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Alternative Medicine/
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Issue 44

NEVILLE-SMITH, Linton, Cleveland UK conducted a study to examine the activity of a new service providing a homoeopathic clinic at a community hospital.
Methods: The service was initiated in a limited fashion and was served by a relatively inexperienced practitioner.
Results: The authors describe a range of presenting complaints, treatments and outcomes. Funding has been maintained by the Health Authority and referrals have continued to be made by local eligible General Practitioners. Outcomes have been quite good; however, the default rate has been disappointingly high.
Neville-Smith R. Community hospital homeopathy clinic: audit of the first 12 months activity. British Homoeopathic Journal 88(1): 20-3. Jan 1999.

The NIH CONSENSUS STATEMENT presents the biomedical research and clinical practice communities with the results of the NIH Consensus Development Conference on Acupuncture, providing the latest information regarding the appropriate use of acupuncture, identifying areas of study deserving further investigation for family practitioners, medical acupuncturists, psychiatrists and specialists in pain medicine.
Methods: Participants were a non-Federal, nonadvocate, 12-member panel from the fields of acupuncture, pain, psychology, psychiatry, physical medicine and rehabilitation, drug abuse, family practice, internal medicine, health policy, Epidemiology, statistics, physiology, biophysics and the public. In addition, 25 experts from these fields presented data to the panel and a conference audience of 1,200. A Medline literature search was performed, an extensive bibliography of references provided, as well as abstracts with relevant citations. Scientific evidence was given precedence over clinical anecdotal experience.
Consensus Process: The panel developed their conclusions based on the scientific evidence presented in open forum and the scientific literature. The panel composed a draft statement, which was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at conference end. Within a few weeks the panel finalised the revisions. The draft statement was made available on the World Wide Web immediately following its release at the conference and updated in accordance with the final revisions.
Conclusions: Acupuncture is widely practised as a therapeutic intervention in the United States. Although there have been many studies of its potential use, many of these studies provide equivocal results due to design, sample size and other factors. There are further complications regarding the use of appropriate controls, including placebos and sham acupuncture groups. Promising results have emerged, showing efficacy for acupuncture in adult postoperative and chemotherapy nausea and vomiting and in postoperative dental pain. Acupuncture may also be useful as an adjunct treatment or an acceptable alternative to be included in a comprehensive management programme for other conditions including addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome and asthma. Further research will likely reveal additional areas where acupuncture is therapeutically effective.
NIH Consensus Statement 15(5): 1-34. Nov 3-5 1997.

KLEPSER and KLEPSER, Division of Clinical and Administrative Pharmacy, College of Pharmacy, The University of Iowa, Iowa City 52242 USA. teresa-klepser@uiowa.edu discuss unsafe and potentially safe herbal therapies.
Results: Herbal therapy use is increasing in the United States; however, most pharmacists are not adequately prepared educationally to meet request from patients for information regarding herbal products. Pharmacists have to work in an environment in which there is relatively little regulation of herbal therapies by the FDA. Certain herbs have been identified as unsafe, including borage, calamus, coltsfoot, comfrey, life root, sassafras, chaparral, germander, licorice, and ma huang. Potentially safe herbs include feverfew, garlic, ginkgo, Asian ginseng, saw palmetto, St John’s wort, and valerian. Clinical trials have evaluated feverfew for migraine prevention and rheumatoid arthritis; garlic for hypertension, hyperlipidaemia and infections; ginkgo for circulatory disturbances and dementia; ginseng for fatigue and cancer prevention; and saw palmetto for benign prostatic hyperplasia. Also studied in formal trials have been St John’s wort for depression and valerian for insomnia. The results from the clinical trials suggest efficacy of some herbal therapies for certain conditions. German Commission E, a regulatory body which evaluates the safety and efficacy of herbs on the basis of clinical trials, cases and other scientific literature, has established indications and dosage recommendations for many herbal therapies.
Conclusions: Pharmacists have a responsibility to become educated regarding herbal therapies in order to help patients discern fact from fiction, avoid harm and gain what benefits may be available.
Klepser TB and Klepser ME. Unsafe and potentially safe herbal therapies. American Journal of Health-system Pharmacy 56(2): 125-38. Jan 15 1999.

