Scientific evidence – Alternative / traditional treatments; a placebo effect.

Dr. Edzard Ernst is the world’s first professor of complementary medicine. After his 18 years in Peninsula Medical School, in south-west England, he decided to step down his post as professor. Dr Ernst and his research group have pioneered many studies of alternative medicine from Acupuncture and Ayurveda to Reiki channelling and herbal remedies. Alternative medicine is a big business around the world particularly in a country like India where beliefs matters much than science facts. Since it is a large unregulated market, reliable statistics are never available.

The market for these traditional alternative formularies was estimated at Rs 8,000 crore which includes over-the-counter and wellness products, treatment and herbal extracts and it has been growing at 20 per cent year-on-year. The export of these products took a jump from Rs 617.87 crore in 2005-06 to Rs 1335.01 crore in the year 2009-10 and are expected to reach Rs 16,250 crore in 2014. Around the world, according to an estimate the industry’s value is about $60 billion i.e Rs 3181 billion.

Dr Ernst and his group have run multiple clinical trials and published over 160 meta-analyses on alternative medicine (Meta-analysis is a statistical technique for extracting information from lots of clinical trials that are not, by themselves, statistically reliable.) Their findings are unwelcoming for traditional alternative medicine. According to his “Guide to Complementary and Alternative Medicine”, around 95% of the treatments he and his colleagues examined—in fields as diverse as acupuncture, herbal medicine (siddha/ayurveda), homeopathy and reflexology—are statistically indistinguishable from placebo treatments. Thus in lay terms, they are not different from placebos (A placebo is a hoax medical treatment—a pharmacologically inert sugar pill, perhaps, or a piece of pretend surgery).

In only 5% of cases it exhibited a clear benefit above and beyond a placebo or even just a hint that something interesting was happening to suggest that further research might be warranted.  The question is, does it make any sense that spending a huge sum of money over 5% of the placebo benefits?

Pharmacological preparations must be shown to be both safe and efficacious before they can be licensed for sale. That is rarely true of alternative treatments, because they mainly rely on a mixture of appeals to tradition and to the “natural” wholesomeness of their products to reassure consumers. That explains why, for instance, still some traditional practitioners can market treatments for malaria and even AIDS, despite a lack of evidence to suggest that such treatments work, or why some so called herbal traditional healers can claim to cure infertility.

Unlike their modern medicine counterparts, practitioners of alternative medicine often excel at harnessing the placebo effect. They offer long, relaxed consultations with their customers (which is said to be the “good bedside manner” that bothered modern doctors struggle to provide to their patients). Also alternative medicine practitioners believe passionately in their treatments, which are often delivered with great and reassuring ceremony. That alone can be enough to do well, even though the magnets, certain herb preparations, crystals and ultra-dilute solutions applied to the patients are, by themselves, completely useless as the highest level of scientific evidence. (Highest level of scientific evidences is systematic review and meta-analysis).

Dr.P.Ganeshkumar MD
Assistant Professor, Department of Community Medicine
SRM Medical College Hospital & Research Centre, Tamil Nadu. India