tag:theconversation.com,2011:/nz/topics/alternative-medicine-873/articlesAlternative medicine – The Conversation2023-09-06T12:27:15Ztag:theconversation.com,2011:article/2125022023-09-06T12:27:15Z2023-09-06T12:27:15ZTraditional medicine provides health care to many around the globe – the WHO is trying to make it safer and more standardized<figure><img src="https://images.theconversation.com/files/546464/original/file-20230905-503-nlkg3v.jpg?ixlib=rb-1.1.0&rect=3%2C9%2C2114%2C1400&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Ayurveda is one form of traditional medicine that can integrate aromatherapy. It's popular in South Asia. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/ayurveda-aromatherapy-with-essential-oil-diffuser-royalty-free-image/1333713382?phrase=ayurveda&adppopup=true">Microgen Images/Science Photo Library</a></span></figcaption></figure><p>For approximately <a href="https://www.who.int/news/item/25-03-2022-who-establishes-the-global-centre-for-traditional-medicine-in-india">80% of the world’s population</a>, the first stop after catching a cold or breaking a bone isn’t the hospital — maybe because there isn’t one nearby, or they can’t afford it. Instead, the first step is consulting traditional medicine, which cultures around the world have been using for thousands of years.</p>
<p><a href="https://www.who.int/health-topics/traditional-complementary-and-integrative-medicine#tab=tab_1">Traditional medicine</a> encompasses the healing knowledge, skills and practices used by a variety of cultures and groups. </p>
<p>Examples of traditional medicine include <a href="https://www.hopkinsmedicine.org/health/wellness-and-prevention/herbal-medicine">herbal medicine</a>; <a href="https://www.mayoclinic.org/tests-procedures/acupuncture/about/pac-20392763">acupuncture</a>; <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/tui-na">Tui Na</a> – which is a type of massage originating in China; <a href="https://www.nccih.nih.gov/health/ayurvedic-medicine-in-depth">Ayurveda</a> – which is an ancient system of promoting health through diet, exercise and lifestyle from India; <a href="https://www.britannica.com/science/Unani-medicine">and Unani</a> – which is another ancient system of health from South Asia, balancing key aspects of the mind, body and spirit. </p>
<p>In recognizing that traditional medicine and other alternative forms of healing are critical sources of health care for many people worldwide, the World Health Organization and the government of India co-hosted their first-ever <a href="https://www.who.int/news-room/events/detail/2023/08/17/default-calendar/the-first-who-traditional-medicine-global-summit">Traditional Medicine Summit</a>. The summit took place in August 2023 in Gandhinagar, Gujarat, India. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/jW-B8BpLQJE?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">August 2023 marked the WHO’s first global summit on traditional medicine.</span></figcaption>
</figure>
<p>The summit brought together health care policymakers, traditional medicine workers and users, international organizations, academics and private sector stakeholders from 88 <a href="https://www.who.int/countries">WHO member states</a>. Leaders at the summit aimed to share best practices and scientific evidence and data around traditional medicine. </p>
<p>As researchers interested in how to provide patients both in the U.S. and around the globe with the best <a href="http://gsm.utmck.edu/internalmed/faculty/terry.cfm">possible medical care</a>, <a href="https://scholar.google.com/citations?user=Wng1Wh0AAAAJ&hl=en">we were interested</a> in the summit’s findings. Understanding traditional medicine can help health care professionals create sustainable, personalized and culturally respectful practices.</p>
<h2>Critical health care for many</h2>
<p>In many countries, traditional medicine costs less and is <a href="https://doi.org/10.1093%2Fheapol%2Fczw022">more accessible</a> than conventional health care. And many conventional medicines come from the same source as compounds used in traditional medicine – <a href="https://doi.org/10.1021/acs.jnatprod.9b01285">up to 50% of drugs</a> have a <a href="https://theconversation.com/nature-is-the-worlds-original-pharmacy-returning-to-medicines-roots-could-help-fill-drug-discovery-gaps-176963">natural product root</a>, <a href="https://doi.org/10.1016/j.vph.2018.10.008">like aspirin</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/546451/original/file-20230905-17-3flfzw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="An elderly man wearing a gray button-down shirt sorts bundles of dried herbs into eight piles, behind him is a wall of wooden drawers." src="https://images.theconversation.com/files/546451/original/file-20230905-17-3flfzw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/546451/original/file-20230905-17-3flfzw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/546451/original/file-20230905-17-3flfzw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/546451/original/file-20230905-17-3flfzw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/546451/original/file-20230905-17-3flfzw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/546451/original/file-20230905-17-3flfzw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/546451/original/file-20230905-17-3flfzw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">An herbalist sorts herbs at the Great China Herb Company in Chinatown in San Francisco. Herbal medicine is one form of traditional medicine.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/TravelTripSanFranciscoChinatown/c09c3fae7725457ca4e548ceda2a2f34/photo?Query=traditional%20medicine&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=377&currentItemNo=1&vs=true">AP Photo/Eric Risberg</a></span>
</figcaption>
</figure>
<p><a href="https://doi.org/10.2147/PPA.S398644">Many factors</a> may influence whether someone chooses traditional medicine, such as age and gender, religion, education and income level, and <a href="https://doi.org/10.1155/2021/9962892">distance to travel for treatment</a>. Cultural factors may also influence people’s use of traditional medicine. </p>
<p>In China, for example, as more people have embraced Western culture, fewer have <a href="https://doi.org/10.2105/AJPH.93.7.1082">chosen traditional medicine</a>. In contrast, many African migrants to Australia continue to use traditional medicine to express their cultural identity and maintain <a href="https://doi.org/10.1186/s12906-021-03424-w">a cohesive ethnic community</a>. A patient’s preference for traditional medicine often has significant personal, environmental and cultural relevance.</p>
<h2>A framework for traditional medicine</h2>
<p>Countries have been pushing the WHO to study and track data on traditional medicine for years. In the past, WHO has developed a “<a href="https://www.who.int/publications/i/item/9789241506096">traditional medicine strategy</a>” to help member states research, integrate and regulate traditional medicine in their national health systems. </p>
<p>The WHO also <a href="https://www.who.int/teams/integrated-health-services/traditional-complementary-and-integrative-medicine">created international terminology standards</a> for practicing various forms of traditional medicine.</p>
<p>The practice of traditional medicine varies greatly between countries, depending on how accessible it is and <a href="https://www.who.int/publications/i/item/978924151536">how culturally important it is</a> in each country. To make traditional medicine safer and more accessible on a broader scale, it’s important for policymakers and public health experts to develop standards and share best practices. The WHO summit was one step toward that goal.</p>
<p>The WHO also aims to collect data that could inform these standards and best practices. It is conducting the <a href="https://www.who.int/news-room/events/detail/2023/08/17/default-calendar/the-first-who-traditional-medicine-global-summit">Global Survey on Traditional Medicine</a> in 2023. As of August, approximately 55 member states out of the total 194 have completed and submitted their data.</p>
<h2>Acupuncture – a case study in safety and efficacy</h2>
<p>Some traditional medicine practices <a href="https://doi.org/10.7453/gahmj.2014.042">such as acupuncture</a> have shown consistent and credible benefits, and have even started to make it <a href="https://time.com/6171247/acupuncture-health-benefits-research/">into mainstream medicine</a> in the U.S. But leaders at the summit emphasized a need for more research on the efficacy and safety of traditional medicine. </p>
<p>Although traditional medicine can <a href="https://www.who.int/news-room/feature-stories/detail/traditional-medicine-has-a-long-history-of-contributing-to-conventional-medicine-and-continues-to-hold-promise">have a range of benefits</a>, some treatments come with health risks. </p>
<p>For example, acupuncture is <a href="https://www.nccih.nih.gov/health/acupuncture-what-you-need-to-know#">a traditional healing practice</a> that entails inserting needles at specific points on the body to relieve pain. But acupuncture can <a href="https://www.nccih.nih.gov/health/acupuncture-what-you-need-to-know">cause infections and injuries</a> if the practitioner doesn’t use sterile needles or if needles are inserted incorrectly.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/546455/original/file-20230905-17-dzwxii.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two hands insert a needle into a patient's back, which is partially covered with a towel and which already has seven needles stuck in two lines." src="https://images.theconversation.com/files/546455/original/file-20230905-17-dzwxii.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/546455/original/file-20230905-17-dzwxii.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=372&fit=crop&dpr=1 600w, https://images.theconversation.com/files/546455/original/file-20230905-17-dzwxii.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=372&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/546455/original/file-20230905-17-dzwxii.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=372&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/546455/original/file-20230905-17-dzwxii.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=467&fit=crop&dpr=1 754w, https://images.theconversation.com/files/546455/original/file-20230905-17-dzwxii.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=467&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/546455/original/file-20230905-17-dzwxii.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=467&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Acupuncture is an example of a form of traditional healing that’s been implemented on a wide scale in the U.S. It has a variety of benefits, including no risk of addiction.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/AcupuncturePainRelief/0b79ca38552c4b86a845bf4645755106/photo?Query=acupuncture&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=246&currentItemNo=1&vs=true">AP Photo/M. Spencer Green</a></span>
</figcaption>
</figure>
<p>Still, acupuncture is the most commonly used traditional medicine practice across countries, with <a href="https://www.who.int/publications/i/item/978-92-4-001688-0">113 WHO member states</a> acknowledging their citizens practiced acupuncture in 2019.</p>
<p>Interestingly, <a href="https://news.va.gov/94087/battlefield-acupuncture-an-emerging-and-promising-alternative-to-risky-pain-medications/">battlefield acupuncture</a> has successfully treated many U.S. military members, for example, for pain reduction. It is simple to use, transportable and has no risk of addiction.</p>
<p>There’s also some evidence supporting the use of traditional medicine, including <a href="https://www.va.gov/WHOLEHEALTH/professional-resources/Acupuncture.asp">acupuncture</a>, <a href="https://www.va.gov/WHOLEHEALTH/professional-resources/Meditation.asp">meditation</a> and <a href="https://www.va.gov/WHOLEHEALTH/professional-resources/Yoga.asp">yoga</a> to treat post-traumatic stress disorder. </p>
<p>However, acupuncture practitioners aren’t trained in a uniform way across countries. To provide guidelines for best practice, the WHO developed standardized <a href="https://www.who.int/publications/i/item/978-92-4-001688-0">benchmarks for practicing acupuncture</a> in 2021. The WHO aims to develop similar standards for other forms of traditional medicine as well. </p>
<p>Interest in traditional medicine is growing among those who have mainly used conventional medicine in the past. More research and collaborative efforts to develop safety standards can make traditional medicine accessible to all who seek it.</p><img src="https://counter.theconversation.com/content/212502/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr. Ling Zhao received her medical training in China and PhD in the US. Her research focuses on novel interventions for chronic diseases. She has received research funding from NIH, including NCCIH. </span></em></p><p class="fine-print"><em><span>Paul D. Terry does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>More people are seeking out traditional forms of medicine, from acupuncture to herbal medicines. The WHO is working to develop standards to make these healing practices implementable on a wide scale.Ling Zhao, Professor of Nutrition, University of TennesseePaul D. Terry, Professor of Epidemiology, University of TennesseeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2022352023-03-28T19:21:28Z2023-03-28T19:21:28ZGreen juice, microdosing, cupping and … cocaine? Netflix’s Wellmania takes a humorous dive into the heady world of wellness<figure><img src="https://images.theconversation.com/files/517352/original/file-20230324-18-yvhf0j.jpg?ixlib=rb-1.1.0&rect=16%2C0%2C5475%2C3087&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Netflix</span></span></figcaption></figure><p><em>Review: Wellmania, Netflix.</em></p>
<p>What does it mean to be well? Wellmania, inspired by Brigid Delaney’s <a href="https://www.goodreads.com/en/book/show/34451942">book of the same name</a>, attempts to answer this question. </p>
<p>Liv (Celeste Barber) is stranded in Australia after losing her green card, desperate to return to her job in the United States. After failing the necessary medical exam to apply for a new card, Liv embarks on a journey to “get well”. </p>
<p>And she’s going to do it in four weeks.</p>
<p>The show dives into the world of overconsumption of all kinds: food, drugs, sex and, eventually, wellness. Wellmania is a show where a glass of orange juice can’t be presented without a comment about the vitamin C content. </p>
<p>Liv’s health (or apparent lack thereof) is never presented in terms of her weight; instead, her “have it all” lifestyle is constantly critiqued by her friends and family. </p>
<p>You cannot, it turns out, have it all – if the all is a functioning career, family life, and copious amounts of cocaine and alcohol. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/69ZfDTpeBTA?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<p>Throughout the eight episodes of this mini-series, Liv encounters all manner of wellness tropes, from green juices to <a href="https://www.washingtonpost.com/health/2018/09/05/gwyneth-paltrows-goop-touted-benefits-putting-jade-egg-your-vagina-now-it-must-pay/">vaginal crystal eggs</a>. We are taken on a journey with her to cupping massages, watching intensely attractive people glistening on exercise bikes, to a nude session with a sex therapist. </p>
<p>Her journey is never presented as the clean, soft and beautiful acts of wellness we see on our Instagram feeds. Instead, it is hilarious, sweaty, vomit-covered, and has fallen so far off the wagon we are left wondering if she ever actually got on. </p>
<p>In the words of Liv: “Fuck diet, fuck exercise. All I need to do is starve myself and have my colon rinsed out.”</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/517533/original/file-20230327-28-90i7il.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman in a gym, upside down in a harness." src="https://images.theconversation.com/files/517533/original/file-20230327-28-90i7il.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/517533/original/file-20230327-28-90i7il.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/517533/original/file-20230327-28-90i7il.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/517533/original/file-20230327-28-90i7il.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/517533/original/file-20230327-28-90i7il.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/517533/original/file-20230327-28-90i7il.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/517533/original/file-20230327-28-90i7il.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Quick fixes for our health don’t exist.</span>
<span class="attribution"><span class="source">Netflix</span></span>
</figcaption>
</figure>
<p>Wellmania shows us in no uncertain terms that while many of us crave quick fixes for our health, no such thing exists. It is quickly apparent Liv’s wellness extends beyond what she puts in her body (or up her nose). We see a complex relationship between friends, family and coming home. </p>
<p>This is, of course, coupled with all the humour of returning home and turning into an adolescent version of yourself when you are around your adult sibling. There is nothing quite like being 39 and flipping off your younger brother behind your mum’s back.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/marketing-not-medicine-gwyneth-paltrows-the-goop-lab-whitewashes-traditional-health-therapies-for-profit-130287">Marketing, not medicine: Gwyneth Paltrow’s The Goop Lab whitewashes traditional health therapies for profit</a>
</strong>
</em>
</p>
<hr>
<h2>What we mean when we talk about wellness</h2>
<p>Wellness is a part of our everyday vernacular. We see it on our Instagram feeds, in news headlines and in a recent <a href="https://webpublisherpro.com/is-health-and-wellness-content-the-next-big-trend-in-publishing/">trend in publishing</a>. </p>
<p>Self-help books, <a href="https://theconversation.com/keto-diet-a-dietitian-on-what-you-need-to-know-99867">keto diets</a>, green juices and ways to “get well” are promoted everywhere. </p>
<p>Wellness meant something distinctly different when the word first became commonplace. The history of the word wellness dates back to 1961, with medical doctor Halbert Dunn’s book <a href="http://www.connectedandthriving.org/documents/DunnHLW.pdf">High Level Wellness</a>. </p>
<p>Dunn’s definition of wellness relies on an individual’s ability to function to their maximum potential physically, mentally and emotionally. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/517535/original/file-20230327-14-npvplr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman in a robe at a spa." src="https://images.theconversation.com/files/517535/original/file-20230327-14-npvplr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/517535/original/file-20230327-14-npvplr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=337&fit=crop&dpr=1 600w, https://images.theconversation.com/files/517535/original/file-20230327-14-npvplr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=337&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/517535/original/file-20230327-14-npvplr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=337&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/517535/original/file-20230327-14-npvplr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/517535/original/file-20230327-14-npvplr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/517535/original/file-20230327-14-npvplr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Today, ‘wellness’ is a multi-billion dollar industry.</span>
<span class="attribution"><span class="source">Netflix</span></span>
</figcaption>
</figure>
<p>Dunn’s work inspired physician John W. Travis to create the world’s first wellness centre. Travis believed health is not the absence of disease, but an “<a href="https://www.youtube.com/watch?v=LAorj2U7PR4">ongoing dynamic state of growth</a>”.</p>
<p>His centre did not claim to treat or diagnose patients, but to help them understand <em>why</em> they are sick.</p>
<p>Since then, wellness has transformed from an ideology of self-examination used to describe relaxation, meditation and managed nutrition, to its current medicalisation alleged to treat health issues. Today, wellness is an unregulated word. With the popularisation of social media platforms and the commodification of bodies and health, wellness can be bought and sold online.</p>
<p>In Wellmania, we see Liv enter multiple wellness spaces. </p>
<p>Some of these spaces endeavour to help Liv understand her mind and body, like her very concerned and unbelievably patient GP. Others indirectly assist Liv to explore her past and relationship with her body: she hitchhikes to Canberra with a <a href="https://theconversation.com/death-doulas-can-fill-care-gaps-at-the-end-of-life-105743">death doula</a>; she sees a tarot card reader while <a href="https://theconversation.com/could-microdosing-be-as-good-as-yoga-for-your-mood-its-not-that-big-a-stretch-157891">microdosing on LSD</a>.</p>
<p>It’s not all health and wellness. The show includes a significant amount of drug use and shows the dangers and dark side of the wellness industry, and of Liv. Liv’s self-destructive behaviour is mixed in a dangerous cocktail with fasting, <a href="https://theconversation.com/cupping-at-the-olympics-what-is-it-and-why-do-athletes-use-it-63729">bloodletting cupping</a> and an inability to confront the past.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/could-microdosing-be-as-good-as-yoga-for-your-mood-its-not-that-big-a-stretch-157891">Could microdosing be as good as yoga for your mood? It's not that big a stretch</a>
</strong>
</em>
</p>
<hr>
<h2>A holistic journey</h2>
<p>Health is not linear. A consistent theme running through wellness discourse for the past 60 years is that to be completely well requires a holistic approach – not holistic as in the bastardisation of the word by the <a href="https://www.mckinsey.com/industries/consumer-packaged-goods/our-insights/still-feeling-good-the-us-wellness-market-continues-to-boom">multibillion-dollar industry</a> of juice cleanses and essential oils, but holistic as in the sense of the whole body. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/517538/original/file-20230327-14-90i7il.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two women running near a beach." src="https://images.theconversation.com/files/517538/original/file-20230327-14-90i7il.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/517538/original/file-20230327-14-90i7il.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/517538/original/file-20230327-14-90i7il.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/517538/original/file-20230327-14-90i7il.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/517538/original/file-20230327-14-90i7il.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/517538/original/file-20230327-14-90i7il.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/517538/original/file-20230327-14-90i7il.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Wellness is about the whole body – not just your physical self.</span>
<span class="attribution"><span class="source">Netflix</span></span>
</figcaption>
</figure>
<p>Wellness is the physical body, yes, but also emotional, mental, sexual and spiritual health. Each episode of Wellmania shows us this, woven throughout a story of family, home, flourishing careers and the downfalls of them all. </p>
<p>Alongside its wonderful, crude humour (necessary in a show featuring colonics), Wellmania unexpectedly tells the story of grief and how uniquely it penetrates and devastates our bodies. </p>
<p>This series shows us one woman’s world of wellness. But, more than that, it reminds us how closely wellness is tied to our lives, bodies and loved ones, and the consequences of being unwell. </p>
<p><em>Wellmania is on Netflix from today.</em></p><img src="https://counter.theconversation.com/content/202235/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Edith Jennifer Hill does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Wellmania, staring Celeste Barber and inspired by Brigid Delaney’s book, asks: what does it mean to be well?Edith Jennifer Hill, Associate lecturer, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1867372022-11-16T13:29:25Z2022-11-16T13:29:25ZPatients suffering with hard-to-treat depression may get relief from noninvasive magnetic brain stimulation<figure><img src="https://images.theconversation.com/files/477266/original/file-20220802-18-nnapcv.jpg?ixlib=rb-1.1.0&rect=15%2C0%2C5218%2C3931&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Transcranial magnetic stimulation has worked when medication and other therapies have not.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/patient-in-transcranial-magnetic-stimulation-royalty-free-image/548557027?adppopup=true">Monty Rakusen/Image Source via Getty Images</a></span></figcaption></figure><p>Not only is depression a debilitating disease, but it is also widespread. Approximately 20 million adult Americans experience at least <a href="https://www.nimh.nih.gov/health/statistics/major-depression">one episode of depression per year</a>. </p>
<p>Millions of them <a href="https://www.cdc.gov/nchs/products/databriefs/db377.htm#:">take medication</a> to treat their depression. But for many, the <a href="https://www.webmd.com/depression/guide/treatment-resistant-depression-what-is-treatment-resistant-depression">medications don’t work</a>: Either they have minimal or no effect, or the side effects are intolerable. These patients have what is called <a href="https://www.mayoclinic.org/diseases-conditions/depression/in-depth/treatment-resistant-depression/art-20044324">treatment-resistant depression</a>. </p>
<p>One promising treatment for such patients is a type of brain stimulation therapy <a href="https://www.healthline.com/health/tms-therapy#What-is-TMS-therapy">called transcranial magnetic stimulation</a>. </p>
<p>This treatment is not new; it has been around since 1995. The U.S. Food and Drug Administration <a href="https://doi.org/10.1016/j.brs.2021.11.010">cleared transcranial magnetic stimulation in 2008</a> for adults with “non-psychotic treatment-resistant depression,” which is typically defined as a failure to respond to two or more antidepressant medications. More recently, in 2018, the FDA cleared it for <a href="https://www.fda.gov/news-events/press-announcements/fda-permits-marketing-transcranial-magnetic-stimulation-treatment-obsessive-compulsive-disorder#">some patients with obsessive-compulsive disorder</a> and <a href="https://www.fda.gov/consumers/consumer-updates/want-quit-smoking-fda-approved-and-fda-cleared-cessation-products-can-help#">smoking cessation</a>. </p>
<p>Insurance <a href="https://www.mytransformations.com/post/the-ultimate-guide-to-tms-therapy-and-insurance-coverage">generally covers these treatments</a>. Both the psychiatrist and the equipment operator must be certified. While the treatment has been available for years, the equipment to perform the procedure remains expensive enough that few private psychiatry practices can afford it. But with the growing recognition of the potential of transcranial magnetic stimulation, the price will likely eventually come down and access will be greatly expanded.</p>
<h2>Does it work?</h2>
