anyone can set up in business as
a therapist, and no one knows how many are at work. 鈥淵ou could start a practice
without even having attended a training course,鈥� says Jo Barnes, a
researcher in
Ernst鈥檚 department at Exeter. 鈥淭his is worrying from a safety point of view. At
the basic level, any therapist should at least have knowledge about how
the body
飞辞谤办蝉.鈥�
Barnes believes that all alternative therapies should adopt the policy of
osteopathy and chiropractic, which are regulated by official,
government-recognised schemes. The General Osteopathic Council, for example,
runs a register of trained practitioners and sets standards of professional
conduct.
In other fields, therapists have set up their own 鈥渁pproved鈥� bodies, such as
the Traditional Acupuncture Society and the British Homeopathic Association, to
which most trained practitioners belong, but these organisations have no
control
over nonmembers. In the US, alternative practitioners are more strictly
regulated, and anyone offering therapies there is required to have a licence.
Some have been successfully prosecuted for operating without one.
The lack of control in Britain is one of the main criticisms levelled
against
complementary therapists by conventional doctors. Another is the reluctance of
therapists to subject their treatments to scientific trials. Indeed,
enthusiasts
and sceptics unwittingly conspire to keep complementary medicine untried.
Sceptics say it is too absurd to be worth scrutiny, while enthusiasts
claim that
because their treatments are tailored to individual patients, and are mostly
holistic, they cannot be fairly tested by conventional methods. Most treatments
are so ancient, they argue, that the risks of any unexpected side effects are
practically nil.
鈥淭his is nonsense,鈥� says Ernst. 鈥淵ou can鈥檛 assume that because something has
been used for centuries any bad effects would have shown up. It might have a
very rare but serious effect, which would not show up in a single
辫谤补肠迟颈迟颈辞苍别谤鈥檚
lifetime. And saying something cannot be tested by trials simply betrays
ignorance of the scientific method鈥攜ou can construct a trial to test
practically anything.鈥�
Ernst recently wrote to 200 German companies which produce nonlicensed
medicines asking them for information about the efficacy of their
products. Only
four returned reprints of published papers. Ernst himself is attempting to
carry
out trials of various therapies but finds himself endlessly frustrated. 鈥淥n a
dozen occasions we have set up trials with the cooperation of complementary
practitioners, only for them to withdraw when they realise there is a real
chance of the trial returning a negative result.鈥�
Legal minefield
In the absence of adequate efficacy and safety data, it is difficult to draw
up the regulations which critics say are so badly needed. Any hint of
legislation turns the area into a political minefield. When in 1994, for
example, the government announced it was going to license all herbal medicines
to comply with a European Union directive, a well-orchestrated campaign quashed
the idea in months. Faced with up to 2000 letters of protest every day,
ministers declared that Britain was, after all, in full compliance with
European
law on the issue.
At least 80 per cent of 鈥渘atural鈥� health products are marketed in Britain as
food supplements, and as such do not need medicinal product licences and do not
come under the scrutiny of the government鈥檚 Committee on the Safety of
Medicines. In any case, full licences may not be in the best interests of
either
manufacturers or consumers. It costs a minimum of 拢15 000 to license a
product and many small manufacturers would be unable to afford it. Their
products, many of them beneficial and safe, would either go underground or
disappear altogether.
But the absence of licences for such products means that some herbs and
dietary supplements are only found to contain toxic material after they go on
sale. Some of them are referred to the Traditional Remedies Surveillance
Project
based at the National Poisons Unit in London. Last year the project dealt with
more than 100 cases in which 鈥渘atural鈥� remedies were suspected of causing
adverse effects. This, according to project director Virginia Murray, is almost
certainly only a tiny proportion of the total.
鈥淲e know we are only scratching the surface,鈥� she says. 鈥淭his is a big
problem, and we think it must be getting worse because more of these products
come onto the market every year. We badly need to step up our surveillance, and
to take steps to get some of these remedies under some sort of control.鈥�
The surveillance project鈥檚 office at New Cross Hospital contains an
assortment of weird, homely and alarming concoctions. Murray produces a small
lump of brown, Plasticine-like material 鈥攁 Chinese herb ball. 鈥淲e found
mercury in that,鈥� she says. 鈥淣ot in a form that is easily absorbable, but
enough
to mount up and give you a serious case of poisoning.鈥�
The growth in exotic remedies makes the job of the surveillance project
especially difficult, because their ingredients are largely unknown in Western
Europe. Each batch may differ from the next, and many medicines are made up by
individual practitioners to their own recipes. Several people have died after
using Chinese herbs, and in Belgium and France 80 people needed kidney dialysis
after taking a Chinese slimming cure.
However, Murray is anxious that remedies based on systems of medicine other
than our own do not get a reputation as poisons. 鈥淲e are in no position to
judge
these things because we don鈥檛 understand how they work,鈥� she says. 鈥淲e do not
necessarily want to restrict them, but we do need to know what is in them.鈥�
Despite the widespread use of herbal and other complementary medicines,
government funding for research is minimal. The Ministry of Agriculture,
Fisheries and Food, which finances Murray鈥檚 project, has told her that no more
money will be forthcoming. So next March, when the original five-year plan
comes
to an end, the project will probably shut.
Unlike the 1994 threat to introduce licences for herbal remedies, its
closure
is unlikely to cause much of a stir. People will continue to buy exotic herbs
and flock to alternative therapists regardless of how untested or unregulated
they are. As Ernst suggests: 鈥淧erhaps people need a little magic in their
尘别诲颈肠颈苍别.鈥�
