Research Database -
International Updates

Alternative Medicine/
Complementary Therapies

Issue 82

RATCLIFFE and colleagues, Health Economics Research Group, Brunel University, Uxbridge, Middlesex, UK, jratcliffe@rti.org, carried out a study to investigate the preferences of patients with asthma for characteristics associated with their treatment, and to investigate the extent to which such preferences may differ between patient subgroups.

Background: Conventional and homeopathic treatment for asthma were compared.

Methods: A Conjoint Analysis questionnaire was administered to 300 asthma patients, 150 receiving conventional treatment and 150 receiving homeopathic treatment. The questionnaire investigated patients’ strength of preference for several key attributes of services for asthma treatment.

Results: Statistically significant attributes influencing patients’ preference in both patient groups were (1) the extent to which the doctor gave sufficient time to listen to the patient, (2) the extent to which the treatment seemed to relieve symptoms, and (3) the travel costs of attending for a consultation. Patients receiving homeopathic treatment also expressed a preference for the extent to which the doctor treated them as a whole person.

Conclusion: The study shows that aspects associated with the delivery of treatment are important to patients in addition to outcome of the treatment. Patients who receive homeopathic treatment express a stronger preference for the doctor to treat them as a whole person.

Issue 81

LUEDTKE and colleagues, Karl and Veronica Carstens-Stiftung, Essen, Germany, r.luedtke@carstens-stiftung.de, examined the test-retest reliability and validity of kinesiology muscle testing when used as a method of identifying a substance (wasp venom) known to be an allergen to a particular group of patients.
Methods: This randomized, double-blind, placebo-controlled study involved seven patients who were allergic to wasp venom, as confirmed by clinical and laboratory tests, and four Health Kinesiology practitioners (examiners). Using the anterior deltoid as the indicator muscle for each patient, the examiners tested each patient for their ‘sensitivity’ towards the substance contained in each of 10 bottles containing venom and 10 bottles containing placebo. ‘Sensitivity’ was indicated by a weak muscle hold and ‘not sensitive’ (normal) was indicated by stable holding.
Results: Analysis of the results showed the kinesiology test to be unreliable as a method of identifying the allergenic substance (kappa=0.03). The method was estimated to have a sensitivity of 40% and specificity of 60%.
Conclusion: In this small study, the use of Health Kinesiology as a diagnostic tool appeared to be no more effective than random guessing.
Luedtke R et al. Test-retest-reliability and validity of the Kinesiology muscle test. Complementary Therapies in Medicine 9 (3): 141-5. Sep 2001.

BRYGGE and colleagues, H:S Rigshospitalet, allergiklinikken, ortopaedkirurgisk afdeling, Koebenhavns Universitet, Biostatistisk Afdeling og oejenpatologisk Institut, Denmark, thorbrygge@dadlnet.dk, studied a group of asthma patients to determine whether reflexology treatment could be of benefit to the condition.
Background: Claims have been made by asthma patients who have sought alternative or complementary treatment for their condition and by reflexology practitioners that reflexology can be of benefit to sufferers of bronchial asthma.
Methods: Subjects were 40 patients with bronchial asthma. They received 10 weeks of genuine (‘active’) or simulated (‘placebo’) reflexology in a double-blind manner (i.e. neither assessors nor patients knew who was receiving genuine and who was receiving simulated treatment.). Outcome measures included tests of lung function, subjective symptom scores and bronchial sensitivity to histamine. During the study, patients self-scored their asthma in a symptom diary.
Results: No changes in objective tests of lung function occurred in either group. Both groups showed improvements in subjective scores and bronchial sensitivity to histamine, with no significant differences detected between the active and placebo treatments. A supplementary analysis of the patients’ symptom diaries revealed a trend towards improvement favouring reflexology over placebo. However, a significant pattern suggesting subconscious unblinding with regard to the study treatments was also found.
Conclusion: This study found no evidence that reflexology benefited asthma any greater than placebo.
Brygge T et al. (Zone therapy and asthma.) Ugeskrift for Laeger 164 (18): 2405-10, Apr 2002.

Comment: I would like to see both the above research studies replicated. In particular, it needs to be shown that a reliable placebo for reflexology is used.