Comments (Michael McIntyre, Chairman of the European Herbal Practitioners Association :
It is inaccurate to say that all these herbs listed are unsafe. Liquorice is a common ingredient of sweets so it can hardly be said to be unsafe. In huge doses, it may raise blood pressure because it has a mild mineralocorticoid effect but this hardly makes it unsafe. Ma Huang (Ephedra sinica) obviously contains ephedrine. It is entirely safe in the hands of a trained herbalist who knows that it is contraindicated if someone is taking an MAOI, has high blood pressure, an enlarged prostate, glaucoma, heart disease, tacchycardia, or is a professional athlete. I use it every day in my practice and have never had a single adverse effect.
Borage, comfrey liferoot and coltsfoot are all attacked for causing liver damage because they contain pyrrolizidine alkaloids. But after extensive discussions, the UK authorities have permitted the use of comfrey leaf because the PA levels are so very low. This is also true of coltsfoot and borage leaf. Comfrey is completely safe as an ointment since PAs cannot pass through the skin. Life root has higher amounts of PAs and we no longer use it. I think the same may be true for Sassafras.
It is true that there is evidence that chaparral and germander may cause liver damage and we have agreed not to use these plants. Calamus it is claimed may cause cancer but evidence for this is shaky and it continues to be a major herb legally in use in the UK.

Issue 43

FALKENBACH and colleagues, Research Institute Gastein, Badgastein, Austria write that massage courses for medical students have been held at Frankfurt University Medical School from 1987. The authors surveyed students’ motives for participation and changes in attitude towards massage therapy.
Methods: Students were asked to complete a standardised questionnaire in 1990, 1993 and 1995/96.
Results: Motives for participation and attitudes towards massage therapy remained largely unchanged throughout these years. The motives for participation were: 1) to practise massage therapy (86%); 2) to be better able to (later) prescribe massage therapy (66%); 3) to improve palpation skills (75%); 4) to do ‘something practical’ (56%); and 5) to (later) practise massage therapy as medical doctor (23%). The proportion of theory and practical instruction of 1:3.2 was considered suitable.
Falkenbach A et al. Course in massage therapy for medical students. Medical Education 32(5): 514-6. Sep 1998.

MAUDSLEY and KERR, Department of Microbiology, University of Leeds UK investigated the safety of plant essential oils.
Methods: The authors determined the sterility of eight plant essential oils obtained from retail outlets. They also examined the ability of oils to support the growth of fungal and bacterial pathogens and assessed the antimicrobial activity against 7 bacterial species and Candida albicans.
Results: All the oils and their respective carriers were found to be sterile. Methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa were not able to survive in oils for longer then 6 hours; however C. albicans was able to survive, but not multiply, in ylang ylang oil for at least 48 hours.
Maudsley F and Kerr KG. Microbiological safety of essential oils used in complementary therapies and the activity of these compounds against bacterial and fungal pathogens. Supportive Care in Cancer 7(2): 100-2. Mar 1999.

ALKAISSI and colleagues, Department of Anaesthesiology and Intensive Care, University Hospital in Linkoping, Sweden write that acupuncture and acupressure have previously been reported to possess antiemetic (anti-nausea) effect. The authors conducted a double-blind and randomised study to investigate the "genuine" and placebo effect of acupressure in the prevention of postoperative nausea and vomiting (PONV).
Methods: 60 women undergoing outpatient minor gynaecological surgery were recruited into the study. One group received acupressure with bilateral stimulation of P6 (A); a second group received bilateral placebo stimulation (P); and a third group received no acupressure writ band and served as a reference group (R). PONV was evaluated as number of patients with complete response (no PONV), nausea only or vomiting. Additionally, the need for rescue antiemetic medication and nausea after 24 hours was registered.
Results: A complete response (no PONV) was obtained in 11, 11 and 9 patients in groups A, P and R respectively. 9, 7 and 6 patients had nausea prior to discharge home, and 1, 1 and 8 patients were nauseated 24 hours following operation in A, P and R groups respectively. Compared to placebo acupressure (2 patients vomited and 5 needed rescue), significantly fewer P6 acupressure patients required rescue antiemetic medication (no vomiting or rescue medication). Compared to the observation group (5 vomited and 4 needed rescue antiemetics), significantly fewer vomited following acupressure.
Conclusions: For patients undergoing brief gynaecological surgery, the placebo effect of acupressure decreased nausea after 24 hours; however vomiting and requirement for rescue antiemetics was reduced only by genuine acupressure at the correct stimulation of P6.
Alkaissi A et al. Effect and placebo effect of acupressure (P6) on nausea and vomiting after outpatient gynaecological surgery. Acta Anaesthesiological Scandinavica 43(3): 270-4 Mar 1999.

