Research Database -
International Updates

DRUSS and ROSENHECK, Department of Psychiatry, Yale University, West Haven, Conn USA benjamin.druss@yale.edu. write that the terms alternative and complementary medicine suggest 2 contradictory possibilities, including the use of unconventional therapies as a substitute or as an "add on" to conventional medical treatments. The authors conducted a survey to study the association between the use of unconventional therapies and conventional medical care within a national sample within the US.
Methods: The 1996 Medical Expenditure Panel Survey was distributed to some 32,000 noninstitutionalised, civilian people. 24,676 individuals responded (77.7% response rate), and some 16,000 adults aged 18 years or older were included in the analysis. The main outcome measures were: visits to practitioners for unconventional therapies and conventional medical treatments, including the number of visits to inpatient, outpatient and emergency department, and the use of 8 types of preventive medical services – blood pressure, cholesterol level, physical examination, influenza vaccination, prostate examination, breast examination, mammography and Pap tests.
Results: In 1996, 6.5% of the US population visited both unconventional and conventional medical services. 1.8% used only unconventional services; 59.5% used only conventional care and 32.2% used neither. Compared with those individuals who used only conventional care, those people using both types of care had significantly more outpatient physician visits and used more of all types of preventive services except mammography. These groups did not significantly differ in their use of inpatient care, prescription drug use of number of visits to emergency departments. Those people in the top quartile of number of physician visits were more than twice as likely as those in the bottom quartile to have used unconventional therapies in the past year. This association between unconventional treatments and physician visits remained even after adjustments for potential confounders, and across differing types of unconventional treatments.
Conclusions: This survey demonstrated that use of unconventional therapies was substantially lower than has been reported in previous national surveys, but was associated with increased use of physician services. Hence, from a health services perspective, practitioner-based unconventional therapies appear to act more as a complement than an alternative to conventional medicine.
Druss BJ and Rosenheck RA. Association between use of unconventional therapies and conventional medical services. Jama 282(7): 651-6. 18 Aug 1999.

LAFRENIERE and colleagues, University of Windsor, Psychology Department, Ontario Canada lafrenl@uwindsor.ca. studied the effects of therapeutic touch (TT) upon biochemical indicators and moods in women.
Methods: The authors write that previous research has shown TT to be effective in reducing anxiety and discomfort and promoting relaxation. The authors recruited a sample of 41 healthy female volunteers, who were randomly assigned to either the experimental group who received TT, or to a control group who did not. Pre- and Post-test urine samples were collected, and personality and mood inventories were performed during three consecutive monthly sessions.
Results: Mood disturbance in the experimental group decreased significantly over the there sessions, whereas it increased over time in the control group. The experimental group participants demonstrated significant reductions in tension, confusion, and anxiety and a significant increase in vigour. TT produced a significant decrease in levels of nitric oxide in the experimental group by the third TT sessions.
Conclusions: The results of the above study may have important implications for reducing symptom distress in cancer patients undergoing chemotherapy.
Lafreniere KD et al. Effects of therapeutic touch on biochemical and mood indicators in women. The Journal of Alternative and Complementary Medicine 5(4): 367-70. Aug 1999.

Comments: Perhaps I lost the plot, but there appears to be a bit of a leap going from healthy women volunteers to cancer patients undergoing chemotherapy.

CAMPBELL, Royal London Homeopathic Hospital notes that homoeopathic writers frequently refer to classical homoeopathy, implying that this is the most complete and authoritative version of Hahnemann’s views, which the author claims do not correspond with the facts.
Discussion: Homoeopathy arrived in the USA early in the 19^th century and underwent considerable modifications by individuals deeply influenced by Swedenborg, He mentions that JT Kent is particularly important, and introduced ideas from other sources. The ‘extremist’ character of Kentian homoeopathy may largely explain the gulf separating homoeopathy from orthodox medicine until relatively recently. Kentian ideas, brought to the UK by Margaret Tyler early in the 20^th century to become dominant following the First World War, have given rise to what is called classical homoeopathy today. However, this is not only a considerable modification of Hahnemann’s teaching, but fails to take into account Hahnemann’s late ideas developed during his Paris years and incorporated into the sixth edition of The Organon, published posthumously in 1920.
Conclusions: The author states that whatever one’s opinion of the value of classical homoeopathy, it cannot be legitimately represented as a purely Hahnemannian teaching.
Campbell A. The origins of classical homoeopathy? Complementary Therapies in Medicine. 7(2): 76-82. Jun 1999.

