Complementary therapies for arthritis, a wake-up call for funding bodies?
Reproduced from Issue 106 of Arthritis Today
Professor Edzard Ernst, of the University of Exeter's department of complementary medicine, argues that patients' interests can be served by proper research and clinical trials.
Complementary medicine seems to be everywhere. The media is full of it – sometimes to the point of overflowing. Sales figures of complementary medicines are booming beyond even the wildest imagination of the manufacturers. Patients are voting with their feet and wallets in favour of it. Arthritis sufferers are particularly prone to try complementary treatments: a recent summary of all published surveys on this subject showed that between 30% and 100% of patients with rheumatic disorders use one form of complementary medicine or another [1]. These well-established facts raise a number of issues.
Why are complementary therapies so popular?
Arthritis sufferers may have a whole host of reasons. They have obviously heard encouraging things. The media tends to report in favour of complementary medicine, and interestingly (or perhaps embarrassingly) most users of these methods rely on information from this source. Arthritis patients usually know that mainstream medicine offers no cure for their condition. Often they are somewhat disappointed with mainstream medicine – disappointed because there is no cure, because prescribed drugs have side-effects, and because time, sympathy and empathy are no longer high on the list of mainstream healthcare professionals. By contrast, complementary practitioners promise help without side effects. They also seem to be particularly good at providing time and understanding. Patients want to have more control over their illness and long for understandable explanations – the latest on tumour necrosis factor or receptor mechanisms (even though medically relevant) is less fascinating to them than the "imbalance of Yin and Yang" offered by an acupuncturist as the true reason for their suffering. The Yin and Yang may be medically irrelevant but can be important on a personal level.
Are complementary treatments doing more good than harm?
This question is immensely complex. Each therapeutic modality should be evaluated according to its own merits. Generally speaking, however, there are preciously few proofs of efficacy for any of these treatments to alleviate the symptoms (certainly no therapy represents a cure) of arthritis [2]. Also generally speaking, none of these therapies are entirely risk-free [3]. The risks may be small but at present we cannot be entirely sure in most cases. For establishing whether complementary medicine does more good than harm, essential data are simply not available.
Do we need data at all?
Is it not enough if a patient experiences relief of pain or increased well being after trying complementary medicine? Provided that no harm is being done (e.g. through a herbal remedy interacting with a conventional medicines or through a complementary practitioner advising the discontinuation of prescribed drugs in favour of his/her therapy) this could well be a reasonable argument. Of course, subsequently we want to profit from this patient's experience and see that the benefit is made available for other patients. This is why we need to make sure. For instance, we need to know whether the patient's improvement was due to chance or caused by a placebo effect. In other words, we need rigorous research usually in the form of clinical trials. We need this research not for some weird academic ambitions but to safeguard the interests of future patients.
Why are there so few clinical trials?
Such tests of efficacy are expensive and time consuming. Today most research (in mainstream medicine) is financed by the pharmaceutical industry and there is no shortage of highly skilled investigators to carry it out. In contrast, complementary medicine is burdened with a notorious shortage in funds and research expertise. The pharmaceutical industry has no real reason to invest. Other funding sources like the NHS or medical charities have so far looked upon complementary medicine as a strange fad or as outright quackery – certainly not as a subject that deserves their support in any meaningful way. There is no real tradition of research either. Those highly trained individuals with expertise and know-how are likely to prefer the full coffers of the pharmaceutical industry than to jeopardise their academic career by investigating an area still widely associated with charlatanism.
What needs doing?
Even if (semi) official bodies are against it, it seems unwise (even cynical) for them to totally ignore complementary medicine. If so many patients are using complementary medicine it is their ethical obligation to determine whether it does more good than harm. Thus funding bodies like the NHS and medical charities might be well advised to take complementary medicine seriously and dedicate research funds to it. After all, these bodies exist through funds from the public. The public has a moral right to see at least some of their money spent solving the most essential questions related to treatments they use on a daily basis.
References
- Ernst E. Usage of Complementary Therapies in Rheumatology: A systematic review. Clin Rheumatol 1998;17:301-305.
- Ernst E (ed). Complementary medicine, an objective appraisal. Butterworth, Oxford 1996.
- Ernst E, de Smet PAGM. Risks associated with complementary therapies. In Meyler's Side Effects of Drugs, 13th edition, ed Dukes MNG. Amsterdam: Elsevier
