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Eyeing Alternative Medicine
Can prodding your back or examining your eyes provide a cure for what ails you?
By Vicki Hyde, NZSM
Many alternative medical treatments had their origins in the days before medicine was put on a scientific footing. When patients had to contend with the then orthodox practices of blood-letting and purging, it is hardly surprising that alternatives were eagerly sought and often more effective.
These alternatives still often hearken back to ancient practices, whether the bone-setting techniques on which chiropractic was partially based or the sympathetic magic of homeopathy. In recent years, such alternative practices have gained increasing support, with much of this seen as a reaction of "natural" therapies versus the orthodox medical establishment.
Dem Bones, Dem Bones
Back pain is one of the most common of medical complaints, with up to 80% of adults suffering it at some stage. Relief from back pain can be spasmodic and unpredictable, and manipulation of various forms, whether by a chiropractor or physiotherapist, can produce results.
Chiropractic was developed in the late 1880s by Daniel Palmer, who suggested that "subluxations" of the spine impinge on nerves, impeding the flow of the "Innate Life Force". Palmer said that subluxations not only produced spinal problems, but also were responsible for all diseases.
Chiropractic has grown immensely, and has split into many different groups with different approaches. While some chiropractors say that the subluxation theory has been discarded, there are still many who display charts showing nerves from all over the body converging on the spine.
In one graphic demonstration, a Yale University anatomist showed that it was necessary to break the spine or completely sever all ligaments before any nerve impingement could be produced. His tests were performed on cadavers, and were criticised by some chiropractors because corpses no longer had the "Innate Life Force".
"Depending on the area of the spine, the nerve only occupies one-third of the intervertebral foramen, so quite a lot of bony movement would need to occur before bone pressed on nerve," concedes chiropractic researcher Bernadette Murphy. "It is now considered much more likely that what chiropractors are doing is imparting mobility to the synovial facet joints in the spine."
In New Zealand, Board Exams are used to test students graduating from accredited chiropractic training institutions. These students undergo training in basic medical and clinical sciences, as well as in manipulation itself. However, there are significant numbers of people practicing as chiropractors or manual therapists without formal training.
"The skill of manipulation is an art developed over time and cannot be learned in a weekend seminar," Murphy says, noting that inappropriate or excessive force can do far more harm than good.
A 1979 Commission of Inquiry into Chiropractic recommended extensive training for manual therapists. It also recommended that chiropractors should not be the first point of call for consultations concerning any disease; should not use spinal charts or call themselves doctors in their publicity material; and should be covered by a code of conduct and complaints committee. These recommendations have yet to find their way into law.
Chiropractic is under scientific study by Dr Noel Dawson and his team at Auckland University's Physiology Department. He and Murphy have been investigating how manipulation affects the excitability of nerve cells in the spinal cord ["A Pain in the Back", March 1992]. Murphy took up the study after observing improvement in patients' neurological function following chiropractic treatment.
"Sometimes the improvement was in the somatic nervous system, as indicated by altered reflex excitability, improved motor power and/or improvement in sensory abnormalities," she says.
In its investigation into chiropractic, the US National Council Against Health Fraud (NCAHF) conceded that about one-third of patients experienced more rapid relief with manipulation than with other treatments. Such relief tends to be on a temporary basis, however, often producing a dependency relationship between patients and chiropractors. The NCAHF also noted many cases of serious complications following manipulative therapy.
There are hazardous practices associated with chiropractic, not least of which are the physical "adjustments" used in manipulating the spine. The "master cervical" adjustment, a fast rotary neck movement, has produced paralysis, stroke and even death in patients, and is still in use, although condemned by some practitioners.
Full spinal x-rays -- a technique more common in the US than in New Zealand -- can also be hazardous. Unnecessary exposure to radiation has its own dangers and, when challenged, chiropractors have been unable to point out subluxations on such radiographs. Conversely, degenerative changes, such as those caused by aging, visible on an x-ray may not have anything to do with back pain.
"A large segment of the population will have spinal degenerative changes on x-ray and yet have no low back pain. Thus one needs to remember to treat the patient and not the x-ray," says Murphy.