ODA and colleagues, Department of Health and Physical Education and Research, Faculty of Education, Hokkaido University, Sapporo, Japan studied the effects of underwater exercise upon relaxation.
Methods: 8 healthy young men, aged 20-26 years were recruited to the study. The experiment consisted of 3 segments: 1) a pre-exercise period of 20 minutes, when the men rested in a semi-supine posture with eyes closed for the final 10 minutes; 2) an underwater exercise period of about 60 minutes, when the men performed gymnastic exercises or aerobic dancing with occasional movements or jumping; 3) a post-exercise rest period. The warm water was 34°. The authors compared the relative power values (power %) of the electroencephalogram alpha bands and profile of moods states (POMS) prior to and following the underwater exercise. The intensity of underwater exercise was ascertained from an estimate of the percentage of maximal heart rate (%HRmax) throughout the experiment.
Results: The %HRmax indicated that the intensity of underwater exercises practised ranged from low to moderate. Compared with the pre-exercise rest, the power % of EEG alpha bands increased significantly following the underwater exercise. The POMS data indicated that positive mood (vigour) increased and negative mood (tension and anxiety, depression and dejection) decreased significantly following the underwater exercise.
Conclusions: This study demonstrated that the subjects showed increased physiological and psychological indices of relaxation following underwater exercise.
Oda S et al. Relaxation effects in humans of underwater exercise of moderate intensity. European Journal of Applied Physiology and Occupational Physiology 80(4): 253-9. Sep 1999.

DATTA and colleagues, Kalyani University, Department of Zoology, India compared, in mice, the efficacy of Arsenicum Album 30C and 200C in protecting against genotoxic effects produced by Arsenic trioxide (As203) injection.
Methods: Healthy mice were injected intraperitoneally with a 0.004% solution of As203 (1 ml/100 gm body weight). Genotoxic effects were assessed through chromosome aberrations (CA), micronucleated erythrocytes (MNE) mitotic index (MI) and sperm head anomaly (SHA) studies. The authors maintained both positive (succussed alcohol-fed) and untreated negative controls. The As203 treated mice were divided into 3 subgroups, which were orally administered the drug 1) prior to; b) following and c)both prior to and following injection of As203 at specific intervals.
Results: Compared to respective controls, CA, MNE and SHA were reduced in the drug-fed series, and MI showed an apparent increase. The most effective in reducing the genotoxic effects of As203 was the combined pre- and post-feeding of Arsenicum album i200C, which was more effective than 30C.
Conclusions: Arsenicum album reduces the genotoxic effect of arsenic poisoning.
Datta S et al. Efficacy of a potentized homoeopathic drug (Arsenicum Album-30) in reducing genotoxic effects produced by arsenic trioxide in mice: comparative studies of pre-, post- and combined pre- and post-oral administration and comparative efficacy of two microdoses. Complementary Therapies in Medicine. 7(2): 62-75. Jun 1999.

SOMMER and colleagues, University of Basel, Health Economics and Social Policy Research Unit, Switzerland investigated the effects of including alternative medicine within the benefit package of health insurance in Switzerland.
Methods: The questions asked in this study included: 1) Are complementary medical services, paid for by a health insurer, used in addition to orthodox medical services, or instead of them; 2) If complementary medical services are included in the basic insurance cover, what are the effects upon costs?; 3) If Complementary medical services are included in the basic cover, what is the effect upon the policyholder's subjective state of health? The authors conducted a randomised experiment in which 7500 members of Switzerland's largest health insurer, Helvetia, were offered free supplementary insurance for alternative medicine for 3 years, having access to the full range of complementary treatments under their health insurance policy. The remaining 670,000 people formed the control group. The health insurer’s costs and benefits data were analysed to evaluate the effect upon costs. Additionally, a survey was conducted among random samples of people from the experimental and control groups using a Short-Form Health Survey (SF-36) to evaluate the effects of including complementary medicine upon subjective state of health.
Results: The analysis of the cost data demonstrated that the people used alternative in addition to orthodox medical services. Alternative medical treatments were used in combination with orthodox medical treatments; fewer than 1% of the experimental group used exclusively alternative medical services. Only a small percentage of experimental subjects (6.6%) took advantage of complementary medicine; hence no significant impact upon overall health costs could be inferred. However, multiple regression analysis showed that the use of complementary medicine had a greater effect upon treatment costs than sex, age or language region. There were no significant differences either at the beginning nor the end of the experiment between the treatment and control groups upon subjective state of health, nor did analysis reveal any effects upon subjects’ state of health because of the inclusion of complementary medicine within the basic insurance cover.
Sommer JH et al. A randomized experiment of the effects of including alternative medicine in the mandatory benefit package of health insurance funds in Switzerland. Complementary Therapies in Medicine. 7(2): 54-61. Jun 1999.