HAID and HUPRIKAR, Northwestern University Medical School, Highland Park, Illinois, USA, investigated whether meditation on the water given to pea or wheat seeds with the intent to either stimulate or inhibit their germination and growth could in fact have actual effects on their germination and/or growth.
Background: Many ancient and so-called primitive cultures hold the belief that human thought processes, including those involved in many traditional ceremonies and rituals, can affect the natural world in which we live.
Methods: In a double-blind, controlled series of experiments, green peas (n=504) and wheat seeds (n=2970) were given water ‘treated’ by meditation on the water with the intention to stimulate (in the case of the green peas) or inhibit (in the case of the wheat seeds) their germination and were compared with ‘non-treated’ controls (peas, n=504; wheat seeds, n=2970). Results were analysed statistically using contingency table, Fisher’s test and Mantel-Haenszel analyses. For wheat seedlings, effects of ‘inhibitory intent’ on growth were also investigated and the results were analysed using analysis of variance (ANOVA).
Results: Peas treated with water with stimulating intent had a germination rate of 60.3%, which was significantly greater than that for control peas (51.8%). Wheat seeds treated with water with inhibitory intent had a germination rate of 70.7%, which was significantly lower than that for control wheat seeds (74.9%). Wheat seedlings from the sixth run of the wheat inhibition experiment were harvested on the 10th day after planting and individually weighed. The mass of seedlings treated with water with inhibitory intent (mean weight 97 mg) was significantly lower than that of control seedlings (106 mg).
Conclusion: This remarkable study demonstrated that meditation upon the water supplied to green peas or wheat seeds with the intent to respectively stimulate or inhibit their growth did indeed have measurable effects on their germination rates and growth.
Haid M, Huprikar S. Modulation of germination and growth of plants by meditation. The American Journal of Chinese Medicine 29 (3-4): 393-401. 2001.

Issue 80

HEMMILA, Folk Medicine Centre, Kaustinen, Finland, E: heikki.hemmila@pp.fimnet.fi, investigated quality of life, healthcare costs and use and effects of various therapies in patients with chronic back pain.
Background: Chronic back pain has mainly been highlighted only in the relatively small proportion of patients whose conditions require high-cost treatment and present a significant burden on healthcare resources. Many patients who suffer back pain receive little publicity, as their treatments are comparatively low cost. There has been little evaluation of patients’ choices of therapy, particularly alternative/complementary therapies.
Methods: Study subjects were 114 Finnish patients being treated by their GPs for chronic back pain. They were studied for 1 year before and for 1 year after they entered a randomized clinical trial. Data were obtained – from the Social Insurance Institution files, patients’ records and questionnaires (the Nottingham Health Profile; NHP) – on therapy use, costs to society and patients’ quality of life. Effects of physiotherapy, bone setting and light exercise therapy on these measures were also explored.
Results: 1 year before they entered the clinical trial, a third of patients had consulted their GP. 50% of the patients had undergone some form of therapy, the main ones being massage, physiotherapy, naprapathy or bone setting. Complementary therapies accounted for one third of direct costs, and rehabilitation for another third. 55% of the total costs (US$1029) were due to sick leave. After the patients received the randomized therapies, mean total costs increased slightly (US$1306). Costs of ambulatory care were similar [to the mean total costs]. Physiotherapy appeared to be the least expensive therapy (US$621), and bone setting the most expensive (US$2072). Physiotherapy and bone setting both resulted in improvements on more subscales on the NHP in comparison with exercise.
Conclusion: Complementary therapies accounted for one third of the direct costs of back pain. After a course of physiotherapy, patients tended to use healthcare services less and take less sick leave. Quality of life of patients with chronic back pain seemed to be improved by physiotherapy and bone setting.
Hemmila HM. Quality of life and cost of care of back pain patients in Finnish general practice. Spine 27 (6): 647-53. Mar 2002.