Of greatest concern medically are those chiropractors who extend their claims to other areas, claiming spinal manipulation as offering cures for everything from astigmatism to allergies. They often combine chiropractic with other alternative practices, such as iridology, homeopathy, crystal healing and vitamin therapy.
Vets in Christchurch have been dismayed in recent months to find an upsurge in healthy cats being brought in to be put down. A local chiropractor has been advising his clients that a range of illnesses have been caused by a feline disease, and has been recommending that family pets be killed. The more scientifically-inclined chiropractors reject these sorts of practices, but they nevertheless remain relatively common.
While a physical mechanism for chiropractic results is discernible, no such mechanism exists for two other popular alternative therapies, homeopathy and iridology.
Homeopathy refers to "like curing like", the practice's central tenet that a substance which causes symptoms that mimic a disease will be effective in curing that disease. It is a concept expounded by German physician Samuel Hahnemann in the late 1700s.
Hahnemann used a huge range of extracts from plants, animals and chemicals to produce disease symptoms in healthy people. He reasoned that artificially induced symptoms would drive out the real disease, as he believed no-one could be infected with two diseases at the same time. Many of Hahnemann's identified extracts are still in use, along with remedies based on infectious bacteria taken from the sputum of patients.
Over the years, certain substances have been "matched" with certain personality types of patients. The properties of oyster shells, for example, are said to suit patients who are fearful and who feel better when constipated. Homeopathic consultations involve a large number of questions looking at a wide range of factors in the patient's life in order to build up a personality picture that will determine which substances to use.
Over 2,000 different extracts are in use, with many different preparations for the same complaint. Thus a remedy for a cold may use arsenic (for symptoms similar to arsenic poisoning, such as vomiting and diarrhoea), yellow jasmine (for lethargy and dizziness) or Byronia alba (for headaches and irritability). Some 250 preparations exist to treat headaches alone.
While it may seem reasonable that such extracts would have some physiological effect, the second basic tenet of homeopathy ensures that none of these substances actually comes into contact with the patient.
This is a result of the homeopathic belief that the potency of the preparation increases as the dosage is reduced, or "least is best". Homeopathic extracts are diluted in 100-fold steps to increase their potency. Thirty such dilutions are commonly used in producing homeopathic preparations, resulting in a final solution that has a dilution factor of 1060. Practical chemistry shows that, at that concentration, there would be no molecules remaining of the original extract. Indeed, a 1024 dilution, or 12th potency, is enough to ensure this.
While undergoing these dilutions, the solutions are shaken violently, or "succussed". Homeopaths claim that this process alters the physical nature of the water molecules so that the water "remembers" the long-gone drug. In addition, this potentised solution has enough power, it is said, to affect the water within a patient, allowing the preparations to be efficacious internally for many months.
In 1988, the prestigious science journal Nature sparked a controversy when it reported the results of a French trial which showed that homeopathic solutions of antibodies were able to produce degranulation in basophils, a type of white blood cell. A later investigation, in itself controversial, found unacceptable practices such as discarding data that didn't agree with the results and strong observer bias.
There have been other trials of homeopathy, but all have been heavily criticised for their lack of scientific rigour. One author, in reporting the apparent success of homeopathy in treating rheumatoid arthritis, went on to note that although the "results were not statistically significant", the treatments were "notable for the absence of toxic side effects".
Ironically, given the claims of higher potency at extremely low concentrations, the lack of side effects is one commonly cited advantage of homeopathy. However, use of homeopathy as an alternative to conventional medicine can have disastrous consequences.
In a Coroner's Court late last year, a mother described how she had refused antibiotics for her baby's ear infection, preferring to take homeopathic advice. Two weeks after the initial consultation, the baby was taken again to the homeopath, who expressed concern about its poor health but who did not suggest seeking conventional medical treatment.
The mother, a registered nurse, commented that the symptoms looked like meningitis and, two days later, took her baby to her regular doctor. The doctor insisted on the baby being hospitalised immediately and noted that it took some time to convince the mother to do this.
