ALTERNATIVE THERAPIES: WHERE'S THE HEALTH WARNING

when multiple sclerosis sufferer Rosalie Kerbekian entered the Tyringham Clinic, a centre for complementary medicine, in April, she was fit and well. Despite her illness, she was working for the NHS three days a week as a child psychotherapist and seeing private patients at home.

When she left the clinic, two weeks later, she could hardly walk. She had to go to bed, stop working and two months later ended up in hospital, taking steroids.

"The regime at the clinic was too strenuous for me," says Ms Kerbekian, 56, who lives in Hampstead, north London. "I was given a programme of water aerobics every day, acupuncture three times a week, osteopathy and many different types of baths. I was rushing from one treatment to another. I trusted the staff that it was doing me good. The disillusionment when I got home and had to be hospitalised was horrendous."

Ms Kerbekian, who trained at the Tavistock Clinic and is particularly interested in seeing clients with MS or other disabilities, has only just been able to go back to work five months later and is still angry about her treatment.

Some doctors would argue that the experience of Kerbekian and others like her is powerful evidence that the whole area of complementary medicine needs better regulation, to avoid raising false hopes or subjecting people to danger. At present, any member of the public is entitled to put up a brass plate and call themselves a herbalist, acupuncturist or naturopath.

Already this month, doctors have reported the death of a 32-year-old Nottingham man from Chinese herbal medicine, while in May, pathologists recorded the death of a 40-year-old woman, whose heart was punctured by an acupuncture needle. Five cases of lead poisoning from traditional Asian remedies have also recently been reported in the Midlands.

Unfortunately, alternative medicine has become such a sacred cow that its dangers are often ignored. Many doctors are frightened to speak out in case they are labelled as narrow-minded and self-serving. One of the few exceptions is Dr John Garrow, emeritus professor of human nutrition at St Bartholomew's Hospital, London.

"The dangers of complementary medicine are underestimated both by practitioners and by patients," he says. "Alternative medicines are often presented as being natural and of great antiquity, and these two qualities falsely give the impression that they are safe. There are many compounds that are natural that are extremely deadly. Eating plants such as rhubarb leaves or belladonna are two examples.'

A particular problem with Chinese and some other herbal remedies, is that one batch of herbs can differ a great deal from another, whereas with conventional medicine. you know that the aspirin you buy in Guildford is the same as the one you buy in Glasgow.

Monique Roffey, 30, is a journalist from north-west London who suffered serious ill health after taking a Chinese herbal remedy. When she developed a particularly severe bout of asthma a year ago, a friend recommended that she visit a Chinese doctor and herbalist.

"He gave me some pills which I took. I started feeling weaker and weaker and experienced pain in my groin. I then developed the most horrific kidney infection and within 10 days, I got a rare auto-immune disease, known as Churq-Strauss syndrome. I was in hospital for two months. Although no one knows whether the pills caused it, my doctor thought they could have sparked it off."

Many alternative therapists themselves recognise the dangers of patients being offered unlicensed remedies. The Centre for Complementary Health Studies at Exeter University is particularly concerned about it.

"Something needs to be done," says Simon Mills, the centre's projects co-ordinator. "There are several hundred licensed herbal remedies in this country, including such things as camomile, valerian and peppermint, which come under the Medicines Act, and which have to meet standards of safety, quality and efficacy.

"But there is a large and growing unlicensed sector, including traditional remedies from China, the Indian sub-continent, Africa and the Caribbean, which are subject to no control at all. If these are sold on a one-to- one basis, by a practitioner to an individual client, they are exempt from the Medicines Act.

"We think there should be a second tier of licensing registration system that is a halfwway house. It could ensure that producers adopt good manufacturing practice and that consumers get exactly what is on the label. There could also be a negative list of those ingredients which should not be included because of their toxicity."

It is easy to understand why many patients turn to alternative therapies. Modern medicine has raised expectations that it often cannot fulfil and there are many chronic conditions, such an arthritis, eczema, asthma and hay fever, for which the conventional remedies are often unsatisfactory. The public has also been horrified at the well-publicised side-effects of modern drugs, such as steroids, amphetamines and tranquillisers.

"Alternative medicine is also private medicine," says Dr Thurstan Brewin, chairman of the campaigning group, HealthWatch, which monitors both conventional and complementary medicine.