GRANT and colleagues, Liberton Hospital, Edinburgh, UK. d.j.grant@btinternet.com conducted a randomised clinical trial comparing acupuncture with transcutaneous electrical nerve stimulation (TENS).
Methods: 60 patients aged 60 and over who had been suffering from back pain for at least 6 months were recruited from GP referrals and randomised to 4 weeks of acupuncture (n = 32) or transcutaneous electrical nerve stimulation (TENS) (n = 28) treatment. All treatments were from the same physiotherapist. Outcome measures, measured at baseline, completion and at 30month follow-up were: 1) pain severity on a visual analogue scale (VAS); 2) pain subscale of Nottingham Health Profile (NHP); 3) the number of pain tablets taken in previous week; 4) spinal flexion from C7 to S1. Two patients withdrew from the acupuncture group, one from TENS.
Results: Between baseline and completion, there were significant improvements on VAS, NHP and tablet count in both groups. These improvements remained significant comparing baseline with follow-up with a further non-significant improvement in VAS and NHP in the acupuncture group. The acupuncture but not the TENS group showed a small yet statistically significant improvement in mean spinal flexion between baseline and completion; however this was not maintained at follow-up.
Conclusions: In these elderly patients with chronic back pain, both acupuncture and TENS showed demonstrable benefits outlasting the treatment period. Acupuncture may improve spinal flexion. However, this trial cannot exclude the possibility that both treatments are ‘placebos’.
Grant DJ et al. A randomized comparative trial of acupuncture versus transcutaneous electrical nerve stimulation for chronic back pain in the elderly. Pain 82(1): 9-13. Jul 1999.

RAO and colleagues, Roudebush Veterans Affairs Medical Center, Indiana University School of Medicine, and Regenstrief Institute for Health Care, Indianapolis 46202, USA write that people with chronic conditions commonly use complementary and alternative medicine (CAM). The authors conducted a telephone survey to identify and describe patients’ perspectives on the use of CAM for rheumatologic conditions.
Methods: 232 of 428 consecutive patients (54%) answered questions regarding use of CAM, functional status, pain, satisfaction with healthcare provider and use of health services. Reviews of charts provided demographic information and rheumatologic diagnoses. Bivariate analyses identified correlates of 4 CAM outcomes: 1) History; 2) Magnitude; 3) Frequency of CAM use and 4) Communication regarding CAM use with a physician. Multiple logistic regression identified independent correlates of regular CAM use.
Results: About two thirds (n = 146) of the patients had used CAM. Of the 146 respondents. 82 (56%) currently used CAM and 132 (90%) regularly used CAM or had done so in the past. 55 patients (24%) had used 3 or more types of CAM. Those individuals who used CAM regularly were more likely to have osteoarthritis (odds ratio (OR) = 5.6), severe pain (OR = 2.6) than those who had not. Almost 50% of the respondents discussed the use of CAM with their physicians. The most common reasons for not discussing Cam use were that the physician had not asked about it and the patient forgetting to tell the physician. Fear of disapproval was rarely given as a reason. Discussion between patients and physician occurred more frequently among patients with fibromyalgia and those who regularly used CAM or several forms of CAM.
Conclusions: Patients with rheumatologic conditions frequently use CAM. Severe pain and osteoarthritis predicted regular use of CAM but did not predict a likelihood of discussing CAM use with physicians.
Rao JK et al. Use of complementary therapies for arthritis among patients of rheumatologists. Annals of Internal Medicine 131(6): 409-16. 21 Sep 1999.

LI, Nanjing University of Traditional Chinese Medicine and Pharmacology writes that obesity manifests itself as derangement of qi and blood with disorder of the defensive qi in particular to be a causative factor of primary importance, with contributions from deficiency of the primary qi in Sanjiao.
Treatment Approach: Fundamentally the pathological changes of obesity are related to dysfunction of the spleen and stomach. According to syndrome differentiation, obesity is classified into 3 types: heat in the stomach and intestine; spleen and stomach qi deficiency; and deficiency of primary qi. The principal methods of treatment include clearing and reducing heat in the stomach and intestine; regulating qi in the fu organs; and promoting water metabolism; balancing and regulating qi and blood, yin and yang and removing stagnation of defensive qi.
Li J. Clinical experience in acupuncture treatment of obesity. Journal of Traditional Chinese Medicine. 19(1): 48-51. Mar 1999.