The consultant paediatrician at Wellington Hospital, Dr Thorston Stanley, reported a "great sense of frustration in dealing with the mother, who opposed him every step of the way". Despite intensive treatment, the child died a week later from brain damage as a result of bacterial meningitis.
Cases like this are, fortunately, rare, as most homeopaths will refer patients to general practitioners if they are obviously suffering from problems outside their sphere. However, the uncontrolled aspect of this form of health advice does not guarantee this.
The Eyes Have It
Like many alternative medical practices, iridology had its genesis in the late 1800s. Hungarian Ignatz von Peczely observed a mark in the eye of a bird with a broken wing, and went on to postulate that bodily ills were reflected in markings in the eye.
Some two dozen different iris indices are now used by iridologists to show which parts of the body are represented in which parts of the eye. These indices are often contradictory and bear no relation to actual anatomy. The left eye is said to mirror conditions on the left side of the body, and the right eye the right side, despite the fact that half the optic nerves cross between the eye and the brain.
Iridologists state that only two eye colours exist: brown and blue. Any other colouring is said to be a result of toxins or genetic weakness. Unhealthy eye colours -- green, white, yellow, orange or hazel -- can be changed, they say, through dietary modifications. This has yet to be demon-strated.
Some schools of irido-logy
Iridology is difficult to test, as iridologists often claim that their diagnoses are sub-clinical, made before overt symptoms are apparent. In addition, many of the conditions claimed are non-specific, such as "weak lungs" or "underactive pancreases".
A number of controlled clinical trials have been made producing results no better than chance, and with the various diagnoses of iridologists contradictory. One trial involved renal patients, as iridologists have often claimed a high success rate in determining kidney problems. Neither opthalmologists nor iridologists were able to diagnose kidney dysfunction on the basis of patient eye photos.
Prominent US iridologist Bernard Jensen has stated that "iridology is the kind of science that cannot be related through scientific tests".
Placation and Placebos
Why is there such strong support for alternative medical practices?
Doctors recognise that many medical problems will abate without treatment. Advice to take things easy or simply wait a while may not be acceptable to a patient looking for a definite "cure". Suggestions that some illnesses may have more of a psychological component than physiological are also unacceptable to many patients.
There is increasing criticism of the way in which conventional practitioners treat patients. Crowded waiting rooms, short consultations and harried staff combine to make patients more inclined to turn to perceived "people-centric" alternative practices. Many alternative therapies involve long, personal consultations where the patient is encouraged to feel that the practitioner is really interested in them as a person. Orthodox medicine is starting to realise that such an approach has its advantages.
"To my mind, the problem is not with the doctor who knowingly supports unorthodox approaches having exhausted the reasonable possibilities of orthodox diagnosis and treatment in the patient's interest, however repugnant this may seem to the scientific purist," remarks one doctor.
"Rather the problem is with the doctor who is unable to maintain sufficient detachment or intellectual rigour to see when an alternative approach is inappropriate, or worse, who comes to believe that pseudoscientific explanations actually are true."
Such a belief can be easy to establish. Should the easing of a condition, physical or psychosomatic, occur soon after some form of alternative treatment, then a spurious causal relationship between the two may be established, often as a result of the placebo effect.
A placebo is a non-active drug or treatment often used to test the efficacy of another substance. Thus one group of patients may be given a sugar tablet, as a control group, while another is given a drug. It is quite common for the control group to react positively to the placebo, in some cases dramatically so. Placebo preparations can provide headache relief for one-third to one-half of patients.
By including a placebo, researchers are able to measure how much the results are affected merely by the patients' belief in the drug or doctors, and how much can be attributed to the actual substance or procedure under testing. The placebo effect can be a two-edged weapon. It can convince a therapist that the treatment in use is truly effective, rather than the result of patient response.
The difficulty in assessing alternative therapies is that few have been subjected to controlled trials, relying instead on personal testimonials and unsubstantiated anecdotal accounts. This is not adequate scientifically, but is acceptable to many people in search of some form of cure for what ails them. Without greater knowledge of the questionable science behind such cures, alternative therapies will continue to be popular.
Vicki Hyde is the editor of New Zealand Science Monthly.
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