<p>Transcranial magnetic stimulation is a noninvasive, pain-free procedure that has minimal to no side effects, and it often works. Research shows that 58% of once treatment-resistant patients experience <a href="https://doi.org/10.1002/da.21969">a significant reduction in depression</a> following four to six rounds of the therapy. More than 40 independent clinical trials – with more than 2,000 patients worldwide – have demonstrated that repetitive transcranial magnetic stimulation <a href="https://doi.org/10.1136/gpsych-2019-100074">is an effective therapy</a> for the treatment of resistant major depression. </p>
<p><a href="https://medicine.fiu.edu/about/faculty-and-staff/profiles/psychiatry-and-behavioral-health/junquera,-patricia.html">As a professor and psychiatrist</a> who has used transcranial magnetic stimulation to treat some of my patients, I have seen depression symptoms decrease even within the first two weeks of treatment. What’s more, the effects continue after the treatment has ended, typically for six months to a year. After that, the patient has the option of maintenance treatment. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/pfy0t5Yapco?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Transcranial magnetic stimulation helps increase blood flow and dopamine levels in the brain.</span></figcaption>
</figure>
<h2>About the procedure</h2>
<p>For the patient, the procedure is easy and simple. One sits in a comfortable chair with a snug pillow that holds their head in place, puts on earplugs and can then relax, check their phone, watch TV or read a book.</p>
<p>A treatment coil, which looks like a figure 8, is placed on the patient’s head. A nearby stimulator sends an electrical current to the coil, which transforms the current into <a href="https://www.livescience.com/38059-magnetism.html">a magnetic field</a>. </p>
<p>The field, which is highly concentrated, turns on and off rapidly while targeting a portion <a href="https://neuroscientificallychallenged.com/posts/know-your-brain-prefrontal-cortex">of the prefrontal cortex</a> – the area of the brain responsible for mood regulation. </p>
<p>Researchers know that people suffering from depression have reduced blood flow and less activity in that part of the brain. Transcranial magnetic stimulation causes increases in both blood flow and in the levels of <a href="https://www.healthdirect.gov.au/dopamine#">dopamine</a> and <a href="https://doi.org/10.1007/s00702-014-1180-8">glutamate</a> – two neurotransmitters that are responsible for brain functions like concentration, memory and sleep. It’s the repeated stimulation of this area – the “depression circuit” of the brain – that brings the antidepressant effect. </p>
<h2>It is not ‘electroshock’ or deep brain stimulation</h2>
<p>Some people confuse transcranial magnetic stimulation with <a href="https://www.psychiatry.org/patients-families/ect#">electroconvulsive therapy</a>, a procedure used for patients with severe depression or catatonia. With electroshock therapy, the anesthetized patient receives a direct electrical current, which causes a seizure. Typically, people who undergo this procedure experience <a href="https://www.mayoclinic.org/tests-procedures/electroconvulsive-therapy/about/pac-20393894#:">some memory loss after treatment</a>. </p>
<p>Transcranial magnetic stimulation is very different. It doesn’t require anesthesia, and it doesn’t affect memory. The patient can resume daily activities right after each treatment. Dormant brain connections are reignited without causing a seizure.</p>
<p>It should also not be confused with <a href="https://www.mayoclinic.org/tests-procedures/deep-brain-stimulation/about/pac-20384562">deep brain stimulation</a>, which is a surgical procedure used <a href="https://theconversation.com/deep-brain-stimulation-can-be-life-altering-for-ocd-sufferers-when-other-treatment-options-fall-short-186109">to treat obsessive-compulsive disorder</a>, tremors, epilepsy and Parkinson’s disease. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/a_8bOCNjJpY?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Transcranial magnetic stimulation stimulates the ‘depression circuit’ in the brain.</span></figcaption>
</figure>
<h2>Side effects and access</h2>
<p>Transcranial magnetic stimulation patients undergo a total of <a href="https://www.mindpath.com/resource/what-a-typical-tms-treatment-looks-like/">36 treatments, at 19 minutes each</a>, for three to six weeks. Research has concluded that this is the best protocol for treatment. Some patients report that it feels like someone is tapping on their head. Others don’t feel anything. </p>
<p>Some very minor side effects may occur. The most common is facial twitching and scalp discomfort during treatment, sensations that go away after the session ends. Some patients report a mild headache or discomfort at the application site. Depending on how effective the therapy was, some patients return for follow-ups every few weeks or months. It can be used in addition to medications, or with no medication at all. </p>
<p>Not everyone with depression can undergo <a href="https://www.clinicaltmssociety.org/content/who-cannot-have-tms">this type of brain stimulation therapy</a>. Those with epilepsy or a history of head injury may not qualify. People with metallic fillings in their teeth are OK for treatment, but others with implanted, nonremovable metallic devices in or around the head are not. Those with pacemakers, defibrillators and vagus nerve stimulators may also not qualify, because the magnetic force of the treatment coil may dislodge these devices and cause severe pain or injury. </p>
<p>But for those who are able to use the therapy, the results can be remarkable. For me, it is amazing to see these patients smile again – and come out on the other side feeling hopeful.</p><img src="https://counter.theconversation.com/content/186737/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Patricia Junquera does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Patients who undergo transcranial magnetic stimulation say it’s painless, with few to no side effects. The treatment isn’t yet widely accessible, but for those who use it, the effects can be profound.Patricia Junquera, Associate Professor and Vice Chair of Clinical Services, Florida International UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1813482022-07-11T12:29:10Z2022-07-11T12:29:10ZMigraine sufferers have treatment choices – a neurologist explains options beyond just pain medication<figure><img src="https://images.theconversation.com/files/472113/original/file-20220701-26-9o11ui.jpg?ixlib=rb-1.1.0&rect=7%2C22%2C5084%2C3359&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">For some, too much medication might make migraine worse.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/headache-conceptual-artwork-3d-illustration-royalty-free-image/1156927795?adppopup=true">peterschreiber.media/iStock via Getty Images Plus</a></span></figcaption></figure><p>Migraine headaches currently affect more than one billion people across the globe and are the <a href="https://doi.org/10.1186/s10194-020-01208-0">second-leading cause</a> of disability worldwide. Nearly one-quarter of U.S. households have at least <a href="https://doi.org/10.1046/j.1526-4610.2001.041007646.x">one member who suffers from migraines</a>. An estimated <a href="https://doi.org/10.1177/0333102410363766">85.6 million workdays</a> are lost as a result of migraine headaches each year. </p>
<p>Yet many who suffer with migraine dismiss their pain as simply a bad headache. Rather than seeking medical care, the condition often <a href="https://pubmed.ncbi.nlm.nih.gov/25588281/">goes undiagnosed</a>, even when other incapacitating symptoms occur alongside the pain, including light and sound sensitivity, nausea, vomiting and dizziness.</p>
<p>Researchers have discovered that genetics and environmental factors play a role in the condition of migraine. They happen when changes in your brainstem activate <a href="https://my.clevelandclinic.org/health/body/21581-trigeminal-nerve">the trigeminal nerve</a>, which is a major nerve in the pain pathway. This cues your body to release inflammatory substances such as <a href="https://www.scienceofmigraine.com/pathophysiology/cgrp">CGRP</a>, short for calcitonin gene-related peptide. This molecule, and others, can cause blood vessels to swell, producing pain and inflammation.</p>
<h2>For some, medication has its limits</h2>
<p>A migraine can be debilitating. Those who are experiencing one are often curled up in a dark room accompanied by only their pain. Attacks can last for days; life is put on hold. The sensitivity to light and sound, coupled with the unpredictability of the disease, causes many to forego work, school, social gatherings and time with family.</p>
<p>Numerous prescription medications are available for both the prevention and treatment of migraine. But for many people, conventional treatment has its limitations. Some people with migraine have a poor tolerance for certain medications. Many can’t afford the high cost of the medicines or endure the side effects. Others are pregnant or breastfeeding and can’t take the medications.</p>
<p>However, as a <a href="https://som.ucdenver.edu/Profiles/Faculty/Profile/29586">board-certified neurologist</a> who specializes in headache medicine, I’m always amazed at how open-minded and enthusiastic patients become when I discuss alternative options. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/qwZypa0iKq8?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Your brain sends you warning signals, such as fatigue and mood changes, to let you know a migraine may be on the way.</span></figcaption>
</figure>
<p>These approaches, collectively, are called <a href="https://www.hopkinsmedicine.org/health/wellness-and-prevention/types-of-complementary-and-alternative-medicine">complementary and alternative medicine</a>. It might be surprising that a traditionally trained Western doctor like me would recommend things like yoga, acupuncture or meditation for people with migraine. Yet in my practice, I value these <a href="https://doi.org/10.7326/0003-4819-135-5-200109040-00011">nontraditional treatments</a>. </p>
<p>Research shows that alternative therapies are associated with <a href="https://doi.org/10.1016/j.ctcp.2017.12.003">improved sleep, feeling better emotionally and an enhanced sense of control</a>. Some patients can avoid prescription medications altogether with one or more complementary treatments. For others, the nontraditional treatments can be used along with prescription medication. </p>
<p>These options can be used one at a time or in combination, depending on how severe the headache and the cause behind it. If neck tension is a contributor to the pain, then physical therapy or massage may be most beneficial. If stress is a trigger, perhaps meditation would be an appropriate place to start. It is worth talking to your provider to explore which options may work best for you. </p>
<h2>Mindfulness, meditation and more</h2>
<p>Because stress is a <a href="https://www.healthline.com/health/migraine-from-stress#bottom-line">major trigger for migraines</a>, one of the most effective alternative therapies is <a href="https://americanmigrainefoundation.org/resource-library/understanding-migraine-cattreatmentmindfulness-meditation-migraine/">mindfulness meditation</a>, which is the act of focusing your attention on the present moment in a nonjudgmental mindset. Studies show that mindfulness meditation can reduce <a href="https://medcentral.net/doi/full/10.4103/0366-6999.228242">headache frequency and pain severity</a>. </p>
<p>Another useful tool is <a href="https://americanmigrainefoundation.org/resource-library/biofeedback-and-relaxation-training/">biofeedback</a>, which enables a person to see their vital signs in real time and then learn how to stabilize them. </p>
<p>For example, if you are stressed, you may notice muscle tightness, perspiration and a fast heart rate. With biofeedback, these changes appear on a monitor, and a therapist teaches you exercises to help manage them. <a href="https://doi.org/10.1016/j.pain.2006.09.007">There is strong evidence</a> that biofeedback can lessen the frequency and severity of migraine headaches and reduce headache-related disability.</p>
<p><a href="https://www.medicalnewstoday.com/articles/yoga-for-migraine#can-it-help">Yoga</a> derives from traditional Indian philosophy and combines physical postures, meditation and breathing exercises with a goal of uniting the mind, body and spirit. Practicing yoga consistently <a href="https://americanmigrainefoundation.org/resource-library/yoga-and-migraine/">can be helpful</a> in reducing stress and treating migraine.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/ayfe4XWCZdg?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Meditation is an alternative therapy that could help with your migraine.</span></figcaption>
</figure>
<h2>Manipulation-based therapy</h2>
<p><a href="https://www.webmd.com/migraines-headaches/physical-therapy-for-migraine">Physical therapy</a> uses manual techniques such as <a href="https://www.myofascialtherapy.org/myofascial-therapy">myofascial and trigger-point release</a>, <a href="https://www.healthline.com/health/exercise-fitness/passive-stretching">passive stretching</a> and <a href="https://www.verywellhealth.com/manual-cervical-traction-2696409">cervical traction</a>, which is a light pulling on the head by a skilled hand or with a medical device. Studies show that <a href="https://doi.org/10.1016/j.apmr.2015.12.006">physical therapy with medication was superior</a> in reducing migraine frequency, pain intensity and pain perception over medications alone. </p>
<p>By lowering stress levels and promoting relaxation, massage can <a href="https://www.webmd.com/migraines-headaches/migraine-massage-therapy">decrease migraine frequency</a> and <a href="https://doi.org/10.1207/s15324796abm3201_6">improve sleep</a>. It may also reduce stress in the days following the massage, which adds further protection from migraine attacks. </p>
<p>Some patients are helped by <a href="https://www.hopkinsmedicine.org/health/wellness-and-prevention/acupuncture">acupuncture</a>, a form of traditional Chinese medicine. In this practice, fine needles are placed in specific locations on the skin to promote healing. A large 2016 meta-analysis paper found <a href="https://doi.org/10.1111/head.12857">acupuncture reduced the duration and frequency of migraines</a> regardless of how often they occur. Acupuncture benefits <a href="https://doi.org/10.1001/jamainternmed.2016.9378">are sustained after 20 weeks of treatment</a>.</p>
<p>What’s also fascinating is that acupuncture <a href="https://doi.org/10.2147/JPR.S162696">can change the metabolic activity</a> in the thalamus, the region of the brain critical to pain perception. This change correlated with a decrease in the headache intensity score following acupuncture treatment.</p>
<h2>Vitamins, supplements and nutraceuticals</h2>
<p><a href="https://my.clevelandclinic.org/health/drugs/15829-herbal-supplements">Herbal supplements</a> and <a href="https://americanmigrainefoundation.org/resource-library/nutraceuticals-for-migraine/">nutraceuticals</a>, which are food-derived products that may have therapeutic benefit, can also be used to prevent migraine. And there is evidence to suggest vitamins work reasonably well compared to traditional prescription medication. They also have fewer side effects. Here are some examples:</p>
<ul>
<li><p>Magnesium is believed to help regulate the <a href="https://doi.org/10.1111/j.1526-4610.2011.01847.x">blood vessels and electrical activity in the brain</a>. A study found that patients given 600 milligrams of magnesium citrate daily for 12 weeks had a 40% <a href="https://doi.org/10.1046/j.1468-2982.1996.1604257.x">decrease in migraine</a>. Side effects included diarrhea in nearly 20% of patients. </p></li>
<li><p>Vitamin B2, or riboflavin, <a href="https://doi.org/10.1111/head.12789">is also considered useful in migraine</a> prevention. When dosed at 400 milligrams daily for 12 weeks, researchers found it <a href="https://doi.org/10.1111/head.12789">reduced migraine frequency by half</a> in more than half of participants. </p></li>
<li><p>Another beneficial supplement is Coenzyme Q10, which is involved in <a href="https://doi.org/10.1073/pnas.95.15.8892">cellular energy production</a>. After three months, about half of those taking 100 milligrams of Coenzyme Q10 three times a day <a href="https://pubmed.ncbi.nlm.nih.gov/15728298/">had half the number of migraine attacks</a>. </p></li>
<li><p>A potential natural solution is <a href="https://headaches.org/feverfew-tanacetum-parthenium/">feverfew</a> or <em>Tanacetum parthenium</em>, a daisylike perennial plant known to have <a href="https://doi.org/10.4103/0973-7847.79105">anti-migraine properties</a>. Taken three times daily, feverfew <a href="https://doi.org/10.1111/j.1468-2982.2005.00950.x">reduced migraine frequency by 40%</a>. </p></li>
</ul>
<h2>Devices can be beneficial</h2>
<p>The Food and Drug Administration has approved several <a href="https://www.everydayhealth.com/migraine/guide/treatment/nerve-stimulation-devices/">neurostimulation devices</a> for migraine treatment. These devices work by neutralizing the pain signals sent from the brain.</p>
<p>One is the <a href="https://doi.org/10.3389/fpain.2021.753736">Nerivio device</a>, which is worn on the upper arm and sends signals to the brainstem pain center during an attack. Two-thirds of people report pain relief after two hours, and side effects are rare. </p>
<p>Another device that shows promise is the <a href="https://americanmigrainefoundation.org/resource-library/understanding-migrainecefaly-for-migraine-prevention/">Cefaly</a>. It delivers a mild electrical current to the <a href="https://my.clevelandclinic.org/health/body/21581-trigeminal-nerve#">trigeminal nerve</a> on the forehead, which can lessen the frequency and intensity of migraine attacks. After one hour of treatment, patients experienced a nearly 60% reduction in pain intensity, and the relief lasted up to 24 hours. Side effects are uncommon and include sleepiness or skin irritation. </p>
<p>These alternative therapies help treat the person as a whole. In just my practice, many success stories come to mind: the college student who once had <a href="https://migrainetrust.org/understand-migraine/types-of-migraine/chronic-migraine/">chronic migraine</a> but now has rare occurrences after a regimen of vitamins; the pregnant woman who avoided medication through acupuncture and physical therapy; or the patient, already on numerous prescription medications, who uses a neurostimulation device for migraine instead of adding another prescription. </p>
<p>Granted, alternative approaches are not necessarily miracle therapies, but their potential to relieve pain and suffering is notable. As a physician, it is truly gratifying to see some of my patients respond to these treatments.</p><img src="https://counter.theconversation.com/content/181348/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Danielle Wilhour does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Research suggests that alternative treatments for migraine, including physical therapy, massage and vitamin supplements, can make a difference.Danielle Wilhour, Assistant Professor of Neurology, University of Colorado Anschutz Medical CampusLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1653772021-08-05T12:41:37Z2021-08-05T12:41:37ZOlympic athletes excel at their sports but are susceptible to unproven alternative therapies<figure><img src="https://images.theconversation.com/files/414386/original/file-20210803-25-khztso.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5000%2C3532&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Cupping, K-tape and cryotherapy are a few alternative therapies commonly used by athletes.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/massage-and-spa-for-men-male-torsos-in-the-royalty-free-illustration/1268389138">juliawhite/iStock via Getty Images Plus</a></span></figcaption></figure><p>Australian Olympic swimmer Kyle Chalmers earned a silver medal and his personal-best time in the 100-meter freestyle event at the 2021 Tokyo Games. While most of the world focused on his thrilling performance, others were equally interested in the <a href="https://www.independent.co.uk/life-style/health-and-families/olympics-cupping-circles-swimmers-backs-b1892490.html">conspicuous, circular bruises</a> on his back and shoulders. Similar marks were seen on <a href="https://well.blogs.nytimes.com/2016/08/08/what-are-the-purple-dots-on-michael-phelps-cupping-has-an-olympic-moment/">Michael Phelps</a> in 2016 when he added six medals to his tally to cement his title as history’s most successful Olympian.</p>
<p>Those blemishes were the work of <a href="https://doi.org/10.1016/S2005-2901(11)60001-0">cupping</a>, an alternative therapy in which small glass cups are placed on the skin at sites of injury or soreness, and used to create suction that stimulates “energy flow.” One form of cupping – wet cupping – involves piercing the skin to bleed the area and remove stagnant blood and toxins.</p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/7djtuUyx7j","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<p>As an <a href="https://scholar.google.com/citations?user=F8Gr-jAAAAAJ&hl=en">exercise physiologist</a> who studies critical thinking, I can’t help but wonder how an athlete’s unwitting endorsement of alternative therapy might influence the progression of a sport. This is because cupping is fairly characteristic of <a href="https://www.who.int/health-topics/traditional-complementary-and-integrative-medicine#tab=tab_1">alternative therapy</a> that, by definition, hasn’t been accepted by conventional science and medicine. When tested in <a href="https://doi.org/10.1016/S2005-2901(11)60001-0">controlled studies</a>, cupping doesn’t work. </p>
<p>In fact, all alternative therapies exist on a spectrum, from treatments with some merit to scientifically disproven nonsense. And interventions like cupping, that masquerade as science without fulfilling its robust methodology, are known as <a href="https://www.scientificamerican.com/article/what-is-pseudoscience/">pseudoscience</a>.</p>
<h2>Alternative therapies are rife in sport</h2>
<p>When it comes to unproven alternative therapies, cupping is just the tip of the iceberg. Other such practices in sport include <a href="https://pubmed.ncbi.nlm.nih.gov/21952385/">chiropractic spinal manipulation</a>, <a href="https://doi.org/10.1007/s00405-020-06202-5">nasal strips</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3737916/">hologram bracelets</a>, <a href="http://dx.doi.org/10.1136/bjsm.2006.028936">oxygen drinks</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/25835541/">reiki (healing hands)</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/26383887/">cryotherapy</a> and <a href="https://doi.org/10.1177%2F0269215520963846">kinesiology tape or K-tape</a>. </p>
<p>While an estimated <a href="https://www.cdc.gov/nchs/data/nhsr/nhsr012.pdf">40% of Americans have used alternative therapies</a>, approximately 20% have used alternative therapies to enhance <a href="https://pubmed.ncbi.nlm.nih.gov/28987072/">athletic performance</a>. <a href="https://doi.org/10.3810/psm.1998.06.1066">Studies</a> <a href="https://doi.org/10.1177%2F1012690205057199">in</a> <a href="https://doi.org/10.1097/00042752-200605000-00008">amateur</a> and <a href="https://doi.org/10.1155/2021/5572325">elite</a> <a href="https://doi.org/10.1159/000511247">athletes</a> show a higher prevalence of 50% to 80%.</p>
<p>A detailed discussion of the evidence – or lack thereof – underpinning each practice can be found in <a href="https://doi.org/10.4324/9780429446160">books and scientific journals</a>. However, most alternative therapies generally have three things in common:</p>
<p>1) They’re sold on strong claims and weak evidence.</p>
<p>2) They invoke scientific-sounding terms like “energy,” “metabolites” and “blood flow” to feign scientific legitimacy.</p>
<p>3) They’re based on low-quality studies that are poorly controlled and have small samples sizes. This makes it impossible to distinguish the real benefits of the treatment from perceived or imagined ones.</p>
<h2>Why do some athletes love alternative therapies?</h2>
<p>Despite scientific consensus on their poor efficacy, alternative therapies appear to be more popular among athletes than the general population. So what makes them so popular?</p>
<p>Humans evolved to take mental shortcuts called <a href="https://doi.org/10.1126/science.185.4157.1124">heuristics</a> that lead to rapid but imperfect solutions, particularly when making <a href="https://doi.org/10.3389/fpubh.2019.00006">health and fitness decisions</a>. Proponents of some alternative therapies exploit the economy heuristic by offering grand rewards for comparatively little investment. Athletes are always chasing the extra 1% and may be particularly susceptible to extravagant claims.</p>
<p>In some instances, a lack of scientific evidence for a given alternative therapy may be the very reason that someone is drawn to it in the first place. The last decade has seen an upswing in <a href="https://doi.org/10.1371/journal.pbio.3000683">anti-science movements</a> and unprecedented attacks on scientists around the world. An individual may turn to alternative treatments due to dissatisfaction or distrust in conventional science, <a href="https://doi.org/10.1136/bmj.321.7269.1133">rejection of societal norms</a>, or both. A therapy may become popular simply because it defies the established order.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"426647061870956544"}"></div></p>
<p>Sponsorship is another factor. American athletes only win between <a href="https://www.cnbc.com/2021/07/29/tokyo-olympics-how-much-athletes-earn.html">$15,000 and $37,500 for an Olympic medal</a>, while British athletes receive no prize money whatsoever. Many have <a href="https://www.goodhousekeeping.com/life/money/news/g3797/how-olympians-make-money/">regular jobs</a>, while some earn the bulk of their income from <a href="https://www.forbes.com/sites/oliviaevans/2021/07/31/what-do-some-us-olympic-athletes-spend-and-how-much-can-they-make-going-for-gold/?sh=439e4cfc1f00">paid advertising</a>. Marketing companies are shrewd: <a href="https://www.researchgate.net/publication/312116633_Consuming_rationally_How_marketing_is_exploiting_our_cognitive_biases_and_what_we_can_do_about_it">They understand our biases better than we do</a>. A company can increase product sales by sponsoring an athlete and affiliating itself with success, fitness and beauty. It’s a win-win because athletes are able to leverage their hefty social media followings into an advertising base. Seemingly innocuous <a href="https://doi.org/10.1080/16184742.2020.1806897">Instagram posts</a> must not be taken at face value.</p>
<p>Finally, some products like <a href="https://sciencebasedmedicine.org/olympic-pseudoscience-tokyo-edition/">K-tape</a> boost their sales through visibility. This phenomenon, where consumers prefer products they’re more familiar with, is called the <a href="https://doi.apa.org/doi/10.1037/h0025848">exposure effect</a>. Increased visibility leads to increased popularity in an ongoing, reciprocal relationship.</p>
<p>Importantly, none of these factors speak to the effectiveness of a product.</p>
<h2>How do alternative therapies benefit athletes?</h2>
