29. Other Modalities of Complementary and Alternative Medicine

The scope of complementary and alternative medicine is far too broad to permit a comprehensive assessment. Therefore, this chapter will aim to sum up a few of the modalities that have not been covered so far. It will include the following topics:

Some forms of treatment aim to make people feel calm and relaxed. That can have a beneficial effect, especially in conditions such as irritable bowel syndrome and anxiety where the mind is so important to the body. In everyday life a little time taken to relax and to put aside the stresses of the day may well be a good idea. As well as making us feel better it might possibly have a beneficial effect on blood pressure and risk of coronary heart disease or stroke. However, if this is what it does, this is how it should be presented and not marketed as a system of healing capable of curing all ills and preventing cancer.

I would like compulsion for any claims that are made to be backed by verifiable evidence. Time and again there is insufficient evidence to pass a valid judgement on quite outrageous claims. Verifiable evidence is required for drugs, including those sold directly to the public. This may require an amendment to the Medicines Act or the Trades Descriptions Act. If someone makes claims for a washing machine or a paint, it has to do what they say. We need the same for claims for benefit to health. If alternative practitioners wish to be treated equally with conventional medicine, they must achieve the same standards of proof.

Aromatherapy

A pleasant CAM technique is called aromatherapy. It involves the use of “essential oils” diluted in a carrier and they may be inhaled along with a pleasant and relaxing smell or they may be massaged into the skin. Either through the lungs or through the skin some absorption is likely to occur. There are very many essential oils and carriers and various recipes to enjoy them.1Aromatherapy. How does it work scientifically? Do not take the word “scientifically” in that reference too seriously. Sometimes aromatherapy is advertised simply as scented candles to use when enjoying a warm, relaxing bath. The question is whether there is any benefit above and beyond that of pleasant relaxation.

Practitioners claim that the oils have a specific pharmacological effect. If this is so, the amount inhaled must be very small and so the effect for a given weight must be very potent. Anaesthetics are inhaled as are heroin, tobacco and drugs for asthma but they are inhaled far more directly than the oils in aromatherapy. It would be naïve to believe that substances applied to the skin are not absorbed and such absorption is claimed. Drugs can be slowly absorbed through the skin via patches for pain relief and nicotine patches. There is also a form of HRT to be rubbed on. Excessive use of steroid creams can lead to significant absorption. Oils would be quite good at penetrating the skin, but I still wonder to what extent. I have often seen parents put a vapour rub for the congestion of a cold on a child’s chest and back and then put clothes on top. They seem to think that the substance is absorbed through the skin, fat, muscle and bones and into the lungs rather than the vapour being the active ingredient.

There is evidence that oils absorbed through the skin do have an effect beyond placebo.2Relaxing effect of ylang ylang oil on humans after transdermal absorption There is also evidence that inhaled oils may have an effect on the appraisal of pain but not a direct pain relieving effect.3Sensory and affective pain discrimination after inhalation of essential oils Such trials are few and far between and there is very little good research in the field.

Aromatherapy is pleasant and relaxing and there is a feeling of being pampered

Massage may be involved with aromatherapy or other techniques. Where there is pain or tension there may be muscle spam, and this can cause a vicious circle. The muscle spasm pulls on ligaments and joints, especially in the neck, and this causes pain which causes more muscle spasm. Presumably massage works by interrupting the gate in the pain pathway as has been briefly described with Manipulation of the Spine. There is also the person to person contact, the feeling of being pampered and a great placebo effect. Websites on aromatherapy often like to cite the finding that smell can produce changes in the EEG. This stands for electro-encephalogram and it is a tracing of electrical waves from the brain. This may be so, but it is not proof that the aroma is having any effect on the body, either good or bad.

There are such a vast number of treatments for such a wide variety of conditions that any scientific appraisal would have to look specifically at one form of treatment for one condition. A Cochrane review looked at pain relief in labour and found in favour of acupuncture and hypnosis but there was inadequate evidence for aromatherapy, massage and some other techniques. They found just one trial for aromatherapy in dementia. Although it was promising they were unable to recommend it from just one small trial. A few other studies seem to be underway but were not available at the time. The reader may wish to explore the Cochrane website to see if more are now published.

A systematic review of aromatherapy for NHS Evidence, based at the Centre for Reviews and Dissemination in York, examined six fields for aromatherapy.4Aromatherapy: a systematic review They concluded that despite the small size of the original studies and their methodological flaws, the results seem to support a belief that aromatherapy massage can be helpful for reducing anxiety for short periods. They support the concept that aromatherapy massage is pleasant, slightly reduces anxiety, and is often enjoyable for patients in stressful situations. However, they do not support the prescription of aromatherapy massage in a health care setting. It seems to have no lasting effects, good or bad. A major difficulty for good RCTs of aromatherapy must be the provision of an adequate placebo control. Almost every review of aromatherapy or any other form of CAM calls for more studies of better quality.

