x Abu Dhabi, UAEWednesday 17 January 2018

Complementary or quackery?

Acupuncture is one widely popular alternative medical treatment, but controversy persists.

Acupuncture, an ancient Chinese medical practice that treats illness or provides therapy by the insertion of needles into the body, has become popular in the West.
Acupuncture, an ancient Chinese medical practice that treats illness or provides therapy by the insertion of needles into the body, has become popular in the West.

Complementary medicine (CM) is big business. Covering everything from massage to colonic irrigation, the field encompasses any treatment or therapy that sits on the boundary of what's considered to be conventional medicine. Its success has been the subject of ridicule mixed with fierce debate for decades, along with intense scrutiny by the scientific community. If you listen to mainstream medical advice, alternative therapies offer no benefits whatsoever. The vast majority of the medical fraternity dismisses the favourable benefits patients report after such treatment as a placebo effect.

But at times, this dismissal may reflect a completely different medical phenomenon: an ego effect on the part of the health professional. If you don't believe me, the next time you're ill and you need to visit your general practitioner, I dare you to ask if it would be worth your while to see an applied kinesiologist. I dare you. Doctors, quite rightly, are proud of what they do and the amount of study they have to put in to enter their profession. The idea that someone can do a three-month aromatherapy course and set themselves up in business as a health professional causes, at best, a level of bemusement; at worst, it triggers downright outrage.

The medical community has to a large degree closed itself off to the very idea that alternative therapies have benefits. They want to protect their profession from pseudoscience. The only answer is that practical scientific studies should be applied to all aspects of complementary medicine. At the forefront of this approach is Dr Edzard Ernst, who became the United Kingdom's first professor in complementary medicine when a department was formed at Exeter University in the 1990s.

Since he became head of the department, Dr Ernst has pushed for scientific data to be applied to all aspects of medical treatments as a normal practice of representing the effectiveness of a clinical setting. "I'm still convinced that the best approach is to apply rigorous science," he says. "What we need is reliable data, and at present they do not exist." Dr Ernst has become some thing of a thorn in the side of advocates of complementary medicine, but he makes no apologies for applying hard science to the subject.

"There can only be one standard and it has to be applied across the board, whether it's applied to a pharmaceutical or complementary medicine," he says. "Double standards will be bad in the long term." However, Dr Ernst is well aware of the pull alternative medicine has with the public. In a review published in the Journal of the Royal Society of Medicine in 1995 he wrote: "The topic of CM seems deeply entrenched in misconceptions which clearly are obstructive to meaningful advances in this complex area. At the same time, the subject of CM has become so important that it would be foolish of mainstream medicine to carry on ignoring it. Our patients demand CM from us. Where they cannot get it, they help themselves by bypassing the medical profession."

This remains true today, so much so that there has been a push in recent years in several countries for health services to provide alternative health therapies to cater to the growing number of patients requesting them. It's commonly known as Integrated Medicine, and Dr Ernst believes the protocol being followed isn't appropriate. "In my view, using treatments and then some time down the road testing them to see if they work is wrong," he says. "Do research first then talk about integration."

Another issue relating to integrated medicine is cost. How much money should a health service dedicate to make these treatments available? Dr Ernst applies the scientific method to answer this question as well. "This can only be determined by the amount of reliable evidence," he says. "Unless we turn health into a supermarket, it is the need, not the demand that counts." But if the demand is not met, he says, the patients will "help themselves by bypassing the medical profession." It comes down to research, and as Dr Ernst proposes once the evidence is there it should not be ignored. The problem that then arises is how the benefits of certain treatments can be quantified.

"It's complex," Ernst says. "Acupuncture may work for pain, but not for alleviating smoking, so is that effective or not?" Acupuncture is an alternative treatment that offers strong evidence of having practical benefits for a number of ailments, but there have been claims about its effectiveness for many more conditions which, when scientifically evaluated, have proven inconclusive. Nevertheless it has become widely popular in the West.

While the jury is still out on acupuncture as a treatment, many acupuncturists have adopted state of the art technologies and the latest research to improve their ancient craft. The Swiss Academy of Scientific Acupuncture, which has opened a clinic in Dubai Healthcare City, has taken this route. Dr Sandi Suwanda, the centre's medical director, accepts that his patient base has a certain perception of what acupuncture is, and what it can do for them.

"It's a different culture and a different sensitivity for European patients to accept acupuncture, so a specific range of technology was designed for these patients," he says. "So, for example over the last six years we've been using laser needle technology, which means we don't use metal to penetrate the skin's surface, we use laser without any penetration." Dr Suwanda is also applying hard science in his practice. Using products that are widely available in pharmacies across the globe, acupuncture has arrived in the 21st century.

"Hyaluronic acid keeps water in the skin to keep it flexible. The ageing process is reduced. Here we apply a gel with this added and we work it into the skin using the laser," he says. "I think the classic philosophy of acupuncture combined with the latest scientific technology is the best way to introduce this form of treatment to countries like the Emirates that perhaps don't know all the facts about acupuncture medicine."

Knowing all the facts is a factor in any form of complementary medical treatment, but ultimately a therapy's benefits must be quantified, and it is this aspect that Dr Ernst believes will hold the key to the future of complementary medicine. "The long-term future will be determined by the evidence, not by opinions of even the most influential or powerful people," he concludes. Peter Donnelly is a Science Correspondent with the Life Science Divison of IIR Middle East in Dubai