Research Database -
International Updates

Alternative Medicine/
Complementary Therapies

Issue 57

ASTIN, HARKNESS and ERNST, University of Maryland School of Medicine, Baltimore, USA. jastin@compmed.ummc.umaryland.edu conducted a systematic review (52 references) of the efficacy of any form of distant healing as treatment for any medical condition.
Methods: Studies of prayer, mental healing, Therapeutic Touch, or spiritual healing were identified by a search of MEDLINE, Psychlitt, EMBASE, CISCOM and Cochrane electronic databases from their inception to the end of 1999 and by contact with researchers in the field. Studies with the following features were included: random assignment, placebo or other adequate control, publication in peer-reviewed journals, clinical investigations, and use of human participants. Two investigators independently extracted data on study design, sample size, type of intervention, type of control, direction of effect and nature of the outcomes. A total of 23 trials involving 2774 patients met the inclusion criteria and were analysed. Heterogeneity of the studies precluded a formal meta-analysis. Of the trials, 5 examined prayer as the distant healing intervention, 11 assessed non-contact Therapeutic Touch, and 7 examined other forms of distant healing.
Results: Of the 23 studies, 13 (57%) yielded statistically significant treatment effects, 9 showed no effect over control interventions, and 1 showed a negative effect.
Conclusions: The methodological limitations of several studies make it difficult to draw definitive conclusions about the efficacy of distant healing. However, given that approximately 57% of trials showed a positive treatment effect, the evidence thus far merits further study.
Astin JA et al. The efficacy of "distant healing": a systematic review of randomized trials. Annals of Internal Medicine 132(11): 903-10. Jun 2000.

LEE, GEORGIOU and RAAB, Department of Food Science and Human Nutrition, Iowa State University, Ames, USA examined the perceived knowledge and attitudes of dietitians regarding the effectiveness and safety of functional foods, nutrient supplements, and herbs.
Methods: A questionnaire was developed and face-validated after a focus group discussion. A geographically stratified, random sample of 202 dietitians licensed in Oregon (LDs) was surveyed by mail; usable data were collected from 162 LDs (80%). The data were analysed statistically.
Results: LDs considered themselves to be knowledgeable of functional foods and nutrient supplements. More than 80% were confident of the effectiveness of functional foods and nutrient supplements for prevention of illness and treatment of chronic illness, and at least 89% were confident of their safety for these uses. Fewer than 75% considered herbs to be safe and only about 50% were confident of the effectiveness of herbs. Only 10% or fewer LDs considered themselves to be knowledgeable about herbs for prevention and treatment of illness. Interest in training about each of these less-traditional nutrition therapies was high.
Conclusions: Oregon LDs consider themselves to be actively practising in the area of complementary medicine and have a strong desire for further training. The dietetics profession can capitalize on this interest by taking the lead in training dietitians about the role of functional foods, nutrient supplements, and herbs in health.
Lee YK et al. The knowledge, attitudes, and practices of dietitians licensed in Oregon regarding functional foods, nutrient supplements, and herbs as complementary medicine. Journal of American Dietetic Association 100(5): 543-8. May 2000.

Comment: In view of these dietitians' poor knowledge and attitude regarding herbs, it is worrying that the authors are recommending LDs to taking a leading role in the prescribing of herbs for health-related problems.

OLDENDICK and colleagues, South Carolina Complementary Medicine Program Baseline Research Team. Institute of Public Affairs, the Department of Epidemiology and Biostatistics, School of Public Health, University of South Carolina, Columbia 29208, USA conducted a population-based survey of complementary and alternative medication usage, patient satisfaction and physician involvement.
Background: With an increasing proportion of Americans using complementary or alternative medicine (CAM), physicians need to know which patients are using CAM to effectively manage care.
Methods: In this cross-sectional study, telephone interviews were conducted with 1,584 South Carolina adults (ages 18 and older); 66% responded to the survey of demographics, general health, frequency of CAM use, perceived CAM effectiveness, and physician knowledge of CAM use.
Results: A total of 44% had used a CAM during the past year. Increasing age and higher education were significantly associated with CAM use. More than 60% perceived CAM therapy as very effective and 89% said they would recommend CAM to others. Physicians were unaware of CAM use in 57% of their patients using CAM.
Conclusions: CAM use in this rural Southern state is similar to national usage. Users view CAM as effective. Physicians are frequently unaware of patients' CAM use. More research is needed to establish CAM effectiveness and how CAM affects medical care, training, and public health.
Oldendick R et al. Population-based survey of complementary and alternative medicine usage, patient satisfaction, and physician involvement. Southern Medical Journal 93(4): 375-81. Apr 2000.