MCCARNEY and colleagues, Academic Unit, Royal London Homeopathic Hospital, London WC1N 3HR, UK, investigated whether dowsing homeopaths were able to correctly identify a homeopathic remedy using dowsing at a higher rate than would be expected by chance.
Background: Dowsing using a pendulum or similar device is believed to employ motor automatism and is an intuitive method employed by some practitioners of alternative/complementary medicine, including homeopaths, as an aid to diagnosis and/or treatment.
Methods: This small randomized double-blind trial examined the ability of six homeopaths, who frequently employed dowsing in their practices, to correctly identify the homeopathic remedy Bryonia (in a 12c potency) versus placebo using dowsing alone.
Results: The homeopaths correctly identified Bryonia in 48.1% of bottle pairs (n=156), a result consistent with what would be expected to occur by chance.
Conclusion: The results of this small study provided no support for the usefulness of dowsing in the context investigated.
McCarney R et al. Can homeopaths detect homeopathic medicines by dowsing? A randomized, double-blind, placebo-controlled trial. Journal of the Royal Society of Medicine 95 (4): 189-91. Apr 2002.

HOGEBOOM and colleagues, Department of Epidemiology Biostatistics, University of California-San Francisco, 94118, USA, E: hogeboom@dnai.com, assessed the reliability of diagnosis and treatment of chronic low-back pain using Traditional Chinese Medicine (TCM) among acupuncturists.
Methods: Six TCM acupuncturists assessed the same six patients on the same day. Outcome measures were TCM diagnosis, acupoint prescriptions and auxiliary treatment recommendations.
Results: The acupuncturists used 20 diagnoses and 65 acupoints at least once. Most acupuncturists gave a diagnosis of Qi/Blood Stagnation with Kidney Deficiency and used the acupoint UB23 for every patient. Consistency of diagnostic details and use of other acupoints were poor among the acupuncturists. For a subgroup of patients, no diagnoses, and only one acupoint, were used preferentially. Some diagnoses and treatment recommendations were practitioner-, rather than patient-, dependent. Fine-grained diagnoses and most acupoints bore no relationship with either the patient or the acupuncturist.
Conclusion: There were wide variations in TCM diagnoses and treatment recommendations for individual patients with low-back pain among the acupuncturists assessed. Lack of consistency among acupuncturists may make it difficult to evaluate or replicate clinical trials of acupuncture that use an individualized treatment. It would be useful to develop a standardized TCM treatment approach and evaluate this in comparison with individualized treatment, to assess which, if any, is superior in terms of inter-rater reliability.
Hogeboom CJ et al. Variation in diagnosis and treatment of chronic low back pain by traditional Chinese medicine acupuncturists. Complementary Therapies in Medicine 9 (3): 154-66. Sep 2001.

Issue 79

MACKERETH and colleagues, Marie Curie Cancer Care, Newcastle-upon-Tyne, UK, reviewed (24 references) recently published papers reporting on research into reflexology and healthcare, with a view to identifying optimal research methodology for future studies.
Background: The authors’ intention was to examine and/or suggest research methodology for conducting meaningful research studies in reflexology, including reflexology practice and study outcome measures.
Discussion: The review includes recommendations published in 1997 in a report by the Foundation for Integrated Medicine (FIM) on conducting research and audits. The reviewers propose the use of these recommendations as a framework for reviewing past studies on reflexology and for designing and conducting future studies. They outline possible and likely problems that might confront researchers, illustrating these issues with examples from recently published studies. Mackereth et al have themselves carried out some small-scale studies on reflexology and so describe their personal experiences in relation to analysis and design/conduct of research in this area.
Mackereth P et al. Reflexology: recent research approaches. Complementary Therapies in Nursing and Midwifery 6 (2): 66-71. May 2000.

BARBOUR, connienp@mindspring.com, investigated the use and effectiveness of alternative/complementary medical treatments for fibromyalgia.
Background: Patients with fibromyalgia suffer not only muscle pain but also a range of other symptoms, leading them to seek complementary treatment when conventional medicine fails to provide sufficient or complete relief.
Methods: The author developed a questionnaire in order to collect information about CAM treatments and their effectiveness.
Results: 60 subjects visited the researcher’s website and completed an online questionnaire on CAM use for fibromyalgia. The most commonly tried interventions were information (literature), heat, walking, vitamins and massage. The interventions that were rated the most effective were information (literature), aromatherapy, support groups, heat and massage.
Barbour C. Use of complementary and alternative treatments by individuals with fibromyalgia syndrome. Journal of the American Academy of Nurse Practitioners 12 (8): 311-6. Aug 2000.