A Cochrane review of aromatherapy for dementia noted, “The benefits of aromatherapy for people with dementia are equivocal from the seven trials included in this review. It is important to note there were several methodological difficulties with the included studies.”5Aromatherapy for dementia

Cochrane has examined aromatherapy for a number of other situations including pain in labour and pain and nausea in cancer. They may be found by going to http://www.cochrane.org/ and putting in the condition that you seek. By and large it is the old problem of inadequate quality trails that prevent a definitive verdict.

A paper from Cochrane was called 6If there are no randomised controlled trials, do we always need more research It is poor quality studies that hold back understanding of what works and what does not. Many CAM websites will pretend that there is much published evidence to support their modality. The truth is that most of what is published is of little or no value. For example, a survey of patient satisfaction with a form of treatment that patients have paid for is no alternative for finding if it really does do any good.

Are the claims made really backed by evidence?

Claims are made for the healing ability of the various essential oils that are used in aromatherapy. There are plenty of papers giving the chemical structure of various oils and often examining their effects such as antibacterial action in vitro (in glass) but there seems to be little or no evidence to support this in vivo (in life). What happens in the laboratory must not be translated to the live person without evidence.

In summary, it would seem that aromatherapy is a pleasant way of getting relaxation with reduction of anxiety and stress. This may be helpful but it should not be portrayed as a system of healing. In fairness, most practitioners sell it as pleasant and relaxing rather than as a medical therapy. There may sometimes be allergy to the substances used, but overall it seems a safe technique.

Crystal Therapy

As a form of healing, this has to be
classified as “having a laugh”

There are many other forms of CAM whose supposed basis causes utter incredulity, an unrestrained smirk or even overt laughter. It is possible to get a diploma in crystal therapy. Therefore, its practitioners are qualified. According to one resource, “Crystal therapy is the belief that certain crystals and other charm stones have healing, mystical and/or paranormal powers.”. This sounds like magic. “Every living organism has a vibrational energy system, which includes chakras, electromagnetic fields around the body known as an aura, subtle bodies and meridians. By using the appropriate crystals one can tune an energy system or rebalance energies. Using the vibrations of the crystals a trained practitioner can move, absorb, focus, direct and diffuse energy within the body, using the perfect structure of the crystal for the body to emulate.” There is also mention of aiding the body’s immune system, but as usual, no mention of how it is measured or what it really means.

This might impress aging hippies, but the rational world will be agog. Has anyone tried measuring the magnetic field around bodies? Do people deflect a compass? This moves us on to the next field of magnetic healing.

A PubMed search for “crystal therapy” produced more than 14,000 results and more than 1,400 reviews, but none in the first few pages of each seemed to related to what is discussed here.

Magnetic Healing

According to a website to promote magnetic healing therapy:

“Magnet therapy is a natural way to treat a wide variety of ailments in both humans and animals. It is 100% safe, drug free and has no side effects. It works well as a therapy alone or in conjunction with both natural and conventional therapies. Small high strength healing earth magnets are placed on the body as close to the point of pain as possible.”

Wonders indeed!

Once again it is “natural” whatever that means. What is an earth magnetic? There is such as thing as a rare-earth magnet, made from alloys of the rare earth elements but I very much doubt if this is it. The website goes on to explain how magnetic therapy works:

“Magnets increase blood flow and circulation. They speed up the healing process and alleviate pain. Our bodies contain a magnetic charge that is essential for it to function. The modern environment in which we live emits various types of interference from mobile phones, radio waves, microwaves etc. This interference disrupts the bodies’ natural magnetism. Using magnet therapy realigns the bodies’ natural magnetism returning it to normal. As a result of this, inflammation in the body is reduced particularly around injuries. Excess fluid retained in the tissues is removed along with toxins, which are stored there. Magnets also stimulate the blood circulation and increase the blood flow through the heart. This results in increased oxygen to the organs and tissues.”7Magnetic Therapy Council

With regard to mobile phones, radio waves, wi-fi, etc, this will be discuss in a later chapter called “Mobile telephones, masts and Wi-Fi”.

I decided to see if there was any evidence to support the concept that magnetic fields may influence the body. There are literally thousands of papers about magnetism in the medical literature but most are about the use of magnetic resonance imaging (MRI) in diagnosis. I found a paper from a physics department which showed that a magnetic pulse could reduce the viscosity of blood by 20 to 30%, aiding flow without impairing oxygen transfer, but it went back to normal after the field was removed.8Reducing blood viscosity with magnetic fields Furthermore, the strength of the magnetic field was in the realms of MRI rather than simple magnets. MRI scanners produce incredibly strong magnetic fields. The effect of magnetic fields on blood flow gives contradictory results. Some papers show increased blood flow, some reduced blood flow and some no effect.9The effects of magnetic field exposure on blood flow and blood vessels

An advertisement for magnetic therapy. The magnets are not over either the radial or ulnar arteries and the arrow labelled “Artery” points to a tendon.
To have an effect on blood flow requires a magnetic field of MRI strength