TREGUT and colleagues Zentrale Radiologische Abteilung, Stauferklinik Schwabisch Gmund, Mutlangen, Deutschland investigated whether corona electrography of Kirlian photography is an accidental pattern or an individual specific discharge pattern.
Methods: 30 patients suffering from a various diseases were enrolled. At intervals of 10-15 min 10 Kirlian photos of all fingers and toes were taken from each patient. From 8 patients, 4 Kirlian photos were selected, each with evident similarity of the discharge radiographs of 3 fingers. These images were scanned for mathematical procedures, and heuristic measurements of the histograms were evaluated by a genetic algorithm.
Results: Three pattern groups showed different heuristic measurements: accidental pattern 0.28 ± 0.01, Kirlian pattern in general 0.3 ± 0.02, and Kirlian pattern of the same person 0.44 ± 0.05.
Conclusions: The mathematical objectivation of the Kirlian photographs confirm the visual impression of strong similarity. Because of the lack of anatomical irregularities and since, due to new positioning, physical and chemical surface characteristics were changed in the single Kirlian photographs, the identification of the basic pattern stresses the existence of an individual discharge pattern and thus of an individual electromagnetic field.
Treugut H et al. Kirlian photography: accidental or person-specific pattern? Forschende Komplementarmedizin 7(1): 12-6. Feb 2000.

Comments: These fascinating results may form part of the evidence supporting many tenets of energy medicine.

Issue 56

BLOOM and colleagues, University of Pennsylvania, USA performed an evaluation of randomized controlled trials on complementary and alternative medicine.
Background: The use of complementary and alternative medicine (CAM) is growing in all Western countries. The aim of this study was to evaluate the quality of randomized controlled trials (RCTs) for CAM interventions for specific diagnoses to assist informed clinical decision making.
Methods: MEDLINE and related databases were searched for CAM RCTs. A visual review was performed of bibliographies, meta-analyses, and CAM journals. Inclusion criteria for review and scoring were blinded RCT, specified diagnosis and intervention, complete study published between January 1, 1966 and July 31, 1998 in an English-language, peer-reviewed journal. Two reviewers independently scored each study.
Results: More than 5,000 trials were found, but only 258 met all study inclusion criteria. The main cause for rejection (> 90%) was that the study was not a RCT or had no blinding. The mean score across 95 diagnosis/intervention categories was 44.7 (S.D. +/- 14.3) on a 100-point scale. Ordinary least-squares regression found date of publication, biostatistician as author or consultant, published in one of five widely read English-language medical journals and diagnosis/intervention category of hypertension/relaxation as significant predictors of higher scores.
Conclusions: The overall quality of evidence for CAM RCTs is poor but is improving slowly over time. This is comparable to that of biomedicine. Thus, most clinical decision making is provided without good evidence of benefit.
Bloom BS et al. Evaluation of randomized controlled trials on complementary and alternative medicine. International Journal of Technology Assessment in Health Care 16(1): 13-21. Winter 2000.

HEMMINGS and colleagues, Division of Sport Studies, University College Northampton, United Kingdom set out to describe the effects of massage on the performance of athletes.
Background: Despite massage being widely used by athletes, there is little scientific evidence to confirm the efficacy of massage for promoting physiological and psychological effects during and after exercise.
Methods: The aim of the authors was to investigate the effect of massage on perceived recovery and blood lactate removal, and also to examine massage effects on repeated boxing performance. Eight amateur boxers completed two performances on a boxing ergometer on two occasions in a counterbalanced design. Boxers completed performance one, after which they received a massage or passive rest intervention. Each boxer then gave perceived recovery ratings before completing a second performance, which was a repeated simulation of the first. Heart rates and blood lactate and glucose levels were also assessed before, during, and after all performances.
Results: A repeated measures analysis of variance showed no significant group differences for either performance, although a main effect was found showing a decrease in punching force from performance one to performance two (p<0.05). A Wilcoxon matched pairs test showed that the massage intervention significantly increased perceptions of recovery (p<0.01) compared with the passive rest intervention. A doubly multivariate multiple analysis of variance showed no differences in blood lactate or glucose following massage or passive rest interventions, although the blood lactate concentration after the second performance was significantly higher following massage (p<0.05).
Conclusions: These findings provide some support for the psychological benefits of massage, but raise questions about the benefit of massage for physiological restoration and repeated sports performance.
Hemmings B et al. Effects of massage on physiological restoration, perceived recovery, and repeated sports performance. British Journal of Sports Medicine 34(2): 109-14. Apr 2000.