GAY and colleagues, Psychology Department, Universite de Paris X, 200 avenue de la Republique, Nanterre, 92000, France, marieclaire.gay@free.fr, explored the effectiveness of Erikson hypnosis and Jacobson relaxation in helping to reduce the pain of osteoarthritis.
Methods: This was a randomized controlled study involving patients with osteoarthritis pain of the knee or hip. Patients received one of three treatments options: 1) 8 standardized sessions of hypnosis; 2) 8 standardized sessions of Jacobson relaxation; or 3) referral to a waiting list (controls).
Results: Patients who received either hypnosis or relaxation interventions experienced a lower level of pain than the controls and the level of subjective pain decreased over time in the two former groups. Beneficial effects of treatment seemed to be experienced sooner by patients in the hypnosis group. Patients receiving hypnosis or relaxation therapies were able to reduce the amount of painkiller medication they regularly took. Findings also suggested that patient differences in imagery ability tempered the effect of the psychological interventions when assessed at 6 months’ follow-up, but this was not evident at earlier time points (after 4 or 8 weeks of treatment or at 3-months’ follow-up).
Discussion: The researchers present an interpretation of the study results in terms of psychological processes underlying hypnosis and discuss the implications for the use of psychological interventions in pain management.
Conclusion: The programmes of Erikson hypnosis and Jacobson relaxation used in this study were able to reduce the subjective experience of pain due to osteoarthritis of the knee or hip, at least in the short term (up to 3 months), and the beneficial effects seemed to occur the quickest with hypnosis.
Gay MC et al. Differential effectiveness of psychological interventions for reducing osteoarthritis pain: a comparison of Erikson (correction of Erickson) hypnosis and Jacobson relaxation. European Journal of Pain 6 (1): 1-16. 2002.

Issue 78

NICOLAKIS and colleagues, University Department of Physical Medicine Rehabilitation, Vienna, Austria, Peter.Nicolakis@AKH-Wien.ac.at, evaluated the usefulness of jaw exercise, physical therapy techniques, postural correction and relaxation for relieving pain and improving jaw movement in patients with osteoarthritis of the temporomandibular joint (TMJ; the jaw).
Methods:The study involved 20 patients with osteoarthritis (OA) in the TMJ who had pain in the jaw area, symptoms of OA in the TMJ for at least 3 months, and presence of OA in the TMJ confirmed by X-ray. The subjects were entered onto a waiting list, and the period prior to the start of the study treatment protocol was used to assess study measures during a ‘control’ (no treatment) period (mean duration 35 days). The treatment protocol (mean duration 46 days) involved active and passive jaw movements, manual therapy, correction of body posture and relaxation techniques. Study measurements included measures of pain, impairment [of jaw movement] and incisal edge clearance.
Results: 19 of the 20 patients completed the study. None of the study measures changed significantly during the control period. At the end of the study treatment period, pain and impairment had decreased significantly and incisal edge clearance increased significantly. No adverse effects of the treatment protocol were reported. When followed up again at a later date, pain and impairment were found to be further reduced. In addition, the number of patients who reported experiencing no pain at rest increased significantly to 80%, the number reporting no associated stress increased to 47% and the number reporting no impairment increased to 37%.
Conclusion:The treatment protocol used in this study, which combined exercise, physical therapy, postural correction and relaxation techniques, appeared to be beneficial for treating the symptoms and impairment caused by OA of the jaw.
Nicolakis P et al. An investigation of the effectiveness of exercise and manual therapy in treating symptoms of TMJ osteoarthritis. Cranio 19 (1): 26-32. Jan 2001.

BROLINSON and colleagues, Sports Care Welltrack, Toledo Hospital, OH 43606, USA, aimed to identify nurses’ perceptions of the effectiveness and safety of complementary and alternative medical (CAM) therapies, as well as their recommendations for and personal use of such therapies.
Methods: The researchers carried out a three-wave mailing of a random sample of 1,000 nurses in the USA.
Results: About 50% of respondents perceived conclusive or a preponderance of evidence for effectiveness of five CAM therapies: biofeedback, chiropractic, meditation/relaxation, multivitamins and massage therapy. 50% also perceived that five therapies were definitely safe: hypnotherapy, chiropractic, acupressure, acupuncture and healing touch. Nurses were most likely to recommend, regularly or periodically, four therapies: multivitamins, massage, meditation/relaxation and pastoral/spiritual counselling. 79% of nurses thought that they had fair or poor professional preparation in this area.
Brolinson PG et al. Nurses’ perceptions of complementary and alternative medical therapies. Journal of Community Health 26 (3): 175-89. Jun 2001.

