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
- Feldenkrais technique
- Fish oil
- Laughing therapy
- Music therapy
- Oil pulling
- Progressive muscle relaxation
- Tai chi
- Triggerpoint therapy
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.