HUHTALA and colleagues, Department of Pediatrics, Turku University Hospital, Turku, Finland. virpi.susanna.huhtala@utu.fi conducted a clinical trial comparing infant massage with a crib vibrator for colic.
Methods: Colicky infants of less than 7 weeks of age were randomly assigned to an infant massage group (n = 28) or a crib vibrator group (n = 30). Treatments were recommended three times daily. Parents recorded infant crying and number of treatments given in a structured cry diary that was kept for one week before (baseline) and for three weeks during the treatments. Parents were interviewed after the first and third weeks of intervention to obtain their evaluation of the effectiveness of the given treatment.
Results: At baseline, the mean amount of total crying was 3.6 ±1.4 hours/day in the massage group and 4.2 ±2.0 hours/day in the vibrator group. The mean amount of colicky crying was 2.1± 1.1 hours/day and 2.9 ±1.5 hours/day, respectively. The mean number of daily intervention periods was 2.2 in both groups. The amount of total and colicky crying decreased significantly in both groups: 48% (massage) and 47% (vibrator), and colicky crying decreased by 64% and 52%, respectively. The amount of other crying (total crying minus colicky crying) remained stable in both groups during the treatment period. Ninety-three percent of the parents in both groups reported that colic symptoms decreased over the 3-week treatment period with 61% of the parents in the massage group and 63% of the parents in the crib vibrator group perceiving the 3-week treatment period as colic reducing.
Conclusions: Infant massage was comparable to the use of a crib vibrator in reducing crying in colicky infants. The authors suggest that the decrease of total and colicky crying in the present study reflects more the natural course of early infant crying and colic than a specific effect of the massage or crib vibrator.
Huhtala V et al. Infant massage compared with crib vibrator in the treatment of colicky infants. Pediatrics 105(6): E84. Jun 2000.

PITTLER and colleagues, Department of Complementary Medicine, School of Postgraduate Medicine and Health Sciences, University of Exeter, Exeter, United Kingdom. MHPittler@exeter.ac.uk systematically investigated the location bias in controlled clinical trials of complementary and alternative medicine.
Background: The authors set out to systematically investigate location bias of controlled clinical trials in complementary and alternative medicine (CAM).
Methods: Literature searches were performed to identify systematic reviews and meta-analyses, which were used to retrieve controlled clinical trials. Trials were categorized by whether they appeared in CAM or mainstream medical (MM) journals, their direction of outcome, methodological quality, and sample size.
Results: 351 trials were analysed. A predominance of positive trials was seen in non-impact factor CAM and MM journals, (58) / (78) (74%) and (76) / (102) (75%) respectively, and also in low impact factor CAM and MM journals. In high impact factor MM journals there were equal numbers of positive and negative trials, a distribution significantly different from all other journal categories (P < 0.05). Quality scores were significantly lower for positive than negative trials in non-impact factor CAM journals (P < 0.02). A similar trend was seen in low-impact factor CAM journals, but this was not statistically significant. There were no significant differences between the quality scores of positive and negative trials published in MM journals, except for high impact factor journals, in which positive trials had significantly lower scores than negative trials (P = 0.048). There was no difference between positive and negative trials in any category in terms of sample size.
Conclusions: More positive than negative trials of complementary therapies are published, except in high-impact factor MM journals. In non-impact factor CAM journals positive studies were of poorer methodological quality than the corresponding negative studies. This was not the case in MM journals that published on a wider range of therapies, except in those with high impact factors. Thus location of trials in terms of journal type and impact factor should be taken into account when the literature on complementary therapies is being examined.
Pittler MH et al. Location bias in controlled clinical trials of complementary/ alternative therapies. Journal of Clinical Epidemiology 53(5): 485-9. May 2000.

RESCH, ERNST and GARROW, Forschungsinstitute fur Balneologie und Kuortwissenschaft, Bad Elster, Germany conducted a clinical trial of reviewer bias against an unconventional medicine.
Background: The study was designed to test the hypothesis that experts who review papers for publications are prejudiced against unconventional therapies.
Methods: Two versions of a 'short report' (A and B) were produced concerning the treatment of obesity. Reports A and B were identical except for the nature of the invention with version A related to a conventional treatment and version B to an unconventional treatment. Three hundred and ninety-eight reviewers were randomized to receive one or other of the reviews for peer review. The primary outcome measures were the reviewers rating of importance (scale1-5) and their verdict regarding rejection or acceptance of the paper.
Results: The overall response rate was 41% and 141 assessment forms were suitable for statistical analysis. There was a statistically significant difference in favour of the orthodox version with an odds ratio of 3.01 (95% confidence interval, 1.03 to 8.25). The medians and interquartile ranges measured on the visual analogue scale mirrored this result with of 67% (51%-78.5%) for version A and 57% (29.7%-72.6%) for version B.
Conclusions: Reviewers showed a significant albeit small bias in favour of the orthodox paper and therefore authors of technically good, unconventional papers may be at a disadvantage in the peer review process.
Resch KI et al. A randomised controlled study of reviewer bias against an unconventional therapy. Journal of the Royal Society of Medicine 93(4): 164-7. Apr 2000.