Issue 77

BRUE and OAKLAND, Department of Psychology and Philosophy at Texas Woman’s University in Denton, USA, reviewed (107 references) the case for using complementary/alternative medicine (CAM) for treating attention-deficit/hyperactivity disorder (ADHD).
Background: Up to 3 million children in the USA are affected by ADHD and one of the most common conventional treatments is stimulant medication. However, many parents turn to CAM due to concerns about side effects of stimulant drugs, because they are sympathetic to CAM philosophies and health beliefs, and/or because of unsatisfactory results with conventional treatments.
Discussion: Parents generally use a trial-and-error approach to assess the usefulness of CAM in treating ADHD and results vary widely. Popular CAM treatments include: neuro[bio]feedback, homeopathy, herbal medicine, iron supplements and dietary approaches. There is an increasing body of evidence – from anecdotal and case reports, as well as research studies – to indicate that several CAM approaches may be useful in the treatment of ADHD. However, more definitive studies are needed before any particular CAM therapy can be recommended as an effective and reliable treatment. The authors therefore recommend that, if CAM treatments prove unsuccessful, parents should consider using conventional treatments.
Brue AW, Oakland TD. Alternative treatments for attention-deficit/hyperactivity disorder: does evidence support their use? Alternative Therapies in Health and Medicine 8 (1): 68-70. Jan-Feb 2002.

BEER and colleagues, Modellabteilung fuer Naturheilkunde, Klinik Blankenstein, Hattingen, Germany, wellbeer@cityweb.de, investigated the possible benefits of naturopathic treatment, and specifically a fasting therapy, on intestinal and general immune status.
Background: Some naturopaths have found that the immune system of patients who have undergone naturopathic treatments, particularly fasting, seems to become more ‘stabilized’ after such treatments. The immune status of and the status of microorganisms that inhabit the intestines reflect a person’s immune system as a whole. In this study, the researchers decided to investigate the effects of a course of hospital-based naturopathy, including fasting, on patients with a range of common ailments, including their intestinal immune status.
Methods: Subjects were 55 patients suffering from various medical conditions. 56% had conditions affecting the bones, joints, muscles and/ or connective tissue. The patients were assigned to receive either a 3-week standardized diet of high-quality nutritious food or they underwent a 3-week juice-modified fasting therapy. Intestinal immune status was assessed from measurements of levels of secretory immunoglobulin A (sIgA) in the patients’ faeces. Lowered immune function was represented by an sIgA level below 0.5mg/g. Patients also assessed their own medical condition in terms of quality of life on a standardized scale.
Results: In both study groups, the sIgA level in the faeces increased over the course of the hospital programme. 3 months after the treatment, faecal sIgA levels remained higher at between 0.78 and 0.89 mg/g, significantly higher than levels before the start of the study. The greatest effects were seen in the patients who underwent the fasting therapy. A modest improvement in the patients’ medical conditions was also detected post-treatment, but this appeared to be unrelated to any changes in sIgA levels.
Conclusion: The authors concluded that the 3-week in-hospital naturopathic therapy used in this study, particularly the fasting therapy, led to significant improvement in intestinal immune status which lasted beyond the in-hospital period. By extrapolation/association, this improvement was probably beneficial to the general immune status and the general health of the patients.
Beer AM et al. (Progression of intestinal secretory immunoglobulin A and the condition of the patients during naturopathic therapy and fasting therapy.) Forschende Komplementaermedizin und Klassische Naturheilkunde 8 (6): 346-53. Dec 2001.

Comment: Please also see a Research Update in Issue 76 (May ’02) where 10-day water fasting was beneficial for cardiac patients.