An article in the BMJ called 10Magnet therapy. Extraordinary claims, but no proved benefits said that in the USA, sales of therapeutic magnets was worth $300 million or £171 million annually and more than a billion dollars worldwide. Valid techniques such as transcranial magnetic stimulation (TMS) in neurology should not be included in the garbage dump of therapeutic magnets.11Don’t discount magnet therapy

Franz Mesmer

An interesting paper was a historical review of the famous Dr Mesmer who founded the concept of “animal magnetism”.12Mesmer’s 1780 proposal for a controlled trial to test his method of treatment using ‘animal magnetism’ The term “mesmerism” derives from his name but it refers to hypnosis. The time was 18th century pre-revolutionary France. Mesmer had come from Vienna and was trying to get his technique accepted by the establishment. At the time they were followers of Galen and believed in bloodletting. They regarded Mesmer as a charlatan and were unafraid to say so. Mesmer suggested a controlled trial of 24 patients. There would be 12 treated by his technique and 12 by conventional means and they would be allocated to each group by drawing lots. At first this may seem like a suggestion for an RCT that was way ahead of its time and it included random allocation. However, the patients would have a variety of ailments. The doctors of Paris refused to take part because they regarded Mesmer as a charlatan and not because his suggestion was not scientifically robust. Back then, neither were doctors scientifically robust.

The concept of treatment with magnets is ludicrous. There is no plausible explanation for a mechanism or evidence of efficacy. One person they were quoting on the website had been reluctant to drink magnetised water. How do you magnetise water? How do you get people to think?

Reiki

Another mystical system is called Reki, pronounced “ray key”. It was developed by a Japanese Buddhist called Mikao Usui in 1922. It uses a technique called “palm healing”. Practitioners claim to transfer healing energy in the form of qi or chi through the palms. It is administered by “laying on hands” and is based on the idea that an unseen “life force energy” flows through us and is what causes us to be alive. If one’s “life force energy” is low, then we are more likely to get sick or feel stress, and if it is high, we are more capable of being happy and healthy.

The word Reiki comes from the Japanese word Rei which means “God’s Wisdom or the Higher Power” and Ki which is “life force energy”. It is translated as “spiritually guided life force energy.”

The Japanese for Reiki

It is said that Reiki is not taught but is transferred to the student during a Reiki class. This ability is passed on during an “attunement” given by a Reiki master and allows the student to tap into an unlimited supply of “life force energy” to improve one’s health and enhance the quality of life.13What is Reiki? “Attunement” is not a word to be found in the English dictionary.

To quote the UK Reiki Federation, “A healing technique based on the principle that the therapist can channel energy into the patient by means of touch, to activate the natural healing processes of the patient’s body and restore physical and emotional well-being”.14What is Reiki healing?

To take that reference further:

Scientific research findings may help us to understand how Reiki works. There is much to learn and more research is necessary before a definitive explanation can be given, but research is producing very interesting results:

  • When giving Reiki, practitioners have been shown to emit electro-magnetic or bio-magnetic energy from their hands. The frequencies of the energy emitted vary from one moment to the next; but many appear to correspond to those that medical researchers have identified as being the optimum frequencies for stimulating the healing process in tissues, bones and other body parts so far investigated.
  • The bio-magnetic energy (or field) flowing from a practitioner’s hands has been shown to induce current flows in the tissues and cells of individuals who are in close proximity but this pulsing energy is not produced by non-practitioners of energy healing techniques. Two ways in which these pulsing magnetic fields may stimulate repair of bone and other tissues include:
  • A cascade of reactions takes place from the cell surface to the cytoplasm and on to the nucleus and genes, where selective effects on the DNA have been documented.
  • A phenomenon called amplification, in which a single hormone molecule, neurotransmitter or photon of electromagnetic energy has been shown to trigger a cellular response; and in fact very tiny fields have been shown to produce the best effects, suggesting that living tissues are much more sensitive to external fields than previously considered possible.
  • NB: A bio-magnetic field can also be created by passing electric currents though living tissue as has been used for medical diagnoses and treatments for almost a century for example in ECG & MRI scanning.
  • Reiki is often referred to as an intelligent form of healing. It is suggested that this and similar energy therapies may be valuable in the prevention and remission of some serious diseases that are so costly in terms of human suffering and likely to be more expensive to health care in the future.

Naturally, there were no references given for these assertions. There was even a section about “distance healing”.

Where do I begin with all this garbage? There is not a scrap of evidence amongst the pseudoscience that has foundation. Even the assertion that “A bio-magnetic field can also be created by passing electric currents though living tissue as has been used for medical diagnoses and treatments for almost a century for example in ECG & MRI scanning” is wrong. An ECG does not involve passing an electric current through the tissues. It detects electric current from the depolarisation of the heart muscle. An MRI scan uses an extremely strong magnetic field to distort hydrogen atoms. It does not pass an electric current through the body. As for the assertion that “Reiki is often referred to as an intelligent form of healing”, no one with any intelligence can possible lap up this incredible rubbish.