Issue 55

WEINRICH and colleagues, Health Management Services, Center for Health
Services and Policy Research, University of South Carolina, Columbia
USA studied the benefits of therapeutic massage in older persons.
Background: The authors write that growing recognition of the importance
of holistic nursing interventions has resulted in the revival in the
use of therapeutic massage, a safe, caring and inexpensive intervention
which contributes to health and healing via enhancement of relaxation.
Methods: The authors reviewed the literature (42 references) regarding
therapeutic massage using older populations in order to identify its
theoretical framework, design, outcome variables, sample, procedures,
instruments, analyses and results.
Results and Discussion: In order to establish a scientific basis for
therapeutic massage in the future, it is vital that nurses include the
following elements in their research studies: clear definitions; procedures
for massage which include the types of massage performed, the parts
of the body massaged, and the length of time of massage, as well as
analyses which control for the pre-massage level of the variable of
interest. Research variables need to focus upon concepts which have
major health consequences such as agitation, immune status and pain.
Weinrich SP et al. Therapeutic massage in older persons: research issues. British Journal of Nursing 8(3): 159-64. 11-24 Feb 1999.

KERSNIK, Slovenia, studied an array of characteristics of patients using
alternative medicine.
Methods: The authors, using a stratified sample of 36 GP surgeries in
Slovenia, set out to evaluate patient characteristics, morbidity, functional
status, quality of life, satisfaction with care, practice characteristics
and health care use in general practice patients using alternative medicine.
The main output data included patient's age, sex, educational status,
residence, presence of chronic condition, incidence of anxiety or depressive
symptoms, incidence of patient-expressed need for emergency care in
one year, data on self-care, functional status, quality of life, satisfaction
with care, incidence of use of out-of-hours services and specialist
or hospital services in users versus non-users.
Results: 115/1753 patients (6.6%) reported visits to alternative practitioners
in 1997. Those patients using alternative medicine were from midlife
age groups, were more likely to have a chronic condition, had a lower
perception of life quality and a higher incidence of anxiety and depressive
symptoms and had had more need for emergency treatment. These patients
were heavier users of primary and secondary care services, have changed
their GP recently yet are not significantly dissatisfied with their
current regular GP.
Conclusions: Patients with a more active approach to managing their
health problems use alternative medicine. GPs should enquire from their
patients about use of alternative medicine, particularly those more
likely to seek such help. Raising the question of alternative medicine
will improve doctor-patient communication and help to resolve underlying
health problems.
Kersnik J. Predictive characteristics of users of alternative medicine.
Schweizerische Medizinische Wochenschrift. Journal Suisse de Medicine 130(11): 390-4. 18 Mar 2000.

HAYES and COX, University of Hertfordshire, Centre for Research in Primary
and community Care, Hatfield, Hertfordshire UK conducted a survey to
determine the extent of integration of complementary therapies in critical
care units in the North and South Thames Regional Health Authorities
in the Greater London area.
Methods: 45 critical care units were surveyed at random. The results
of the survey showed that Neonatal Intensive Care Units showed the greatest
interest and provision (75%) of complementary therapies, primarily in
the application of baby massage. In contrast, only 10% of Coronary Care
Units surveyed provided complementary therapies. Further research indicated
that of 51.1% of critical care units which claimed to provide complementary
therapies, only 7% provided interventions on a routine, systematic basis.
Hayes JA and Cox CL. The integration of complementary therapies in North and South Thames Regional Health Authorities&#146; critical care units. Complementary Therapies in Nursing and Midwifery 5(4): 103-7. Aug 1999.