KESSELRING (No affiliation provided) conducted a study to investigate the possible usefulness of foot reflexology on recovery following surgical intervention.
Methods: 130 patients who underwent abdominal surgery under full anaesthesia for different, but exclusively gynaecological reasons participated in this study. Foot reflexology was applied only for a few days for each patient. Measures recorded from the day prior to the operation and until day 10, were: subjective, self-assessed, general condition, pain intensity, bowel movement, micturition and sleep. Two other control treatments were a simple massage of the foot or a personal conversation.
Results: Whereas the simple massage was a relaxing positive experience, the foot reflexology had various effects, including some negative effects.
Conclusions: The author concludes that foot reflexology is not recommended for acute, abdominal postsurgical situations in gynaecology because it can occasionally trigger abdominal pain. Kesselring A. Foot reflexology massage: a clinical study Forschende Komplementarmedizin 6(1): 38-40 Feb 1999.

Comments: While it is encouraging to see more generalised clinical research being undertaken to assess the therapeutic efficacy of complementary therapies, and in fact medical students being trained to perform these therapies, I am concerned about the design of the last research project above, when an apparently standardised protocol of foot reflexology was applied to gynaecological patients postoperatively. I would be very interested in hearing comments from reflexologists regarding the above matter.

Issue42

Comments: There is considerable and impressive breadth regarding the research being conducted about a wide variety of complementary therapies for a large number of conditions. As the data from these studies become available to the wider healthcare professional communities, we will see progressively greater use of complementary therapeutic treatments and natural products amongst medical professionals, as well in the public at large.

Issue 41

JOHNSON AND BORDINAT Department of Family and Community Medicine, Michigan State University College of Osteopathic Medicine, East Lansing 48824-1316 USA have been professionally associated with osteopathic medicine since 1972 and they have observed the processes whereby trainees and osteopathic physicians inculcate their unique professional identity.
Discussion: The authors warn that increasingly, the philosophical and practical components which have historically defined osteopathic medicine as a distinctive approach to medical practice are quickly eroding, due to powerful forces associated with professional prestige, public acceptance, professional collaboration with allopathic physicians and changing trainee expectations. The extent to which osteopathic practitioners embrace the philosophical and clinical components of their profession will determine whether the profession retains its identity as a separate medical entity.
Conclusions: If the current de-emphasis of these identifying characteristics continues, little more than a name will distinguish osteopathic medicine from the allopathic medical profession.
Johnson SM and Bordinat D. Professional identity: key to the future of the osteopathic medical profession in the United States J Am Osteopath Assoc 98(6): 325-31 Jun 1998.

COTT and colleagues, Adult Psychopharmacology Program, National Institute of Mental Health, Rockville, Maryland 20857, USA write that St John’s wort (Hypericum perforatum) is a remarkably safe antidepressant with an apparently unique mode of action. St John’s wort has demonstrated efficacy with mild and moderate depression when compared with placebo or tricyclic antidepressants,; however there is scope for further research areas to be explored. These areas include a comparison of St John’s wort’s effects with serotonin reuptake inhibitors. Additionally, there do not appear to be any studies with severely depressed patients, or studies regarding its utility as a therapeutic adjunct to standard antidepressants.
Cott JM and Fugh-Berman A. Is St John’s wort (Hypericum perforatum) an effective antidepressant? J Nerv Ment Dis 186(8): 500-1 Aug 1998.

JACOBSEN and COHAN, UOP School of Dentistry, San Francisco, CA 94115 USA write that complementary and holistic health care is a growing area in medicine and dentistry. The authors review (16 references) the variety of dental products promoted as an "alternative" to standard commercial dental products. These products can be categorised as standard dental products made with natural ingredients, herbal or homoeopathic products, and synthetic alternative products. They write that use of dental care products needs to be based upon sound basic scientific evidence of safety and efficacy. Dental health care providers need to be aware of the range of alternative dental products in order to help their patients to understand the type of support or evidence required to determine the safety and efficacy of treatment.
Jacobsen PL and Cohan RP. Alternative dental products. J Calif Dent Assoc 26(3): 191-8 Mar 1998.