WYLIE and colleagues, Department of Neuropsychiatry, Bootham Park Hospital, York UK studied the efficacy of acupuncture and massage with relaxation upon chronic headache.
Methods: Patients with chronic headache were randomly assigned to either acupuncture or massage with relaxation instead of a change to their prescribed medication.
Results: There was a significant improvement in pain ratings in both treatment groups, but there was a greater effect seen in migraine patients treated by massage with relaxation compared with acupuncture. No psychological factors were found to predict response to either treatment. At the end of the study, 13% of patients were significantly more worried that there may be a more serious underlying cause for their headache, despite reassurance and improvement in their headache scores.
Wylie KR et al. Does psychological testing help to predict the response to acupuncture or massage/relaxation therapy in patients presenting to a general neurology clinic with headache? Journal of Traditional Chinese Medicine 17(2): 130-9. Jun 1997.

MEISTER and colleagues, Medizinische Klinik, Kantonsspital Glarus, Switzerland write that migraine and other functional disorders are common yet often difficult to treat, with alternative treatment modalities warranted and gaining more widespread acceptance. The authors studies the use of psychofonia, a new form of music therapy for the treatment of migraine.
Methods: With each patient, an individualised sound pattern is created based on their individual EEG using computer technology. The authors studied prospectively 55 migraine patients treated with EEG-based music therapy.
Results: 56% of patients showed improvement of at least 50% of symptoms following a12-month treatment period.
Conclusions: These data suggest that this form of music therapy is effective in treating migraine patients and should be studied in a prospective, randomised, controlled trial.
Meister M et al. Psychofonia – a neurophysiological music therapy in migraine. Schweizerische Rundschau faer Medizin Praxis 88(21): 946-9. 20 May 1999.

Comments: It is extremely interesting that such good results are being obtained for headache and migraine using such non-invasive therapies as massage/relaxation and music therapy. The next stage of these treatments is to enable a person to use these methods him or herself when they have a headache.

MANSOUR and colleagues, College of Nursing, University of Saskatchewan, Saskatoon, Canada. Mansour@duke.usask.ca write that Reiki is a popular alternative therapy, advocated as a precise method for connecting universal life energy with the body’s innate process of healing through hands-on techniques. Although Reiki research supports anecdotal records of reducing a variety of physical problems and improving psychospiritual well-being, there is an absence of randomised and placebo-controlled trials. The authors tested the standardisation procedures developed by their research team for placebo Reiki, prior to conducting a full-scale randomised and placebo-controlled Reiki efficacy study.
Methods: The design was a 4-round, crossover trial in which 20 blinded subjects (12 students, 4 breast cancer survivors and 4 observers) were exposed to a combination of 2 interventions (Reiki plus Reiki, or placebo plus placebo, or Reiki plus placebo, or placebo plus Reiki). Subjects were then asked to evaluate the interventions using a self-administered questionnaire. Blinded observers were used in round number 4. 2 real Reiki practitioners (Usui system) were chosen first, then 2 placebo practitioners who closely resembled them were recruited. The placebo practitioners were trained in Reiki by the study Reiki Master and the principal investigator, but were not initiated. The belief in Reiki is that only practitioners that are initiated can give Reiki, thus making it possible to have a placebo arm in efficacy studies.
Results: The data of the study demonstrate that the developed standardisation procedures were successful because none of the final participants in round 4 (4 breast cancer patients and 4 observers) could differentiate between the identity of placebo and Reiki practitioners. The qualitative comments expressed by the participants further confirmed the quantitative data.
Conclusions: The conclusions reached based on these findings was that it was safe to proceed and conduct the planned randomised 3-arm Reiki efficacy clinical trial. The authors recommend that those interested in Reiki research ought to incorporate their techniques to strengthen their designs by having a placebo arm.
Mansour AA et al. A study to test the effectiveness of placebo Reiki standardization procedures developed for a planned Reiki efficacy study. The Journal of Alternative and Complementary Medicine 5(2): 153-64. Apr 1999.