"You get more time, the surroundings are more pleasant and you are treated with more respect and dignity. Added to this is the fact that you are paying money and this has a placebo effect.

"Practitioners are also paternalistic, which some patients like. Orthodox doctors have been told that they must never be paternalistic, so when they do not know what is wrong with a patient, they admit it. Patients then rush off to an alternative practitioner who gives their illness a name, even if it means inventing it, and tells them that their treatment will make them better."

Most therapies are not dangerous, they simply do not work, Mr Brewin says. The patient would have got better anyway. Patients are grateful, but they have nothing to be grateful for.

As well as getting better by themselves, patients can obviously get worse, and should not always blame the remedy. This is the explanation for Ms Kerbekian's experience, according to Patrick Welsh, director of the Tyringham clinic in Newport Pagnell. Buckinghamshire, who denies any responsibility for her condition saying: "With multiple sclerosis, patients can have a relapse at any time. It is arguable that she might have had a relapse anyway. She was also using other therapies before she came to us, so they might have contributed."

A cruel aspect of complementary therapy, however, is the way that it raises false hopes. Mrs Patricia Moore, a 38-year-old mother of two from County Down, Northern Ireland, can testify to that. Her husband, Alexander, developed testicular cancer five years ago, at the age of 32, and friends immediately advocated complementary therapies, as well as orthodox medicine.

"He tried everything from cranial osteopathy to psychic surgery, Bach flower remedies and visualisation techniques. Many practitioners promised to cure him. It made no difference to the course of the disease, but meant that when we should have been having time together as a family, he was off chasing these butterflies or mirages.

"We had a Macmillan nurse who was trying to help us come to terms with our impending loss. Then in the middle of it, some therapist would come along and tell my husband he was not going to die. We had people coming to the house and visiting him in hospital, demanding pounds 25 an hour to heal his aura. I started off with no opinions about alternative medicine but after two years off it, I was very angry.

"It was very divisive. Things got so bad, that my husband was even claiming that the reason he was not getting better was because I did not have enough faith in the therapies. The message of many therapists is: `We will teach you the correct technique to cure yourself, if you do these techniques correctly, you will get better; if you don't, you won't'. So if you don't get better, it is your fault." Mrs Moore's husband died in 1993 and she is now bringing up her two children, aged four and seven, on her own.

Evidence such as this makes Dr Brewin very angry. "People in alternative medicine are always claiming that orthodox doctors intervene too much, instead of letting nature do its work. But they always give all their patients something. When did someone last go to a homoeopath or acupuncturist to be told that they did not need homoeopathy or acupuncture?"ACUPUNCTURE

Strengths: Practised in China for 3,500 years. Used for back pain, arthritis, rheumatism, allergies, anxiety, digestive problems, insomnia and stress.

Dangers: Collapsed lung, spinal cord damage, fainting, skin infections, transmission of Hepatitis and HIV from non-sterilised needles.

AROMATHERAPY

Strengths: Most patients appreciate the oils for their calming effect and the general sense of well-being that they promote. Used for constipation, depressions, digestive problems, poor circulation, headaches, migraine and tension.

Dangers: Skin rashes if sensitive to the oils, but largely risk free.

HERBAL MEDICINE

Strengths: Origins pre-date recorded history. Used for arthritis, migraine, digestive problems and skin disorders.

Dangers: Cases of liver damage have been recorded from the use of Chinese herbal remedies, including two recent deaths. With unlicensed remedies, one batch can vary significantly from another, affecting the strength.

HOMEOPATHY

Strengths: Patients are given minute doses of substances that in large amounts would produce the symptoms from which they are suffering. Remedies unlikely to produce harmful side effects, because they are highly diluted. Some are so diluted that they do not contain any of the original substance.

Dangers: There is no evidence that homeopathic vaccines confer immunity, so patients might be given the impression that they are protected from disease when they are not.

OSTEOPATHY AND CHIROPRACTICE

Strengths: Used to treat lower back and neck pain, tension headaches, sports injuries to muscles or joints and backache caused by pregnancy.

Dangers: Strokes, resulting from damage to the vertebral artery, which runs through the spinal column; dislocated vertebra; damage to nerves.