<p>It’s not all squandered time and money, however, and there are benefits to some alternative therapies. <a href="https://doi.org/10.1016/j.jad.2020.09.134">Meditation</a> has been used to successfully improve anxiety, depression and psychological well-being, and <a href="https://doi.org/10.1016/j.ypmed.2016.03.013">yoga</a> is a valid means of weight loss. Moreover, <a href="http://dx.doi.org/10.1136/bjsm.32.3.212">massages</a> and other soft tissue therapies appear to reduce muscle soreness and possibly prevent injury. </p>
<p>A distinction can be made between these and unproven alternative therapies based on the data. Care should be taken not to confound plausible claims like weight loss and relaxation with implausible ones like physical healing and detox. </p>
<p><iframe id="Prqt8" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/Prqt8/3/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>Even without a quantifiable mechanism of action, many alternative remedies claim efficacy based on <a href="https://doi.org/10.2165/00007256-200939040-00004">placebo effects</a>. The placebo effect manifests when a product improves performance via a positive psychological outcome, attributable to an individual’s belief in the product’s effectiveness. The outcome can be powerful. For instance, <a href="https://doi.org/10.1097/00005768-200009000-00019">one study</a> administered flavored water to competitive cyclists and told them it was a glucose supplement. They saw performance improve by 4% relative to a second group, which was told they’d received a placebo.</p>
<p>In Olympic sport, where gold and silver can be decided by less than a half-second, it’s understandable why sports teams may condone use of placebos, particularly when <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3778695/">athletes believe in the powerful effects</a>.</p>
<h2>Are there risks of alternative therapies in sport?</h2>
<p>The downside is that, yes, there are clear risks associated with certain alternative therapies. For instance, there are numerous reports of serious injury and even death following both <a href="https://doi.org/10.1111/j.1742-1241.2010.02352.x">chiropractic spinal manipulation</a> and <a href="https://doi.org/10.3233/JRS-2010-0503">acupuncture</a>. Moreover, skin burns are a common side effect of <a href="https://doi.org/10.5694/mja17.00230">cupping therapy</a>. </p>
<p>Of course, all medical procedures carry risk. But in conventional medicine, physicians make treatment decisions based on a <a href="https://doi.org/10.1016/s0197-2456(96)00092-x">risk-to-benefit ratio</a>. When the benefit of alternative therapy hinges on a placebo, the potential risks become hard to justify, especially given the possible loss of training time due to injury or other negative outcome that results from an alternative treatment.</p>
<p>The broad and indiscriminate use of alternative therapies in sport may also have downstream consequences for clinical practice. This is because it’s impossible to restrict placebo use only to minor ailments and sports performance. A sincere belief in the effectiveness of an alternative therapy that isn’t backed by science will lead to its inevitable use by some individuals to treat a potentially <a href="https://www.independent.co.uk/news/world/americas/parents-found-guilty-letting-baby-son-die-meningitis-a7003866.html">serious</a> <a href="https://doi.org/10.1136/bmj.j4006">condition</a>, sometimes with <a href="http://whatstheharm.net/index.html">fatal consequences</a>.</p>
<h2>Is there a place for alternative therapy?</h2>
<p>Might alternative treatments complement those endorsed by science? Perhaps. But safe practice requires drawing a clear line in the sand to restrict alternative therapies to minor ailments and sports performance, not replace modern medicine.</p>
<p>Pseudoscience is a major barrier to both <a href="https://dx.doi.org/10.1016%2Fj.optom.2017.08.001">evidence-based practice</a> and <a href="https://doi.org/10.1002/(SICI)1098-237X(199806)82:3%3C407::AID-SCE6%3E3.0.CO;2-G">science education and literacy</a>. That’s why it’s a potential burden in sport, and why education programs are needed to help people <a href="https://plato.stanford.edu/entries/pseudo-science/">distinguish science from pseudoscience</a>. Not just in sport, but in all facets of society.</p>
<p>And despite what you may hear in Olympics coverage, <a href="https://news.berkeley.edu/2018/05/23/rehabilitating-lactate-from-poison-to-cure/">lactic acid does not cause fatigue</a>.</p><img src="https://counter.theconversation.com/content/165377/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicholas B. Tiller is a board member of the Pulmonary Education and Research Foundation (PERF). </span></em></p>Many elite athletes turn to alternative therapies to improve performance and enhance recovery. But are these treatments helping or hindering their quest for sporting success?Nicholas B. Tiller, Research Fellow (exercise physiology/respiratory medicine), University of California, Los AngelesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1149802019-05-30T19:50:13Z2019-05-30T19:50:13ZTraditional medicines must be integrated into health care for culturally diverse groups<figure><img src="https://images.theconversation.com/files/276758/original/file-20190528-42588-uc0t6z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Traditional Chinese herbal remedies are today used in many countries.</span> <span class="attribution"><span class="source">From shutterstock.com</span></span></figcaption></figure><p><em>This article is the fifth part in a series, <a href="https://theconversation.com/au/topics/where-culture-meets-health-70226">Where culture meets health</a>.</em></p>
<hr>
<p>Many people seek <a href="https://www.racgp.org.au/afp/2017/may/patterns-of-complementary-and-alternative-medicine-use-and-health-literacy-in-general-practice-patients-in-urban-and-regional-australia/">complementary treatments</a> for various ailments. Perhaps herbal remedies to cure a cold, or acupuncture to ease lower back pain. </p>
<p>“Complementary medicine” refers to practices outside Western medicine, adopted from other cultures, and often used in high-income countries.</p>
<p>But “traditional medicine” covers a range of practices and therapies indigenous to their practising population. Based on historical and cultural foundations, it operates outside of mainstream health care. </p>
<p>So for example, traditional Chinese medicine is indigenous to the Chinese and is therefore classified as a traditional medicine. But when it’s used by non-Chinese ethnicities, we’d call it a complementary medicine.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/nearly-1-in-4-of-us-arent-native-english-speakers-in-a-health-care-setting-interpreters-are-essential-115125">Nearly 1 in 4 of us aren't native English speakers. In a health-care setting, interpreters are essential</a>
</strong>
</em>
</p>
<hr>
<p>While many people use complementary medicines, traditional medicines form a particularly important influence on the way migrants look after their health.</p>
<p>This can present a challenge in the delivery of Western medical care to diverse communities in their destination countries.</p>
<p>But even where there’s little consensus around their efficacy, as we strive to achieve better health outcomes for culturally and linguistically diverse people, we must recognise traditional and complementary medicines as an essential component of their health care.</p>
<h2>A holistic approach</h2>
<p>Traditional and complementary medicines <a href="https://link.springer.com/article/10.1007%2Fs10903-018-0832-4">used among culturally and linguistically diverse populations</a> include herbal medicine, acupuncture, massage, traditional Chinese medicine, yoga, ayurveda, homeopathy, and tai chi. Different modalities are favoured in different communities.</p>
<p>Ayurveda is more than 5,000 years old and <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/ayurveda">native to India</a>. It combines lifestyle, diet, exercise and predominantly plant products as treatment options. Translating to “life science”, it aims to cleanse a person of disease-causing substances and restore balance in the body. </p>
<p>Ayurvedic practitioners believe this approach is effective in managing a number of acute and chronic conditions including <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3718571/">diabetes</a>, <a href="http://www.plantsjournal.com/archives/2017/vol5issue1/PartA/4-6-26-508.pdf">cancer</a>, <a href="http://www.ayurvedjournal.com/JAHM_201843_03.pdf">anxiety</a> and <a href="https://www.researchgate.net/profile/Rajkala_Patil/publication/319037230_Management_of_Rheumatoid_Arthritis_through_Ayurveda/links/598c2890a6fdcc58acb737ec/Management-of-Rheumatoid-Arthritis-through-Ayurveda.pdf">rheumatoid arthritis</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/does-traditional-chinese-medicine-have-a-place-in-the-health-system-6166">Does traditional Chinese medicine have a place in the health system?</a>
</strong>
</em>
</p>
<hr>
<p>While some studies point to its efficacy – one found ayurvedic formulations <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Ayurvedic+medicine+offers+a+good+alternative+to+glucosamine">were comparable to conventional medicines</a> such as glucosamine to treat knee osteoarthritis – varied results and limited study designs make it difficult to draw firm conclusions.</p>
<p>Meanwhile, traditional Chinese medicine has evolved since it was first used more than 2,000 years ago. But it remains grounded in its aim to treat the whole body, rather than targeting the problem alone.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/276759/original/file-20190528-42600-w6r5nh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/276759/original/file-20190528-42600-w6r5nh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=423&fit=crop&dpr=1 600w, https://images.theconversation.com/files/276759/original/file-20190528-42600-w6r5nh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=423&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/276759/original/file-20190528-42600-w6r5nh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=423&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/276759/original/file-20190528-42600-w6r5nh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=532&fit=crop&dpr=1 754w, https://images.theconversation.com/files/276759/original/file-20190528-42600-w6r5nh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=532&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/276759/original/file-20190528-42600-w6r5nh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=532&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Traditional remedies often accompany migrants to their destination countries.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
</figcaption>
</figure>
<p>Encompassing practices including tai chi, acupuncture, and a variety of herbal remedies, Chinese medicine is today used to prevent and treat many conditions.</p>
<p>Patients with <a href="https://www.ncbi.nlm.nih.gov/pubmed/19877092">knee osteoarthritis</a> who practised tai chi recorded significant improvements, while there have been positive results for acupuncture in relieving <a href="https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/413107">lower back pain</a> and nausea associated with chemotherapy. </p>
<p>Traditional Chinese medicine has also been used for the prevention of <a href="http://www.onlinejacc.org/content/69/24/2952?_ga=2.21281211.1216051978.1500588607-1243537711.1500588607&sso=1&sso_redirect_count=2&access_token=">heart disease and stroke</a>, and to improve quality of life for people with <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/227164">chronic heart failure</a>.</p>
<p>A <a href="https://www.ncbi.nlm.nih.gov/pubmed/28619197">recent review</a> found certain Chinese medicines may control some risk factors for heart disease, like diabetes and high blood pressure. But several studies were limited by small sample sizes and flawed research designs.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/do-you-know-whats-in-the-herbal-medicine-youre-taking-72726">Do you know what's in the herbal medicine you're taking?</a>
</strong>
</em>
</p>
<hr>
<p>Herbal remedies from Chinese medicine and beyond are employed to treat a range of conditions. St John’s wort has been used <a href="https://www.ncbi.nlm.nih.gov/pubmed/18843608">to treat mild depression</a>, Ginkgo Biloba for memory loss, and ginseng for musculoskeletal conditions. </p>
<p>Despite <a href="https://www.ncbi.nlm.nih.gov/pubmed/18843608">some promising results</a>, a substantial gap still exists between the strength of evidence supporting many of these practices and consumers’ use and acceptance of traditional and complementary medicines.</p>
<h2>If the evidence is limited, why should we pay attention?</h2>
<p>Some migrant communities experience poorer health than their host populations. For example, <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-13-252">the rates of type 2 diabetes</a> are higher among migrants than in the wider Australian population.</p>
<p>It’s important to recognise that for minority groups, feeling as though a doctor doesn’t understand their cultural needs can be a barrier to help-seeking.</p>
<p>For instance, if a person doesn’t believe their doctor will approve of their use of traditional medicines, they may not disclose it. We know <a href="https://link.springer.com/article/10.1007%2Fs10903-018-0832-4">non-disclosure</a> of traditional and complementary medicine use is common among culturally diverse groups.</p>
<p>This can be dangerous, as some traditional and complementary medicines can <a href="https://europepmc.org/abstract/med/28762712">negatively interact</a> with other drugs.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/going-to-the-naturopath-or-a-yoga-class-your-private-health-wont-cover-it-110699">Going to the naturopath or a yoga class? Your private health won't cover it</a>
</strong>
</em>
</p>
<hr>
<p>Where patients feel their practitioners are non-judgemental or even accepting of their traditional medicine use, they are <a href="https://www.ncbi.nlm.nih.gov/pubmed/19273869?dopt=Abstract">more likely to disclose it</a>.</p>
<p>So medical providers may benefit from education around different types of traditional and complementary medicines, including culturally sensitive methods to enquire about their use.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/277124/original/file-20190530-69055-v2lyrq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/277124/original/file-20190530-69055-v2lyrq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=418&fit=crop&dpr=1 600w, https://images.theconversation.com/files/277124/original/file-20190530-69055-v2lyrq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=418&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/277124/original/file-20190530-69055-v2lyrq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=418&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/277124/original/file-20190530-69055-v2lyrq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=526&fit=crop&dpr=1 754w, https://images.theconversation.com/files/277124/original/file-20190530-69055-v2lyrq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=526&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/277124/original/file-20190530-69055-v2lyrq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=526&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Acupuncture, a popular complementary therapy, has its roots in Chinese medicine.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
</figcaption>
</figure>
<h2>What does Australia need to do?</h2>
<p>The most mature integrative health care systems are evident in Asia. Countries like South Korea and India <a href="https://www.bmj.com/content/322/7279/164.extract">have regulated</a> traditional and complementary medicines into their national health policies.</p>
<p>To effectively tackle health inequities, our health systems need to consider and address the impact of cultural influences on patients’ health-care decisions. This is vital even when the treatments they value may not be grounded in evidence.</p>
<p>Investigating and considering these practices will ultimately help us to design and facilitate safe, effective, culturally sensitive and coordinated care for all patients and communities across Australia.</p>
<p><em>Professor Jon Adams contributed to this article.</em></p><img src="https://counter.theconversation.com/content/114980/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Josephine Agu does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>From herbal remedies to acupuncture, traditional therapies are valued particularly by ethnically diverse groups.Josephine Agu, PhD candidate, University of Technology SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/974912018-06-21T10:26:37Z2018-06-21T10:26:37ZWhat the US can learn from other countries in dealing with pain and the opioid crisis<figure><img src="https://images.theconversation.com/files/223377/original/file-20180615-85845-1qdqt74.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The U.S. has the highest daily opioid use rate in the world.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/white-prescription-pills-spilled-onto-table-747676462?src=IehrLEh-_rLRltn66Ep3sw-1-1">Kimberly Boyles/shutterstock</a></span></figcaption></figure><p>With all the recent news on opioid overuse in the U.S., it’s not surprising that Americans consume <a href="https://www.cnbc.com/2016/04/27/americans-consume-almost-all-of-the-global-opioid-supply.html">the vast majority of the global opioid supply</a>. Daily opioid use in the U.S. is the <a href="https://qz.com/1198965/the-surprising-geography-of-opioid-use-around-the-world/">highest in the world</a>, with an estimated one daily dose prescribed for every 20 people. That rate is 50 percent higher than in Germany and 40 times higher than in Japan.</p>
<p><a href="https://www.washingtonpost.com/news/to-your-health/wp/2016/03/29/amid-heartbreaking-stories-obama-pushes-for-more-funding-to-treat-addiction/">As former U.S. Surgeon General Vivek Murthy once said</a>, the U.S. “arrived here on a path that was paved with good intentions,” but “the results have been devastating.” “We have nearly 250 million prescriptions for opioids written every year. That’s enough for every person in America to have a bottle of pills and then some,” he added. </p>
<p>Has the U.S.’s heavy reliance on prescription opioids caused more harm than good? And, likewise, have other countries’ low use of opioids caused more pain than good?</p>
<p>I have been pondering these issues at Texas A&M Health Science Center, where I am the chair of a newly established <a href="https://www.tamhsc.edu/community/opioidtaskforce/index.html">Opioid Task Force</a>, an initiative that emphasizes a multifaceted approach to the opioid epidemic. To me, it seems like most countries need to find a happy balance between the American attitude that all pain needs to be cured – and the ethos in other countries that pain is to be endured.</p>
<p><iframe id="9S1Qq" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/9S1Qq/1/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>Differing views on pain</h2>
<p>In investigating this issue, I came across two reasons that might explain the worldwide differences in pain management strategies. </p>
<p>First, while pain is universal, pain is fundamentally <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2959190/">a subjective phenomenon</a>. People from different countries <a href="https://theconversation.com/how-different-cultures-experience-and-talk-about-pain-49046">experience pain differently</a>, based on traditional beliefs rooted in social and cultural values.</p>
<p>For example, people in Africa, especially men, may be <a href="https://doi.org/10.1080/20786190.2014.977034">reluctant to admit to pain</a>, as doing so would be a sign of weakness. In contrast, Americans <a href="https://www.theatlantic.com/health/archive/2017/12/america-experiences-more-pain-than-other-countries/548822/">report more pain</a> than people from any other country, with about a third of adults reporting pain “often” or “very often.” </p>
<p><iframe id="SgC47" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/SgC47/1/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>In traditional African society, pain is viewed as something to be endured and pain medication has often been <a href="https://doi.org/10.2217/pmt.13.68">a luxury for those who could afford it</a>. Self-medication with simple analgesics and traditional herbs are often the first -— but not necessarily effective – strategies to reduce pain. </p>
<p>Secondly, many countries have <a href="https://www.vox.com/policy-and-politics/2017/8/8/16049952/opioid-prescription-us-europe-japan">much stricter regulations</a> than the U.S. regarding when opioids may and should be prescribed. </p>
<p>For example, until the past few years, there were few U.S. regulations for the medical prescription of opioids. With the goal of eliminating pain, physicians generously prescribed opioids after most surgical procedures or for routine patient complaints of pain. (It’s worthwhile to note that, thanks to new restrictions, <a href="https://www.aafp.org/news/health-of-the-public/20180425opioidstudy.html">opioid prescriptions in the U.S.</a> decreased by more than 20 percent between 2013 and 2017.)</p>
<p>Conversely, in Europe, opioids are dispensed by specialists and more tightly regulated, including restrictions on advertisements. It’s less common to dispense opioids for non-cancer related pain such as chronic back or musculoskeletal pain. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/223379/original/file-20180615-85834-14h1r8x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/223379/original/file-20180615-85834-14h1r8x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/223379/original/file-20180615-85834-14h1r8x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/223379/original/file-20180615-85834-14h1r8x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/223379/original/file-20180615-85834-14h1r8x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/223379/original/file-20180615-85834-14h1r8x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/223379/original/file-20180615-85834-14h1r8x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/223379/original/file-20180615-85834-14h1r8x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Alternative and complementary treatments like acupuncture could help people manage pain.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/closeup-woman-receiving-acupuncture-treatment-beauty-329803421?src=fokPgUQHWUmZqU9ST9n_Eg-1-21">Leonardo da/shutterstock</a></span>
</figcaption>
</figure>
<p>Many countries have traditionally treated pain with other approaches. With a view of pain as a condition, <a href="https://nccih.nih.gov/health/whatiscam/chinesemed.htm">Chinese medicine</a> has long incorporated the use of herbs, acupuncture and lifestyle changes to manage pain. Acupuncture has been adopted in many clinical settings around the world, including in the U.S., and is considered effective for certain pain conditions and safe when performed by an experienced practitioner. </p>
<p>With a similar aversion to narcotics and concerns about addiction, Japanese health care providers have traditionally avoided opioid prescriptions, recommending non-pharmacological treatments for dealing with pain such as acupressure, massage and relaxation techniques. Yet, with the aging of the population, there has been <a href="https://www.bloomberg.com/news/articles/2017-09-21/painkiller-sales-take-off-as-japan-s-baby-boomers-demand-relief">a greater demand for opioids</a> and growing concerns about abuse. </p>
<p>In Europe, there are positive attitudes among both the medical profession and the public alike about <a href="https://nccih.nih.gov/health/integrative-health#cvsa">complementary and alternative medicine</a> – or the use of natural products or mind and body practices developed outside of mainstream Western medicine. These approaches are increasingly <a href="https://www.pae-eu.eu/wp-content/uploads/2013/12/Survey-of-chronic-pain-in-Europe.pdf">integrated into primary care</a>, with reimbursement through national health care systems. For example, <a href="https://doi.org/10.1089/acm.2008.0306">German physicians</a> often prescribe physical therapy, exercise, massage and relaxation therapies, all of which have been associated with pain relief. However, there’s some concern about the use of unregulated natural health practitioners, as well as the need for better communication among certified medical providers, natural health practitioners and patients.</p>
<h2>A happy balance</h2>
<p>What’s the best strategy for dealing with pain? There are no simple answers. </p>
<p>What does seem clear is that pain management strategies are slowly converging in the face of the opioid crisis. Countries that have been overprescribing are now <a href="https://www.aafp.org/news/health-of-the-public/20180425opioidstudy.html">putting the brakes on uncontrolled prescriptions</a> through increased regulation and continuing education. Meanwhile, in counties with limited access to pharmacological treatments, there’s <a href="https://www.thelancet.com/commissions/palliative-care">increased recognition</a> of the rampant suffering and the need for <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4052588/">increased access to opiates</a> as part of an overall approach that includes traditional non-pharmacological strategies too.</p>
<p>I’m heartened to see physicians start to emphasize alternatives to opioid prescriptions as a first step in pain management, in line with <a href="https://www.cdc.gov/drugoverdose/prescribing/guideline.html">Centers for Disease Control and Prevention guidelines</a>, and practices in other countries. To go even further will require better education of both health care professionals and patients regarding complementary and alternative treatments, as well greater access to and payment for them. </p>
<p>For me, the issue goes beyond the simplistic characterizations of pain management often seen in different countries and cultures. Pain isn’t just to be cured – or to be endured. Rather, all Americans, whether providing or receiving care, need to understand what can be learned from best practices in pain management around the world.</p><img src="https://counter.theconversation.com/content/97491/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marcia G. Ory does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Most countries need to find a happy balance between the American attitude that all pain needs to be cured – and the ethos in other countries that pain is to be endured.Marcia G. Ory, Regents and Distinguished Professor, Associate Vice President for Strategic Partnerships and Initiatives, Texas A&M UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/865512017-11-24T00:09:21Z2017-11-24T00:09:21ZIs apple cider vinegar really a wonder food?<figure><img src="https://images.theconversation.com/files/196026/original/file-20171123-6013-r42cm1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It makes a tasty dressing, but the health claims are overblown.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/apple-cider-vinegar-glass-bowl-background-748849060?src=enPf_6rd5DcWGShxP9TRIg-1-98">Madeleine Steinbach/Shutterstock</a></span></figcaption></figure><p>Folk medicine has favoured apple cider vinegar for centuries and many <a href="https://www.rd.com/health/wellness/apple-cider-vinegar-benefits/">claims</a> are made for its supposed benefits.</p>
<p>Apple cider vinegar is made by chopping apples, covering them with water and leaving them at room temperature until the natural sugars ferment and form ethanol. Bacteria then convert this alcohol into acetic acid. </p>
