MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

My recent book discusses 20 of the worst and 20 of the best so-called alternative treatments. Some people are surprised and ask HOW DID YOU MANAGE TO FIND 20? WHAT THERAPIES ARE YOU TALKING ABOUT? As the book is in German, I have for non-German speakers the translated list and my concluding remarks from the book about the 20 best:

  • Alexander technique
  • Autogenic training
  • Chondroitin
  • Feldenkrais technique
  • Fish oil
  • Glucosamine
  • Hypnotherapy
  • Hypericum
  • Garlic
  • Laughing therapy
  • Lymphdrainage
  • Music therapy
  • Oil pulling
  • Pilates
  • Progressive muscle relaxation
  • Cupping
  • Tai chi
  • Triggerpoint therapy
  • Visualization
  • Yoga

When I look at the ’20 best’, I notice a few things that are perhaps worth highlighting again. The most striking thing is certainly that they are often therapies that are so close to conventional medicine that they can hardly be counted as alternative medicine anymore. Autogenic training, chondroitin, Feldenkrais therapy, fish oil, glucosamine, hypnotherapy, St. John’s wort, laughter therapy, lymphatic drainage, music therapy, and trigger point therapy are all procedures that are now at least partially integrated into conventional medicine. This brings to mind Tim Minchin’s bon mot, “You know what they call alternative medicine that’s been proven to work? – Medicine.”

The ’20 best’ can be roughly divided into three main categories:

1. physical therapies such as Alexander Technique, Feldenkrais Therapy, Lymphatic Drainage, Pilates, Tai Chi, and Yoga.
2. relaxation therapies such as autogenic training, hypnotherapy, laughter therapy, music therapy, progressive muscle relaxation, and visualization.
3. pharmacological therapies such as chondroitin, fish oil, glucosamine, St. John’s wort, and garlic.

That exercise, relaxation, and pharmacology can be effective is probably no surprise to anyone. In other words, unlike the ’20 Most Questionable’, almost all of the ’20 Best’ are supported by some plausibility. Very rarely does one find a therapy that is both implausible and effective. Among the procedures discussed in this book, this is the case only for Feldenkrais therapy.

In the review of the ’20 Best’, I have repeatedly emphasized that the evidence, while positive, is seriously flawed and therefore not as convincing as one might wish. There may be several reasons for this:

– In most cases, there is too little research funding available to conduct a sufficient number of good studies.
– Even if the money were available, the expertise (and occasionally the will) to test the methods scientifically is often lacking.
– Clinical trials of alternative medicine are often considerably more difficult to design and conduct than studies in conventional medicine. For instance, it is not always easy to find an adequate placebo. For example, what is an appropriate placebo for a study of hypnotherapy that allows patients to be blinded?

It follows that we must occasionally turn a blind eye, but ultimately cannot be completely certain that the procedure in question is in fact anything more than a placebo.

While the ’20 Most Questionable’ include many procedures that have been touted as panaceas, this is rarely the case with the ’20 Best’. On the contrary, most of the treatments in this category are effective for only a very few indications. Here the saying of one of my clinical teachers comes to mind, “If a therapy is supposed to be good for everything, it most likely won’t work for anything.”

What further strikes me as important is the fact that while all of the methods mentioned are effective, they are invariably symptomatic. None of the ’20 Best’ represents a causal therapy that can address a disease causally and thus actually cures it. This is in stark contrast to the many claims of healing made by alternative medicine providers, who all too often advertise their methods as addressing the root cause of a condition.

If we take a close look at the ’20 best’, we must finally also ask ourselves which of these methods are actually better than the conventional treatment of the same condition. All 20 have been positively evaluated by me in terms of their benefit/risk ratio. But this does not mean that they are superior to conservative therapy with respect to this important criterion. St. John’s wort is the most likely to meet this condition; it is as effective as conventional antidepressants for mild to moderate depression and has fewer side effects than them. Its benefit/risk ratio is thus superior to that of conventional antidepressants. I am not sure about any of the other treatments in the ’20 Best’ category.