A PubMed search for reiki produced 2,856 results with 515 reviews, but it would be naïve to assume that this means that there is a scientific basis. Basically, it is a form of laying on of hands. It may produce relaxation and a feeling of being cared for. A review of its use in palliative care was quite positive in terms of easing pain and anxiety but it must not be assumed to have any curative value.15Reiki therapy for pain, anxiety and quality of life Palliative care is an area where the aim is to ease suffering, not to cure disease. An American review concluded that, “CAM may provide a limited short-term benefit in patients with symptom burden. Additional studies are needed to clarify the potential value of CAM in the hospice or palliative setting.”16Complementary and Alternative Medicine in Hospice and Palliative Care

A Cochrane review of Reiki for depression and anxiety found that there was insufficient good evidence to support its use.17Reiki for depression and anxiety. Where Reiki is used to help pain, it seems to be a system for offering support and trying to relieve anxiety, all of which will have a slight benefit. A meta-analysis of four trials with 104 in the active groups and 108 in the control groups, found benefit for reiki but the degree of benefit was very unimpressive.18The effect of reiki on pain: A meta-analysis The conclusions of the meta-analysis were also criticised as a misinterpretation.19Misinterpretation of the results from meta-analysis about the effects of reiki on pain

I came across a website entitled 20Reiki Really Works: A Groundbreaking Scientific Study . The URL was UCLAhealth.org which is the medical school for University College Los Angeles. Although UCLA is not one of the eight Ivy League colleges or universities, it is held in high regard. However, the author of this piece was called “Green Lotus”. The paper claimed that “There have been many other controlled studies submitted to peer-journals and to The Touchstone Process for review. Ailments and disorders that tested favorably to Reiki treatment include: 1. Post operative pain after tooth extraction 2. Cognition in elderly, related to dementia/Alzheimers 3. Pre-operative relaxation and post-op pain 4. Pain in chronically ill patients 5. Depression and stress 6. Well-being in Reiki practitioners.

I wondered what was “The Touchstone Process”. It seems that it is an organisation or publication that is dedicated to researching reiki. In the Touchstone Press I found21An Ongoing Critical Evaluation of Reiki in the Scientific Literature. 2010. The opening paragraph of the supposedly scientific review concluded with “One assumption underlying the philosophical orientation about Reiki touch therapy is consistent with an Eastern paradigm, that is, the belief that a regular flow of life energy is needed by the human body for health to be achieved and maintained.” With such a tenet, how can anyone take them seriously? However, they state that there are now 800 hospitals in the USA that offer reiki. Perhaps this is a feature of a consumer led system rather than an evidence-based service.

Green Lotus did not give any direct references or links to reputed scientific journals for research about reiki and I have had great difficulty getting anything relevant from PubMed. However, The efficacy of “distant healing”: a systematic review of randomized trials was a systematic review of the available data on the efficacy of any form of “distant healing” (prayer, mental healing, Therapeutic Touch, or spiritual healing) as treatment for any medical condition. It concluded that “The methodologic limitations of several studies make it difficult to draw definitive conclusions about the efficacy of distant healing. However, given that approximately 57% of trials showed a positive treatment effect, the evidence thus far merits further study.”22The efficacy of “distant healing”: a systematic review of randomized trials

King Charles II applies the Royal Touch. It was a practice started by Edward the Confessor and used in England and France for many centuries. It was used as late as Queen Anne

Hundreds of years ago the royal touch was used to cure disease, especially scrofula.23The King’s Evil and the Royal Touch I cannot take reiki any more seriously.

Iridology

Iridology was invented by a Hungarian doctor called Ignatz Peczely in 1890. As a child he had noted that an owl with a broken leg had a prominent black stripe in the iris of one eye. From this he developed the whole notion. In 1952 an American chiropractor called Bernard Jensen published a book called “The Science and Practice of Iridology”. The science is seriously lacking but pseudoscience is present in abundance. The website Science-Based Medicine has much more.24Iridology It seems that the text book maps of the iris for such practitioners are also a figment of someone’s imagination. An article called 25Iridology – Our Health Diagnosed Through The Eyes says, “Iridology is a science that implies means of diagnosing actual medical conditions or future disorders that may appear in an individual’s organism through the pigmentation of the iris or abnormalities in the eye pigmentation. Iridologists consider that patterns of the iris correspond to all inner organs and bodily functions. The iris is connected through nerves to the organs in our body and that is why there is a map of the iris divided in 60 sections.” There is more to be found on the Quack Watch website including 26Confessions of a former iridologist.

According to the website of the International Iridology Practitioners Association (IIPA):

“Iridology is the study of the iris, or coloured part, of the eye. This structure has detailed fibres and pigmentation that reflects information about our physical and psychological makeup. It identifies inherited dispositions (how our body reacts to our environment and what symptoms to expect), and future challenges (where we are likely to have more problems as we age). It also helps identify inherited emotional patterns, which can create or maintain physical symptoms, as well as identify lessons or challenges and gifts or talents available to us.”

