Is alternative medicine just a load of hocus pocus?

The recent death of a student using Chinese herbal medicine has reignited controversy over alternative therapies. With little regulation and scant evidence of effectiveness, are users risking their health?
Ling Wang, a 25-year-old PhD student, died after taking Chinese herbal medicine to treat a stomach upset and skin rash.

An inquest last month heard that Ling, from Newcastle, fell into a coma and died shortly after taking the medicine in tea or pill form last August.

One in five Britons uses some kind of complementary therapy, according to an ICM poll, but the industry is largely unregulated and there's little or no evidence that many of the therapies work.

In fact, only osteopathy and chiropractic therapy are covered by regulations insisting that practitioners be qualified with a relevant body.


Other types of practitioners may be registered with a representative body. But Ian Cambury-Smith of the Prince's Foundation for Integrated Health says: "Although many of these are ethically sound, there are so many of them that it can be confusing, and standards vary."

The government is considering regulating for herbal medicine, traditional Chinese medicine and acupuncture.

This summer, a Complementary and Natural Healthcare Council will start work.

It's a single body that will cover a range of therapies, ensuring its members meet certain criteria and will be governed by a code of ethics.

So in the event of something going wrong, you can make a complaint.

"However, it's voluntary, so a therapist can still practise even if they're not registered," says Ian Cambury-Smith.

"And it has nothing to do with effectiveness, so there's no guarantee that the therapy will help you. But it will help people feel reassured that its practitioners are reputable."

Here we look at the safety of, and the evidence behind, the most popular therapies...

Chinese herbal medicine

Chinese herbs - as teas, pills or creams - are used for a variety of conditions.

The evidence: Some research has found that certain herbal blends could have a benefit.

For example, a study at the Chinese University of Hong Kong found that a concoction of herbs could help ease eczema.

But it's crucial that you visit a reputable practitioner as some medicines have been found to contain banned substances that could have serious side-effects.

Research at King's College Hospital, London, analysed 11 Chinese herbal creams prescribed for eczema and found that eight contained powerful steroids.

For a reputable practitioner contact the register of Chinese Herbal Medicine: www. rchm.co.uk.

Homeopathy

Homeopaths claim to be able to treat a wide variety of physical and emotional conditions by treating "like with like".

They believe a substance that in large doses produces the symptoms of a disease will, in small doses, cure it. So it is diluted until little of is left in the remedy, the idea being that dilution enhances its positive effects and removes the negative ones.

For example, urtica urens from the stinging nettle is used for treating skin rashes.

The evidence: In 2005 an analysis of several major homeopathy trials published in The Lancet showed that homeopathic remedies had no more effect than a placebo.

Sarah Buckingham of the British Homeopathic Association claims that the analysis was flawed. She said: "Most independent scientific observers would regard The Lancet paper as inconclusive."

But Edzard Ernst, professor of complementary medicine at the University of Exeter, agrees there's no evidence the remedies work.

"Homeopaths tend to be gentle, understanding people.

In my view, it's this care and attention that helps people feel better," he says.

Chiropractic and osteopathy

Both use spinal manipulation, aiming to detect and treat problems with the joints, muscles, ligaments and tendons.

"The type of manipulation varies between therapies, and chiro-practors are trained to take X-rays while osteopaths aren't," says Leicester chiropractor Tim Hutchful.

The evidence: A large trial found that spinal manipulation could be effective for low back pain. Both osteopathy and chiropractic are widely accepted by the medical profession, with doctors frequently referring patients.

And both are regulated, which means it's illegal for a practitioner to work without a licence.

But Prof Ernst has some concerns.

"Neck manipulation could be dangerous and has been linked with problems such as stroke. I would advise against letting a practitioner touch your neck," he says.

Tim Hutchful disagrees: "Canadian research found people who visit a chiropractor were no more likely to have a stroke than those visiting a doctor," he says.

Visit the British Chiropractic Association at chiropractic-uk.co.uk; or the general osteopathic council at osteopathy.org.uk

Acupuncture

An ancient Chinese treatment, acupuncture involves inserting fine needles into specific points on the body. The idea is that stimulation of these points can ease illness by rebalancing the body's "energies".

The evidence: German research last year found that acupuncture was more effective than conventional treatment for easing lowerback pain.

"Evidence shows it may work for some conditions, including osteoarthritis and morning sickness," says Prof Ernst.

"What we don't fully understand is how - there isn't evidence to support the theory that it brings "energies" into balance."

Acupuncturist Persis Tamboly stresses the importance of seeing a qualified practitioner.

"Acupuncture can be dangerous if someone isn't properly trained," she says.

Visit the British Acupuncture Council at www.acupuncture.org.uk

Applied kinesiology

It uses muscle-strength testing to diagnose dysfunction or imbalance in the body's organs - it's thought this can show up as weakness in the corresponding muscle. Practitioners also claim to be able to diagnose allergies or intolerances. Treatment might involve manual muscle stimulation and diet changes.

The evidence: Last year, research published in the journal Chiropractic and Osteopathy found there was little to support the theory that AK can diagnose - some studies found muscle responses were random, while there was no evidence to show diagnoses were any better than guesswork.

Visit the British Complementary Medicine association: www.bcma.co.uk

SAFETY FIRST

If you decide to visit a complementary or alternative practitioner, you should always inform your GP, especially if you have a condition or are on medication.

REAL LIFE STORIES

"I had a baby after I had acupuncture"

Helen Branch, 36, became pregnant with Emily, now eight weeks, after a course of acupuncture.

"I first conceived in 2004, in the first month of trying," says Helen, from South-east London.

"But there were complications - at 30 weeks I had to have an emergency caesarean. Our baby, Max, died two months later."

About a year after that, Helen became pregnant again.

"I thought everything was fine but when I went for my 12-week scan they told me I'd lost the baby. A few months later, I got pregnant again but had a miscarriage. At that point, I hit a real low."

Inspired by friends who'd had healthy pregnancies after acupuncture, Helen began treatment every two weeks.

According to a German study, it can significantly improve the chances of pregnancy and some orthodox fertility experts, including Harley Street midwife Zita West, use acupuncture in their practices.

"The therapist did a lot of work bringing energy back into the area where I'd had the caesarean."

Six months on, Helen was pregnant.

"I continued to have acupuncture through my pregnancy. I felt very positive all the way along, and had a beautiful, healthy baby," she says.

"I really believe it was acupuncture that made a difference. It rebalanced me physically but it also helped me emotionally."

"I had a stroke after neck treatment"

Ten years ago, Frances Denoon, now 38, sought help for a stiff neck from a chiropractor in Bristol.

"My GP agreed it could be a good idea, so I found a registered practitioner,' says the mum-of-one.

In the first two sessions, Frances felt reassured that the practitioner took a detailed history and gave her an X-ray. But on her third visit, he performed a technique called a high-velocity thrust on her neck.

"Suddenly I was unable to focus and felt pain. But he didn't seem too worried and left me lying on the couch."

Eventually, though, Frances began being sick and the chiropractor called an ambulance.

"At the hospital, MRI scans showed that I'd had a stroke caused by a vertebral artery dissection and doctors said it was induced by the manipulation."

Frances lapsed into a coma and was in hospital for two months.

"I made a good recovery but even now I have some weakness in my right side. Afterwards, I started to feel angry. I engaged a solicitor and built up a case against the practitioner but he was cleared because, despite what the doctor had said, it couldn't be proven that he'd been negligent.

"I started a support group, chirovictims.org.uk, for people who believe they've been injured in any way by treatment I'm concerned about neck manipulation and think people should be aware of the risks I'd thought it was a harmless treatment but it nearly killed me."