WAINAPEL and colleagues, Department of Rehabilitation Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY USA conducted a survey to document the prevalence, patterns of use of alternative medical therapies and their perceived effectiveness by patients within a rehabilitation medicine outpatient practice.
Methods: The authors conducted a cross-sectional survey using a written questionnaire using an urban rehabilitation medicine outpatient referral office. A random sample of 103 patients referred for outpatient rehabilitation care were provided a questionnaire to complete while awaiting their appointment. The main outcome measures were their use of alternative therapies and their perceived effectiveness.
Results: 29.1% of respondents had used one or more alternative therapies during the previous 12 months. The most common therapies used were massage, chiropractic, vitamin and mineral supplementation and acupuncture. The most common problems for which patients sought treatment were musculoskeletal pain syndromes of the spine and extremities. 53% of the patients using alternative treatments reported some degree of efficacy.
Conclusions: A significant proportion of rehabilitation medicine patients use and frequently perceive benefit from alternative therapies, especially massage, chiropractic, vitamin and mineral supplementation and acupuncture. The incorporation of alternative therapies into physiatric practice is a desirable future direction for the speciality.
Wainapel SF et al. Use of alternative therapies by rehabilitation outpatients. Arch Phys Med Rehabil 79(8): 1003-5 Aug 1998.

WEISER and colleagues, Biologische Heilmittel heel GmbH, Baden-Baden, Germany. Weiser.michael@heel.de. compared the efficacy and safety of the homoeopathic remedy Vertigoheel with betahistine hydrochloride (active control) in the treatment of patients with vertigo.
Methods: The authors conducted a randomised double-blind controlled clinical trial using 15 study general practice study centres in Germany between November 1995 and November 1996. Of the 119 patients suffering with vertigo of various origins, 105 patients were analysed with the protocol. The major outcome measures were frequency, duration and intensity of vertigo attacks.
Results: Both the homoeopathic and conventional treatments demonstrated a clinically relevant reduction in mean frequency, duration and intensity of vertigo attacks; therapeutic equivalence between the homoeopathic remedy and betahistine was demonstrated with statistical significance.
Conclusions: Therapeutic equivalence was shown between the homoeopathic remedy and betahistine. Both treatments reduced frequency, duration and intensity of vertigo attacks during a 6-week treatment period, and vertigo-specific complaints were significantly reduced.
Weiser M et al. Homeopathic vs conventional treatment of vertigo: a randomized double-blind controlled clinical study. Arch Otolaryngol Head Neck Surg 124(8): 879-85 Aug 1998.

BLAND, HealthComm International, Inc, Harbor, Washington USA reviews (72 references) how the ageing population’s healthcare demands can be met by promoting healthy ageing.
Discussion: Dr Jeffrey Bland notes that by the year 2020, 20% of the US population will be aged 65 years or older, with the highest growth in numbers among people aged 85 years or older. He states that if healthcare demands of this group match those of their parents, it would place an extraordinary burden upon funding for medical services. Complementary medicine practitioners can improve the cost-effectiveness of healthcare delivery by promoting healthy ageing. The components of a scientifically based complementary medicine programme to promote healthy ageing includes: 1) diet and nutritional tailoring; 2) nutrient enhancement to meet specific individual requirements; 3) exercise training; 4) stress management; 5) promotion of structural integrity; 6) environmental adjustment; 7) counselling regarding purposeful living; and 8) normalisation of intercellular communication. The author describes a programme which incorporates these features and focuses upon the following modifiable factors of unhealthy ageing: altered mitochondrial function and oxidative stress, increased protein glycation, chronic inflammation, defects in methylation, reduced detoxification ability and altered immunity.
Bland JS. The use of complementary medicine for healthy aging. Altern Ther Health Med 4(4): 42-8 Jul 1998.

Comments: This is indeed a tall order! The almost insurmountable problems that we will all face in the next 20 years or so are almost unimaginable, given that people are living much longer, and that many elderly people have significant health problems. Despite all the high-tech developments that are forecasted to occur, such as the growth of replacement body parts, genetic engineering to tackle severe diseases such as cancer, I don’t think that these will have much impact upon those of us already adults now. The demographics confound my comprehension. We will be living in a mass population of aged people, with fewer young people than elderly. The equation doesn't fit, unless we suddenly start producing more young people, or unless the numbers of elderly people who remain alive don’t mushroom as projected. Dr Jeffrey Bland is a giant in the field of nutritional medicine; each of the components alluded to in Dr Bland’s programme is a universe in itself, especially such wonderfully enigmatic and difficult to obtain aspects such as purposeful living, environmental adjustment, promotion of structural integrity and the normalisation of intercellular communication. I sincerely hope that this will be all sorted out by the time I reach 65.

