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George Smith introduces a series on a growing phenomenon
Alternative medicine began to flourish at the end of the 1970s. Before then, therapies such as homeopathy, acupuncture, osteopathy and herbal medicine had dedicated adherents but were considered distinctly suspect and unconventional. In 1914 the General Medical Council issued a warning notice to newly qualified doctors, directing that there should be no associating with unqualified persons or collusion with therapists using conventional or alternative therapies without appropriate qualifications and registration with the GMC.
The 1980s saw mushrooming interest in and practice of alternative therapies with medical and nursing journals such as The Practitioner and Nursing Times devoting increasing space to them. The BMA and House of Lords commissioned various investigations. Although significant evidence for the efficacy and safety of such therapies did not emerge, official attitudes changed surprisingly. In 1991, Stephen Dorrell, Minister of Health, issued GP guidelines for the use of such therapies and relationships with alternative therapists.
Recent surveys suggest that almost half of the population in the UK use alternative therapies and over half of GPs practise or advise such treatments. Interest in alternative medicine has been closely paralleled with an interest in the New Age and Holistic Movement. Alternative medicine has been called its 'medical arm'.
The terminology has changed significantly over the years. When it was realised that alternative therapies could not replace conventional medicine, particularly in serious disease, 'alternative' gave way to 'complementary'. The term 'holistic' also became fashionable, implying treatment of the whole person (body, mind, emotions and spirit). At present 'Complementary and Alternative Medicine' (CAM) is generally being used but is now being superseded, particularly in the USA, by the term 'Integrative Medicine'.
Precise definition is very difficult. In the UK these therapies are described as 'those which are not widely used by orthodox medical professionals nor widely taught at undergraduate level in medical and paramedical courses'. A similar definition applies in the USA. However, these definitions are becoming blurred as an increasing variety of therapies are now being used in NHS primary care centres, wards and outpatient clinics. CAM falls broadly into three categories:
Conventional medicine is based on the facts of anatomy, physiology, biochemistry and pharmacology. Diagnosis depends upon symptoms, signs and scientific investigations such as blood tests and X-rays. The aim is to find a specific cause for the disease. Treatment aims to be evidence-based with a scientific evaluation of efficacy, dose and toxicity. Valid clinical trials are very important and law strictly regulates it. It is essentially non-spiritual.
Alternative medicine is based on healing systems or concepts, folklore and 'individual revelations'. It is frequently rooted in Eastern religion, mysticism or vital force/energy. The diagnosis is essentially non-scientific (except when the practitioner is medically qualified) and may involve divination, the occult, astrology, dowsing or pendulum swinging. Treatment aims to be holistic, and the 'healing power' often relates to energies within oneself. Essentially, it involves a spiritual dimension but the concept of 'God' is of a cosmic force rather than a personal Father God. It is largely not regulated by law.
The underlying aim of treatment is to achieve a balance in the flow of energy: different cultures and therapies give these different names. The ch'i of acupuncture with its two components (yin and yang, representing negative and positive energy) is the most widely known.
In assessing individual therapies, there are some suspicious phrases: life force, cosmic/vital energy, flow of energy, blocked channels, lines of force, meridians, chakras, potentisation and natural magnetism. No valid scientific evidence has been presented for the existence of meridians, energy centres or chakras.
Practical assessment of alternative therapies needs to be considered from both medical and Christian perspectives, applying checklists to each therapy.
Due to the admixture of techniques, rituals, medicines and belief systems involved in various therapies, it has been argued that standard forms of investigation and clinical trials (such as randomised controlled trials) cannot be applied to CAM. But what is the alternative?
In the first British University Department of CAM at Exeter, Professor Edzard Ernst and his colleagues evaluate clinical trials and correlate information by meta-analysis with meticulous care producing FACT, a quarterly journal, as well as holding a yearly international conference. Whilst investigations show varying degrees of promise, there is little conclusive evidence. When alternative therapies appear to work, this may be due to inaccurate diagnosis, natural remission, concurrent use of conventional treatments or to the placebo effect, when the patient may feel better without significant improvement in the pathological process. Professor Ernst believes that there is 'an astonishing and embarrassing lack of knowledge and information' on the subject of CAM, even that relating to the most fundamental question: 'Does CAM work and is it safe?'
A 1986 BMA investigation into CAM concluded that the evidence for efficacy was scanty. This view was reiterated in 1997 when Health Watch interviewed Professor J Howell, chairman of the BMA's Board of Science and Education. The careful review in Which? Guide to Complementary Therapy is prefaced by the warning, 'Many complementary practitioners are well aware that they still have to prove to the world that their therapies work'.
Investigation of individual therapies produces little convincing evidence for their effectiveness. There are a few apparent exceptions such as acupuncture for dental pain, nausea and vomiting as well as chiropractic and manipulative treatment for back pain. St John's Wort seems helpful for depression and Saw Palmetto may improve prostate enlargement but unwelcome side effects have been observed.
The popular view of CAM is that its therapies are advertised as being natural, safe, free from side effects and perhaps 'God given'. Complete safety is by no means assured. Some medicines (such as some Chinese herbal preparations and aromatic oils) have been demonstrated as having toxic properties, particularly on the liver. Physical complications such as pneumothorax may arise from acupuncture. Cerebrovascular accidents and neurological damage have been recorded following chiropractic and other manipulative therapies. Whilst these complications may be uncommon, a particularly worrying aspect is possible delay or incorrect diagnosis, especially if serious organic disease is missed and conventional treatment delayed. Tragedies do occur as a result. The 1997 Which? Guide states, 'Complementary medicine can be extremely harmful if used as a substitute for proper diagnosis and treatment'.
From a Christian perspective, there are other important considerations. Some therapies have roots that clearly arise from Eastern religious beliefs: for example, the acupuncture of Taoism and the yoga of Hinduism. Whether these roots are accepted as important is controversial but the Bible clearly teaches that roots are important: 'A good tree cannot bear bad fruit, and a bad tree cannot bear good fruit'. 8 Some Christian pastors and counsellors have observed 'spiritual ill health' (manifested as anxiety, depression, fear, lack of Christian assurance and interference with prayer life and Bible reading) in those who become involved with these therapies or therapists. There may also be evidence of demonic oppression.
A salutary note was sounded in the New England Journal of Medicine: 'It is time for the scientific community to stop giving alternative medicine a free ride. There cannot be two kinds of medicine - conventional and alternative. There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work. But assertions, speculation and testimonials do not substitute for evidence'.
Alternative medicine is a challenge to Christian doctors and other care providers. Rather than being prejudiced, we need to be informed about therapies that are so popular and about which we are often asked. We need to respond with truth, integrity and biblically based attitudes. Many of our patients are clutching at straws and we should be sensitive to this. Fundamentally, we need to ask whether there is a vacuum in our own practice of whole person care, a void that is being filled by alternative therapists and New Age practitioners. We are called to heal the sick and to preach the gospel: surely this is biblical holistic medicine!
'Finally brethren, whatsoever things are true, whatsoever things are honest, whatsoever things are just, whatsoever things are pure, whatsoever things are lovely, whatsoever things are of good report; if there be any virtue, and if there be any praise, think on these things…and the God of peace shall be with you.' (Philippians 4:8,9 KJV)