<p>Strands of a “mother” will form in the cider. These are strained out of many products but left in others, and are often the target of health claims. The “mother” can also be used to start the production of the next batch of cider. </p>
<p>But will apple cider vinegar really help you lose weight, fight heart disease, control blood sugar and prevent cancer? And what about claims it is <a href="http://bragg.com/products/acv.html">rich in enzymes and nutrients</a> such as potassium?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-long-strange-history-of-dieting-fads-82294">The long, strange history of dieting fads</a>
</strong>
</em>
</p>
<hr>
<h2>Weight loss</h2>
<p>The evidence that apple cider vinegar helps fight fat is weak.</p>
<p>A short-term <a href="https://www.jstage.jst.go.jp/article/bbb/73/8/73_90231/_pdf">study in Japan</a> added two daily drinks of 15 millilitres of apple cider vinegar mixed with 250 ml of water to the usual diet of overweight men and women. Their weight fell by about one kilogram over 12 weeks, but returned to usual levels within four weeks.</p>
<p>According to a <a href="https://www.ncbi.nlm.nih.gov/pubmed/23979220">UK study</a>, it may be that vinegar can suppress appetite. When offered a pleasant-tasting vinegar drink, one that was less palatable, or a non-vinegar drink with their breakfast, volunteers who downed both vinegar drinks felt slightly nauseated. Not surprisingly, this depressed their appetite, with the least palatable vinegar drink having the greatest effect.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/196020/original/file-20171123-6016-n2kgoa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/196020/original/file-20171123-6016-n2kgoa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=448&fit=crop&dpr=1 600w, https://images.theconversation.com/files/196020/original/file-20171123-6016-n2kgoa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=448&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/196020/original/file-20171123-6016-n2kgoa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=448&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/196020/original/file-20171123-6016-n2kgoa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=563&fit=crop&dpr=1 754w, https://images.theconversation.com/files/196020/original/file-20171123-6016-n2kgoa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=563&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/196020/original/file-20171123-6016-n2kgoa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=563&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The ‘mother’ is strained from some cider vinegars and left in others.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/jeepersmedia/16359198940/in/photolist-qVBaU9-7dxtSr-21y66eJ-UP2QZs-Vuufu6-7dxtJr-4G1x8j-d5DQ9b-7jeaB1-9qH8Hu-dV5z8Y-6ULTvW-dmJFcj-V6kVz5-byU88G-b5DxP8-5HnD5Z-dP5Ma8-b5Dyaa-ptaDGu-UjFgv1-eF67JW-hShNHy-poxd1a-rzGBF-WuRLAk-XWk1RF-eWLamJ-rd5pCo-qVHhbz-p5nJ8V-7xpHgH-2j2uNJ-oBykH6-ZMTx2d-qycyLi-sZgn-3bNoov-rd2kT4-SEhbva-UFR1dx-gJQsGp-XXCYLt-bLPqag-RNSXs6-Vt4MiK-Zu622Y-aDjuA4-UZCuEP-rheYoD">Mike Mozart</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Others claim taking apple cider vinegar with meals will help digest proteins faster and therefore generate <a href="https://health.usnews.com/health-news/blogs/eat-run/2013/12/06/the-surprising-benefits-of-apple-cider-vinegar">higher levels of growth hormone</a>. This is claimed to break down more fat cells. Unfortunately, there’s no evidence to support such ideas.</p>
<p>Claims that pectin – a type of viscous dietary fibre – in cider vinegar will help weight loss by <a href="http://www.healthyandnaturalworld.com/apple-cider-vinegar-for-weight-loss-cholesterol-blood-sugar/">making you feel full for longer</a> ignores the fact that the pectin in apples <a href="https://health.howstuffworks.com/wellness/food-nutrition/facts/the-health-benefits-of-vinegar2.htm">is not found in apple cider vinegar</a>.</p>
<h2>Heart disease</h2>
<p>Pectin is again credited for cider vinegar’s supposed benefits for heart disease, with claims it “<a href="http://www.healthyandnaturalworld.com/apple-cider-vinegar-for-weight-loss-cholesterol-blood-sugar/">attracts bad LDL cholesterol</a>”. </p>
<p>However, the Japanese study referred to for weight loss found no difference in LDL cholesterol with either a low or higher amount of cider vinegar over a 12-week period. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/heart-disease-what-happens-when-the-ticker-wears-and-tears-69150">Heart disease: what happens when the ticker wears and tears</a>
</strong>
</em>
</p>
<hr>
<p>Others claim that cider vinegar <a href="http://www.naturalvitamins.in/products/heart-blockage-apple-cider-vinegar">works like a broom to clean toxic wastes out of the arteries</a>. Sadly, there’s no evidence for that one either.</p>
<h2>Blood sugar and diabetes</h2>
<p>Several studies have reported on the effects cider vinegar can have on blood glucose levels. One small study of healthy volunteers found that adding vinegar to a meal <a href="https://www.ncbi.nlm.nih.gov/pubmed/16015276/">reduced glucose and insulin levels</a> – at least for 45 minutes – and increased satiety for up to two hours. </p>
<p>Another small study of people with type 2 diabetes reported <a href="https://www.ncbi.nlm.nih.gov/pubmed/20502468">adding vinegar to a high carbohydrate meal</a> reduced the subsequent rise in the blood glucose level. </p>
<p>However, this effect was only apparent for a high glycaemic index carbohydrate, such as mashed potatoes. When the carbs came from a lower GI food such as wholegrain bread, the vinegar had no effect.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-diabetes-11842">Explainer: what is diabetes?</a>
</strong>
</em>
</p>
<hr>
<p>A word of warning for those with type 1 diabetes who also have damage to the vagus nerve (a common co-problem): when taking apple cider vinegar in water before a carb-rich meal, the delay in the stomach contents passing to the small intestine may <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2245945/">alter the quantity of insulin</a> so the usual daily injection may be inappropriate.</p>
<h2>Other diseases</h2>
<p>As for <a href="https://thetruthaboutcancer.com/health-benefits-of-apple-cider-vinegar/">allergies, acne, arthritis, hiccups and leg cramps</a>, there is no evidence that apple cider vinegar prevents or cures any of these conditions.</p>
<p>Nor is there evidence from any studies that cider vinegar has benefits for preventing or curing cancer. Unproven cancer cures can waste valuable time in seeking reliable treatments.</p>
<h2>So is it worth taking?</h2>
<p>Some sites promoting <a href="http://www.apple-cider-vinegar-benefits.com/food-high-in-potassium.html">unrefined cider vinegar</a> claim it is a good source of potassium. We certainly need potassium to help regulate the balance of water and acidity in the blood. </p>
<p>But with apple cider manufacturers declaring their products have just <a href="https://www.vitacost.com/bragg-organic-raw-apple-cider-vinegar/?ci_src=14110925&ci_sku=074305001321&csrc=SITEREF-linkshare">11 milligrams per 15 ml</a> serve (and a recommendation for two serves a day) it is a negligible source. The recommended dietary intake of potassium is 2,800 mg/day for women and 3,800 mg/day for men. Bananas have around 400 mg.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/196031/original/file-20171123-6039-1vfbfa5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/196031/original/file-20171123-6039-1vfbfa5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/196031/original/file-20171123-6039-1vfbfa5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/196031/original/file-20171123-6039-1vfbfa5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/196031/original/file-20171123-6039-1vfbfa5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/196031/original/file-20171123-6039-1vfbfa5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/196031/original/file-20171123-6039-1vfbfa5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">An average banana has 400 mg of potassium.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/Ar0QYv-qtw4">Scott Webb/Unsplash</a></span>
</figcaption>
</figure>
<p>In Australia, products cannot claim to be a source of any nutrient unless a reasonable daily intake provides at least 10% of the recommended daily intake (RDI). A “good source” must have 25% of the RDI.</p>
<p>There is also no evidence to support the idea that apple cider vinegar makes it easier to absorb calcium.</p>
<p>On the good side, like all vinegars, it has virtually no kilojoules and, mixed with extra virgin olive oil, makes an excellent salad dressing.</p>
<p>Finally, a word of warning: don’t drink apple cider vinegar “neat”. It can damage the throat and oesophagus. Even diluted, its acidity can damage tooth enamel.</p><img src="https://counter.theconversation.com/content/86551/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rosemary Stanton does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Folk medicine has favoured apple cider vinegar for centuries and many claims are made for its supposed benefits. But what does the science say?Rosemary Stanton, Nutritionist & Visiting Fellow, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/727262017-02-23T19:23:34Z2017-02-23T19:23:34ZDo you know what’s in the herbal medicine you’re taking?<figure><img src="https://images.theconversation.com/files/157614/original/image-20170221-18640-1m65eoo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Vitamins are often seen as benign since they're meant to be natural, but the list of ingredients isn't always accurate.</span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p>Complementary medicine has received a lot of attention in the past couple of weeks. First, <a href="https://www.mja.com.au/system/files/issues/206_02/10.5694mja16.00614.pdf">a study</a> focused on potential safety concerns about taking herbal products. Second, <a href="http://www.abc.net.au/4corners/stories/2017/02/13/4616948.htm">ABC’s Four Corners</a> looked at the need for better regulation of product claims, and questioned the credibility of the pharmacy industry for endorsing and selling these products.</p>
<p>Both of these are particularly relevant, <a href="https://www.ncbi.nlm.nih.gov/pubmed/12200102">considering complementary and alternative medicines</a> are <a href="https://nccih.nih.gov/research/statistics/2007/camsurvey_fs1.htm">widely used</a> by <a href="https://www.mja.com.au/journal/2006/184/1/continuing-use-complementary-and-alternative-medicine-south-australia-costs-and">different populations</a> and by more than <a href="http://www.nicm.edu.au/health_information/information_for_consumers/reports,_surveys,_audits">half of all people</a>. People like complementary medicines often because they find such natural alternatives to be more in line with their <a href="https://www.ncbi.nlm.nih.gov/pubmed/9605899">values and beliefs</a>, and desire to lead a more “natural” life.</p>
<p>However, in many instances complementary medicines have no added benefit when compared to placebo, or weak evidence. These include <a href="http://www.cochrane.org/CD000980/ARI_vitamin-c-for-preventing-and-treating-the-common-cold">dietary supplements such as vitamin C</a> and <a href="http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000530.pub3/abstract">echinacea</a> for the common cold, and <a href="http://www.metabolictrial.com">weight-loss</a> <a href="https://theconversation.com/do-over-the-counter-weight-loss-supplements-work-53167">supplements</a>. </p>
<p>On the other hand, there is evidence for complementary medicines in preventing or managing a range of conditions. Some examples include <a href="https://www.ncbi.nlm.nih.gov/pubmed/10759336">improvement</a> in <a href="https://www.ncbi.nlm.nih.gov/pubmed/23832433">mental health</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/17174460">conditions</a>, managing <a href="http://jamanetwork.com/journals/jama/fullarticle/2529629">menopausal symptoms</a>, and for <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa1503734">healthy outcomes during pregnancy</a>.</p>
<h2>How complementary meds end up on our shelves</h2>
<p>In contrast to pharmaceuticals (otherwise known as conventional “Western” medicines), government typically does not subsidise complementary medicines. Therefore, the cost burden is shifted to consumers. While this is good news for government budgets, consumers need to have confidence the products they’re spending their money on are safe and effective.</p>
<p>All herbal medicines (these are products derived from plant sources and fall under the complementary medicines umbrella) must be listed on the Australian Registry of Therapeutic Goods before they are made available for sale. This <a href="https://www.tga.gov.au/listed-medicines">gives them an AUST-L number</a>. However, this still relies on the manufacturer’s honesty with respect to its effectiveness. </p>
<p>This stands in stark contrast to pharmaceuticals. These have high up-front development costs, go through rigorous registration processes and have no guarantee of approval. Once pharmaceuticals are approved they are given an AUST-R number, which is different to the AUST-L number.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/158023/original/image-20170223-32111-1o510lp.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/158023/original/image-20170223-32111-1o510lp.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/158023/original/image-20170223-32111-1o510lp.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=452&fit=crop&dpr=1 600w, https://images.theconversation.com/files/158023/original/image-20170223-32111-1o510lp.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=452&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/158023/original/image-20170223-32111-1o510lp.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=452&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/158023/original/image-20170223-32111-1o510lp.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=568&fit=crop&dpr=1 754w, https://images.theconversation.com/files/158023/original/image-20170223-32111-1o510lp.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=568&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/158023/original/image-20170223-32111-1o510lp.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=568&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Echinacea for colds has been found to have limited effectiveness.</span>
<span class="attribution"><a class="source" href="https://www.google.com.au/search?q=echinacea&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjE9YiLqKXSAhVljFQKHZGHBZ0Q_AUICCgB&biw=1960&bih=1118#tbm=isch&q=echinacea+supplements&*&imgrc=qD4fkLWUnoKduM:">Elaine Thompson/AP</a></span>
</figcaption>
</figure>
<p>Natural or herbal medicines do not face the same regulatory scrutiny as pharmaceutical drugs because of their origin from “natural” sources. </p>
<p>However, as the <a href="https://www.mja.com.au/system/files/issues/206_02/10.5694mja16.00614.pdf">recent piece in the Medical Journal of Australia</a> points out, some products (particularly traditional Chinese medicines) often inaccurately list ingredients and may contain undeclared products (including DNA from endangered animals such as the snow leopard) or <a href="http://www.nature.com/articles/srep17475#t1">toxic and pharmaceutical contaminants</a>. </p>
<p><a href="http://journals.plos.org/plosgenetics/article?id=10.1371/journal.pgen.1002657#s4">Similar findings</a> have been reported previously for traditional Chinese medicines.</p>
<p>If a complementary medicine product does not have an AUST-L number you should not buy it: you are putting yourself at risk. </p>
<h2>Not all bad eggs</h2>
<p>It’s often the poor compliance of a few companies tarnishing the industry as a whole. One example is “Hydroxycut”. Not only has the product been banned in the US several times, it has put <a href="http://www.ncbi.nlm.nih.gov/pubmed/20104221">consumers’ health</a> in <a href="http://www.ncbi.nlm.nih.gov/pubmed/19139478">serious jeopardy</a>. </p>
<p>Other dietary supplements have led to questions being asked of the industry due to case reports of liver damage from taking products containing, for example, <a href="http://link.springer.com/article/10.2165/00002018-200831060-00003">green tea extract</a>. It’s the concoction of different ingredients in these supplements that often makes it difficult to pinpoint the exact root of concern. Therefore, tighter regulation of the industry is needed. </p>
<p>But many companies are meeting regulatory requirements and performing good-quality research to support their product claims. One <a href="http://link.springer.com/article/10.1007/s00213-016-4471-y">recent example</a> is an extract from the green–lipped mussel for those with attention deficit hyperactivity disorder (ADHD) or learning difficulties. This supplement showed some benefits in reducing hyperactivity and inattention, and improving memory in children and adolescents. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4690059/">Similar studies</a> with other products are under way.</p>
<p>Regulatory reform is needed to protect those companies performing good-quality research from other companies “piggy-backing” off this evidence for their similarly marketed product, perhaps with the same or similar ingredients. The Therapeutic Goods Administration should require manufacturers to have independent testing performed on their products before marketing to ensure <a href="https://www.mja.com.au/system/files/issues/206_02/10.5694mja16.00614.pdf">the ingredients listed on the packet are accurate</a>. </p>
<p>However, this still doesn’t stop people purchasing complementary medicine over the internet, <a href="https://www.tga.gov.au/book-page/purchasing-complementary-medicines-over-internet">despite clear warnings</a> against this.</p>
<p>We need to encourage and better incentivise research and development of complementary medicines. And we need to give adequate resources to a relevant body capable of more closely regulating the listing of complementary medicines to ensure patient safety. </p>
<p>Until this happens, make sure you only purchase supplements with an AUST-L number to ensure it’s safe – and do some research into the efficacy to ensure you’re not wasting your money.</p><img src="https://counter.theconversation.com/content/72726/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nick Fuller has received research grants for clinical trials funded by Australian Egg Corporation, Arnotts Biscuits, SOHO Flordis International Research, Sanofi-Aventis, Novo Nordisk, Allergan, Roche products, MSD, and GlaxoSmithKline.</span></em></p>In many instances complementary medicines have no added benefit when compared to a placebo, or weak evidence of effectiveness.Nick Fuller, Research Fellow, Clinical Trials Development & Analysis, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/649312016-09-12T10:42:16Z2016-09-12T10:42:16ZWhy are vaccination rates in England falling?<figure><img src="https://images.theconversation.com/files/137089/original/image-20160908-25253-1bsc7an.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-432466561/stock-photo-vaccination-for-women-in-vaccine-roomselective-focusmedical-concept.html?src=MGpi8gJPZveksm6kA4A9DA-1-12">Komsan Loonprom/Shutterstock.com</a></span></figcaption></figure><p><a href="https://www.nice.org.uk/news/article/nice-to-tackle-falling-child-vaccination-rates">Millions of children</a> in England risk contracting potentially fatal diseases as vaccination rates continue to fall for the second year running. According to Gillian Leng, deputy chief executive of the UK’s National Institute for Health and Care Excellence, about 3m children and adolescents may have missed their mumps, measles and rubella (MMR) vaccine.</p>
<p>It is not possible to vaccinate every child in the country. At any given time, some children will be too young and a very small number will have allergies or other conditions that make vaccination unacceptably risky. However, if a sufficient proportion of the population are vaccinated, a disease cannot spread and everyone is protected. This is known as “<a href="https://theconversation.com/explainer-what-is-herd-immunity-52377">herd immunity</a>”. The World Health Organisation (WHO) considers that a 95% uptake is necessary to achieve this protection. </p>
<p>Low vaccination rates are a particularly English problem: Scotland, Wales and Northern Ireland all achieve the WHO target, although there are pockets, particularly in economically deprived urban areas, where they fall short. In England, the national rates are 2-3% below WHO recommended levels. In some urban areas, particularly those with high levels of deprivation and minority ethnic populations, rates fall towards 80%. This creates a high risk of outbreaks of serious childhood diseases.</p>
<h2>Reasons for the fall in uptake</h2>
<p>The decline in vaccination rates is often attributed to parental resistance provoked in the late 1990s by the <a href="https://theconversation.com/mondays-medical-myth-the-mmr-vaccine-causes-autism-3739">now-discredited claim</a> made by Andrew Wakefield of a link between the MMR vaccine and autism. However, the comparisons between the different nations within the UK suggest a more complex picture. </p>
<p>Before we blame parents, we should consider whether they have easy access to child health advice and vaccination services. If they are not aware of the benefits and cannot get to the places where vaccines are available, we should not be surprised if their children are not vaccinated. </p>
<p>Although the UK has a single framework of principles and funding for the NHS, each component nation chooses how to organise their delivery. Scotland, Wales and Northern Ireland have had less reorganisation than England so they have been able to focus on providing rather than reforming their services. </p>
<p>An improvement in <a href="https://www.gov.uk/government/statistics/cover-of-vaccination-evaluated-rapidly-cover-programme-2015-to-2016-quarterly-data">vaccination rates</a> in England coincided with the rebuilding of the health visiting service under the 2010-15 UK coalition government. Health visitors are specialist nurses who provide screening, counselling, advice and support to all families with children from birth to the age of five. <a href="http://www.unitetheunion.org/uploaded/documents/Health%20visiting%20in%20England%20May%20201611-26805.pdf">Health visitor numbers increased</a> by 49% and the average caseload for each health visitor fell from just over 400 to around 280 children. Staffing shortages remained in the urban areas where low vaccination rates are found. </p>
<p>However, much of this investment has since been negated by <a href="http://www.unitetheunion.org/uploaded/documents/Health%20visiting%20in%20England%20May%20201611-26805.pdf">local authority cuts</a> since they took over responsibility for the service in October 2015. The improvement in vaccination rates seems to have come <a href="https://www.nice.org.uk/news/article/nice-to-tackle-falling-child-vaccination-rates">to a halt or reversed slightly</a> in the last two years. This is a time when there have been increasing cutbacks in Sure Start children’s centres – their <a href="http://sticerd.lse.ac.uk/dps/case/spcc/RR04_SUMMARY.pdf">numbers and budgets</a> are down by about a quarter since 2010 – and problems in <a href="https://www.nice.org.uk/guidance/GID-QS10015/documents/briefing-paper">sustaining GP vaccination clinics</a> among the other pressures on primary care. </p>
<p>The lack of support for reaching out to parents contributes to the low uptake. Traveller groups, for example, have difficulty accessing healthcare. Some minorities have distinctive medical traditions. These beliefs are often dismissed as irrational or primitive by health professionals – a poor foundation for persuading parents of the benefits of change. Recent migrants may simply not understand how the health system works and what is available to them. </p>
<p>All these problems are familiar to health visitors, whose interpersonal skills can make an impact, provided that caseloads allow enough time to engage parents. </p>
<p>Overt resistance is much less common. There are a small number of “new age” parents, whose preferences for alternative medicine could probably be accommodated without compromising herd immunity. </p>
<p>Of more concern is the emerging group of affluent parents who are opting out because they believe they can micromanage all risks to their children. This group has not been studied in the UK, but <a href="http://sociology.nd.edu/students/kevin-estep/">recent work</a> in California found that where there is a critical mass of parents who think this way in a school catchment, refusal rates are high because the parents believe that the minimal risks from vaccination need not be accepted. They can insulate their children from the “others” who carry infectious disease. Their children do not share school classrooms, public transport or public leisure facilities with children from poorer backgrounds. Their children’s social contacts are carefully supervised so that they only mix with other children from a similar background whose parents think in the same way. They seem to be the forerunners of the “helicopter parents” who hover over their children at university and even into first employment. </p>
<p>We may need to relearn the lessons that drove public health reform in 19th-century Britain: infectious diseases are a potential threat to everyone. No one can buy protection on an individual basis.</p><img src="https://counter.theconversation.com/content/64931/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Robert Dingwall does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>We can’t keep blaming the MMR-autism scare – there are other forces at play.Robert Dingwall, Professor, Nottingham Trent UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/495982015-11-10T03:40:04Z2015-11-10T03:40:04ZNatural cancer remedies: sorting fact from fiction<figure><img src="https://images.theconversation.com/files/101259/original/image-20151109-29341-1ec67lb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Different parts of the guayabano or soursop plant has cancer-fighting properties. </span> <span class="attribution"><span class="source">shutterstock</span></span></figcaption></figure><p>When it comes to natural remedies for cancer therapy, many patients are given anecdotal advice about the usefulness of alternative traditional medicines. They are also often told to combine these with their conventional medication for added effect.</p>
<p>While conventional treatments are subjected to rigorous research before they can be recommended for clinical use, alternative treatments are not. These “natural” remedies are either turned into over-the-counter medicines or can be taken in their natural forms. </p>
<p>It is important to note that alternative methods labelled “natural” are not necessarily “good”. Nor do they necessarily translate into healing. The use of traditional remedies should always be discussed with a physician or an oncologist. They may have adverse effects or may reduce the efficacy of conventional treatment.</p>
<p>Many alternative or traditional medicines <a href="http://www.cancer.org/acs/groups/cid/documents/webcontent/acspc-041660-pdf.pdf">claim</a> to have the ability to heal but there is <a href="http://www.cancer.org/acs/groups/cid/documents/webcontent/acspc-041660-pdf.pdf">no scientific evidence</a> to support this. In some cases scientific evidence may even <a href="http://www.cancer.org/acs/groups/cid/documents/webcontent/acspc-041660-pdf.pdf">contradict</a> the claims.</p>