LODHA and BAGGA, Department of Pediatrics, All India Institute of Medical
Sciences, New Delhi, India reviewed (52 references) the MEDLINE database
to identify clinical trials conducted using traditional Ayurvedic Indian
medicines.
Methods: The authors reviewed the MEDLINE database to identify clinical
trials conducted using traditional Indian medicines. Single case reports
were excluded.
Results: Ayurvedic preparations have been successfully used for the
treatment of bronchial asthma, ischaemic heart disease and hyperlipidaemia.
Formulations containing curcumin were reported to reduce inflammation
and disability in double-blind clinical trials on patients with rheumatoid
arthritis. Several products are reported to be useful in patients with
acute viral hepatitis. A multicentric study by the Indian Council of
Medical Research showed that a preparation from Pterocarpus marsupium
was effective in reducing levels of blood glucose and glycosylated haemoglobin
in patients with non-insulin-dependent diabetes mellitus. In another
multicentric trial, patients with fistula-in-ano were randomized to
either surgery or application of medicated seton (Ksharsootral). Surgical
treatment led to a faster cure; however, recurrence rates were lower
with medicated seton. Administration of extract from Bacopa monnieri
to children with mental retardation was reported to significantly improve
short-term and long-term memory.
Conclusions: Evidence-based studies regarding the efficacy and safety
of traditional Indian medicines are limited. The essential ingredient
in many formulations is not precisely defined. High quality studies
are required to evaluate and compare the value of traditional Indian
drugs to modern medicine.
Lodha R and Bagga A. Traditional Indian systems of medicine. Annals
of the Academy of Medicine, Singapore 29(1): 37-41. Jan 2000.

Issue54

ASTIN and colleagues, Stanford Center for Research in Disease Prevention, Stanford University School of Medicine, Palo alto, California 94304-1583 USA. astin@scrdp.stanford.edu surveyed the use of complementary and alternative medicine (CAM) in elderly persons in California.
Methods: The authors surveyed Californians enrolled in a Medicare risk product which offered coverage for acupuncture and chiropractic care. Surveys were posted to 1597 members in 1997; responses were received from 728 respondents (51% response rate). Health risk assessment data were obtained at baseline and at 12-15 months following enrollment in the plan. Multiple logistic regression analyses were performed to analyse predictors of CAM use.
Results: 40% of senior citizens reported using CAM, of which the most frequently cited therapies were herbs (24%), chiropractic (20%), massage (15%) and acupuncture (14%). Users of CAM tended to be younger, more educated, reported either arthritis and/or depression/anxiety, not be hypertensive, engage in exercise, practise meditation and visit physicians more frequently. CAM was not associated with any observed changes in health status. Respondents expressed considerable interest in receiving third-party coverage for CAM. 80% of respondents reported that they had substantially benefited from using CAM; however the majority (58%) did not discuss their use of CAM with their medical doctor.
Conclusions: These data suggest that there is significant interest in and the use of complementary/alternative medicine among elderly people, and suggest the importance of further research regarding the use of potential efficacy of these therapies within the senior population.
Astin JA et al. Complementary and alternative medicine use among elderly persons: one-year analysis of a Blue Shield Medicare supplement. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences 55(1): M4-9. Jan 2000.

LUSKIN and colleagues, Stanford University USA review (91 references) the literature regarding complementary and alternative treatments, specifically mind/body techniques for musculoskeletal diseases.
Methods: The authors set out to perform a comprehensive literature review and provide a rationale for future research for 'successful ageing'. The authors conducted computerized searches using MEDLINE, PsychInfo, Stanford Library, Dissertation Abstracts, Lexus-Nexus, the Internet, in addition to interviews conducted with practitioners and the elderly. The authors evaluated the following mind/body practices: social support, cognitive-behavioural therapy, meditation, the placebo effect, imagery, visualization, spiritual/energy healing, music therapy, hypnosis, yoga, tai chi, and qigong. Research published after 1990 were prioritized; however when more recent literature was scarce, other controlled studies were included.
Results: Mind/body techniques were found to be effective primarily as complementary treatments for musculoskeletal disease and related disorders. The research provided evidence for treatment efficacy; however most apparent was the requirement for further controlled research.
Conclusions: The authors found a dearth of randomized controlled research conducted in the US, and a lack of studies with which to determine appropriate dosage and understand the mechanisms by which many of the practices work. Anecdotal evidence, some controlled research, clinical observation, cost effectiveness and lack of side effects of the mind/body treatments make further investigation a high priority.
Luskin FM et al. A review of mind/body therapies in the treatment of musculoskeletal disorders with implications for the elderly. Alternative Therapies in Health and Medicine 6(2): 46-56. Mar 2000.