Issue 76

CHOPRA and DOIPHODE, Center for Rheumatic Diseases-Hermes Doctor House, Bharati Hospital and Medical College, Inlaks-Budhrani Hospital, Pune, India, archopra@pn2.VSNL.net.in, reviewed (37 references) the traditional concepts and therapeutic principles of Ayurvedic medicine and explored their potential relevance to health in the modern world.
Discussion: According to the ancient principles of Ayurveda, each human being is a model of the universe, in which the basic matter and dynamic forces (Dosha) inherent to the individual determine health and disease and the medicinal value of plant and mineral substances. Ayurvedic practices, mainly diet, lifestyle and Panchkarma, aim at maintaining the balance of the dynamic forces. With Ayurvedic medicine, therapy is tailored to the constitution (Prakruti) of the individual. Studies have investigated the biological (especially immunological) and clinical potential of many Ayurvedic medicines, in particular those of plant origin. The results of such studies provide the basis for integrating Ayurvedic practice into modern medicine. However, successful application and integration will require physicians/therapists to first understand the origins, basic concepts and principles of Ayurveda.
Chopra A, Doiphode VV. Ayurvedic medicine. Core concept, therapeutic principles, and current relevance. The Medical Clinics of North America 86 (1): 75-89. Jan 2002.

LI and colleagues, Institute of Qigong Research, Guangzhou University, People’s Republic of China, explored the potential of Qi Gong to aid in the detoxification of individuals addicted to heroin.
Background: Qi Gong is a traditional Chinese movement discipline believed to promote general health and facilitate healing and recovery from ill health/disease. The authors were able to identify a limited amount of scientific literature on Qi Gong and its effectiveness, but none on its use in treating substance addiction.
Methods: Subjects for study were 86 men aged 18 to 52 years who were addicted to heroin (according to the substance addiction criteria of the Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition Revised) and had a history of heroin usage for between 6 months and 11 years. The subjects were residents at a mandatory drug treatment centre in China. They were randomly assigned to 1 of 3 groups: 1) Qi Gong treatment (n=34); 2) medication (n=26); 3) no treatment (control group; n=26). The Qi Gong group undertook daily practice of Pan Gu Qi Gong and received Qi adjustments from a Qi Gong master. The medication group received detoxification treatment with lofexidine-HCl, with gradual dose reduction over 10 days. The control group received basic care and medications to treat severe withdrawal symptoms. Effects of treatments were assessed by the following measures taken before and during the 10-day treatment period: urine morphine test; ECG recording; Hamilton Anxiety Scale scores; and a withdrawal symptom evaluation scale.
Results: The Qi Gong group showed more rapid reduction of withdrawal symptoms than the other 2 groups. Mean symptoms scores were significantly lower for the Qi Gong group from Day 1 than for the other 2 groups (p<0.01). Anxiety scores were significantly lower for the Qi Gong and the medication groups than for the control group (p<0.01), and were significantly lower for the Qi Gong group than the medication group (p<0.01). Before treatment, the urine morphine test was positive for all subjects. By Day 3 of treatment, 50% of the Qi Gong group, 23% of the control group and 8% of the medication group had negative urine tests (p<0.01). 100% of the Qi Gong, medication and control groups achieved negative urine tests by Day 5, Day 9 and Day 11 respectively.
Conclusion: Qi Gong appeared to be an effective alternative to detoxification drug treatment or symptomatic treatment of withdrawal symptoms for heroin addicts and had no side effects. The authors acknowledged that it was not possible to completely eliminate the possibility of a placebo effect in this study.
Li M et al. Use of qigong therapy in the detoxification of heroin addicts. Alternative Therapies in Health and Medicine 8 (1): 50-4, 56-9. Jan-Feb 2002.

TOVEY, School of Healthcare Studies, University of Leeds, UK, p.a.tovey@ac.uk, carried out what he believed to be the first [published] study on the effectiveness of reflexology in managing symptoms of irritable bowel syndrome (IBS).
Background: Currently there are few, if any, effective conventional treatment options for IBS, which can become a chronic, and distressing, disorder. Many sufferers are turning increasingly to complementary and alternative medicine (CAM), including reflexology, to help alleviate symptoms. To date, despite the popularity of reflexology, no published research studies have examined its potential effectiveness in IBS. The author of this paper hoped to provide the first published evidence on the effectiveness of reflexology in managing the core defining symptoms of IBS.
Methods: This single-blind study involved 34 patients diagnosed with IBS according to the Rome Criteria. They received either a reflexology foot massage or a non-reflexology foot massage (control group) and were monitored on the core defining symptoms of IBS (abdominal pain, constipation/diarrhoea and abdominal distension).
Results: No statistically or clinically significant differences were found between the treatment and the control groups on any of the core symptoms monitored.
Conclusion: From this study, there was no evidence to indicate that reflexology resulted in any specific benefit for patients with IBS. However, this was a single, relatively small-scale study. Further research is needed. The author suggests that one area it might be useful to investigate is the impact of therapist (professional and lay) versus therapy.
Tovey P. A single-blind trial of reflexology for irritable bowel syndrome. The British Journal of General Practice 52 (474): 19-23. Jan 2002.
Comment: Readers are also referred to the article regarding clinical hypnotherapy for IBS.