The Guild of Naturopathic Iridologists claims to be the leading professional body for iridologists in the UK. I followed a case history on their website. It was headed, “Naturopathic assessment – investigating biochemical, structural and emotional integrity”. It started with:

“My GP thought it was hyperthyroidism. A week later she confirmed it was an autoimmune disorder called Graves Disease”

Graves’ disease is hyperthyroidism. It is caused by an auto-antibody which attaches to the thyroid gland where the thyroid stimulating hormone from the pituitary gland normally binds and overstimulates it. She was started on carbimazole which is the standard treatment and a researched and licensed drug. However, the article stated:

“When I met Sarah in April she’d researched Graves Disease and had found a product via the internet comprising typical herbs for hyperthyroidism, using Bugleweed, Motherwort and Lemon Balm; on inspection I found this to be a much weaker strength formulation than a qualified UK herbalist would be likely to prescribe. The revelations of the iris analysis (Iridology) I undertook were particularly helpful, suggesting weakness of the pituitary gland and the likelihood of a significant influence on the spleen emanating from the liver. Her digestive system was prone to low enzymatic secretions resulting in a toxic digestive tract. The likelihood of subluxation of specific cervical vertebrae and resulting nerve impingement that could influence the endocrine system was another key feature of the analysis.”

All this came from looking at the eye. Having been given the correct medical treatment the patient went off to see various charlatans who have given her herbs of variable potency and dubious value. The high level of thyroid hormone would supress the thyroid stimulating hormone from the pituitary but otherwise the disease has nothing to do with the pituitary, liver or spleen. Subluxation or a minor dislocation of the bone of the neck would lead to compression of the spinal cord which would cause paralysis and loss of sensation. The woman let an osteopath manipulate her neck which is the last thing you would really want with subluxation of the cervical vertebrae. These people are not just quacks who take money from the gullible. They do harm. She was being given the correct treatment for a quite serious disease but instead it was stopped and all sorts of mad diagnoses and treatments were given and she was lucky not to suffer serious consequences.

One reason for registration of these practitioners is to assure standards whereby they will not interfere with appropriate treatment for serious conditions. Even the Daily Mail seems to regard them as freaks. It says that a consultation costs between £30 and £60 an hour.27Iridology. It is really quite worrying that some people will turn away from effective treatment to something as frankly ludicrous as this. The iridologist, herbalist and osteopath all seem to be colluding.

An iridology chart

People with an overactive thyroid gland may have protruding eyes. A gross example was the comedian and writer Marty Feldman. However, not all do, and a common physical sign is that on looking down some white cornea appears above the iris. This is called lid-lag. The iridologist looked at the eyes but apparently failed to note this.

Iridology is promoted as a technique for diagnosis rather than treatment. A PubMed search for “iridology” found just 40 papers going back to 1955 but many were in foreign languages and many had no abstract. In an early paper from 1979, slides from 153 patients were shown to three iridologists. Some of the patients had kidney disease. The iridologists did no better than random at diagnosing which ones these were.28An evaluation of iridology

Spectacularly
unimpressive results

Another paper examined gall bladder disease. The presence of an inflamed gall bladder containing gall stones is said to be easily recognised by certain signs in the lower lateral part of the iris of the right eye. Five iridologists all failed to show that their technique had diagnostic validity.29Looking for gall bladder disease in the patient’s iris

Another paper examined diagnosis of allergies and found that iridology was amongst the useless ones.30Unproven diagnostic procedures in IgE-mediated allergic diseases

We might expect a paper from Germany in a CAM journal to be positive, but it assessed the ability of iridology to detect cancers. There were 68 subjects with proven cancers of the breast, ovary, uterus, prostate, or large intestine and 42 were control subjects. An iridologist was allowed to make up to five diagnoses per subject. He identified the correct diagnosis in only three cases giving a sensitivity of 0.04.31Can iridology detect susceptibility to cancer?

There is not much evidence about iridology as a diagnostic procedure but what there is shows it to be utterly useless.

Ear Candles

Ear candling, also called ear coning or thermal-auricular therapy, is a practice which is claimed to improve general health and well-being by lighting one end of a hollow candle and placing the other end in the ear canal. It is also sometimes called Hopi Indian ear candling. In this case, the term “Indian” means that the Hopi are a tribe of native Americans, not people from India. However, the public relations officer for the Hopi Tribal Council, has stated that ear candling “is not and has never been a practice conducted by the Hopi tribe or the Hopi people”. The Hopi tribe has repeatedly asked Biosun, the manufacturer of “Hopi Ear Candles”, to stop using the Hopi name.

The silver disc is to prevent hot wax from running down into the ear

Proponents of the practice state that only specially-made cone-shaped candles are suitable for this therapy. Ear candles are created from a fabric structure that is coated in one of three different kinds of wax. The pointed end is placed in the ear while the wider end is set alight. The flame is supposed to draw debris up from the ear. Adherents also advise that the use of an ear wax removal candle must only be carried out by experienced practitioners, whose services can be secured for a nominal fee. These practitioners will often crack open the ear candle after a session to reveal a potentially disturbing build-up of debris and wax inside. This is held forth as evidence of various kinds of impurities and ear wax that has just been drawn from the ear canal. However, much or all may have come from the candle.