Issue 40

BITTINGER and colleagues, III. Medizinische Klinik, Zentralklinikum Augsbug Germany review the literature (34 references) regarding alternative treatments for functional gastrointestinal disorders.
Discussion: The authors write that patients with functional disorders of the gastrointestinal tract respond poorly to standard therapeutic regimes and often try alternative treatments, such as homoeopathy, acupuncture, phytotherapy, dietary modification, psychotherapy and hypnosis. As placebo response is high in gastrointestinal tract functional disorders and there is usually no placebo-controlled studies available to prove the efficacy of these therapies, critical assessment of alternative treatments is difficult. Up to the present, there is little data available to prove the efficacy of homoeopathy and phytotherapy and the efficacy of acupuncture is still questionable. In contrast, hypnosis, psychotherapy and several forms of diet modification appear to be useful for at least some patients with functional disorders of the gastrointestinal tract.
Bittinger M et al. Alternative therapy methods in functional disorders of the gastrointestinal system. Z Gastroenterol 36(6): 519-24 Jun 1998.

REUTHER and ALDRIDGE, Faculty of Medicine, Universitat Witten Herdecke, Witten, Germany conducted a pilot study to investigate the efficacy of Qigong Yangsheng for the treatment of asthma. Qigong Yangsheng is a health-promoting method of traditional Chinese medicine, combining movement, mental exercise and breathing technique. In China it is used for the therapeutic treatment of bronchial asthma.
Methods: The authors conducted a single- case research design pilot study with baseline, one teaching phase, a phase of self-practice and a refresher teaching course. 36 asthma patients, with varying degrees of severity of illness were taught, under medical supervision, Qigong Yangsheng. They were requested to exercise independently, if possible, on a daily basis and to keep a diary of their symptoms for 6 months, recording peak-flow measurements 3 times per day, their use of medication, frequency and length of exercise and 5 asthma symptoms: sleeping through the night, coughing, expectoration, dyspnea and general well-being. A 4-week follow-up period was carried out in the same season as the original baseline phase 52 weeks later. An improvement was scored if subjects showed a decrease of at least 10 percent in peak-flow variability between the 1st and 52^nd week.
Results: Improvement occurred more frequently in the group of the exercisers (n = 17) than with the nonexercisers (n = 13). In a comparison between the study year with the year prior to the study, there was also improvement in reduced hospitalisation rate, less sickness leave, reduced antibiotic use and fewer emergency consultations, resulting in reduced treatment costs,
Conclusions: Qigong Yangsheng is recommended for asthma patients under professional supervision. Improvement in airway capability and decrease in illness severity can be achieved by regular self-conducted Qigong Exercises.
Reuther I and Aldridge D Qigong Yangsheng as a complementary therapy in the management of asthma: a single-case appraisal J Altern Complement Med 4(2): 173-83. 1998.

HAMMERSCHLAG, Yo San University of Traditional Chinese Medicine, Santa Monica, California 90401 USA reviews (48 references) controlled clinical trials of acupuncture.
Methods and Discussion: Controlled clinical trials of acupuncture are divided into 5 categories, based upon the treatment with which acupuncture is compared: 1)Waiting list or no treatment controls, ethically acceptable for stable, chronic conditions, assess the efficacy of acupuncture relative to the natural history of the condition, but do not control for nonspecific treatment effects; 2) Placebo controls, defined as noninvasive procedures such as inactive transcutaneous electrical nerve stimulation (TENS) or mock needling, assess whether acupuncture has an effect beyond that of the therapeutic milieu; 3) Sham controls, defined as invasive but inappropriate procedures such as shallow needling at nonacupoint sites, assess whether acupuncture efficacy depends upon the style and location of needling; 4) Standard care comparisons assess whether acupuncture performs at least as well as a medication, medical device or physiotherapy; 5) Adjunctive care comparisons assess the efficacy of acupuncture plus standard care relative to standard care alone. From an ethical perspective, active debate surrounds placebo and sham controls, with those arguing against these procedures considering withholding treatment to be improper. These people favour the waiting list and both standard care designs in which all patients receive treatment. Others argue that testing a treatment prior to demonstrating its efficacy against a placebo is equally improper. It should also be considered that most clinical trials of acupuncture have assessed its efficacy by administering a fixed course of treatment based upon biomedical diagnosis.
Conclusions: The challenge for future trials is to design conditions that more closely mimic the application of acupuncture in clinical practice, as individualised treatment informed by its own diagnostic traditions.
Hammerschlag R Methodological and ethical issues in clinical trials of acupuncture. J Altern Complement Med 4(2): 159-71 Summer 1998.