Kraft, Medizinische Universitats-Poliklinik Bonn, Germany writes that herbal medicinal products are very popular in Germany, with patients and physicians. However, very little tends to be known regarding the effects of drug law upon herbal products.
Results and Conclusions: The author elaborates upon the definition of herbal medicinal products, the importance of the terms quality, efficacy and safety, which products are available only at a pharmacy or in other stores. Terms including review procedure, authorisation procedure, registration and traditionally used herbal medicinal products are explained in detail. The author also discusses the special problems of non-European drugs with no marketing authorisation in Germany, and provides a short outlook for developments in Europe and worldwide.
Kraft K. Herbal medicine products and drug law. Forschende Komplementarmedizin 6(1): 19-23 Feb 1999.

Comments: Please also see Michael McIntyre’s comments in the Research Updates and Letters sections of Issue 44 (Sept ’99) regarding herbal medicines in the UK. He says in part "UK herbal practitioners are now engaged in the process of exploring statutory-self regulation with the Department of Health and there is a good chance that soon herbal practitioners like osteopaths and chiropractors will be state registered. This would mean that more powerful plant medicines could be restricted to those with adequate training to make use of them. This after all is the arrangement for orthodox drugs many of which are prescription only medicines, while many others remain freely available over-the-counter without prescription."

HOWARD, Bach Centre, Oxon UK reminisces about the different ‘types’ of people she met during her nursing career.
Personal Comments: She remembered constantly being aware of patients needing emotional help: those frightened about a forthcoming operation, those shocked and despairing following a difficult diagnosis and prognosis, others down in the dumps because they couldn’t go home as soon as they had hoped. There were the ‘ward clowns’ who tried to make everyone laugh with their good humour and little pranks, yet who felt no less anxious, worried or depressed than anyone else. She writes that patients seemed to fit into categories: the nervous one, the depressives, the jovial types, the moaners, those who demanded attention and those who shunned attention. She feels certain that every nurse has noticed the different ‘types’ of people who fill hospital beds – ordinary people who seem to take on a new persona as soon as they get into their pyjamas and become a ‘patient’. Somehow, their identity gets folded up and put away in their locker, along with their outdoor clothes and other reminders of the outside world.
Howard J. Bach Flower Remedies: a personal commentary on the work of Dr Edward Bach. Complementary Therapies in Nursing and Midwifery. 4(5): 148-9. Oct 1998.

PRICE, Shirley Price International College of Aromatherapy, Leicestershire, UK writes that as the use of aromatherapy within the health care setting has grown so rapidly recently, and continues to so do, the requirement for suitable training has become obvious.
Personal Comments: She writes that no health service can afford to risk employing staff using essential oils incorrectly on patients, especially if the essential oils used are not to a suitable standard for therapeutic use. She writes that training to an acceptable level in aromatic therapy is essential for safety and effectiveness, including knowledge of the nature of make-up of essential oils, their effects on the body and emotions, and how and where to apply them therapeutically. Additionally, contraindications for certain oils, patients, or treatments must be thoroughly understood, and the dosage used related to some extent to the standard of training undertaken.
Price S. Using essential oils in professional practice. Complementary Therapies in Nursing and Midwifery 4(5): 144-7. Oct 1998.

Comments: There is presently considerable activity ongoing within the aromatherapy profession devoted to the development of suitable training and standards for practitioners, as well as to the quality of essential oils.

GOODYEAR, LEWITH and LOW, School of Medicine, University Medicine, University of Southampton, UK write that homoeopathic "drug" pictures are developed by recording the symptomatic effects of homoeopathic remedies given to healthy volunteers, called a "proving". The authors conducted a double-blind randomised controlled trial to test the hypothesis that individuals using an infinitesimal dilution of Belladonna – thirtieth potency, C30 – would record more true symptoms.
Methods: The authors recruited 60 volunteers to the study; 47 completed data collection. A questionnaire was used, containing both true and false Belladonna proving symptoms, which was administered to the treatment and placebo groups.
Results: The authors were unable to distinguish between Belladonna C30 and placebo using their primary outcome measure. For the secondary outcome measure the authors analysed the number of individuals who proved to the remedy according to the predefined criteria. 4 out of 19 proved in the Belladonna C30 group and 1 out of 27 in the placebo group, which was not statistically significant.
Conclusions; This pilot study did not demonstrate a clear proving reaction for Belladonna C30 versus placebo; however it indicates how the question might be further investigated.Goodyear K, Lewith G et al. Randomized double-blind placebo-controlled trial of homoeopathic ‘proving’ for Belladonna C30. Journal of the Royal Society of Medicine 91(11): 579-82. Nov 1998.