Complementary therapies – a patient led revolution
Reproduced from Issue 109 of Arthritis Today
After more than 60 years concentrating on laboratory based science, the Arthritis Research Campaign is launching a major new initiative to fund research into complementary therapies.
Over the past few years there has been an explosion of interest in complementary therapies among the general public. The media is equally obsessed – open any broadsheet or tabloid and you'll find pages of articles and advertisements enthusiastically proclaiming the virtues of Devil's Claw, St John's Wort and glucosamine sulphate.
Despite the public enthusiasm for non-conventional remedies, the medical profession – including most of the rheumatological community – continues to regard any substance or technique that has not undergone scrupulous clinical trials and/or extensive research with the utmost scepticism, not to say downright hostility.
But the fact remains that many people with arthritis are deeply dissatisfied with traditional, drug-based therapies offered to them by medics. They don't want to simply stuff themselves with pills which can have drastic side effects or may not work anyway. Patients want to feel as though they are doing something for themselves, taking control, being listened to – and taken seriously.
Much complementary therapy, including homeopathy, herbalism, hypnotherapy and acupuncture, remains scientifically unproven. But that doesn't stop one in three people in the UK having tried it – twice that number among people with chronic conditions. Sixty six per cent of rheumatoid arthritis patients use complementary therapy. They can't all be wrong or misguided. And although the power of the placebo is strong – often around 30 per cent – if something makes you feel better what's wrong with taking it?
The problem is, that among the many entirely competent, qualified and effective practitioners of complementary therapists, there are many who are not. And there are many therapies that veer into the lunatic fringe. It's hard for the public to know which ones to take seriously. Magnet therapy? Copper bangles? Coral calcium? MSM? Many people end up paying a lot of money for unproven products.
For these reasons there is a real need for scientific evidence to prove or disprove the effectiveness of complementary therapies. And until very recently, there has never been the will by organisations with sufficient clout or financial backup to do anything about it.
Now arc has decided to direct some of its resources into investigating various forms of complementary therapy. In fact, it has already started – in February it awarded its first-ever project grant to a Newcastle doctor to carry out a clinical trial into the effects of acupuncture in patients with osteoarthritis of the knee.
Chief executive of arc, Fergus Logan, explains: "New medicines and treatments have traditionally been developed under a convention which says in a nutshell: 'Don't use it if you can't prove it.' But in complementary medicine, it is often believed that the proof is provided by use – and that no further investigation is needed. Scientists find this concept difficult – hence the scepticism some feel.
"We are hoping to bridge the gap by devising ways of researching complementary therapies which will provide the rigour science requires without scaring off the complementary therapists.
"The first step is to put the two in touch with each other, so that traditional scientists can explain to prospective complementary researchers the sort of questions they need to be answering."
arc's initiative has been widely welcomed. Stephen Holgate, who chairs arc's programme grant sub committee, and is Professor of Immunopharmacology at the University of Southampton, is also heavily involved in the Foundation for Integrated Medicine.
The Foundation (whose President is Prince Charles) promotes just that – mainstream and complementary therapies working alongside each other. Its ideal would be a GP practice where patients are referred for acupuncture, homeopathy, osteopathy and massage therapy – all within the same centre and funded by the NHS. It's not a complete pipe dream – a recent survey showed that 40 per cent of general practices provide access to complementary therapies, 70 per cent of which was funded by the NHS.
Stephen Holgate believes there are shortfalls in the provision of conventional treatments, and that there is scope for both doctors and qualified private practitioners to work side by side. But , he says, before that can happen there needs to be a proper training programme, and research to make sure complementary therapies are safe – as well as effective. A House of Lords Select Committee is looking to tighten up the regulations applying to complementary therapists to ensure they are all trained, qualified and trained.
Dr Philip Helliwell, a rheumatologist and a member of arc's Education Committee, is cautiously enthusiastic about the charity's new move. His own rheumatology department offers patients acupuncture and manipulation, and refers them for chiropractic, osteopathy, and the Alexander technique.
"You could say that it's up to complementary therapists to prove the efficacy of what they practice, but on the other hand a lot of our patients use them, it morally behoves us to invest in them, " he says. "Some therapies will doubtlessly be debunked, but unless we can come up with a terribly effective cure for their arthritis, people will keep on with these therapies."
Professor Edzard Ernst, who heads the department of complementary therapies at the University of Exeter, and is a long-term advocate of the need for scientific evidence, warns that there has to be enough expertise available to make the initiative work.
"Lack of research skills and facilities means that an injection of funds is unlikely, in itself, to solve the problems of research into complementary therapies," he says. "A lack of research infrastructure has always been regarded as one major obstacle to the production of high-quality research."
Dr George Lewith, honorary consultant physician at the University of Southampton's school of medicine, and author of arc's complementary therapies booklet, takes up the point.
"One of the main problems that exist within complementary medical research is the difficulty of encouraging new projects of high quality. Consequently, some ideas that look very good do need mentoring. While there may be many ideas, the intellectual and research capacity to investigate them competently is limited."
However, once the will is there, ways can usually be found. And to musculoskeletal physician at the University of Newcastle, Dr Susanne Bower, who is leading the arc acupuncture trial, it's quite simple: "Acupuncture requires credibility, and we want to produce an orthodox scientific study which will answer questions about efficacy and safety. If the study is positive towards acupuncture, then the medical establishment will take notice, and it will become accepted – and more widely available for the benefit of patients."
Says Fergus Logan: "What do we hope to achieve? Well, we don't yet know what response we will get from the complementary medicine movement, but we aim for an understanding of where things seem to work of why they do. And, just as important – we want spurious products and quackery to be debunked once and for all."