<p>Here are some of the myths and facts about natural products that purportedly have anti-cancer properties.</p>
<h2>Fruit and vegetable pits</h2>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/101264/original/image-20151109-29309-eul8jf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/101264/original/image-20151109-29309-eul8jf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/101264/original/image-20151109-29309-eul8jf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/101264/original/image-20151109-29309-eul8jf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/101264/original/image-20151109-29309-eul8jf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/101264/original/image-20151109-29309-eul8jf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/101264/original/image-20151109-29309-eul8jf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Chewing apricot pits were considered to have anti-cancer properties but this is not true.</span>
<span class="attribution"><span class="source">shutterstock</span></span>
</figcaption>
</figure>
<p>For generations the pits of many fruits, particularly apricots or kernels, have been promoted anecdotally to treat cancer. Traditionally the pits were chewed in their natural form. <a href="https://www.mskcc.org/cancer-care/integrative-medicine/herbs/amygdalin">Amygdalin</a> found inside apricot pits was thought to be the active ingredient linked to tales of its powerful anti-cancer properties. </p>
<p>But after nearly four decades of research, scientists cannot find any proof of its elusive chemotherapeutic effects. </p>
<p>What has been <a href="http://journals.lww.com/euro-emergencymed/Abstract/2005/10000/Severe_cyanide_toxicity_from__vitamin_supplements_.14.aspx">reported</a> and is nearly guaranteed is that a person who uses this remedy will suffer the adverse effects of chronic poisoning caused by the cyanide found in some of these pits.</p>
<h2>Overripe bananas</h2>
<p>In 2009, an <a href="https://www.jstage.jst.go.jp/article/fstr/15/3/15_3_275/_article">article</a> investigating cancer-related biological activity in ripened bananas was published. The study could not make any direct link to the fruit as an anti-cancer remedy but included the following statement:</p>
<blockquote>
<p>Due to the association between immunostimulatory and anti-oxidative effects, oral banana intake has the potential to help prevent lifestyle-related diseases and carcinogenesis. </p>
</blockquote>
<p>The statement went viral in the media with many memes posted on Facebook suggesting ripened bananas could reduce cancer risk. While <a href="http://libir.tmu.edu.tw/bitstream/987654321/50848/2/JECM_(2012)">studies</a> have demonstrated that antioxidants play an important role in protecting body cells against potential cancer agents, the article does not say bananas have an active ingredient that can combat cancer.</p>
<p>There are, however, remedies that have seen more positive results. </p>
<h2>The tropical guayabano fruit</h2>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/101263/original/image-20151109-29326-flr22d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/101263/original/image-20151109-29326-flr22d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/101263/original/image-20151109-29326-flr22d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/101263/original/image-20151109-29326-flr22d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/101263/original/image-20151109-29326-flr22d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/101263/original/image-20151109-29326-flr22d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/101263/original/image-20151109-29326-flr22d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Different part of the soursop plant have anti-cancer properties.</span>
<span class="attribution"><span class="source">shutterstock</span></span>
</figcaption>
</figure>
<p>A member of the custard apple family fruit tree, <a href="http://dx.doi.org/10.3390%2Fijms160715625"><em>Annona muricata</em></a>, which is more commonly known as soursop, graviola or guayabano, is extensively eaten by indigenous communities in the tropical parts of northern Africa and South America. It is an oval-shaped, dark green, prickly fruit with a mildly acidic, whitish flesh. </p>
<p>When the plant was put through scientific tests, <a href="http://dx.doi.org/10.3390%2Fijms160715625">studies</a> found that several parts had potentially potent anti-cancer properties. This was particularly shown to be the case when used as an adjunct treatment.</p>
<p>Research showed that the leaves have active ingredients that possess anti-cancer properties that kill lung, prostate, colon, breast, and pancreatic cancer cells. Its seeds display properties that perform the same task that chemotherapy treatment would, killing breast, oral and lung cancer cells. And its fruit component has anti-prostate cancer potential. </p>
<p>Traditionally, the leaves and or roots would have been brewed or crushed for consumption, and the fruit eaten. But extracts of the active ingredients from the leaves have been made into tablets and sold <a href="http://ajouronline.com/index.php?journal=AJAS&page=article&op=view&path%5B%5D=1251&path%5B%5D=668">commercially</a>. These are taken in conjunction with conventional chemotherapy.</p>
<h2>South African rooibos herbal tea</h2>
<p>Rooibos, which is only found in the Cederberg region of the Western Cape, South Africa, is known for its aromatic flavour. The plant has been <a href="http://www.sciencedirect.com/science/article/pii/S1383571803003516">found</a> to have anti-cancer properties in <em>in vitro</em> and <em>in vivo</em> animal models. </p>
<p>Additional <a href="http://www.sciencedirect.com/science/article/pii/S0304383504008687">research</a> shows that the herbal tea possesses ingredients that reduce oesophageal and liver cancer and skin tumours. Clinical trials in humans are being planned. </p>
<p>The Cancer Association of South Africa has endorsed the herbal tea’s potential as a form of natural chemoprevention. This means it can aid in preventing cancer and even possibly reduce the growth of cancer cells. And it has funded <a href="http://www.cansa.org.za/rooibos-research-around-the-world/">research projects</a> aimed at identifying the active ingredients.</p>
<h2>The <em>Sutherlandia frutescens</em> plant</h2>
<p><em>Sutherlandia frutescens</em> is indigenous to South Africa, Lesotho, southern Namibia and southeastern Botswana. It is commonly used in traditional medicine. This shrub-like plant has bitter, aromatic leaves and is known for its red-orange flowers during spring to mid-summer.</p>
<p>Studies show that it has anti-cancer properties against <a href="http://www.sciencedirect.com/science/article/pii/S0378874111005307">oesophageal</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/26377232">prostate</a>, liver, <a href="http://www.sciencedirect.com/science/article/pii/S0378874111009238">breast</a> and lung cancer cells. Recent <a href="http://www.sciencedirect.com/science/article/pii/S0378874108004431">studies</a> proposed that cancer bush, the name it is commonly known by, may be a promising adjunctive therapy because of its potent anti-oxidative properties. </p>
<p>Preliminary <a href="http://www.ncbi.nlm.nih.gov/pubmed/25070435">clinical studies</a> proved that it had no negative effects. And the indications are that it may act as an immune stimulant to support the cancer patient. It has been made into tablet form and commercialised but studies are continuing to produce more definitive evidence of its benefits. </p>
<p>It is currently being marketed as a natural remedy that can be used alongside conventional treatment.</p>
<h2>Coix seed</h2>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/101262/original/image-20151109-29317-fk5nk8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/101262/original/image-20151109-29317-fk5nk8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/101262/original/image-20151109-29317-fk5nk8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/101262/original/image-20151109-29317-fk5nk8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/101262/original/image-20151109-29317-fk5nk8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/101262/original/image-20151109-29317-fk5nk8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/101262/original/image-20151109-29317-fk5nk8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Extracts from coix seeds has anti-cancer effects.</span>
<span class="attribution"><span class="source">shutterstock</span></span>
</figcaption>
</figure>
<p>Traditional Chinese Medicine is a significant component of <a href="https://nccih.nih.gov/sites/nccam.nih.gov/files/Backgrounder_Traditional_Chinese_Medicine_10-25-2013.pdf">alternative medicine</a>. Initially confined to Asian countries, big Western pharmaceutical companies have recently started sifting through the orient’s vast indigenous knowledge for natural cancer remedies. </p>
<p><a href="http://www.cancerresearchuk.org/about-cancer/cancers-in-general/cancer-questions/what-is-kanglaite">Kanglaite</a> is an anti-tumour drug that was developed using modern technology. It contains extracts from coix seeds. </p>
<p><a href="http://www.ncbi.nlm.nih.gov/pubmed/25787906">Research</a> shows that Kanglaite has anti-cancer effects particularly in gastric, lung, and liver cancer. After passing the phase three clinical trials it was marketed along with conventional therapy to improve the patient’s quality of life.</p><img src="https://counter.theconversation.com/content/49598/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kareemah Gamieldien does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There are several natural remedies that have can help reduce cancer cells.Kareemah Gamieldien, PhD (Human Physiology), Cape Peninsula University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/476592015-09-18T10:46:21Z2015-09-18T10:46:21ZWhy homeopathy must not gain a foothold in the UK<figure><img src="https://images.theconversation.com/files/95065/original/image-20150916-6295-1s9hhla.jpg?ixlib=rb-1.1.0&rect=0%2C15%2C3462%2C2381&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">'Traditional' homeopathic medicine bottles.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/widnr/6549284621/">Flickr/Wisconsin Department of Natural Resources</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p>Despite <a href="http://www.nhs.uk/Conditions/homeopathy/Pages/Introduction.aspx">the NHS stating</a> that “homeopathy performs no better than placebos”, support for the practice still prevails. The reason why may be that two small, but important, subgroups in the UK support it: the Royal family and some members of the political establishment. </p>
<p>Not only is homeopathy unsafe <a href="http://www.ncbi.nlm.nih.gov/pubmed/12492603">and ineffective</a>, but with the support of the Royals such as the Queen and <a href="http://www.theguardian.com/uk-news/2015/jun/04/black-spider-memos-prince-charles-lobbied-homeopathy-funding-nhs">the secret lobbying of Prince Charles</a> in favour of funding it on the NHS, it also has the potential to cause a ridiculous constitutional crisis. And by gaining more influence within political circles, the chances of it being included on the NHS are higher than ever.</p>
<p>The Queen has had a homeopath by royal appointment for quite some time. Her royal dispenser, Peter Fisher of the <a href="https://www.uclh.nhs.uk/OurServices/OurHospitals/RLHIM/Pages/Home.aspx">Royal London Hospital for Integrated Medicine</a>, hasn’t exactly shied away <a href="http://www.telegraph.co.uk/news/health/news/11739270/Queens-physician-calls-for-more-homeopathy-on-NHS.html">from lobbying</a> the government to provide homeopathy on the NHS – despite much of his own profession being opposed to the idea and calling for it <a href="http://www.theguardian.com/society/2010/jun/29/ban-homeopathy-from-nhs-doctors">to be banned</a>.</p>
<p>When it comes to Prince Charles’ <a href="https://theconversation.com/quacktitioner-royal-is-a-menace-to-the-constitution-and-public-health-16448">support for homeopathy</a>, the apple doesn’t fall far from the tree. His lobbying became ever more apparent in the wake of the <a href="http://www.theguardian.com/uk-news/2015/jun/04/black-spider-memos-prince-charles-lobbied-homeopathy-funding-nhs">black spider letters</a>. </p>
<p>His attempts may have also extended as far as causing Edzard Ernst, the UK’s preeminent scholar of evidence-based approaches to alternative medicine, to <a href="http://www.dailymail.co.uk/news/article-2918600/Top-scientist-claims-lost-job-Prince-Charles-wanted-silence-criticising-report-alternative-medicine-commissioned-royal.html">lose his job</a>. </p>
<p>The second group that seems to favour homeopathy, more than the general public, is a subset of our own elected government. David Tredinnick, a Conservative MP for Bosworth and a member of the Commons health select committee, <a href="http://www.telegraph.co.uk/news/health/news/10991455/Tory-MP-says-astrology-is-good-for-the-health.html">was known affectionately</a> in the House as “the honourable member for Holland & Barret”, due to his support for alternative medicines. </p>
<p>The current health secretary, Jeremy Hunt, is also quite fond of homeopathy. <a href="http://www.theguardian.com/politics/2014/may/08/jeremy-hunt-homeopathy-studies-chief-medical-officer">In 2014</a> he asked the chief medical officer (CMO) to commission expert reviews of three homeopathic remedies. Clearly he hadn’t noticed that the CMO’s publicly expressed belief was that homeopathy <a href="http://www.theguardian.com/politics/2014/may/08/jeremy-hunt-homeopathy-studies-chief-medical-officer">is “rubbish”</a>.</p>
<p>Even when we cross the floor of the House, the outlook doesn’t improve. <a href="https://theconversation.com/uk/topics/jeremy-corbyn">Jeremy Corbyn</a>, the new Labour leader, has stated his support for homeopathy on Twitter. He says he believes they work because both drugs and “homeo-meds” come from organic matter. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"10038631361"}"></div></p>
<p>Corbyn has also signed various parliamentary motions in favour of homeopathy, such as <a href="http://www.parliament.uk/edm/2006-07/1240">advocating NHS homeopathy hospitals</a>.</p>
<p>Heidi Alexander, <a href="http://www.pulsetoday.co.uk/news/political-news/heidi-alexander-appointed-shadow-health-secretary/20020089.article#.VflhUxFViko">the newly appointed shadow health minister</a> has been coy about homeopathy, stating she is “<a href="http://www.buzzfeed.com/jimwaterson/labours-new-shadow-health-minister-considers-backing-homeopa#.pk8BP2yrO">open</a>” to arguments for why it should be provided on the NHS. </p>
<h2>A lack of scientific grounding</h2>
<p>It should not be a shock to learn that homeopathy has no basis in scientific fact – should anyone doubt this I invite them to peruse Edzard Ernst’s <a href="http://www.ncbi.nlm.nih.gov/pubmed/12492603">systematic review</a> of the practice. </p>
<p>Homeopaths have gone to incredible lengths to avoid having their air guitar of medicine tested in any rigorous fashion. Instead, they have created their own self-justifying means of establishing that it works. They call this “<a href="http://homeopathyplus.com.au/tutorial-6-provings">homeopathic proving</a>”.</p>
<p>A “proving” typically involves a dozen people, who will take a homeopathic remedy and record their thoughts, feelings and even dreams. These diaries are then used to “discover” what the remedy can supposedly cure. </p>
<h2>Homeopathy gone wrong</h2>
<p>Proponents of homeopathy will often try to market their remedies with the dual claim that they are both effective and safe. There are many who will shrug their shoulders at those who condemn the practice - “it doesn’t do any harm”, they say, “so why bother?”</p>
<p>Sadly, there are many cases where homeopathy, or at least people’s belief in its supposed healing powers, has caused very real and serious harm. Websites such as <a href="http://whatstheharm.net">Whats the harm?</a> list all kinds of cases where homeopaths have misdiagnosed, mistreated and in some cases even poisoned their patients.</p>
<p>The tragic case of <a href="http://metro.co.uk/2008/11/17/healer-dies-after-letting-cut-foot-rot-150526">Russell Jenkins</a> is a prime example of homeopathy gone wrong. Shunning conventional medical advice in favour of homeopathy, Jenkins died from gangrene caused by a minor injury sustained after standing on a plug. </p>
<p>There are also a depressing number of cases involving the completely unnecessary harm, and even death, of children. <a href="http://www.theguardian.com/society/2003/dec/16/health.medicineandhealth">Isabella Denley</a>, an epileptic toddler from Australia, died after her parents ditched the anti-convulsant medication she had been prescribed in favour of homeopathic remedies. Her parents believed they were doing the best for their child.</p>
<p>Also in Australia, <a href="http://www.smh.com.au/national/parents-guilty-of-manslaughter-over-daughters-eczema-death-20090605-bxvx.html">a Sydney couple</a> were found guilty of manslaughter after their nine-month-old baby died from ill health caused by eczema, after they used homeopathy rather than traditional remedies. </p>
<p>In Rome an Italian couple <a href="http://www.telegraph.co.uk/news/health/alternative-medicine/8844461/Parents-face-inquiry-for-treating-son-with-alternative-medicine.html">were investigated</a> for the manslaughter of their sick three-year-old son, who died after being treated at home with exclusively homeopathic medicine. </p>
<h2>What next?</h2>
<p>Aside from the bogus treatments offered, the frequent undermining of genuine medical advice that some homeopaths engage in is dangerous, particularly when it comes to vaccination.</p>
<p>In the past, the <a href="http://www.rpharms.com/home/about-us.asp">Royal Pharmaceutical Society</a> has <a href="http://news.bbc.co.uk/1/hi/programmes/newsnight/9341713.stm">criticised</a> homeopaths for offering (what they erroneously claim) are “safe alternatives” to vaccinations for diseases such as typhoid, polio and malaria. </p>
<p>Ernst and fellow researcher Katja Schmidt conducted <a href="http://www.1023.org.uk/whats-the-harm-in-homeopathy.php">a covert study</a> to expose the scale of this problem. They found that out of 77 homeopathic practitioners who responded, only two had advised a child should be immunised. The others were content to adopt an anti-vaccination stance and advise parents to choose homeopathic remedies instead. Such advice has had <a href="http://www.bbc.co.uk/news/health-22085678">severe implications</a> for public health in the past.</p>
<p>In short, the idea that homeopathy is “safe” is as tenuous a claim as the delusion that it is effective. Far from being harmless, a belief in the magical powers of <a href="http://www.scilogs.com/in_scientio_veritas/water-memory-myth-that-wouldnt-die/">water’s memory</a> can seriously damage your health.</p><img src="https://counter.theconversation.com/content/47659/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Keir Liddle has received funding from the Chief Scientists Office. He has a member of the SNP. </span></em></p>Support for homeopathy within royal and political circles is a danger for public health.Keir Liddle, PhD Candidate, University of StirlingLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/218272014-01-13T06:12:19Z2014-01-13T06:12:19ZWhat does the public really think about homeopathy?<figure><img src="https://images.theconversation.com/files/38761/original/xt82dmfy-1389291905.jpg?ixlib=rb-1.1.0&rect=1%2C4%2C1022%2C676&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Just add water.</span> <span class="attribution"><span class="source">Richard Craig</span></span></figcaption></figure><p>There is nothing more likely to raise the hackles of any self-respecting rationalist than to be confronted with the latest celebrity story about the miraculous healing power of homeopathy or some other “alternative” or “complementary” quackery. Or, embarrassingly, to discover that some of your best friends are also devotees. </p>
<p>This isn’t a new bugbear in response to some kind of New Age, middle-class hippiedom. Charles Darwin wrote <a href="http://www.darwinproject.ac.uk/letter/entry-1352">in a letter</a> to a cousin: </p>
<blockquote>
<p>You speak about Homeopathy; which is a subject which makes me more wrath, even than does Clair-voyance: clairvoyance so transcends belief, that one’s ordinary faculties are put out of question, but in Homeopathy common sense and common observation come into play, & both these must go to the Dogs, if the infinetesimal doses have any effect whatever</p>
</blockquote>
<p>There is no serious scientific debate about the efficacy of homeopathy. It performs no better than placebo and is based on principles wholly at odds with established scientific understanding. Nevertheless, it whips up what might seem like a disproportionate amount of political controversy. </p>
<p>Health Secretary Jeremy Hunt (yes, the man in charge of UK national health policy) is <a href="http://blogs.telegraph.co.uk/news/tomchiversscience/100179258/jeremy-hunt-health-secretary-thinks-homeopathy-works/">a known sympathiser</a> and got into hot water for allowing <a href="http://www.independent.co.uk/life-style/health-and-families/health-news/hes-at-it-again-prince-charles-accused-of-lobbying-health-secretary-over-homeopathy-8723145.html">Prince Charles to lobby him</a> about prescribing it on the NHS. </p>
<p>A newly appointed public health shadow minister, Luciana Berger, was “forced to renounce” <a href="http://www.independent.co.uk/life-style/health-and-families/health-news/labour-tells-new-health-spokeswoman-to-drop-her-support-for-homeopathy-8876469.html">previously positive</a> views. </p>
<p>And earlier in 2013, Chief Scientist Mark Walport called homeopathy “nonsense”, while his predecessor, John Beddington, said that NHS spending on homeopathy was the only issue where ministers had “fundamentally ignored” his scientific advice. Sally Davis, England’s Chief Medical Officer, said that <a href="http://money.uk.msn.com/socialvoices/why-spend-4m-of-our-taxes-on-homeopathy">the taxpayers’ £4m</a> would be better spent on proven treatments as hospitals suffer painful cutbacks. </p>
<h2>Our survey says</h2>
<p>Yet while binary opposition between support for homeopathy (and other complementary and alternative (CAM) treatments) is how public debate is framed, it is far from clear that the public thinks and does the same.</p>
<p><a href="http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0053174#abstract0">In research</a> we carried out <a href="http://www.wellcome.ac.uk/About-us/Publications/Reports/Public-engagement/WTX058859.htm">using the</a> Wellcome Monitor Survey, we interviewed a random sample of 1179 UK adults aged over 18 about homeopathy and other CAM. We also wanted to know why some people chose or not to use these treatments. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/38695/original/z2x5zm39-1389198272.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/38695/original/z2x5zm39-1389198272.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=349&fit=crop&dpr=1 600w, https://images.theconversation.com/files/38695/original/z2x5zm39-1389198272.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=349&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/38695/original/z2x5zm39-1389198272.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=349&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/38695/original/z2x5zm39-1389198272.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=439&fit=crop&dpr=1 754w, https://images.theconversation.com/files/38695/original/z2x5zm39-1389198272.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=439&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/38695/original/z2x5zm39-1389198272.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=439&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Hands up if you’ve tried it.</span>
<span class="attribution"><span class="source">Wellcome Monitor, 2009</span></span>
</figcaption>
</figure>
<p>A slim majority of the group reported that they had never used CAM. The most popular treatments with the remaining half were herbal medicines, homeopathy and acupuncture.</p>
<p>A quarter of the respondents who reported that they had never used homeopathy said this was because they hadn’t heard of it; a third because they had never been advised to take the treatment and/or that they’d never had an illness that required it; and 3% said it was because homeopathic remedies were too expensive. </p>
<p>Less than a quarter of non-users said that they had avoided homeopathy because they didn’t believe that it worked, or that conventional medicine worked better. </p>
<p>Of course, this may be in part a result of asking a question in a survey of this kind: it is quite hard for people to single out reasons for not doing things.</p>
<p>The most telling statistics emerged when we asked people that said they had used homeopathy why they had: 49% said they were “willing to try anything and didn’t think it could do any harm”. Only 16% said it was because they believed they worked better than conventional medicine. This means that only around 3% of the population have used homeopathy from a belief that it works where conventional medicine doesn’t. The rest either have not used it, or used it for other reasons.</p>
<h2>Disaffected, conventional and dissonant</h2>
<p>To explore this further, we used a statistical modelling technique called <a href="http://www.methods.manchester.ac.uk/methods/latentclass/">latent class analysis</a>, which helps identify groups of persons that are similar to each other in their profile of survey responses. We selected questions for analysis based on the key dimensions of public debate: the importance of science education, belief in the effectiveness of homeopathy, use of CAM, trust in medical doctors and optimism about medical advances in general.</p>
<p>We found that we could split the public <a href="http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0053174#pone-0053174-t001">into three groups</a>. The first, who we called the “disaffected”, comprise just under 30%. They are generally pessimistic about medicine, don’t see the value of science education and don’t believe in the efficacy of homeopathy either. </p>
<p>A second “conventional” group, accounting for just over 30% of citizens, are likely to be supportive and trusting of conventional medicine, reject CAM and value science education. </p>
<p>The third and largest group (just over 40% of the population) is the most interesting. This group is likely to have used CAM and to think that homeopathy is effective. Yet they are overwhelmingly trusting of medical doctors, value science education and are optimistic about medical advances. We call this group the “dissonants” (although they are unlikely to call themselves that). </p>
<p>So what makes it likely that someone will be a dissonant rather than a conventional? Women are <a href="http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0053174#pone-0053174-t002">more likely</a> to be found in the dissonant group. Interestingly, people who are better educated are also more likely to be found in this group, (although from a set of questions we posed in the survey, those with a science qualification and who did better in a scientific quiz are less likely to be included), along with those that think that there’s too little regulation of medical research.</p>
