Do alternative therapies work?
I’ve already said elsewhere that I believe some complementary therapies are potentially useful. What about the rest…do they work?
Well, it depends what we mean by ‘work’. I don’t know who originally came up with the well-worn gag but it bears repeating:
Q: What do you call alternative medicine that works?
In other words, once it has been conclusively demonstrated that a therapy works, it becomes part of mainstream medicine.
No alternative remedy cures or prevents serious illness or injury. I know that not all practitioners claim that they do, but some certainly do make that claim and they are lying.
But if by ‘work’ we simply mean that they make us feel better – free from pain, energised, with a healthy appetite, perhaps getting to sleep quicker, it’s fair to say that for some people they do work as a placebo. Whether a patient’s recovery from their sore throat or headache is due to the placebo effect or whether they would have recovered exactly the same without taking anything, is anybody’s guess. But anyone who’s spent an hour talking about themselves to someone who really listens and seems to care, will know how much better you can feel as a result. If someone’s CAM remedy was prescribed after a session with a charismatic therapist who made them feel really, really special and, at the end of it, devised an ‘individualised’ remedy, my guess would be that their recovery is down to the placebo effect of the whole CAM package. The placebo effect is far more powerful than people realise.
It must be frustrating, for those who swear by one or other CAM therapies because ‘it works for them’, to find their faith challenged by people who, not being open-minded enough to try it themselves, are content to point to the lack of clinical evidence that they work. And how delighted they are if they discover that there are at least some trials that give positive results for their favourite brand of quackery. This is particularly true of homeopushers who love mentioning certain reviews such as Linde et al (1997) and Cucherat et al (2000) as being evidence that homeopathy has been scientifically proven.
Let’s look at the conclusions in those two studies:
The results of our meta-analysis are not compatible with the hypothesis that the clinical effects of homeopathy are completely due to placebo. However, we found insufficient evidence from these studies that homeopathy is clearly efficacious for any single clinical condition. Further research on homeopathy is warranted provided it is rigorous and systematic. Linde K, Clausius N, Ramirez G, Melchart D, Eitel F, Hedges LV, Jonas WB, 1997 (89 studies)
CONCLUSIONS: There is some evidence that homeopathic treatments are more effective than placebo; however, the strength of this evidence is low because of the low methodological quality of the trials. Studies of high methodological quality were more likely to be negative than the lower quality studies. Further high quality studies are needed to confirm these results. Cucherat M, Haugh MC, Gooch M, Boissel JP. 2000, (16 studies)
Linde’s follow up paper in 1999 concluded that,
in the study set investigated, there was clear evidence that studies with better methodological quality tended to yield less positive results…it seems, therefore, likely that our meta-analysis at least over-estimated the effects of homeopathic treatments.
There have been hundreds of trials of homeopathic remedies including many that show positive results. Invariably there are problems with these trials. There are numerous ways in which clinical trials can give false or ambiguous results and this is just as true for trials of conventional drugs as it is for CAM therapies. To be truly fair and produce results that can be considered reliable, clinical trials must be sufficiently large, they must be double-blinded and they must be properly randomised.
It’s incredibly easy, it seems, to get one or more of these factors wrong as the meta-analysis by Shang et al (2005) demonstrates. Starting with 110 homoeopathy trials and 110 matched conventional medicine trials, Shang ruthlessly excluded any trials that didn’t involve a sufficiently large number of participants and didn’t meet his high benchmark for quality i.e. decent blinding and proper randomisation. He ended up with a mere 8 trials for homeopathy and 6 for conventional medicine and they were unmatched i.e. the homeopathy trials were for different ailments than the conventional trials. This didn’t particularly matter as all the trials included a placebo control. The results on how the treatments compared against placebo gave very weak evidence for homeopathy and very strong evidence for conventional medicine and declared that,
This finding is compatible with the notion that the clinical effects of homoeopathy are placebo effects.
But the homeopushers don’t let such details bother them and leap at any opportunity to publicise the fact that there are lots of trials showing a positive benefit from homeopathy, thereby contributing to the impression that there is good scientific evidence for homeopathy.
But there isn’t.
If there were any benefits beyond placebo, this would have been proven overwhelmingly and conclusively by now. The best we have are many poor quality trials that show an effect slightly better than placebo. The only research left to do, as far as I’m aware, is on the homeopathic consultation i.e. a trial in which the value of having an hour long consultation with a therapist hanging on to your every word is compared to the typical rushed job you get with an NHS GP. I wonder why a big homeopathic pill company like Boiron (estimated to be worth $500 million) hasn’t offered to fund such a trial.
CAM therapy promoters display pronounced schizophrenic tendencies when it comes to science. They’ll happily quote any review they think supports them, without even reading it properly, while any that doesn’t is dismissed as being funded directly or indirectly by Big Pharma. They will applaud proper (i.e. medically qualified) doctors and nurses who lend an air of credibility to alternative therapies by offering them in addition to evidence-based ones. But they will sneer at the vast majority of health professionals who eschew or criticise them. Similarly, they’ll happily use sciencey-sounding but meaningless terms and phrases when talking about their therapies because they think it makes them sound all complicated and important.
However, on realising what evidence there is for homeopathy isn’t likely to fool all of the people all the time, they will earnestly explain how homeopathy does not lend itself to conventional clinical trials. Win-win from their perspective.
In fairness, there are many alternative therapies that have not yet been subjected to rigorous clinical testing. They may yet be found to work. In the meantime, use alternative remedies at your peril. The fact that a remedy is not being produced by Big Pharma or prescribed by a proper doctor of medicine but can be bought on the High Street or in a shopping mall, does not mean it’s harmless.
I recommend this website: What’s the harm?