PAPADOUPOULOS and colleagues, South Birmingham Mental Health NHS Trust UK evaluated an aromatherapy service for older adults with physical health problems and their carers in Birmingham.
Methods: The authors evaluated, using interview scripts and written descriptions, an aromatherapy service based in a carer support unit at a Birmingham hospital in an attempt to answer the question: 'What types of benefits do clients/carers report from aromatherapy?' Interviews were conducted either at the carer support unit, at a connected day centre or at the client/carer's home. Participants included six clients and four carers who were in contact with the carer support unit and who had received aromatherapy from the aromatherapist in the past year. Main outcome measures were to explore which part of a session they preferred, perceived benefits of aromatherapy and a smell attribution to certain essential oils. The aromatherapist was also asked to write descriptions of her perceived benefits for the clients and carers. Interviews were qualitatively analysed and compared to the written descriptions of the aromatherapist.
Results: All the clients and carers reported that they had benefited from the aromatherapy and felt more relaxed following a session. Qualitative analysis revealed a 70% area of overlap and a 30% 'hidden' area of congruence. The smell analysis revealed individual differences in attribution depending upon past experience and expectation of the oil presented.
Conclusions: The findings of this evaluation suggest that the aromatherapy service was valuable to clients and carers and that their perception of its benefits for them were largely congruent with those of the aromatherapist.
Papadopoulos A et al. Evaluation and attributional analysis of an aromatherapy service for older adults with physical health problems and carers using the service. Complementary Therapies in Medicine 7(4): 239-44. Dec 1999.

HILL and colleagues, (Address not supplied) conducted a preliminary investigation of the effects upon quality of life of floatation spa therapy in patients with osteoarthritis.
Methods: The authors conducted an uncontrolled clinical trial within a private floatation spa therapy centre. Recruited to this study were fourteen patients with chronic osteoarthritis of the weight-bearing joints. Four patients subsequently dropped out of this study. The main intervention was six weekly sessions of floatation spa therapy. Outcome measures consisted of SF36, AIMS2 and MYMOP quality-of-life questionnaires.
Results: All patients improved; differences between baseline and discharge scores showed statistically significant improvement for MYMOP, but not for AIMS2 or SF-36.
Conclusions: Controlled trials of floatation spa therapy for patients with osteoarthritis are justified.
Hill S et al. A pilot study to evaluate the effects of floatation spa treatment on patients with osteoarthritis. Complementary Therapies in Medicine 7(4): 235-8. Dec 1999.

VAN HASELEN and colleagues, Royal London Homoeopathic Hospital, UK conducted a study to measure the marginal costs of providing complementary medicine services (mostly homeopathy) in outpatient clinics for patients with rheumatoid arthritis (RA).
Methods: The authors conducted a retrospective, observational costing study at the outpatient clinic of the Royal London Homoeopathic Hospital. Recruited were a random sample of 89 patients from the 427 RA patients attending outpatient clinics from April 1995 to March 1996. Main outcome measures were the marginal costs incurred by the hospital of treating 89 patients attending outpatient clinics and the relative contribution of the differing resources to the total costs.
Results: The total costs of treating 89 patients were £7124, of which £543 was assumed to be fixed and the remainder variable. The authors present the marginal costs of treating additional patients, starting from zero patients treated. Consultation time (doctors and dietician) contributed to 29% of the total costs, non-conventional drugs contributed to 22% of the total costs.
Conclusions: Understanding the marginal costs of providing complementary care to RA patients will inform the debate over whether these therapies are likely to be cost-effective. Additionally, those wishing to explore the practicalities of establishing a service involving complementary medicine will gain an understanding of the likely provider costs. The cost of complementary medicine would appear to be most sensitive to the time spent between the doctor and patient.
van-Haselen RA et al. The costs of treating rheumatoid arthritis patients with complementary medicine: exploring the issue. Complementary Therapies in Medicine 7(4): 217-21. Dec 1999.

ESKINAZI and MUEHSAM, Rosenthal Center for Complementary and Alternative Medicine, Department of Rehabilitation Medicine, Columbia University College of Physicians and Surgeons, New York, New York 10032 USA. Eskinazi@helix.nih.gov write that bias expressed by conventional journals against the field of 'alternative', 'integrative' or 'complementary' medicine has been said to drive the appearance of new journals dedicated to this field.
Methods: The authors studied two examples of recent articles regarding complementary and alternative medicine appearing in two major medical journals in 1998. One was an editorial regarding risks of alternative medicine which was published in The New England Journal of Medicine; the other was a study on Therapeutic Touch, published in the Journal of the American Medicine Association. The authors evaluated whether information and opinions presented in the editorial and article were objective or not.
Results: The authors found that these examples reflected, at best, misinformation or misunderstanding of the field, or at worst, disingenuousness. They considered the possibility that this apparent bias could be due to the fact that some of the concepts implicit in alternative medicine are outside the current biomedical framework.
Conclusions: It is only by exploring knowledge outside the boundaries of existing dogmas that real (as opposed to incremental) progress can occur.
Eskinazi D and Muehsam D. Is the scientific publishing of complementary and alternative medicine objective? The Journal of Alternative and Complementary Medicine 5(6): 587-94. Dec 1999.