Issue 39

DAVIS and colleagues, Department of Internal Medicine, University of California at Davis, USA write that, despite advances in the diagnosis and treatment of asthma, the incidence of mortality is increasing throughout the developed world. A variety of complementary and alternative medical therapies are now being used in the treatment and prevention of asthma. The authors conducted a survey to identify the type and prevalence of complementary and alternative treatments for asthma in use in the United States.
Methods: 10,000 copies of a survey developed by an expert panel were inserted into the May 1996 issue of Alternative Therapies in Health and Medicine. Only those professionals who treated asthma were invited to respond. The survey attempted to identify characteristics of the respondent, their particular type of practice, use of complementary, alternative or conventional medicine, patient characteristics and numbers, as well as their use of 20 specific potential therapies for the treatment of asthma. A total of 564 surveys were returned, a low response rate (5.64%), but reflective of the demographics of the readership of this journal.
Results: The responders to the survey were 46% male and 43% female; 11% did not specify gender. The ranged in age from under 31 years to over 70. The largest group of respondents (37%) were medical doctors, 27% held doctorates in complementary and alternative medicine-related disciplines, 11% had registered nursing degrees, 4% were acupuncturists and 18% did not specify their training. The characteristics between MD and non-MD asthma care providers did not differ. The majority had general practices (75%) with all ages of patients. MDs were less likely than non-MDs to employ complementary and alternative medicine techniques for the treatment of asthma. Both groups cited dietary and nutritional methods as their most prevalent and effective asthma treatment option. Botanicals, meditation and homoeopathy were frequently cited therapies. There were statistically significant differences in the rankings of treatment usefulness and prevalence between MD and non-MDs. Non-MD asthma practitioners were more likely to question patients regarding their use of complementary and alternative asthma treatments than were MDs (92% vs 70%). Both groups of practitioners showed statistically significant increases in their levels of patient inquiries compared to 2 years previously (up 9% and 8% for MDs and non-MDs respectively).
Conclusions: The predominance of diet and nutritional supplements used both by MDs and non-MDs suggests that further research be directed toward these practices, as well as toward the use of botanicals, meditation and homoeopathy. The variations between MDs and non-MDs regarding the use of therapies may reflect differing philosophies and training.
Davis PA et al. The use of complementary/alternative medicine for the treatment of asthma in the United States. J Investig Allergol Clin Immunol 8(2): 73-7 Mar-Apr 1998.

NORLANDER and colleagues, Department of Psychology, Karlstad University, Sweden. at.norlander@mailbox.swipnet.se investigated the possible psychological effects of the physioacoustic chair, an application of low-frequency sound waves, regarding deductive thinking and creativity in addition to its possible effect upon heart rate.
Methods: 21 men and 21 women were randomly assigned in equal numbers to one of either: 1) a control group; 2) a placebo group, i.e. a group who believed that they underwent a physioacoustic treatment programme which, however, they did not undergo; or 3) a physioacoustic treatment group. Following manipulation, the subjects took 3 psychological tests which assessed fluency and originality, preconscious thinking and deductive thinking in random order. The heart rates of the subjects were registered every minute throughout the entire experiment.
Results: The data demonstrated no significant differences among the groups regarding psychological effects or heart rate.
Conclusions: These results were interpreted to mean that the physioacoustic chair provides a form of relaxation which does not produce effects upon the creative process.
Norlander T et al. The physioacoustic method and the creative process. Percept Mot Skills 86(3 Pt 1): 1091-6 June 1998.

BREWER, University of Plymouth, Faculty of Human Sciences, Institute of Health Studies, Taunton UK explores Guzzetta's (1988) notion that musical vibrations which are in tune with our human vibratory pattern may have a profound healing effect upon the entire body.
Results: The author addresses why music therapy is effective for some and not other people and offers solutions. An understanding of the principles and theories of sound and harmonics is central to using therapeutic music and healing sounds with positive effects. These principles and theories are explored; there is a focus upon strategies for the holistic nurse wishing to use this knowledge to facilitate communication and balance between the mind and body of the patient.
Brewer JF. Healing Sounds Complement Ther Nurs Midwifery 4(1): 7-12 Feb 1998.

