Alternative treatments under scientific scrutiny

From osteopathy to fish oils, may alternative treatments are finally coming under scientific scrutiny. Are we right to trust any of them? Jane Feinmann examines the latest evidence

Fish oil for the heart

The claims
Research over 30 years convinced the Food Standards Agency (FSA) and British Heart Foundation (BHF) to recommend oily fish or fish oil capsules, the richest sources of omega-3 fatty acids. One 2002 trial by Dr Michael Burr of the University of Wales College of Medicine raised doubts. “The Burr study shouldn’t be ignored, but it is out of step,” says Phillip Calder, professor of nutritional immunology at Southampton University. “It goes against a plausible, well-tested explanation of the benefits of omega-3 fatty acids.”

The criticisms

A new statistical analysis of the 48 best trials that investigated whether fish oil cuts the risk of dying from heart disease or stroke has found “little evidence” of benefit – and suggests that fish oil capsules may actually increase the risk. The researchers from the University of East Anglia acknowledge that the analysis, published in last Friday’s BMJ, was “significantly influenced” by the Burr study. Lead author Dr Lee Hooper, lecturer in the university’s School of Medicine and Health Policy, says advice to the public to eat more oily fish should continue, but adds that further reviews are needed on whether it is appropriate to recommend a higher intake of omega-3 fats for people with heart disease.

The truth

This was a controversy waiting to happen after the Burr study, sponsored by Seven Seas, appeared. The BHF and FSA recommendations were made while both were fully aware of the Burr findings. Research is now looking into the value of omega-3 supplements for people with heart disease (anyone with concerns should talk to their GP). The BMJ paper does not affect the evidence that fish oil protects against arthritis, or the growing evidence that it helps behavioural problems in children and protects against depression.

Acupuncture for pain

The claims
The development of sham needles (that work in a similar way to stage daggers) has enabled proper clinical trials of the traditional therapy, used for several thousand years in the East and increasingly popular in the West. “Considerable research activity is now under way and the first results are very positive, with scientific evidence that acupuncture is effective in treating osteoarthritis of the knee (Annals of Internal Medicine, Dec 2004) as well as migraine (Journal of the American Medical Association in May 2005),” says Day Post, assistant coordinator of the Acupuncture Research and Resource Council in Ealing. He says the confidence in acupuncture is reflected in the fact that it is due to become a registered practice in the UK later this year.

The criticisms
There is still room for scepticism over what happens during acupuncture. While the osteoarthritis trial found that acupuncture needles, applied to specific points on the leg, provide great pain relief and improved function, the migraine trial was less conclusive. While sufferers treated with acupuncture needles had around half the number of migraines compared to before treatment, so did those treated with sham needles – suggesting that it’s the expectation of success that works. Henry McQuay, professor of pain relief at Oxford University, says: “The great bulk of randomised controlled trials to date do not provide convincing evidence of pain relief over placebo.”

The truth
The disagreement may simply reflect the continuing problems in trying to pin down the clinical impact of a therapy that works in diverse ways – and which has most success with difficult-to-treat long-term problems where the symptoms vary between individuals. The Migraine Action Association continues to recommend acupuncture for sufferers while emphasising that the condition does not have a “one-size-fits-all” treatment.

Homeopathy for long-term health

The claims
This gentle, holistic therapy with roots in ancient Greece uses very dilute, “potentised” remedies, prescribed after the practitioner has taken a full history of both emotional and physical symptoms. A six-year study by the NHS Bristol Homeopathic Hospital (one of five NHS homeopathic hospitals), published in the Journal of Alternative and Complementary Medicine in November 2005 found that 70 per cent of 6,500 patients treated over the last six years reported positive or very positive benefits for a wide range of chronic health problems including eczema, asthma, irritable bowel syndrome and chronic fatigue syndrome.

The criticisms
A statistical analysis of 110 homeopathy trials, published in The Lancet in August 2005, reported no benefits beyond the placebo effect, warning that one favourable study by the World Health Organisation was “little more than pro-homeopathy propaganda”. The Lancet concluded that doctors should be: “Bold and honest with their patients about homeopathy’s lack of benefit, and with themselves about the failings of modern medicine to address patients’ needs for personalised care.”

The truth
If you are one of the 30 million Europeans who are regular users of homeopathy, you are unlikely to be impressed by accusations that the therapy lacks an evidence base or goes against all known physical laws. After all, “real life” studies, such as that carried out in Bristol, persistently show the value of homeopathy for patients. Just don’t expect your GP to be supportive.

Spinal manipulation for back pain

The claims
The therapy, popularly known as “cracking the spine”, is carried out tens of thousands of times every day in Britain by chiropractors and osteopaths (who have been registered practitioners since 2001). It involves a high-velocity thrust to a joint to achieve maximum painless movement. A trial, funded by the Medical Research Council and published in the BMJ in 2004, showed that spinal manipulation, as provided by osteopaths and chiropractors, is an effective and cost-effective therapy for back pain within a larger package of care, pain control and advice.

The criticisms
A review of 16 studies conducted over the past five years, appearing in next month’s issue of the Journal of the Royal Society of Medicine, has found no benefit in using spinal manipulation to treat general or menstrual pain, and that it is no better than exercise in treating back pain. The lead author, Professor Edzard Ernst, says he is concerned at the lack of continuing research into osteopathy and chiropractic since the practices became registered. “They seem to think they are home and dry. They are not, and people should be aware of that.”

The truth
Trials of “universally poor quality” have failed to show that spinal manipulation relieves acute or chronic back pain, with any improvements disappearing within three months, according to the authoritative, evidence-based website Bandolier (www.jr2.ox.ac.uk/Bandolier/)

Soya

The claims
The nutritious soya bean has kept Asia healthy for 3,000 years, and there is a large base of evidence that it lowers cholesterol (backed by the US Food and Drug Administration and the UK Joint Health Claims Initiative), eases menopausal symptoms and provides significant protection against osteoporosis, heart disease and hormone-related cancers, including breast and prostate cancer.

The criticisms
There is little evidence that consuming soy products is effective in managing hot flushes. Research suggesting that soya consumption may contribute to both male and female infertility has been published over the last two years.

The truth
Substantial evidence exists to show that daily soya consumption reduces cholesterol and the risk of osteoporosis. There is a continuing interest in its role in preventing some cancers, not least because prostate and breast cancers are virtually unknown in countries where soya is a major component of daily diet. But don’t rely on it to manage the menopause – and cut it out entirely if you’re trying for a baby.

Echinacea

The claims
Echinacea purpurea, a member of the daisy family, is a native American remedy (often used to treat snake bites); it is also now the top-selling herbal remedy for colds in the US and Europe. An analysis of 16 controlled clinical trials, published by the Cochrane Library in January this year, found that the herb is effective in alleviating cold symptoms (although it warned of considerable variation in the quality of products on sale). A second study published in Clinical Therapeutics last month, using the leading brand Echinaforce (which is made from freshly harvested, organic plants that are holistically standardised), showed that the tincture prevents 55 per cent of colds and speeds up recovery if the bug does strike.

The criticisms
The quality and efficacy of different products vary considerably, and there is a shortage of good-quality trials. Even Michael McIntyre, the chairman of the European Herbal Practitioners Association, has admitted that “echinacea’s popularity is due to word of mouth, not credible science”.

The truth
Trials show that echinacea does reduce the misery of winter colds – although it’s not clear whether it can also prevent them. With herbal remedies, be prepared to buy the best, as the herbs used vary from poorly tended plants stored for months to carefully tended organic produce processed with no expense spared to maximise potency.