11 Responses to The 20 best so-called alternative treatments

  • “What further strikes me as important is the fact that while all of the methods mentioned are effective, they are invariably symptomatic. None of the ’20 Best’ represents a causal therapy that can address a disease causally and thus actually cures it.”

    The Alexander Technique is an approach for better general use and functioning. It is most effective when specific symptoms are not targeted. Rather, by learning to recognise and avoid ingrained habits of undue tension, natural balance and coordination are restored and particular symptoms may resolve as a consequence.

  • A bit surprising (to me) that cupping made it to the list. But on the other hand, I can’t think of a SCAM-modality, that should replace it.

  • Oil pulling??

    No.

  • I think your concluding remark tells it all. After declaring St. John’s wort as worthy, you conclude:
    “I am not sure about any of the other treatments in the ’20 Best’ category.”

    So if I understand you correctly professor, in reality, you have only found one SCAM that works, right? And it has indeed become a rather widely used product for mild depression, albeit not convincingly so according to my psychiatrist friends. So technically it should not be considered among SCAM anymore?
    The rest of the twenty lame runners up have consistently failed to reach the goal. So they remain in the SCAM category.

    Your. list is curiously heterogeneous though. Here are some personal thoughts on some of its components.
    Chondroitin and Glucosamine were indeed thought to be plausible drug candidates for a good while. But they have for some years been fading from fame and disappearing from treatment guidelines as evidence and clinical experience just does not hold up. They certainly didn’t do anything for my arthritis. As many derivatives from food they seem to be just that, components of food. So is garlic, just food with a smell and a long lasting but undeserved assumption of magical properties.

    What surprises me perhaps most is to see “cupping” on your list. I would have placed it among the worst, due to its character. This archeological exhibit stemming from the practice of blood letting produces intentional injury mistakenly thought to bring benefit. I have never seen credible evidence for its utiliity or efficacy for any ailment. I look forward to learning why you placed it among thhe hopeful. Its safety level is below zero as its modus operandi is infliction of injury. So by design, its risk/benefit ratio is above one, which rules this naivety out as a medical modality. It is effective as in effectively deceptive.

    “Yoga” is also an interesting item. In my view it cannot in modern context be considered an entity i.e. a defined method of SCAM. The term is used for whatever performance, calisthenics, New-Age ceremonies, relaxation sessions, meditation, etc. the user wants to sell and can in any way pretend to be related to ancient Indian antics. In our so called “western” societies, “Yoga” is in effect just a marketing buzzword.

    Other items such as Tai Chi and Pilates are simply variiants on more or less physiical activity, usually involving group activities and calisthenics. Anything that activates and excerciises body and mind is naturally of benefit and does not have to be classed as quuestiionable or listed along with SCAM. SCAM and medicine are not dichotomous entities. As Dara O’Briain might have put it, “there is more to life than” SCAM and medicine 🙂 There are also arts and entertainment, fun and games, for example. I am tempted to put many variants of Yoga and popular activities such as Tai-Chi in that category, despiite it often benig mixed with esotericism and new-age nonsense.
    I have had fun participating in a “Laughter therapy session” by a nurse friend. Such theatrical pastimes can certainly lift spirits and give temporary relief from the burden of worries and woes. But claims of medical efficacy for disease should be discouraged.

    Now this little essay of mine really grew a bit out of intended proportions. 🙂
    I hope our resident trolls and other sourpusses will realise it will be futile to heckle me for my musings. I don’t mind being on the receiving end of their mundane mud-pies.

    I certainly look forward to your new book, which should be on its way from Amazon.

  • As mentioned by Malcolm Williamson above, the rationale behind the Alexander Technique is that bad habits of posture and movement can cause problems, and that changing these habits can solve them. The claim is clearly that the technique deals causally with disease, albeit within certain limits.

    On the fundamental level this is axiomatic: Stop banging your head against the wall and it will stop hurting. The question is to what degree bad habits are the cause, and to which degree the Alexander Technique can change said habits. There is some evidence, but not as much as we would have liked.

    Halvard Heggdal
    Alexander Technique teacher

  • Could I suggest that rather than best SCAM you should call it “more acceptable to yourself”.

  • Maybe they are your best 20 because they fit with your mechanistic paradigm of life.

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