Many of those who practice ear candling further claim that it drains all “passages” in the head via the tympanic membrane (ear drum), boosting overall well being. They say that ear candles on one side can clean wax from both ears. The most cursory look at anatomy will show that this could only be achieved in people with nothing between their ears.

The diagram shows that it is impossible to drain fluid past an intact ear drum

There are many claims on the Internet, as well as many sources saying that it is ineffective and possibly dangerous. Hence, I tried a PubMed search for “ear candles” and received six relevant citations. No article was positive about the practice. They all warned of dangers from it. Two of the articles were entitled, “Coning candles–an alert for otolaryngologists?” An otolaryngologist or even otorhinolaryngologist, is more commonly called an ENT (ear, nose and throat) surgeon. One article was called 32Ear candles: a triumph of ignorance over science.

In the article called 33Ear candles–efficacy and safety, the abstract is worth quoting:
“Ear candles are a popular and inexpensive alternative health treatment advocated for cerumen removal. A hollow candle is burned with one end in the ear canal with the intent of creating negative pressure and drawing cerumen from the ear. If effective, significant savings could result from the use of ear candles. This study evaluates the efficacy and safety of this alternative method for cerumen management. Tympanometric measurements in an ear canal model demonstrated that ear candles do not produce negative pressure. A limited clinical trial (eight ears) showed no removal of cerumen from the external auditory canal. Candle wax was actually deposited in some. A survey of 122 otolaryngologists identified 21 ear injuries resulting from ear candle use. Ear candles have no benefit in the management of cerumen and may result in serious injury.” Tympanometry is measurement of pressure across the tympanic membrane or eardrum. Cerumen is ear wax.

In summary, this is a practice with nothing to commend it. The theory is flawed. It may cause deposition of material in the ear and unskilled placement of the candle may perforate the ear drum.

Copper Bracelets and Bangles for Arthritis

Copper bracelets and bangles have been peddled as an aid or cure for arthritis for many years. Most people I have seen wearing such items have crippling arthritis, suggesting lack of effect. However, as it is people with severe arthritis who would purchase such products, this is an unfair conclusion and we must examine the evidence.

Copper is an interesting element and metal34Copper and it has some antibacterial properties.35Physicochemical properties of copper important for its antibacterial activity and development of a unified model However, that would not account for any benefit in arthritis. The early intra-uterine contraceptive devices (contraceptive coils) were made of plastic but later ones were coated in copper. These included the copper-7 and the copper-T. Newer devices are impregnated with hormones, but they have not completely superseded the copper devices. Copper devices are highly effective36The safety of intrauterine devices among young women: a systematic review. and may reduce the risk of pelvic infection compared with others.37The Use of Copper as an Antimicrobial Agent in Health Care, Including Obstetrics and Gynecology However, the point at issue here is if copper bracelets reduce the severity of arthritis.

Copper is an important trace element. It causes toxicity in Wilson’s Disease but this is a hereditary condition in which there is an absence of caeruloplasmin which is the protein which transports copper in the blood. Copper is absorbed through the skin.38An investigation of the therapeutic value of the ‘copper bracelet’-dermal assimilation of copper in arthritic/rheumatoid conditions.

I have found two randomised, double-blind crossover trails of copper bracelets for arthritis. Both had the same lead author. The first was from 200939Therapeutic effects of magnetic and copper bracelets in osteoarthritis: a randomised placebo-controlled crossover trial. and it examined magnetic as well as copper bracelets. They concluded that magnetic and copper bracelets are generally ineffective for managing pain, stiffness and physical function in osteoarthritis. Reported therapeutic benefits are most likely attributable to non-specific placebo effects.

The second was from 201340Copper bracelets and magnetic wrist straps for rheumatoid arthritis–analgesic and anti-inflammatory effects: a randomised double-blind placebo controlled crossover trial. and it looked specifically at rheumatoid arthritis. It concluded, “Wearing a magnetic wrist strap or a copper bracelet did not appear to have any meaningful therapeutic effect, beyond that of a placebo, for alleviating symptoms and combating disease activity in rheumatoid arthritis.”

Both reports seem to be well-conducted tests with vigorous methodology. The conclusion has to be that copper and magnetic bracelets both have no therapeutic value in arthritis beyond that of a possible placebo. They are unlikely to cause any significant toxicity or harm.

Traditional Chinese Medicine

All is not sweetness and light in the world of Chinese medicine

Chinese civilisation dates back many thousands of years. They were way ahead of the west in inventions such as gunpowder, paper and printing and it is the source of acupuncture and moxibustion that have already been mentioned. A PubMed search for “traditional Chinese medicine” gave 29,113 results. Many were in the Chinese language. Many that were in English were in “Evidence based complementary and alternative medicine”, a publication whose evidence base may not live up to its name. Searching for clinical trials brought the number of publications down to 2,018. Reviews produced 4,515. Many of these are about acupuncture. The number of papers found on a search gives no indication of the scientific validity of a treatment. Quantity and quality must not be confused.