<h2>At odds in the public mind?</h2>
<p>Our research suggests that nearly half of the public don’t believe and act as if CAM and conventional medicine are at odds. Coupled with the significant global industry that has grown up around CAM, it is easy to see why politicians have been unwilling to respond to the clear evidence that homeopathy and CAM are ineffective. In the US, <a href="http://www.richarddawkins.net/news_articles/2013/6/19/alternative-medicine-is-a-34-billion-industry-but-only-one-third-of-the-treatments-have-been-tested">it’s a $34bn industry</a> where half of people report using them.</p>
<p>The competition between proponents and opponents of CAM in all likelihood is set to continue. But there’s some evidence that better science education can help people to distinguish between scientific and pseudo-scientific claims, and it appears that at least some of the openness to CAM might stem from concerns about how medical research is regulated. And it is these that might hold the key to who ultimately comes out of the ring in better shape.</p>
<p><em>The research on which this article is based was carried out with Paul Stoneman, Patrick Sturgis and Elissa Sibley.</em></p><img src="https://counter.theconversation.com/content/21827/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nick Allum and team were partially funded by the Wellcome Trust</span></em></p>There is nothing more likely to raise the hackles of any self-respecting rationalist than to be confronted with the latest celebrity story about the miraculous healing power of homeopathy or some other…Nick Allum, Professor of Sociology, University of EssexLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/172702013-09-08T20:36:57Z2013-09-08T20:36:57ZComplementary medicines may put cancer patients’ lives at risk<figure><img src="https://images.theconversation.com/files/30858/original/d6mkppc3-1378442390.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Combining complementary medicine with conventional cancer treatment opens up the possibility of drug interactions.</span> <span class="attribution"><span class="source">hkpuipui99/Flickr</span></span></figcaption></figure><p>Recent <a href="http://dx.doi.org/10.1007/s00432-013-1460-y">German research</a> found that more than 70% of people with cancer supplement their regular hospital treatment with complementary and alternative medicine. More worryingly, many do so without advising their doctor. </p>
<p>This is important because interactions of the complementary medicines and their regular drugs could make cancer treatment ineffective, or worse still, cause toxic side-effects that could lead to death.</p>
<p>The study found a high degree of complementary medicine use by people with cancer across all age groups, and higher use among women than men. A small percentage (8%) of cancer patients were found to only use complementary medicines and shun conventional treatment. </p>
<p>A <a href="http://dx.doi.org/10.1089/jpm.2012.0461">separate study</a> also found that many parents of children with cancer (30%) also reported giving complementary medicines to their kids.</p>
<p>Studies in the <a href="http://dx.doi.org/10.1200/JCO.2007.13.5905">United States</a>, and across other <a href="http://dx.doi.org/10.1093/annonc/mdi110">European countries</a>, found similarly high rates of complementary medicine use among cancer patients. Research of this sort hasn’t been conducted in Australia, but high complementary medicine use means it’s likely the same happens here.</p>
<h2>Why people do it</h2>
<p>According to the German study, people supplementing their treatment with complementary medicines do so in a variety of ways, and with different products. By far the most popular options are vitamins, metals such as <a href="http://en.wikipedia.org/wiki/Selenium">selenium</a> and other trace elements.</p>
<p>Some patients also try non-chemical or drug-based therapies, including prayer, relaxation and physical activity; but these tend to be the least used types of complementary therapies.</p>
<p>More than 50% of the participants in the German study expressed an interest in also using acupuncture or medical herbs, and a quarter were interested in trying mistletoe and homoeopathy treatments.</p>
<p>When asked why they were interested in complementary medicines, most people couldn’t give a reason, or said they’d used them before being diagnosed with cancer and merely continued that use. Some believed complementary therapies boosted their immune system and helped to “detoxify” their body. </p>
<p>Interestingly, more than a third of the German patients reported using complementary therapies simply because it enabled them to do something for themselves; it let them feel more in control of their treatment.</p>
<p>There’s considerable debate about the usefulness of complementary therapies, but what is more worrying about all three studies into complementary therapy use is that it happens without the knowledge of the patient’s doctor.</p>
<p>When asked about the source of their information on complementary medicines, the four most common responses in the German study were television and radio, family and friends, books, and the Internet. </p>
<p>The three least used sources of information were, in decreasing order, doctors, non-medical practitioners and pharmacists. In total, fewer than 10% of the people in the study using complementary medicines stated they gained information on them from health professionals.</p>
<p>This could be a problem because there’s no guarantee that popular sources of information about complementary therapies are accurate. <a href="http://dx.doi.org/10.1371/journal.pone.0002406">Australian research</a> from 2008 found that much of the information available in the media about complementary therapies is either incomplete or inaccurate.</p>
<h2>Lurking dangers</h2>
<p>Combining complementary medicine with conventional cancer treatment opens up the possibility of drug interactions that can make cancer treatment ineffective. Worse still, the drugs may interact to exacerbate side-effects of chemotherapy, which can be so severe they endanger the person’s life.</p>
<p>What’s more, many complementary medicines, particularly those marketed herbal or all natural, can contain ingredients not listed on the labels. So people don’t know what they are taking.</p>
<p>The <a href="http://www.tga.gov.au">Therapeutic Goods Administration</a> regularly bans and issues <a href="http://www.tga.gov.au/safety/alerts-current.htm">safety advisories</a> for complementary medicine products that patients are buying over the Internet because they contain unlisted, often prescription-only, ingredients.</p>
<p>Cancer patients should discuss any medicines they plan to use that are outside their normal treatment plan with their doctor. Many complementary medicines they choose will be safe. </p>
<p>Regardless of efficacy, complementary medicines provide people with an important way to gain a feeling of ownership over their treatment. Doctors will always be supportive of their patients and can help choose complementary medicines that are effective and safe for them to use. </p><img src="https://counter.theconversation.com/content/17270/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nial Wheate in the past has received funding from the ACT Cancer Council, Tenovus Scotland, Medical Research Scotland, Scottish Crucible and the Scottish Universities Life Sciences Alliance for research into anticancer drugs.</span></em></p>Recent German research found that more than 70% of people with cancer supplement their regular hospital treatment with complementary and alternative medicine. More worryingly, many do so without advising…Nial Wheate, Senior Lecturer in Pharmaceutical Chemistry, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/164482013-07-30T05:17:20Z2013-07-30T05:17:20ZQuacktitioner Royal is a menace to the constitution and public health<figure><img src="https://images.theconversation.com/files/28265/original/4rb8xssb-1375097210.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2200%2C1501&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Prince or medical expert: which hat shall I wear today?</span> <span class="attribution"><span class="source">PA/Eddie Mulholland</span></span></figcaption></figure><p>A constitutional monarch is purely ceremonial and plays no part in politics. But in the UK it isn’t quite as simple as that. The first problem is that we have no constitution. </p>
<p>Things haven’t changed much since the 19th century when Walter Bagehot, author of The English Constitution, wrote that “the sovereign has, under a constitutional monarchy … three rights - the right to be consulted, the right to encourage, the right to warn.”</p>
<p>These are not inconsiderable powers in a country which is meant to be run by elected representatives. But nobody knows how these powers are used: almost all of it is done in secret. </p>
<p>Charles, Prince of Wales, is unusually public in expressing his views. But he also does so in private. He is <a href="http://www.guardian.co.uk/uk-news/2013/jul/25/prince-charles-letters-judges-allow-appeal">currently the subject of an appeal</a> to force the publication of letters written to government officials - the so-called “black spider memos”.</p>
<p>In 2010, <a href="http://www.telegraph.co.uk/news/uknews/theroyalfamily/7147870/Prince-of-Wales-I-was-accused-of-being-enemy-of-the-Enlightenment.html">he told a conference</a> he was proud of being called “the enemy of the Enlightenment” - a remarkable point of view for someone who, as King, would become the patron of the Royal Society, that product of the age of enlightenment.</p>
<p>I’ve no doubt that Prince Charles means well. But his views on medicine date from a few centuries ago, and he has lost no opportunity to exploit his privileged position to proclaim them.</p>
<h2>Euphemisms for quackery</h2>
<p>The “integration” in the Foundation for Integrated Health (PFIH), which was set up to promote the prince’s views, is just the latest euphemism for “alternative” or “quack”. When the Foundation collapsed because of a financial scandal in 2010, it was replaced by the “College of Medicine”. The name changed, <a href="http://www.dcscience.net/?p=3632">but not the people</a> behind it. </p>
<p>Initially this phoenix was to be named the “<a href="http://www.dcscience.net/?p=3263">College of Integrated Health</a>”, but by this time the Prince’s views on medicine had become sufficiently discredited that the word “integrated” was quickly dropped. This might be thought less than frank, but it is just the classic <a href="http://www.sciencebasedmedicine.org/the-bait-and-switch-of-unscientific-medicine/">bait and switch</a> technique, beloved by used car salesmen.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/28264/original/n27hmw3r-1375097012.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/28264/original/n27hmw3r-1375097012.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/28264/original/n27hmw3r-1375097012.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/28264/original/n27hmw3r-1375097012.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/28264/original/n27hmw3r-1375097012.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/28264/original/n27hmw3r-1375097012.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/28264/original/n27hmw3r-1375097012.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">They promise you the world …</span>
<span class="attribution"><span class="source">Loozrboy</span></span>
</figcaption>
</figure>
<p>The prince’s views were also well publicised in Complementary Healthcare: a Guide for Patients, which omitted or misrepresented the evidence about whether treatments worked or not. I wrote a more accurate version: the <a href="http://www.dcscience.net/?page_id=733">Patients’ Guide to Magic Medicine</a>.</p>
<h2>A letter from the prince</h2>
<p>This guide was arguably a danger to public health. When it was rightly criticised by Edzard Ernst, an academic expert in complementary medicine, a letter sent from an aide at Clarence House <a href="http://www.guardian.co.uk/uk/2007/mar/11/health.monarchy">to Ernst’s vice-chancellor</a>, Steve Smith, resulted in <a href="http://www.dcscience.net/?p=89">disciplinary proceedings</a> against Ernst that lasted for a year, and ended with a pompous reprimand.</p>
<p>None of this criticism has dimmed the prince’s enthusiasm for barmy medical ideas.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/28266/original/zw9w83ht-1375098236.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/28266/original/zw9w83ht-1375098236.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=823&fit=crop&dpr=1 600w, https://images.theconversation.com/files/28266/original/zw9w83ht-1375098236.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=823&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/28266/original/zw9w83ht-1375098236.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=823&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/28266/original/zw9w83ht-1375098236.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1035&fit=crop&dpr=1 754w, https://images.theconversation.com/files/28266/original/zw9w83ht-1375098236.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1035&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/28266/original/zw9w83ht-1375098236.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1035&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">On the hunt for answers: we might never know why Jeremy visited the prince.</span>
<span class="attribution"><span class="source">PA/Dominic Lipinski</span></span>
</figcaption>
</figure>
<p>In July, Minister of Health Jeremy Hunt visited the prince at Clarence House. The visit was <a href="http://www.independent.co.uk/life-style/health-and-families/health-news/hes-at-it-again-prince-charles-accused-of-lobbying-health-secretary-over-homeopathy-8723145.html">reportedly to persuade the minister</a> to defend homeopathy, though it was more likely to have been to press the case to confer a government stamp of <a href="http://www.dcscience.net/?p=5562">approval on herbalists</a> and traditional Chinese Medicine practitioners through statutory regulation.</p>
<p>Charles’s greatest ally, <a href="http://www.dcscience.net/?p=6007">the Conservative MP David Tredinnick</a>, who got into trouble for charging to expenses astrology software that purported to <a href="http://www.guardian.co.uk/politics/2010/dec/09/tory-mp-david-tredinnick-astrology">diagnose medical conditions</a>, recently raised this again <a href="http://www.publications.parliament.uk/pa/cm201314/cmhansrd/cm130709/halltext/130709h0001.htm#130709h0001.htm_spnew0">in parliament</a>. </p>
<p>We might never know what was discussed in Hunt’s meeting. And <a href="https://www.gov.uk/government/publications/written-ministerial-statement-freedom-of-information-act-veto-of-release-of-prince-charles-letters">the Attorney General</a> has blocked the release of private letters sent to seven government departments as “disclosure of the correspondence could damage The Prince of Wales’ ability to perform his duties when he becomes King.” This is precisely why they should be made public.</p>
<h2>The prince’s influence</h2>
<p>The prince’s influence is big in the Department of Health (DH). He was given £37,000 of taxpayers’ money to produce his guide, and an astonishing £900,000 to prepare the ground for the hapless self regulator “Ofquack”, or the <a href="http://www.dcscience.net/?p=3311">Complementary and Natural Healthcare Council</a>. </p>
<p>When NHS Choices (set up by the DH to assess evidence) was rewriting its web page about the most discredited of all forms of quackery, homeopathy, officials <a href="http://www.dcscience.net/?p=5778">referred the new advice to Michael Dixon</a>, the Prince’s Foundation medical director. Were it not for the Freedom of Information act, inaccurate information would have been included.</p>
<p>The Prince of Wales’ business, Duchy Originals, <a href="http://www.dailymail.co.uk/health/article-440103/Duchy-original-sins--Charles-range-spotlight.html">has been condemned</a> by the Daily Mail, for selling unhealthy foods. And when it started selling quack “detox” and herbal nonsense he found himself censured by the medicines regulator, <a href="http://www.quackometer.net/blog/2009/03/duchy-originals-pork-pies.html">the MHRA</a> and <a href="http://www.asa.org.uk/Rulings/Adjudications/2009/5/Duchy-Originals-Ltd/TF_ADJ_46199.aspx">the Advertising Standards Authority</a> (ASA) for unjustifiable medical claims.</p>
<p>Ainsworth’s homeopathic pharmacy has two royal warrants, from both Prince Charles and the Queen. They sold “homeopathic vaccines” for meningitis, measles, rubella and whooping cough. </p>
<p>Ainsworth’s had already been <a href="http://bit.ly/16tAm8j">censured by the ASA</a> in 2011 for selling similar products. The MHRA failed to step in until Sam Smith, a young BBC reporter, made a <a href="http://www.youtube.com/watch?v=TZf9mUzI4RI&feature=c4-overview&list=UUei35H3nu7bduw-6DBJFGrQ">programme about it</a>. It still sells Polonium metal 30C and Swine Meningitis 36C, and a booklet recommending homeopathic “vaccination”. Ainsworth’s sales are no doubt helped by the royal warrants. </p>
<h2>Runs in the family</h2>
<p>Charles is not the only member of the royal family to be obsessed with bizarre forms of medicine. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/28262/original/vyytgbzm-1375095788.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/28262/original/vyytgbzm-1375095788.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=944&fit=crop&dpr=1 600w, https://images.theconversation.com/files/28262/original/vyytgbzm-1375095788.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=944&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/28262/original/vyytgbzm-1375095788.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=944&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/28262/original/vyytgbzm-1375095788.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1186&fit=crop&dpr=1 754w, https://images.theconversation.com/files/28262/original/vyytgbzm-1375095788.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1186&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/28262/original/vyytgbzm-1375095788.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1186&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Frederick Quin, England’s first homeopathic doctor in Vanity Fair 1872.</span>
<span class="attribution"><span class="source">Wikimedia Commons/Adriano Cecioni</span></span>
</figcaption>
</figure>
<p>The first homeopath to the British royal family, Frederick Quin, was a son of the Duchess of Devonshire (1765-1824). Queen Mary (1865-1953) headed the fundraising efforts to move and expand the London Homeopathic Hospital. King George VI was so enthusiastic that in 1948 he conferred the royal title on it. </p>
<p>The present Queen’s homeopathic physician is Peter Fisher, who is medical director of a hospital, now rebranded, as the Royal London Hospital for Integrated Medicine (RLHIM).</p>
<p>The RLHIM is a <a href="http://www.dcscience.net/?p=4213">great embarrassment</a> to the otherwise excellent UCL Hospital Trust. It has been repeatedly <a href="http://bit.ly/11UK3Ze">condemned by the ASA</a> and has been forced to withdraw all of its patient information. It’s hard to imagine that this anachronistic institution would still exist without the patronage of the Queen.</p>
<p>To justify the secrecy of Charles’s letter, the attorney general said: </p>
<blockquote>
<p>It is a matter of the highest importance within our constitutional framework that the Monarch is a politically neutral figure. </p>
</blockquote>
<p>Questions about health policy are undoubtedly political, and the highly partisan interventions of the prince in the political process make his behaviour unconstitutional. They endanger the monarchy itself. Whether that matters depends on how much you value tradition and how much you value the tourist business generated by the Gilbert & Sullivan flummery at which royals excel.</p>
<p>The least that one can ask of the royal family is that they should not endanger the health of the nation. If I wanted to know the winner of the 2.30 at Ascot, I’d ask a royal. For any question concerning science or medicine I’d ask someone with more education.</p><img src="https://counter.theconversation.com/content/16448/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David Colquhoun does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A constitutional monarch is purely ceremonial and plays no part in politics. But in the UK it isn’t quite as simple as that. The first problem is that we have no constitution. Things haven’t changed much…David Colquhoun, Professor of Pharmacology, UCL, UCLLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/123732013-04-29T04:33:05Z2013-04-29T04:33:05ZMonday’s medical myth: you can think yourself better<figure><img src="https://images.theconversation.com/files/22877/original/dhs2mqr5-1366940194.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Being blindly and unrelentingly positive can be a burden to disease sufferers.</span> <span class="attribution"><span class="source">Image from shutterstock.com</span></span></figcaption></figure><p>Of all the cultural beliefs about health and illness that saturate the developed world, there is none so pervasive and deeply held as the idea that you can “battle” an illness by sheer force of will. </p>
<p>We admire people like AFL great <a href="http://en.wikipedia.org/wiki/Jim_Stynes">Jim Stynes</a> who show a brave and positive face to the public when confronted with a diagnosis of cancer, and somehow expect that a positive and determined mindset will help “overcome” the disease.</p>
<p>The underlying assumption here is that the mind and body are separate, a philosophical stance known as <a href="http://en.wikipedia.org/wiki/Dualism">dualism</a>.</p>
<p>In contrast, the scientific viewpoint is that the mind is caused by the brain. And all the neuroscientific data points this way.</p>
<p>So what, you may say. Even if the mind is caused by the brain, I can still consciously control my thoughts, and therefore I can influence things that go on in my body. This is quite true. </p>
<p>The next question, then, is whether there is evidence that optimism, positive thinking or learning to control your thoughts in some way will be enough to have a significant influence on any disease process. </p>
<p>It’s important to note that we’re not talking about quality of life. We’re interested in whether the actual course of a disease can be changed by purely mental effort. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/22885/original/mpv5mybs-1366940979.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/22885/original/mpv5mybs-1366940979.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/22885/original/mpv5mybs-1366940979.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/22885/original/mpv5mybs-1366940979.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/22885/original/mpv5mybs-1366940979.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1130&fit=crop&dpr=1 754w, https://images.theconversation.com/files/22885/original/mpv5mybs-1366940979.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1130&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/22885/original/mpv5mybs-1366940979.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1130&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">People who are optimistic are more likely to turn up to health appointments.</span>
<span class="attribution"><span class="source">Image from shutterstock.com</span></span>
</figcaption>
</figure>
<p>It’s common sense (and supported by mountains of positive studies) that sick people’s quality of life can be improved by having a positive outlook. </p>
<p>The consensus is that optimistic people turn up for their treatments more regularly and are more likely to find resourceful ways to get as much as they can out of their life with chronic illness. </p>
<p>Interestingly, <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3273547/">pessimism may be more predictive of a bad outcome</a> than optimism is of a good one.</p>
<h2>What does the evidence say?</h2>
<p>The most comprehensive summary of the evidence on the subject of optimism and health is <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2941870/">this 2010 analysis of 83 studies </a>. Most of the studies take a cohort of subjects, score them by questionnaire to rate their levels of optimism, then sit back and watch what happens. </p>
<p>There are no control groups and no intervention to assess – the researchers just trawl the data for a correlation. If links are found, which isn’t always the case, a press release is issued and everyone marvels at how amazing the mind-body connection is. </p>
<p>Even if you find a robust and reproducible correlation, it doesn’t automatically follow that the link is causal. This is especially true if the study was not specifically set up to show the exact link you are looking for, with all bias and potential distractions removed. </p>
<p>I couldn’t find any studies that were set up to look at the effect of becoming more optimistic, or switching from pessimism to optimism, on a person’s disease. </p>
<p>But at least there’s no harm in being positive, right?</p>
<p>There’s not, but it’s possible that being blindly and unrelentingly positive can be a burden to disease sufferers. </p>
<p><a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2858803/">US researcher James Coyne</a> makes this point in his 2010 paper critiquing the positive psychology movement in cancer care. Coyne notes that enforcing a cultural expectation of positivity leaves many cancer patients scared that they’re reducing their chance of survival every time they feel scared, depressed or angry about their disease.</p>
<p>The paper quotes Dutch Olympian Maarten Van der Weijden, who rejected being identified with Lance Armstrong’s approach of “fighting” cancer:</p>
<blockquote>
<p>What he basically says is that it is your own fault when you don’t make it… You always hear those stories that you have to think positively, that you have to fight to survive. This can be a great burden for patients.</p>
</blockquote>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/22881/original/t64dr84h-1366940635.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/22881/original/t64dr84h-1366940635.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=453&fit=crop&dpr=1 600w, https://images.theconversation.com/files/22881/original/t64dr84h-1366940635.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=453&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/22881/original/t64dr84h-1366940635.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=453&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/22881/original/t64dr84h-1366940635.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=569&fit=crop&dpr=1 754w, https://images.theconversation.com/files/22881/original/t64dr84h-1366940635.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=569&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/22881/original/t64dr84h-1366940635.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=569&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Don’t feel you need to be completely positive 100% of the time.</span>
<span class="attribution"><span class="source">Image from shutterstock.com</span></span>
</figcaption>
</figure>