Comments: The above studies reflect the wide variation in the types of possible clinical research, ranging from the very preliminary pilot study to comprehensive reviews of the literature, to investigation regarding publication bias. Although there appears to be a current emphasis (some might say obsession) with 'evidence-based medicine', where everything must be measured by a randomized double-blind controlled clinical trial, I have always applauded and highlighted the pluralistic approach available in conducting research.

Issue 53

PERRY and DOWRICK, Department of Primary Care, University of Liverpool, UK write that General practitioners (GPs) in more affluent areas of the UK have shown considerable interest in the use of complementary medicine. The authors investigated the use of and attitudes towards homoeopathy among GPs working in a socio-economically deprived urban area such as Liverpool.
Methods: The authors carried out a postal questionnaire survey of all GP practices in Liverpool, including a reminder after 3 weeks. GPs were asked whether they treat with, refer to or endorse 3 common complementary therapies. GP’s views were asked regarding NHS funding, effectiveness, adverse reactions, training needs and theoretical validity for each therapy.
Results: The response rate was 131/252 (52%), and was higher among women and doctors aged under 40. During the previous week, 37 (28%) of GPs had been involved in homoeopathy with their patients: 6.5% had treated directly, 18.5% had referred to, and 7% had endorsed homoeopathy. 31% of GPs reported successful outcomes by homoeopath treatment, compared with 14% reporting adverse effects. GPs were generally uncertain regarding the validity of the theoretical basis of homoeopathy; only 23% considered it to have a valid basis.
Perry R and Dowrick C. Homeopathy and general practice: an urban perspective. The British Homoeopathic Journal 89(1): 13-6. Jan 2000.

STRAUMSHEIM and colleagues, Arena Medisinske Senter, Sognsveien, Oslo, Norway evaluated the efficacy of homoeopathy in the prevention of migraine attacks and accompanying symptoms.
Methods: The authors conducted a randomized, double-blind, placebo-controlled clinical trial, consisting of a one-month registration period without treatment, followed by four months individualized homoeopathic treatment or identical placebo. Patients were stratified for common or classical migraine. Of the 73 patients who were randomized, 68 completed the trial.
Results: Baseline values were similar in the two groups, as were the migraine diaries. Both the homoeopathy and placebo groups had reduced attack frequencies, pain intensity and drug consumption. There was a statistically non-significant difference in favour of homoeopathy. The neurologists’ trial evaluation indicated a statistically significant reduction in attack frequency in the homoeopathy group and non-statistically significant trends in favour of homoeopathy for pain intensity and overall evaluation.
Conclusions: Further research incorporating improved trial design, regarding the potential role of homoeopathy in relief of migraine is justified.
Straumsheim P et al. Homeopathic treatment of migraine: a double blind, placebo controlled trial of 68 patients. The British Homoeopathic Journal 89(1): 4-7. Jan 2000.

Issue 52

COLLIS and colleagues, Department of Plastic Surgery, Bradford Royal Infirmary, West Yorkshire, England UK. nicollis@aol.com write that cellulite is a common phenomenon particularly affecting the thighs and buttocks of women, and that there is little scientific evidence supporting any of the many advertised treatments. The authors conducted a randomized controlled trial to assess the effectiveness of two cellulite treatments.
Methods: 52 out of 69 women, divided into three groups, completed a 12-week, randomized controlled trial. Patients acted as their own controls. Treatments investigated were twice-daily application of aminophylline cream and twice-weekly treatment with Endermologie ESI. Group 1 (double blind) received aminophylline to one thigh/buttock and a placebo cream to the other. Group 2 (singly blind) received Endermologie to one thigh/buttock. Group 3 received Endermologie to both sides and used the same cream regimen as group 1. Results were assessed subjectively by the patient and by clinical examination and photographic assessment by the surgeon before and after the trial. Morphologic assessment included body mass index, thigh girth at two points, and thigh fat depth measurement by ultrasound.
Results: No statistical difference were detected in measurements between legs for any of the treatment groups. The best subjective assessment by the patients themselves, revealed that only 3 of 35 aminophylline-treated legs and 10 of 35 Endermologie-treated legs had their cellulite appearance improved.
Conclusions: The authors do not believe that either of these two treatments is effective in improving the appearance of cellulite.
Collis N et al. Cellulite treatment: a myth or reality: a prospective randomized, controlled trial of two therapies, endermologie and aminophylline cream. Plastic and Reconstructive Surgery 104(4): 1110-4. Sep 1999.