Issue 75

NESTLER, Department of Complementary-Alternative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA, Nestlerg@musc.edu, reviewed (10 references) the practice and philosophy of traditional Chinese medicine with a view to its future incorporation into integrated healthcare.
Discussion: Continuing physician education will further the growing trend towards integrated medicine in conventional medical establishments in the USA (Wald, November 2000 issue of Strategic Healthcare Marketing). In recognition of patients’ needs and demands, many leading medical schools are incorporating into their programmes courses on alternative medicine, and hospital administrators too are recognizing this growing trend. A survey of 3,200 physicians, conducted by Health Products Research, found that more than 50% of physicians expect to start or increase use of therapeutic alternatives outside the traditional pharmaceutical realm over the next 12 months. Physicians’ perceptions are that patients show greater acceptance of alternative therapies and therefore compliance is likely to be greater. Most physicians continue to be sceptical about some alternative treatments, mainly due to a lack of definitive clinical evidence.
Conclusion: As alternative therapies stand to become ever more prevalent in everyday healthcare, clinical research studies, conducted in a teaching hospital environment, are of paramount importance.
Nestler G. Traditional Chinese Medicine. The Medical Clinics of North America 86 (1): 63-73. Jan 2002.

MERRELL and SHALTS, Continuum Center for Health and Healing, Beth Israel Medical Center, New York, USA, eshalts@bethisraelny.org, reviewed (50 references) the main reasons why homeopathy, especially in the USA, has not become integrated into mainstream medical practice.
Background: Historically, there has been a lack of quality published research studies or quality education programmes in homeopathy. More recently, better-designed studies have been conducted and the results published in reputable journals. However, in most cases, findings have been inconclusive and/or study methodology has still had serious short-comings.
Discussion: Four broad reasons are identified for the existing confusion over or opposition to homeopathy by the medical community: 1) Even well-designed clinical studies have failed to provide healthcare practitioners with protocol-driven tools to use in daily practice. Successful homeopathic practice requires individualized treatment, which can only be carried out by a well-trained homeopath. Where positive outcomes have been reported for homeopathy, numerous remedies have often been prescribed for the same medical condition. Some believe that it is incorrect to try to assess the success of homeopathic prescribing by pooling data from trials that have used different therapeutic agents; similarly, research protocols employing combination remedies may be invalid. 2) Many studies of homeopathy have numerous methodological short-comings, the most common being a lack of objective validated outcome measures and a small sample size. Meta-analyses have included data from studies based either on diagnostic category or a particular remedy, but frequently, different concentrations of a remedy have been used in different studies or the same remedy has been used to treat different conditions. Both professional homeopaths and conventional scientists have criticized such studies with regard to the choice of remedy, the condition treated or both, dosing regimens or procedures used, subjective or poorly quantifiable outcome measures, and/or follow-up procedures. In particular, such criticisms have been applied to migraine studies (Vithoulkas, personal communication, 1997) and to studies of Arnica. 3) Few well-designed studies have been reproduced by independent researchers, due mainly to a lack of research funding and a lack of well-trained, qualified homeopaths interested in and capable of conducting research. 4) More quality educational programmes on homeopathy for professionals are needed.
Conclusion: While physicians continue to debate the issue of homeopathy, the public continues to increase its usage of homeopaths and homeopathic remedies. In many other countries, homeopathy and other complementary therapies have been successfully incorporated into healthcare practice. In 1995, it was reported that 69% of GPs in the USA were interested in learning more about homeopathy (Journal of the American Board of Family Practice). We need to study homeopathy in a more systematic way to enable the provision of useful information to medical practitioners. Hopefully, the growing number of complementary and alternative medicine centres affiliated with major teaching hospitals will expand the evidence base and aid the integration process.
Merrell WC, Shalts E. Homeopathy. The Medical Clinics of North America 86 (1): 47-62. Jan 2002.
Comment: The entire point of homeopathy is that, in the hands of qualified homeopaths, different remedies may be prescribed to people suffering from the same conditions, or the same remedy may be prescribed to people suffering from different complaints. I would have hoped that the reason for homeopathy being used in medicine was its success and efficacy in treatment, not whether there were enough homeopaths around who knew what they were doing. Surely we would not wish untrained general physicians who were ignorant of homeopathy to treat patients using this therapy!