DRIVDAHL and colleagues, Department of Family Practice, Madigan Army Medical Center, Tacoma, Wash USA conducted a study which examined the characteristics of family practice patients who used alternative medicine, the health problems which preceded this use and their satisfaction.
Methods: A questionnaire was posted to 250 adults selected at random from a large military family practice clinic. The final response rate was 71%.
Results: Greater than 28% of patients used some form of alternative medicine. The typical user was 30-49 years of age, female, white and well-educated. The most common therapies used were chiropractic (64%), massage (36%), herbal therapy (32%) and acupuncture (16%). The most common problems for which patients sought alternative care included back pain (56%), musculoskeletal pain (22%) and stress and other psychosocial problems (20%). Less than 50% were satisfied with the alternative health care, despite the finding that 82% reported at least some improvement in their condition. 63% did not tell their family doctor about using alternative health care.
Conclusions: A significant number of family practice patients use alternative medicine. Although most derive some benefit, most are not satisfied with the result. The reasons for this disparity between satisfaction and effectiveness of alternative medicine merit further study.
Drivdahl CE and Miser WF. The use of alternative health care by a family practice population. J Am Board Fam Pract 11(3): 193-9 May-Jun 1998.

Comments: Given that an overwhelming majority (82%) of respondents experienced improvement in their symptoms, I find it suspicious that less than half the patients were satisfied with their alternative health care and suspect that the question regarding satisfaction may have been too black or white (ie. a yes or no). A further detraction from the results of this study is the absence of reasons of why these people were not satisfied with their alternative treatments – ie. was it the practitioner, the standard/competence of the treatment, the cost, etc? This finding does not compute with me.

Issue 38

CALDERON, Centro de Salud de Gomez de Alza, Donostia-San Sebastian explored views of Primary Care and Homoeopathic physicians in the same area regarding their attitudes towards Homoeopathy as a discipline and motives which bring patients to use its services.
Methods: This qualitative study used in-depth interviews and a focus group and took place within a community of 18,000 people with a Health Centre and 4 homoeopathic physicians. The 4 homoeopathic physicians and 9 of the 10 doctors participated in the study. Following face-to-face and telephone interviews later on, each of the 4 homoeopathic physicians was interviewed at length; the author led a focus group with the 9 doctors from the Health Centre.
Results: The homoeopaths emphasised an integrated patient-centred approach, insisted upon their status as doctors and asserted that their treatment was not iatrogenic. The Primary Care doctors were ignorant of Homoeopathy, they identified it with a type of remedy of which they knew nothing but for which they demanded scientific evidence.
Conclusions: Primary Care doctors' ignorance of Homoeopathy places them at risk of not understanding patients' expectations. It appears that the patient-centred, as opposed to disease-centred healthcare model is outside the scope of Primary Care health delivery.
Calderon C. Homeopathic and primary care doctors: how they see each other and how they see their patients: results of a qualitative investigation. Aten Primaria 21(6): 367-75. 15 Apr 1998.

SIMPSON, University of Queensland, Sociology Department, Australia writes that in Queensland, Australia, patients suffering work-related injuries must be referred by a general medical practitioner (GP) in order to receive treatment from "nontraditional" practitioners such as physiotherapists, chiropractors or osteopaths, despite the fact that these nontraditional practitioners are primary care provides outside of the workers' compensation system.
Background: The Chiropractors' Association of Australia (CAAQ) surmised that workers injured and who wished to receive chiropractic treatment had little chance of obtaining a medical referral; however the General Manager of the Workers' Compensation Board of Queensland maintained that injured workers had little trouble obtaining such a referral.
Methods: The author conducted a descriptive study in order to canvass GP attitudes and referral patterns to chiropractors, osteopaths, physiotherapists and other nontraditional practitioners such as naturopaths. A questionnaire was mailed to 1509 GPs, representing 50% of all GPs in private practice in Queensland.
Results: The response rate was 52%. 784 questionnaires were returned - 638 male and 142 female GPs. The respondents were aged from 27-79 years and had been in practice from 1-55 years. The survey indicated that attitudes and referral patterns were distinctly different, depending upon the nontraditional practitioner group in question.
Conclusions: The results of the survey confirm that GPs are highly unlikely to have professional relationships with chiropractors and osteopaths, including the referral of patients to such practitioners, even if the patient requests such a referral. Additionally, GPs are much more likely to have professional dealings with physiotherapist than with any of the other nontraditional groups considered.
Simpson JK. A study of referral patterns among Queensland general medical practitioners to chiropractors, osteopaths, physiotherapists and others. J Manipulative Physiol Ther 21(4): 225-31 May 1998.