MANIADAKIS and GRAY, Global Health Outcomes, Searle Division of Monsanto, PO Box 53, High Wycombe UK reports the results of a 'cost-of-illness' study of the socio-economic costs of back pain in the UK.
Results: The direct health care cost of back pain in 1998 is estimated to be around £1,632 million. Approximately 35% of this cost relates to services provided in the private sector and thus is most likely paid for directly by patients and their families. With respect to the distribution of cost across different providers, 37% relates to care provided by physiotherapists and allied specialists, 31% is incurred in the hospital sector, 14% relates to primary care, 7% to medication, 6% to community care and 5% to radiology and imaging used for investigation purposes. However the direct cost of back pain is insignificant compared to the cost of informal care and the production losses related to it, which total £10,668 million. Overall, back pain is one of the most costly conditions for which an economic analysis has been carried out in the UK; this is in line with findings from other countries.
Conclusions: Further research is needed to establish the cost-effectiveness of alternative back pain treatments, so as to minimize cost and maximize the health benefit from resources used for this condition.
Maniadakis N and Gray A. The economic burden of back pain in the UK. Pain 84(1): 95-103. Jan 2000.

Issue 51

VALLBONA and RICHARDS, Department of Family and Community Medicine, Baylor College of Medicine, Houston Texas USA review (117 references) the use of magnetic therapy in rehabilitation medicine.
Discussion and Results: The authors write that static or electromagnetic fields have been used for centuries to control pain and other health problems; however only recently has scientific evidence regarding their efficacy been assembled. The authors provide a historical review regarding the value of magnetic therapy in rehabilitation medicine in terms of static magnetic fields and time varying magnetic fields (electromagnetic). They also discuss the areas of scientific criteria, modalities of magnetic therapy, the mechanisms of the biological effects of magnetic fields and perspectives regarding the future of magnetic therapy.
Vallbona C and Richards T. Evolution of magnetic therapy from alternative to traditional medicine. Physical Medicine and Rehabilitation Clinics of North America. 10(3): 729-54. Aug 1999.

Issue 50

BARNES and colleagues, Department of Complementary Medicine, School of Postgraduate Medicine and Health Sciences, University of Exeter UK. jo.barnes@exeter.ac.uk studied the growth in interest in complementary and alternative medicine within the professional scientific community.
Methods: The authors performed systematic literature searches of MEDLINE in January 1998 for the period 1966 through 1996, using the expanded terms "alternative medicine", "traditional medicine", "acupuncture", "homoeopathy" and "chiropractic". The number of clinical trial-type articles was obtained by conducting searches for those having 1 or more of the following types: clinical trial; clinical trial phase 1, 2, 3, or 4; controlled clinical trial; meta-analysis; randomised controlled trial. The authors limited their searches to trials with human subjects.
Results: Published articles indexed as alternative medicine formed only 0.4% of the total number of MEDLINE-listed articles throughout the 30-year period studied. Whereas the total number of articles listed in MEDLINE rose significantly, reaching a peak of 40,000 additions per year in 1996, the number of articles indexed under alternative medicine rose steadily only from 1972 through 1986, remaining stable since then with about 1500 additions per year. The proportion of clinical trial articles on alternative medicine was low, (2.1% per year); however this rose significantly from 1986 through 1996, reaching about 10% of the total in 1996. The number of publications for Individual therapies varied; clinical trial articles formed only a small part of any increase.
Conclusions: Interest in and awareness of complementary medicine among orthodox health care professionals has grown during the past 30 years, as revealed by the increased number and proportion of reports of clinical trials. This suggests a trend toward an evidence-based approach; however, the cumulative number of clinical trial articles is small and more high-quality original research in complementary is required.
Barnes J et al. Articles on complementary medicine in the mainstream medical literature: an investigation of MEDLINE, 1966 through 1996. Archives of internal medicine 159(15): 1721-5. 9-23 Aug 1999.

Comments: It would appear from the tone of the above research update, that the authors’ point of view is that patients should always see their primary care physician, who presumably know better than the individual concerned. I do not advocate people shunning medical care for their health problems; however, I find the attitude in the above update somewhat patronising. Surely taking a fairly safe herbal remedy such as St John’s Wort, which has a long history of use, is superior to being prescribed powerful anti-depressants or worse, with potentially very serious side effects!

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