SMITH and LOGAN, Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada, msmith@ccnm.edu, reviewed (39 references) naturopathic medicine in relation to its integration into mainstream healthcare.
Background: Naturopathic medicine comprises many complementary modalities aimed at preventing or treating disease. Treatment programmes combine different therapies to address the individual needs of the patient. Naturopathic physicians share a common philosophical belief in the profession’s founding principles.
Discussion: Naturopathic physicians have begun to conduct research and incorporate modern scientific methods into their clinical practice, helping to further develop and validate their profession. Naturopathic medicine is regulated partially by law; this has led to uniform standards of education and practice, and has aided integration of naturopathy into conventional medical practice. In areas where naturopathy is licensed, patients can expect naturopaths to practice to high standards established by state and provincial law.
Conclusion: Conventional medicine faces new challenges as alternative/ complementary therapies become more integrated into the mainstream. Naturopathic physicians, with their eclectic philosophy, may be well placed to aid in the evolutionary process.
Smith MJ, Logan AC. Naturopathy. The Medical Clinics of North America 86 (1): 173-84. Jan 2002.

BARROWS and JACOBS, Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, California, USA, kbl@onebox.com, reviewed (91 references) mind-body medicine (MBM) in relation to its role in modern integrated healthcare.
Background: The existence of the mind-body phenomenon in health and disease is now well established. If we accept that mind and body are one, irretrievably interlinked, then the mind-body phenomenon could be said to be an inherent part of medicine. MBM is popular and beneficial in the treatment of many common chronic medical conditions, and so probably has its greatest role in primary healthcare. MBM’s popularity with the general public has led to the emergence of a vast range of MBM techniques, and there is now a substantial need for its investigation by rigorous scientific methods.
Discussion: In relation to other complementary therapies, MBM could be said to be in its adolescence in terms of the documented evidence for its clinical usefulness. The majority of the early literature comprised case reports and small studies, and there is still need for a broad range of large, controlled clinical trials. However, existing clinical studies suggest that a number of MBM therapies are effective in improving quality of life, anxiety and intensity of pain in various conditions such as chronic pain, headache, insomnia and other common conditions. Preliminary evidence suggests that MBM techniques may benefit patients with coronary artery disease and cancer.
Conclusion: MBM techniques may turn out to be most effective in combinations or in conjunction with conventional medical treatments.
Barrows KA, Jacobs BP. Mind-body medicine. An introduction and review of the literature. The Medical Clinics of North America 86 (1): 11-31. Jan 2002.

BENOR, db@WholisticHealingResearch.com, reviewed (66 references) the role of energy medicine in integrated healthcare.
Discussion: A growing database of clinical experience and research suggests that integrating energy medicine into conventional healthcare should have significant benefits for patients, physicians and complementary/alternative medicine (CAM) therapists. Infections, endocrine disorders, certain genetic defects and surgically correctable conditions are well-served by conventional medical treatments. However, medications and surgical interventions can have troublesome side effects and the risks may include fatalities. Interventions employing energy medicine may complement conventional treatments with minimal risks. Many patients are expressing satisfaction with energy medicine interventions – perhaps because, as with many CAM therapies and therapists, patients are offered greater time to discuss their problems in comparison with conventional treatments and physicians. Most practitioners of energy medicine lack knowledge/training in conventional medical diagnosis or research methods. Conventional medicine therefore also has much to offer energy medicine practice.
Conclusion: Hopefully the future will bring greater collaboration between practitioners of conventional and energy medicine, encouragement of collaborative, well-designed research studies, greater appreciation of energy medicine by the ‘establishment’, greater understanding of conventional medical/scientific methods by energy medicine and other CAM practitioners, and greater acceptance and wider employment of integrative healthcare.
Benor DJ. Energy medicine for the internist. The Medical Clinics of North America 86 (1): 105-25. Jan 2002.

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