The basic philosophy of traditional Chinese medicine is that there is an imbalance between the ying and yang, the positivity and negativity.41Chinese philosophy and Chinese medicine The lines of qi or chi are important but as mentioned with regard to acupuncture there is no anatomical or physiological basis for this concept. A website from China gives the following introduction:

“Traditional Chinese medicine is a brilliant component of Chinese culture. Characterized by a unique theoretical system and enriched by thousands of years of practical experience, it still possesses great vitality. This seems to be a miracle in the world history of medicine. How could this happen? There are many reasons; the crucial one is the dialectical viewpoint of ancient Chinese philosophical thought, which provided the theoretical basis for the founding and developing of traditional Chinese medicine. The achievements of traditional Chinese medicine, in turn, further stimulated philosophical thought, thus forming a benign circle. In fact, traditional Chinese medicine is not a collection of piecemeal experiences. Most experiences have been summed up, forming a theoretic system, both medical and philosophical. The philosophical strands that gave the greatest impetus to the development of traditional Chinese medicine are the theories of Essential Qi, Yin-Yang and the Five Elements.”

It is philosophical. It has been around for years. No mention is made of any evidence base. The need to rectify imbalances is reminiscent of Galen’s philosophy that dominated western medicine for many centuries. In the west, attempts to correct the imbalance were by bloodletting and often purgation. The Chinese offer a rather greater range of treatments. These include a liberal demand for the body parts of many endangered species. Even the Journal of Chinese Medicine says that there is no longer any justification of the use of endangered species but this article is archived and so I offer this instead.42Chinese Medicine and Endangered Wildlife

Wildlife in China is under pressure from intensive industrialisation and rapid economic development. These pressures are further aggravated by the demand for certain animal body parts but not all animals hunted for Chinese medicine come from China. Three of the five subspecies of tigers are severely endangered. There are estimated to be 30 to 80 South China tigers, 150 to 200 Siberian tigers and 600 to 650 Sumatran tigers in the world. Chinese medicine uses the eyeballs to treat epilepsy, the tails for various skin diseases, bile for convulsions in children, the whiskers for toothache and the penis for erectile dysfunction. However, the most sought-after part is the bones that are used for rheumatism or for weakness, stiffness or paralysis.

Rhino, tiger and snow leopard DNA have all been found in traditional Chinese medicines

Rhinoceros horn is supposed to be an aphrodisiac. There are about 12,500 rhinos in the wild and the species is threatened. The bile of bears is used to treat a variety of ailments and bear paw is used to make soup. Draining bile from live bears is a hideous procedure.

Shark’s fin is used mainly as a delicacy for soup, but it can also be used in treatment. The sharks are caught, their fins are lopped off and they are thrown back into the sea to die.

The Smithsonian Institute in Washington names 10 species that are under threat from this genre of treatment. As well as the rhinoceros and tiger they include water buffalo, Chinese alligator, Asian elephant, musk deer, sun bear, Grevy’s zebra, banteng and the Hawksbill sea turtle.43Ten Threatened and Endangered Species Used in Traditional Medicine

As many as 20 million sea horses may be killed each year to treat asthma, arteriosclerosis, incontinence, impotence, insomnia, thyroid disorders, skin ailments, broken bones, heart disease, throat infections, abdominal pain, sores and skin infections. It is also used as an aphrodisiac and in childbirth. In one study, 58 seahorse samples were collected from various vendors in Taiwan. Eight species were found, of which seven were vulnerable, and one was endangered.44Authenticating the use of dried seahorses in the traditional Chinese medicine market in Taiwan using molecular forensics

Neither the masked civet nor the ferret badger is endangered according to the IUCN (International Union for Conservation of Nature) but both are TCM remedies supposedly to ward off flu. This is ironic considering that the outbreak of SARS (sudden acute respiratory syndrome) was traced back to these animals in Guangdong.45(China Rises. John Farndon. Chapter 7. Hong Kong on Song.) It was initially thought to be a variant of bird-flu but is caused by a different virus.

In 2015, an Australian publication called “Business Insider” reported that nearly 90% of traditional Chinese medicines had trace amounts of toxic and disturbing substances.46Study reveals that nearly 90% of traditional Chinese medicines contain trace amounts of disturbing and toxic substances This was based on a paper in Scientific Reports.47Combined DNA, toxicological and heavy metal analyses provides an auditing toolkit to improve pharmacovigilance of traditional Chinese medicine (TCM) It revealed that in 50% of the traditional Chinese medicines, an undeclared pharmaceutical agent was detected including warfarin, dexamethasone, diclofenac, cyproheptadine and paracetamol. Mass spectrometry revealed heavy metals including arsenic, lead and cadmium, one with a level of arsenic more than 10 times the acceptable limit. The study showed 92% of the TCMs examined were found to have some form of contamination and/or substitution. Genetic analysis revealed that 50% of samples contained DNA of undeclared plant or animal origin, including an endangered species of Panthera or the snow leopard.