<p>Cancer patients should be reassured that their disease was not caused by personality or emotional factors. Such a callous and false conclusion follows logically from a serious acceptance of the myth. It also would follow that cancer, multiple sclerosis, stroke or any other serious disease could be curable by addressing the emotional issues that supposedly underlie it. </p>
<p>So if there’s little evidence that just being an optimistic person is good for your health, there’s even less evidence that forcing yourself to use positive thinking can beat your disease. <a href="http://www.ncbi.nlm.nih.gov/pubmed/23390882">Positive psychology interventions</a> have only really been studied in mental health diseases such as depression and there seems to be no attempt to use thought to cure disease. </p>
<p>If faced with a serious illness, you’re likely to have a better quality of life if you have good social supports and avoid giving in to complete pessimism. Nobody can tell you the perfect formula to deal with the impact of a serious diagnosis. </p>
<p>But don’t believe those who tell you your illness is your fault somehow, or that you wouldn’t have it if you’d somehow been a better person.</p>
<p>You don’t need to feel that you should be completely positive 100% of the time, because not only does that not happen, it’s not healthy either. Coping the best way you know how to is all you should be aiming to do.</p><img src="https://counter.theconversation.com/content/12373/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Vagg does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Of all the cultural beliefs about health and illness that saturate the developed world, there is none so pervasive and deeply held as the idea that you can “battle” an illness by sheer force of will. We…Michael Vagg, Clinical Senior Lecturer at Deakin University School of Medicine & Pain Specialist, Barwon HealthLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/61662012-04-02T01:02:44Z2012-04-02T01:02:44ZDoes traditional Chinese medicine have a place in the health system?<figure><img src="https://images.theconversation.com/files/9183/original/frdgzv2p-1333327588.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Despite recent attempts to retain traditional healing practices in China, modern medicine is supplanting traditional medicine there.</span> <span class="attribution"><span class="source">Jean-François Chénier</span></span></figcaption></figure><p>Most of traditional healing practices are based on intuitive principles of diseases involving the imbalance of elemental qualities. </p>
<p>For the ancient Greeks and Romans, whose systems of traditional healing were accepted in Europe until the scientific revolution, these elements were the four bodily fluids or humours. Each corresponded to the four fundamental elements of the world – earth, water, air and fire. </p>
<p>In traditional Chinese medicine, the elements are wood, fire, earth, metal and water; for the ancient Unani medicine in India, the four humors (akhlaat) are air, earth, fire and water; for Indian Ayurveda medicine, health is the balance of three elemental energies in the universe: air, water and fire.</p>
<p>None of the ideas have any scientific basis. </p>
<p>With the advent of modern medicine, traditional European practices were relegated to a handful of surviving herbal remedies. Similarly <a href="http://www.nature.com/nature/journal/v480/n7378_supp/full/480S82a.html">in China</a>, despite <a href="http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.93.7.1082">recent attempts to retain</a> traditional healing practices, modern medicine is supplanting traditional medicine.</p>
<p>Paradoxically, in Australia and other developed countries there’s increased interest in complementary and alternative medicines, reverting to irrational approaches to health practice, despite people from such countries benefiting most from medicine’s advances.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/9180/original/5nj772bv-1333327045.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/9180/original/5nj772bv-1333327045.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=897&fit=crop&dpr=1 600w, https://images.theconversation.com/files/9180/original/5nj772bv-1333327045.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=897&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/9180/original/5nj772bv-1333327045.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=897&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/9180/original/5nj772bv-1333327045.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1127&fit=crop&dpr=1 754w, https://images.theconversation.com/files/9180/original/5nj772bv-1333327045.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1127&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/9180/original/5nj772bv-1333327045.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1127&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Chinese medicinal herbs.</span>
<span class="attribution"><span class="source">Jennifer Yin</span></span>
</figcaption>
</figure>
<p>The <a href="http://www.health.wa.gov.au/publications/documents/discussion%20paper%20-%20regulation%20of%20practitioners%20of%20chinese%20medicine%20in%20wa.pdf">resurgence of interest</a> in traditional Chinese healing in Australia, along with other alternative medicines, is due to rising discontent with conventional medicine; a preference for natural (or gentler) alternatives to pharmaceutical drugs or surgery; desire for greater control over personal health care and the relatively low success rate of conventional medicine in treating conditions, such as chronic pain, for some individuals.</p>
<p>This has led to the recent contentious decision to permit traditional Chinese medicine practitioners to be registered with the new national <a href="http://www.chinesemedicineboard.gov.au/">Chinese Medicine Board of Australia</a> from July this year. The board will be a new member of the <a href="http://www.ahpra.gov.au/">Australian Health Practitioner Regulation Agency</a>. </p>
<p>I have argued against the move, along with my colleague Associate Professor Hubertus Jersmann, in articles published today in <a href="http://www.mjainsight.com.au/view?post=marcello-costa-hubertus-jersmann-chinese-paradox&post_id=8680&cat=comment">MJA Insight</a> and the <a href="http://www.smh.com.au/national/health/alarm-bells-sound-on-registration-of-chinese-medicine-20120401-1w6mo.html">Sydney Morning Herald</a>.</p>
<p>The decision follows Victoria’s move (in 2000) to register traditional Chinese medicine practitioners, which has had a <a href="http://www.publish.csiro.au/paper/AH10869.htm">positive impact</a> on tightening standards and dealing with complaints. </p>
<p>Among traditional Chinese medicine practitioners to be registered are those who provide Chinese medical diagnosis, dispense Chinese herbs and perform acupuncture. All three components of this practice have serious flaws, being based on non-existent energies (Yin and Yang), non-existent bodily structures (meridiens) and on principles of disease diagnosis based on the imbalance of five non-existent elements. It is therefore doubtful whether such practitioners are able to make correct and safe diagnoses.</p>
<p>Proponents of traditional medical practices often point out that extracts from animals and plants have been the source of effective remedies in modern medicine. And while pharmacology and medicinal chemistry have enabled this revolution since mid-1800s, only a handful of the extracts used in traditional healing have been proven to contain active principles beneficial for fighting disease. These include about 120 chemical substances out of the thousands of <a href="http://www.hindawi.com/journals/ecam/2005/629537/abs/">herbal remedies</a> used in traditional medicines. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/9178/original/dmgpqfwg-1333322921.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/9178/original/dmgpqfwg-1333322921.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=713&fit=crop&dpr=1 600w, https://images.theconversation.com/files/9178/original/dmgpqfwg-1333322921.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=713&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/9178/original/dmgpqfwg-1333322921.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=713&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/9178/original/dmgpqfwg-1333322921.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=896&fit=crop&dpr=1 754w, https://images.theconversation.com/files/9178/original/dmgpqfwg-1333322921.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=896&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/9178/original/dmgpqfwg-1333322921.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=896&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Artemisia annua or qing hao su became incorporated into medicine after it’s anti-malarial activity was proven through research.</span>
<span class="attribution"><span class="source">Scamperdale</span></span>
</figcaption>
</figure>
<p>Take, for instance, qing hao su, a herb used in China for treating fever for over 2,000 years. About 40 years ago, scientific research found that it had specific anti-malarial activity and its active compound, artemesin, was isolated. </p>
<p>In fact, it’s fortunate that most herbal remedies have little acute toxicity. This is due to empirical experience, which over time has selected out those proven to be overtly toxic. But the more subtle, chronic toxicity of herbal remedies remains a serious concern. </p>
<p>Only <a href="http://www.hindawi.com/journals/ecam/2005/629537/abs/">6% of plants species</a> have been screened chemically and pharmacologically to identify their active principles. This process, started by modern medicine just over 150 years ago, is continuing with investigations of potential benefits of new therapies often based on a long history of empirical evidence.</p>
<p>This is why research on active chemical principles in herbal remedies showing some potential beneficial effect is fully supported by the <a href="http://www.scienceinmedicine.org.au/">Friends of Science in Medicine (FSM)</a>, of which I am a founding member. </p>
<p>FSM represents a growing number of medical researchers, clinicians and members of the public concerned by the “current trend which sees government-funded tertiary institutions offering courses in the health care sciences that are not underpinned by sound scientific evidence”. We are worried that this gives unwarranted credibility given to their practitioners and practices, including traditional Chinese medicine. </p>
<p>Even though it falls within traditional Chinese medicine, acupuncture requires separate consideration because, despite being based on a flawed theory of non-existent “meridiens”, it has shown promising effectiveness in some ailments. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/9181/original/wynyw8wy-1333327169.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/9181/original/wynyw8wy-1333327169.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/9181/original/wynyw8wy-1333327169.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/9181/original/wynyw8wy-1333327169.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/9181/original/wynyw8wy-1333327169.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/9181/original/wynyw8wy-1333327169.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/9181/original/wynyw8wy-1333327169.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Acupuncture is based on the idea of “meridiens”.</span>
<span class="attribution"><span class="source">aloucha</span></span>
</figcaption>
</figure>
<p>But it’s important to remember that despite its popularity, acupuncture has only proven beneficial in alleviating some symptoms of pain and nausea. And the mechanisms by which it appears to work are similar to the physiological processes in the nervous system underlying the placebo effects on pain. Ultimately, research on acupuncture has enabled it to become incorporated in medicine in the few conditions for which it has proven to be effective.</p>
<p>My view, shared by many, is that there’s only one medicine and adjectives such as traditional and “Western” are irrelevant. Rather, medicine is about efficacy and safety, proven through scientific research. </p>
<p>Living in a modern society requires that in matters of health, we unapologetically only accept practices that have undergone the scrutiny of science. And once that criteria is fulfilled, we can accept it as effective medical treatment and teach it in our universities.</p>
<p>Sadly, this is not the case for most traditional Chinese medical practices and practitioners.</p><img src="https://counter.theconversation.com/content/6166/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marcello Costa does not work or consults for, own shares in or receive funding from any company or organisation that would benefit from this article, and has no relevant undisclosed affiliations. Marcello as member of the Australian Academy of Science, is committed to support the highest scientific standard in education and tertiary institutions.
He is one of the five founding members of the Friends of Science in Medicine.</span></em></p>Most of traditional healing practices are based on intuitive principles of diseases involving the imbalance of elemental qualities. For the ancient Greeks and Romans, whose systems of traditional healing…Marcello Costa, Professor of Neurophysiology, Department of Physiology, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/52422012-02-10T03:34:16Z2012-02-10T03:34:16ZCoffee enemas don’t cure cancer: reviewing the remarkable claims of Ian Gawler<figure><img src="https://images.theconversation.com/files/7548/original/c3skz3y4-1328843538.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Gawler claims to have cured himself of advanced cancer by a series of unorthodox treatments including herbal remedies, meditation, coffee enemas and diets.</span> <span class="attribution"><span class="source">Nick Olejniczak</span></span></figcaption></figure><p>It’s not often that a scientific article in a learned medical journal becomes front page news but that was the case recently when <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1445-5994.2011.02686.x/abstract">a paper I co-authored with Dr Ian Haines</a> of Melbourne’s Cabrini Hospital was published in the Internal Medicine Journal (IMJ) just before the new year. </p>
<p>In very prominent “exclusives”, Fairfax newspapers, including <a href="http://www.theage.com.au/national/cancer-experts-challenge-gawlers-cure-20111230-1pfns.html">The Age</a> in Melbourne, called our paper explosive. What was the fuss about? Ian Haines and I are experienced cancer specialists and had published <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1445-5994.2011.02686.x/abstract">a paper with the rather unexplosive title</a> “Hypothesis. The importance of a histological diagnosis when diagnosing and treating advanced cancer. Famous patient recovery may not have been from metastatic disease.” </p>
<p>In this technical report, we analysed the very public case of Melbourne cancer guru Ian Gawler whose claims to have cured himself of advanced cancer by a series of unorthodox treatments have passed into Australian folklore. His methods included herbal remedies, meditation, coffee enemas and diets. </p>
<p>After careful evaluation of the publicly available case details (mostly made public by Gawler himself), we came up with an alternative theory. We suggested that rather than suffering from advanced cancer, Gawler had been afflicted by tuberculosis, which was appropriately treated with antibiotics and cured.</p>
<p>Gawler vigorously disputes our theory and there will undoubtedly be a lively series of exchanges in the correspondence pages of the IMJ. Both Ian Haines and I have received a number of unpleasant communications from Gawler supporters for having gone public the way we did, often with questions about our motives. Although, to be fair, we also received a considerable number of supporting messages from colleagues.</p>
<p>The obvious question – why did we do it? Why put our reputations on the line to query the diagnosis of a man who is seen by many in the community almost as a saint, as someone who (according to one correspondent) “has helped thousands of cancer patients”. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/7549/original/ycncmjk5-1328843555.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/7549/original/ycncmjk5-1328843555.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=915&fit=crop&dpr=1 600w, https://images.theconversation.com/files/7549/original/ycncmjk5-1328843555.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=915&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/7549/original/ycncmjk5-1328843555.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=915&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/7549/original/ycncmjk5-1328843555.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1149&fit=crop&dpr=1 754w, https://images.theconversation.com/files/7549/original/ycncmjk5-1328843555.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1149&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/7549/original/ycncmjk5-1328843555.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1149&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Ian Gawler in September 2000.</span>
<span class="attribution"><span class="source">AAP</span></span>
</figcaption>
</figure>
<p>Although we didn’t appreciate it at the time we prepared our report, the publication of our paper coincided with increasing stirrings amongst scientists and orthodox medical practitioners against what’s seen as promotion of “<a href="https://theconversation.com/pointing-the-bone-at-chiropractic-quackery-lessons-from-the-uk-5021">pseudoscience, anti-science, dodgy science, bogus science, balderdash, claptrap…</a>”. This description comes from Dr Simon Singh, a British science journalist who recently successfully defended himself in the United Kingdom against a libel action mounted by the chiropractic fraternity for harsh criticism of their philosophy.</p>
<p>So our work hasn’t occurred in a vacuum. The newly formed Australian organisation, Friends of Science in Medicine, is currently campaigning strongly against universities that are seen as sullying their scientific reputations by running courses in alternative and evidence-poor philosophies of medical practice, such as chiropractic and homeopathy. In only a few weeks since their launch in late 2011, FSM has attracted hundreds of supporters and <a href="http://www.nytimes.com/2012/02/06/world/asia/australian-universities-defend-alternative-medicine-teaching.html">garnered international attention</a>.</p>
<p>Although alternative practitioners have always been with us, they became much more prominent during the 1970s and 1980s. Initially, at least, the attitude of the orthodox medical profession was to ignore them and hope they would go away. Orthodox clinicians often adopted an attitude of “at least their treatments can do no harm”; an attitude has been shown to be mistaken in many cases.</p>
<p>But the increasing emphasis in medical teaching and practice on a solid “evidence base” for everything clinicians do is starting, finally, to encourage the profession to challenge the proponents of these alternative philosophies and indeed to be harsher in their criticisms of treatments considered bogus or worse.</p>
<p>So to return to the Gawler story. Ian Haines and I, and many of our medical colleagues, have been distressed over the years to see large numbers of our cancer patients adopt some of his unproven ideas – often to the exclusion of proven orthodox treatments. </p>
<p>We asked the question, how well supported by evidence are Gawler’s claims? We based our enquiries on a quote from the late Carl Sagan that “extraordinary claims require extraordinary evidence”. Gawler’s claim to have cured his cancer by meditation, herbs, coffee enemas and a vegan diet is surely extraordinary by anyone’s interpretation. </p>
<p>If cancer sufferers and other ill people are to follow his advice, which is not an easy thing to do, they need to be sure that it is based on rock solid evidence without there being a possible alternative explanation. </p>
<p>Our motive, pure and simple, was to point out that there’s at least one other highly plausible explanation for his survival. Cancer patients should think carefully before following down the path that Gawler has mapped out.</p>
<p>It’s time science fought back.</p><img src="https://counter.theconversation.com/content/5242/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ray Lowenthal does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>It’s not often that a scientific article in a learned medical journal becomes front page news but that was the case recently when a paper I co-authored with Dr Ian Haines of Melbourne’s Cabrini Hospital…Ray Lowenthal, Professor of Oncology, University of TasmaniaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/37802011-12-06T19:38:38Z2011-12-06T19:38:38ZGiving the right teeth to the tiger: creating an effective TGA<figure><img src="https://images.theconversation.com/files/6179/original/nrkcfcbq-1323149556.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Some complementary medicines fill a medical need while others are of no value whatsoever.</span> <span class="attribution"><span class="source">nicholaslaughlin</span></span></figcaption></figure><p>Some complementary medicines are useful while others are just plain quackery so any attempt to regulate the industry requires an understanding of this heterogeneity. What’s more, the regulator of the industry must have real powers to promote useful products and inform the public of the effectiveness and safety of both types.</p>
<p>Discussions of regulatory requirements for complementary medicines often proceed as though they are a homogenous group. They are not. Some fill a medical need while others are of no value whatsoever.</p>
<p>A number of supplements – such as iodine for pregnant and breastfeeding women and, vitamin B12 for pernicious anaemia sufferers and for vegetarians – are known to be efficacious and this use is endorsed by the <a href="http://www.nhmrc.gov.au/">National Health and Medical Research Council (NHMRC)</a>. </p>
<p>But that’s not to say that all vitamin and mineral supplements are of medical value. For healthy normal adults with no special needs, a balanced diet is the best source of vitamins and minerals. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/6180/original/zd6278xb-1323149640.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/6180/original/zd6278xb-1323149640.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=734&fit=crop&dpr=1 600w, https://images.theconversation.com/files/6180/original/zd6278xb-1323149640.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=734&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/6180/original/zd6278xb-1323149640.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=734&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/6180/original/zd6278xb-1323149640.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=923&fit=crop&dpr=1 754w, https://images.theconversation.com/files/6180/original/zd6278xb-1323149640.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=923&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/6180/original/zd6278xb-1323149640.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=923&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">St Johns Wort.</span>
<span class="attribution"><span class="source">Anne Burgess</span></span>
</figcaption>
</figure>
<p>Then, there are complementary medicines that are never likely to have a scientific basis, such as homeopathic remedies. In 2010, the UK <a href="http://www.publications.parliament.uk/pa/cm200910/cmselect/cmsctech/45/4502.htm">House of Commons Science and Technology Committee</a> concluded that the principle underlying homeopathy was weak and that it should not be funded by the <a href="http://www.nhs.uk/Pages/HomePage.aspx">National Health Service</a>.</p>
<p>Some herbal medicines have been investigated by reputable clinicians, but such studies are of little value without standardisation of the products. A <a href="http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000448.pub3/abstract">2009 review of St John’s Wort</a>, for instance, concluded that the evidence for its efficacy varied according to different research trials. It concluded that “country of origin and precision with effects size complicates the interpretation”. Other influencing factors include country of origin, harvest time, method of processing, part of the plant used, and how long the harvested plant was stored before use in manufacture. </p>
<p>St John’s Wort contains numerous chemical components, some of which have been identified and many of which have not. It’s not known which of these components contribute to antidepresssant activity so they haven’t been tested as a mainstream medicine would be and standardisation of products is next to impossible.</p>
<p>What’s more, it’s highly likely that different batches of a complementary product will contain different chemicals in different ratios and have different profiles for effectiveness, adverse reactions and interactions with other medicines. To suggest, as some do, that numerous minor ingredients have subtle effects that are beyond conventional medicine to define is to indulge in witchcraft. </p>
<p>If the major active ingredient(s) could be identified and formulated as a standardised medicine, and safety and efficacy demonstrated in controlled studies, then St John’s Wort could make a real contribution to human medicine. The same has been done with other substances of vegetable origin, like digoxin from foxglove, morphine from poppies and and artemisinin, the life-saving drug for malaria from Chinese Sweet Wormwood, all of which became medically reliable when standardised and appropriately developed. </p>
<p>But the ethically dubious promotion of some complementary medicines and their extravagant claims must be restrained. So what is it that regulatory government bodies, such as the Therapeutic Goods Administration (TGA), can do about complementary products? </p>
<p>Regulatory options for the TGA include:</p>
<ul>
<li>Publishing its own reviews of the efficacy of complementary medicines in layman’s terms. There’s already a mechanism for doing this via <a href="http://www.nps.org.au/consumers/publications/medicines_talk">Medicines Talk</a>, a part of the <a href="http://www.nps.org.au/">National Prescribing Service</a>. More publicity and perhaps a sexier title would enhance use of this facility. </li>
<li>Monitoring advertising more rigorously. While some companies may advertise appropriately, the notorious case of <a href="http://theconversation.com/sensaslim-and-me-how-criticism-of-a-weight-loss-spray-landed-me-in-court-1911">Sensaslim</a>, described by <a href="http://www.theage.com.au/national/sensaslim-banned-for-advertising-breach-20111124-1nwxk.html">The Age as a “shonky diet nasal spray”</a>, illustrates the depths to which advertising can fall. </li>
<li>Banning payment for items that are represented as “news” in current affairs programs.</li>
<li>Abandoning the requirement that sponsors of complementary medicines must hold data to support their claims but need not submit it to the TGA, and instead adopting a universal standard for all medicinal products. Any product that falls short of this universal standard should not be marketed, except with written TGA approval.