HOPPER and COHEN, Monash University, Melbourne, Australia write that despite the popularity of complementary therapies with the public, knowledge and use of these therapies among doctors appear to be limited. The authors examined the attitudes of medical students toward complementary therapies.
Methods: The authors distributed a questionnaire to 800 1st, 3rd and 5th-year medical students at two universities in Melbourne, Australia.
Results: Although Australian medical students were positive toward complementary therapies, their self-reported knowledge was low, with 56% having no knowledge of the principles of complementary therapies. Attitudes toward various therapies varied widely; students had little knowledge of chiropractic and naturopathy, the two therapies most commonly used by Australians. Students consistently scored meditation, massage and acupuncture highest regarding knowledge, perceived usefulness, intended patterns of referral following graduation and desire to education in the undergraduate degree curriculum.
Conclusions: Where medical course included tuition about complementary therapies, students were more positive. A single lecture on complementary therapies was found to have significant impact upon the views of medical students. Medical students have a high level of interest in complementary therapies which is not being satisfied by their undergraduate curricula.
Hopper I and Cohen M. Complementary therapies and the medical profession: a study of medical students' attitudes. Altern Ther Health Med 4(3): 68-73. May 1998.

Comments: All the above research demonstrates that despite the popularity and demand for complementary therapies from the public, attitudes and practices of the medical profession have been slow to teach medical students, learn these methodologies, let alone integrate complementary therapies into their practices or even to refer patients to such practitioners, even when they are requested for such referrals. Is this the old story of the dinosaur, or is it the ostrich burying its head in the sand?

BUCKEL, Boehringer Mannheim GmbH, Penzberg, Germany writes that "natural medicine" treatments have recently enjoyed a surge in popularity, but that the term "natural" used regarding these healing methods is frequently misunderstood, resulting in the underestimation of the risks involved from incorrect use.
Discussion: The author states that the essential principle which underlies traditional natural medicine - the mobilisation of the body's own forces against disease, is increasingly being applied in a novel, rational form of medicine, that of molecular medicine. There are already available a range of natural endogenous substances for medical use, and human proteins such as erythropoietin can presently be produced as medicines in highly purified form using genetic engineering techniques. Our increasing grasp of the function of human genes and the molecular mechanisms underlying disease are helping to use the body's own resources. Gene therapy will in future enable physicians to mimic the natural conditions in the healthy body in order to cure illness. One important application will be the activation of the immune system to fight cancer. The decoding of the human genome will enable illnesses to be described and possibly prevented at earlier stages, illnesses will be described more precisely and individually at the molecular level, prompting the possibility of targeted, patient-specific cures.
Buckel P. Toward a new natural medicine. Naturwissenschaften 85(4): 155-63 Apr 1998.

Comments: Amen! I too eagerly await the arrival of natural, immune-boosting treatments based upon our individual genetic and biochemical make-up.

BOON, Faculty of Pharmacy, University of Toronto, Ontario Canada, describes naturopathic practitioners with 2 distinct world views - holistic and scientific and explores the relationship of practitioners' socialisation experiences and practice patterns within these two world views.
Methods: Data were assembled using a variety of techniques, including: 1) a 14-page questionnaire posted to all 296 naturopathic practitioners licensed in Canada; 2) a participant observation study conducted at the Canadian College of Naturopathic Medicine (CCNM); 3) open-ended interviews with 16 students attending CCNM and 41 naturopathic practitioners.
Results: Individuals with both holistic and scientific world views entered naturopathic training; none of the practitioners interviewed reported a change in world view while attending naturopathic college. Practitioners, however, reported a newly-found appreciation of the "other" world view upon completion of their studies, indicating the occurrence of a socialisation effect. Many decisions involved in establishing a practice and seeing patients are affected by the practitioners' world views. These included, for example, distinct differences in the way that practitioners with differing world views chose treatment modalities. Those practitioners with scientific world views chose treatments based upon scientific evidence, whereas practitioners with holistic world views explored the patient's spirituality and their own intuition regarding treatment decision. Practitioners with holistic world views reported significantly longer patient visits than those with scientific world views.
Conclusions: The data presented suggest that world view influences perceptions of socialisation experiences and social situations and modulates the effects of both upon practice patterns.
Boon H. Canadian naturopathic practitioners: holistic and scientific world views. Soc Sci Med 46(9): 1213-25. May 1998.

Comments: This was a most interesting and highly creatively designed study, which demonstrates the huge variations in practices even among practitioners of the same discipline, which although appearing to make plain common sense, is a bit of a stark result when placed within a research context. In North America, naturopaths train and can opt to specialise in several different modalities, including nutrition, acupuncture, homoeopathy and herbal medicine, wide-ranging treatment universes each considered individually. No wonder the tremendous scope for differing treatment approaches.