The rare snow leopard in its native habitat

A PubMed search of “Traditional Chinese Medicine” produced more than 29,000 results, most from Chinese authors in the Chinese language. Even reviews produced more than 2,500 results. Hence the place to look is the Cochrane Library. They have a number of summaries as they do not mix different treatments and different diseases. Their usual conclusion is that there is insufficient good evidence to form a firm conclusion. This is a reflection on the quality of nearly 30,000 papers.

General Conclusions about Complementary and Alternative Medicine

Many forms of therapy are pleasant to receive and result in relaxation. This alone can be a useful and valid achievement whether for the stresses of everyday life or for conditions with a significant psychosomatic component. This is where the mind has a marked effect on the body. There are often claims made above and beyond simply being a useful relaxation technique but there is a dire shortage of good evidence to support them. In vitro effects must not be assumed to be valid in vivo. Where substances such as essential oils are used, it is not safe to assume that they are harmless, especially in early pregnancy and NHS Evidence warns about this. By and large these relaxation techniques may be helpful and are unlikely to cause harm.

Many forms of CAM are utterly ludicrous and outrageous in the claims that are made and the babble of pseudoscience that accompanies them. The fact that anyone can take them seriously shows a distinct lack of education and critical thinking amongst the general public. Hence there can be little wonder that popularist politicians can gain such a following from the severely gullible. This also applies to anti-vaccine campaigns and other conspiracy theories. The ability of the public to be willingly fooled seems to know no bounds.

An example of how to identify pseudoscience.

Chinese culture including Chinese traditional medicine may seem very attractive but there is no evidence to suggest that traditional Chinese medicine works. Furthermore, its practice threatens the survival of many endangered species and is often associated with great cruelty to animals. This is totally unacceptable. Those who support it may be abetting the annihilation of endangered species.

There may be some benefit from acupuncture and manipulation, but the evidence is not compelling. Herbal remedies often have some pharmacological effect but the lack of evidence of effectiveness or toxicity and the variable potency of preparations makes it unacceptable. Even St John’s wort would not be accepted as a registered drug if it was presented. Would you accept a pharmacological product that had not been properly investigated and the variation in potency between batches meant that you had no idea what dose you were taking? Hypnosis has a place in treatment. Otherwise I have been unable to find a single type of CAM that I can endorse. The rationale is usually absurd and where there has been evaluation, it has often been with poor methodology. With adequate methodology, they often prove to be no better than placebo. We need proper trials to prove to the gullible that it does not work. However, a paper suggested that evaluation of CAM is the evaluation of the absurd and hence a waste of time.48Is evaluating complementary and alternative medicine equivalent to evaluating the absurd?

Some of these treatments are so risible and absurd that if laughter is the best medicine, their ability to make people laugh out loud can be their only claim.

Regulation of CAM is very contentious. On the one hand we do not want these practitioners failing to recognise serious disease although even qualified doctors may do that at times. On the other hand, there is a fear that official regulation may give a spurious air of validity to useless treatments. I tend to favour refusal of recognition.

Further Resources

References

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Site Index

This website is now completed, although I shall continue to do updates. The following list shows the sections or chapters. Just click on the topic in blue to go to that part of the site.

1 Introduction
2 A Very Brief History of Science And Medicine
Fundamentals of Medical Science
3 Finding Good Medical Advice and Evidence Based Medicine
4 Randomised Controlled Trials
5 Cohort or Longitudinal and Epidemiological Studies
6 Qualitative Research
7 Basic Maths in Medical Research and Decision Making
8 How Good is the Evidence?
9 Ethics in Practice and Research
Public Health Issues
10 Screening Programmes
11 Fake News and Vaccine Scares
12 Electronic Cigarettes (E-Cigarettes)
13 Motor Vehicle Emissions, Air Pollution and Health
14 COVID-19. What You Need to Know
15 What we Must Learn from the COVID-19 Pandemic
Nutrition
16 Basics of Nutrition
17 Exercise, Obesity and Diets for Weight Loss
18 Diets and Nutrition for Health and Fitness
19 Supplements
Complementary and Alternative Medicine
20 Introduction to Alternative Healthcare
21 Homeopathy
22 Acupuncture
23 Manipulation of the Spine
24 Reflexology
25 Herbal Remedies
26 Other Natural Products
27 Chelation Therapy
28 Hypnosis
29 Other Modalities of Complementary and Alternative Medicine
Some Controversial Diseases
30 Fibromyalgia
31 Chronic Fatigue Syndrome (CFS) or Myalgic Encephalitis (ME)
32 Systemic Candidiasis and Leaky Gut Syndrome
33 Mobile Phones, Masts, Wi-Fi and Electro-sensitivity
The Environment
34 Global Warming and Climate Change
35 Alternative Energy
Some Final Thoughts
36 Still Searching for the Age of Reason