<br></li>
</ul>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/6182/original/6tybrzy8-1323149924.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/6182/original/6tybrzy8-1323149924.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=777&fit=crop&dpr=1 600w, https://images.theconversation.com/files/6182/original/6tybrzy8-1323149924.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=777&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/6182/original/6tybrzy8-1323149924.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=777&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/6182/original/6tybrzy8-1323149924.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=976&fit=crop&dpr=1 754w, https://images.theconversation.com/files/6182/original/6tybrzy8-1323149924.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=976&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/6182/original/6tybrzy8-1323149924.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=976&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">This fax was sent to pharmacists.</span>
</figcaption>
</figure>
<p>Instituting such a standard would require compliance with a set of criteria along the lines of – unless otherwise approved by TGA in writing, no medicine may:</p>
<ul>
<li>contain an active ingredient that’s scheduled as prescription-only, pharmacist-only, or pharmacy-only;</li>
<li>contain a substance that’s on a list of banned substances;</li>
<li>claim efficacy for preventing or treating a serious illness, as defined by TGA;</li>
<li>recommend administration other than via oral or topical routes; </li>
<li>be manufactured at premises that are not TGA-licensed for that type of manufacture;</li>
<li>fail to comply with an applicable official standard published by TGA;</li>
<li>claim to be sterile or free of microbes;</li>
<li>fail to comply with general limits on microbial load, and the absence of defined pathogens, such as pseudomonads (this is already the case for other oral and topical medicines); </li>
<li>fail to comply with general limits on the content of heavy metals and pesticides; </li>
<li>fail to include instructions for patients on the container label or in an enclosed consumer medicines information leaflet; and<br></li>
<li>possibly other requirements after consideration by TGA experts.
<br> </li>
</ul>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/6186/original/qn4zkytp-1323153120.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/6186/original/qn4zkytp-1323153120.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=596&fit=crop&dpr=1 600w, https://images.theconversation.com/files/6186/original/qn4zkytp-1323153120.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=596&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/6186/original/qn4zkytp-1323153120.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=596&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/6186/original/qn4zkytp-1323153120.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=748&fit=crop&dpr=1 754w, https://images.theconversation.com/files/6186/original/qn4zkytp-1323153120.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=748&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/6186/original/qn4zkytp-1323153120.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=748&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Chinese Sweet Wormwood.</span>
<span class="attribution"><span class="source">Ton Rulkens</span></span>
</figcaption>
</figure>
<p>The consequences for the TGA if it adopted these criteria would be:</p>
<ul>
<li>a reduced commitment of resources to the existing “pretend” regulating;</li>
<li>a focus on random and targeted sampling and testing, including review of labelling;</li>
<li>a focus on review of advertising; and </li>
<li>no imprimatur for safety and efficacy of medicines that TGA hasn’t evaluated for these things (perhaps these medicines should be labelled as such).
<br></li>
</ul>
<p>But strong action, including publicity for recalls in the event of non-compliance, would be required to accompany such changes. The consequences of strong TGA action (even if not well handled at the time) for Pan Pharmaceuticals, which collapsed soon after a recall of a large number of products, were dire. It wouldn’t take many such events to have a salutary effect on the whole industry. </p><img src="https://counter.theconversation.com/content/3780/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Susan Walters has been a consultant for the WHO and other similar bodies. She also does work for the technical and training organisation for the Australian pharmaceutical industry (ARCS).</span></em></p>Some complementary medicines are useful while others are just plain quackery so any attempt to regulate the industry requires an understanding of this heterogeneity. What’s more, the regulator of the industry…Susan Walters, Adjunct Associate Professor, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/33182011-11-18T03:20:55Z2011-11-18T03:20:55ZConsumers need the facts about complementary medicines<figure><img src="https://images.theconversation.com/files/5171/original/Peter_Sunna.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Vitamins, minerals and herbal therapies should live up to the claims on their packaging.</span> <span class="attribution"><span class="source">Peter Sunna</span></span></figcaption></figure><p>Two out of three Australians use complementary medicines to boost their nutrition, alleviate various symptoms and improve their overall health and well-being. There are around 10,000 products to choose from and they’re not cheap – the industry generates around <a href="http://www.anao.gov.au/%7E/media/Uploads/Audit%20Reports/2011%2012/201112%20Audit%20Report%20No%203.pdf">$1.2 billion in sales</a> each year. </p>
<p>Despite the availability and common use of these vitamins, minerals, herbal remedies, aromatherapy and homeopathic products, consumers can’t always be sure how effective they are.</p>
<p>While pharmaceutical companies are required to prove the quality, safety and efficacy of prescription drugs and over-the-counter medicines to the <a href="http://www.tga.gov.au/">Therapeutic Goods Administration</a> (TGA) before they’re “registered”, complementary medicines aren’t required to live up to the claims on their packaging. </p>
<p>Rather, complementary medicines are “listed” by the TGA after being reviewed for safety and quality only. </p>
<p>The quality requirement means the medicine is produced by a licensed manufacturer and <a href="http://www.anao.gov.au/%7E/media/Uploads/Audit%20Reports/2011%2012/201112%20Audit%20Report%20No%203.pdf">adheres to the Good Manufacturing Principles</a>. The safety requirement is important because the components and content of active ingredients can vary, particularly among herbal products.</p>
<p>The difference between registered and listed products, and whether they’ve proved their efficacy, is often not clear to the consumer.
And as we saw with Ken Harvey’s recent battle with <a href="http://theconversation.com/sensaslim-and-me-how-criticism-of-a-weight-loss-spray-landed-me-in-court-1911">Sensaslim</a> over allegations of false and misleading advertising, consumers can’t always believe the claims made by manufacturers about the efficacy of complementary medicines. </p>
<p>The public backlash after the Pharmacy Guild announced its (now defunct) plan to <a href="http://theconversation.com/one-wrong-foot-after-another-the-ethics-of-the-pharmacy-guilds-deals-3939">recommend Blackmores products</a> to patients filling a prescription for four common ailments also shows consumers feel confused and misled about the efficacy of complementary products.</p>
<p>The TGA is expected to address this problem in the coming weeks
by announcing that <a href="http://www.theage.com.au/national/unprescribed-remedies-to-go-under-the-microscope-amid-efficacy-concerns-20111117-1nl2f.html">complementary medicines will soon have to carry a “not tested” label</a>. </p>
<p>But labels alone wouldn’t provide enough information to consumers, who want to know whether the medicine works. For that, testing is required. </p>
<p>So how should these therapies be tested? And should the same rules that are applied to prescription and over-the-counter medicines be applied to complementary medicines? </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/5629/original/mywellnesscentre.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/5629/original/mywellnesscentre.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=225&fit=crop&dpr=1 600w, https://images.theconversation.com/files/5629/original/mywellnesscentre.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=225&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/5629/original/mywellnesscentre.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=225&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/5629/original/mywellnesscentre.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=283&fit=crop&dpr=1 754w, https://images.theconversation.com/files/5629/original/mywellnesscentre.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=283&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/5629/original/mywellnesscentre.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=283&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">How can you measure therapies that harness human energy?</span>
<span class="attribution"><span class="source">mywellnesscentre</span></span>
</figcaption>
</figure>
<h2>Evidence-based testing</h2>
<p>Pharmaceuticals are subjected to a series of <a href="http://www.nhmrc.gov.au/_files_nhmrc/file/guidelines/evidence_statement_form.pdf">randomised controlled studies</a> to demonstrate their effectiveness. And while <a href="http://summaries.cochrane.org/search/site/complementary">some complementary medicines have undergone similar rigorous reviews</a> to demonstrate their efficacy, the idea of such evidence-based testing is problematic for many complementary and alternative medicine practitioners. </p>
<p>Practitioners of complementary medicines work in many different ways and their patients have varied goals. </p>
<p>Some complementary therapies, such as homeopathy and acupuncture, are based on the assumption that the human body has an energy level, with therapies having a physiological impact via the energy level. How could this be tested?</p>
<p>As Wainwright Churchill noted in an article in the <a href="http://www.jcm.co.uk/product/catalog/product/view/7610/implications-of-evidence-based-medicine-for-complementary-alternative-medicine/">Journal of Chinese Medicine</a>, in order to test the efficacy of complementary medicines, you would first need to address some difficult questions:</p>
<ul>
<li><p>Should the treatment that is researched be individualised for each patient? </p></li>
<li><p>Does it involve the personal relationship between the treating health professional and patient? </p></li>
<li><p>Does it involve the patient’s expectations, conscious or unconscious, of the treatment? </p></li>
</ul>
<p>This leads us to the role of the placebo: Is the placebo effect a valid healing modality?</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/5631/original/rutty.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/5631/original/rutty.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/5631/original/rutty.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/5631/original/rutty.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/5631/original/rutty.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/5631/original/rutty.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/5631/original/rutty.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">Flickr/rutty</span></span>
</figcaption>
</figure>
<p>Sceptics deride the placebo. And yet, the placebo effect is powerful in all therapeutic relationships, in allopathic and complementary medicine. To be effective, <a href="http://www.scientificamerican.com/article.cfm?id=placebo-effect-a-cure-in-the-mind">placebos don’t even require conscious belief</a> in a particular treatment.</p>
<h2>Lesson learned</h2>
<p>In determining a process by which complementary medicines should be evaluated, regulators should look to Switzerland for some lessons on what to avoid. </p>
<p>In the late 1990s, the Swiss government began a Program for Evaluating Complementary Medicine (PEK – <a href="http://www.bag.admin.ch/themen/krankenversicherung/00263/00264/04102/index.html">Programm Evaluation Komplementärmedizin</a>). </p>
<p>The findings of the evaluation were inconclusive but six years later, five complementary therapies were removed from the list of services covered by the national health insurance scheme. This occurred <a href="http://panmedion.org/files/PEK-Einleitung.pdf">before all parts of the review had been completed</a> and the process was far from transparent. </p>
<p>Recently, the Swiss government decided that from 2012 the five complementary therapies that had been removed from the health insurance scheme <a href="http://www.swissinfo.ch/ger/politik_schweiz/Komplementaermedizin_bleibt_auf_dem_Pruefstand.html?cid=29234668">will be included again</a>, at least for another six years. During that time, the organisations representing the five therapies will have to prove their effectiveness.</p>
<p>In Australia, consumers need reliable information about the effectiveness of all medicines, complementary or otherwise. The TGA’s plans to slap an “untested” label on complementary medicines simply isn’t enough. </p>
<p>It’s clear, however, that this world-first style of regulation won’t be easy. Regulators need to find testing methods that are acceptable to the majority of stakeholders – I’m not going to hold my breath but I hope we can one day achieve this goal.</p>
<p><em><strong>Should complementary medicines be tested for efficacy? Share your comments below.</strong></em></p><img src="https://counter.theconversation.com/content/3318/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Monika Merkes' self-managed superannuation fund owns shares in Blackmores.</span></em></p>Two out of three Australians use complementary medicines to boost their nutrition, alleviate various symptoms and improve their overall health and well-being. There are around 10,000 products to choose…Monika Merkes, Honorary Associate, Australian Institute for Primary Care & Ageing, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/22122011-07-10T20:50:41Z2011-07-10T20:50:41ZPanacea or placebo: doctors should only practise evidence-based medicine<figure><img src="https://images.theconversation.com/files/2203/original/Reema.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Some alternative medicine practices, such as homeopathy, have been proven to lack efficacy but remain in demand.</span> <span class="attribution"><span class="source">Photo_Robson/Flickr</span></span></figcaption></figure><p>Read the argument <a href="http://theconversation.com/doctors-should-focus-on-providing-the-best-care-alternative-or-otherwise-2303">for the use of complementary medicine.</a></p>
<p>The question of whether doctors should provide “complementary or alternative” medicines and procedures for which there is no scientific proof of effectiveness to their patients was recently put to me by the Medical Journal of Australia.</p>
<p>My response - no, they should not - is published today alongside an alternative view, opening the subject up to professional and public debate. </p>
<p>I have good reason to be confident in my stance - consumers looking for tactics to help them avoid illness and enhance good health are often bombarded with fraudulent misinformation. </p>
<p>The most recent highly-publicised example of this is the <a href="http://theconversation.com/sensaslim-goes-slapp-public-interest-crusader-cops-a-legal-whack-1889">SensaSlim affair</a>. The company <a href="http://theconversation.com/sensaslim-and-me-how-criticism-of-a-weight-loss-spray-landed-me-in-court-1911">marketed a solution, which, when sprayed on the tongue, had purportedly helped thousands lose weight</a>. </p>
<p>Even more sadly, patients battling illness, particularly one that is chronic or incurable, are easy prey for peddlers of false hope.</p>
<p>Extreme examples of this have ended with<a href="http://www.abc.net.au/news/stories/2003/08/29/935190.htm"> serious charges being brought against “alternative ” practitioners</a>. </p>
<p>Since current regulations are inadequate for protecting health consumers, I think doctors - men and women trained in science - should be the bastions of evidence-based approaches to health care. </p>
<p>Over 80% of Australians visit a doctor a number of times every year. These visits provide the perfect opportunity to educate patients about the uselessness of most alternative approaches - some of which can be dangerous and many of which are expensive.</p>
<h2>Parallel worlds</h2>
<p>In this, the most scientific of ages, it is surely unnecessary to accept two parallel but different approaches to prevention and treatment. </p>
<p>We need to abandon the dichotomy of orthodox medicine <em>versus</em> alternative and complementary medicines: there are, in fact, only two types of medicine - good and bad. </p>
<p>Good medicine is based on evidence, strives to be rigorously tested, does not accept as legitimate the deliberate use of the placebo effect and understands the realities of psychological factors in producing physical symptoms. </p>
<p>Bad medicine ignores scientific methodology, relies on anecdotal and “traditional” evidence, exploits the placebo effect and does not accommodate psychosomatic illness. </p>
<p>In our community, bad medicine often equates to alternative medicine.</p>
<h2>False legitimacy?</h2>
<p>Many universities now study complementary and alternative modalities. Using the scientific method to examine these allows scientists to declare something to be ineffective or not. </p>
<p>Studying alternative medicines also allows those found to be effective, which fill a therapeutic vacuum, to move into the good medicine category. </p>
<p>There are, however, precious few of the latter. </p>
<p><a href="http://en.wikipedia.org/wiki/Medical_uses_of_silver">Colloidal silver</a>, for instance, may kill bacteria but you wouldn’t use it in preference to an antibiotic. </p>
<p>And there are also a number of alternative practices that aren’t worthy of careful study because they’re an affront to certain knowledge of how bodies work as well as the laws of physics and chemistry. </p>
<p>Homeopathy, which was subject to intense study (even though its underlying premise is ridiculous) and shown to be useless; iridology; reflexology; “healing touch” techniques and; a number of claims made for chiropractic, all fall into this category. </p>
<p>Chiropractic practices are under the spotlight at the moment as claims that defects in the spine are responsible for numerous illnesses has some chiropractors treating asthma, migraine headaches, attention deficit syndrome and a host of other diseases, with spinal manipulation. </p>
<p>It is particularly disturbing that chiropractors make up the largest professional group affiliated with the anti-vaccination group known as the <a href="http://www.avn.org.au/">Australian Vaccination Network</a>.</p>
<h2>Seeking comfort</h2>
<p>Consumers are confused by competing assertions but are understandably drawn to the claims made for alternative medicines. </p>
<p>A reporter from the New Yorker magazine explained to me that people in this postmodern world long for simple, and somewhat, magical panaceas. </p>
<p>But it is surely unacceptable that taxpayer dollars supporting private health insurers end up paying for alternative, unproven or indeed discredited treatments. </p>
<p>In fact, such payments give them an imprimatur from insurers and provide them with undeserved credibility. </p>
<p>Doctors billing Medicare for complementary unscientific care are providing similar endorsement while misusing taxpayer dollars.</p>
<p>Pharmacists should protect consumers from much that is fraudulent and unscientific. But a majority of pharmacists, though trained in scientific method, have abandoned the need for evidence and stock their shelves with preparations known to be ineffective. </p>
<p>They’re almost always embarrassed when engaged in a conversation about this practice. Perhaps many have taken the advice I once heard Marcus Blackmore give at a pharmacy guild conference to “capitalise on consumer sentiment”.</p>
<p>Increasing numbers of doctors are advertising that they practice integrative medicine, offering patients “the best of both worlds”. </p>
<p>Some are no doubt exploiting “consumer sentiment”, some may believe they are offering better care but all have an ethical responsibility to concentrate on practising efficacious medicine.</p>
<p>This is expected of them by the majority of their peers, the Medical Board with which they are registered and the patients who trust them with their health.</p>
<p>Read the argument <a href="http://theconversation.com/doctors-should-focus-on-providing-the-best-care-alternative-or-otherwise-2303">for the use of complementary medicines</a>. Both contributions are based on articles published in the Medical Journal of Australia.</p><img src="https://counter.theconversation.com/content/2212/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John Dwyer does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Read the argument for the use of complementary medicine. The question of whether doctors should provide “complementary or alternative” medicines and procedures for which there is no scientific proof of…John Dwyer, Founder of the Australian Health Care Reform Alliance & Emeritus Professor, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.