The media have long had a keen interest in alternative medicine and report regularly on the subject. But all too often the messages conveyed are far from clear. Consequently, alternative medicine can be a minefield for consumers.
Take acupuncture, for instance. Today the press might report that it is an effective and safe therapy for anything from acne to zoster, and tomorrow we learn that it is nothing but a theatrical placebo. Sound information is rare, and consumers find it hard to tell the promotional waffle from the responsible advice. In this situation, institutions informing the public objectively and responsibly would be most welcome. Hundreds of organisations pride themselves on offering just that.
The Acupuncture Now Foundation (ANF) is as good an example as any. The ANF is a worldwide organisation of volunteers which was founded in 2014. Its mission is ‘to become recognised as a leader in the collection and dissemination of unbiased and authoritative information about all aspects of the practice of acupuncture’. This is a high and laudable aim, and when I first read this statement, I thought: great, this is just what we need! But hold on — let’s not jump to conclusions. We must first find out how credible their claims really are. So, let’s check them out.
The ANF have recently published a document — they call it a ‘white paper’ — promising a ‘look at some of the evidence supporting acupuncture’s effectiveness and how it facilitates self-healing’. On closer scrutiny, it turns out to be a masterclass in misinformation. In fact, the white paper very much resembles a whitewash.
Let me try to justify this by checking three statements from the document in question.
Quote No 1
‘Male fertility, especially sperm production and motility, has also been shown to improve with acupuncture. In a recent animal study, electro-acupuncture was found to enhance germ cell proliferation. This action is believed to facilitate the recovery of sperm production (spermatogenesis) and may restore normal semen parameters in subfertile patients.’
The article supplied as evidence for this statement by ANF refers to an animal experiment using a model where sperm are exposed to heat. This has precious little bearing on the clinical situation in humans and certainly does not lend itself to clinical conclusions regarding the treatment of sub-fertile men.
Quote No 2
‘In a recent meta-analysis, researchers concluded that the efficacy of acupuncture as a stand-alone therapy was comparable to antidepressants in improving clinical response and alleviating symptom severity of major depressive disorder (MDD). Also, acupuncture was superior to antidepressants and waitlist controls in improving both response and symptom severity of post-traumatic stress disorder (PTSD). The incidence of adverse events with acupuncture was significantly lower than antidepressants.’
The review provided as evidence by ANF is wide open to bias; it was criticised in no uncertain terms: ‘The authors’ findings did not reflect the evidence presented and limitations in study numbers, sample sizes and study pooling, particularly in some subgroup analyses, suggested that the conclusions are not reliable.’ Moreover, we need to know that by no means all reviews of the subject confirm this positive conclusion, for instance, this, this, or this one; and all of these latter reviews are more up-to-date than the one provided by ANF. Crucially, a Cochrane review (Cochrane reviews tend to be the most reliable available) concluded that ‘the evidence is inconclusive to allow us to make any recommendations for depression-specific acupuncture’.
Quote No 3
‘A randomised controlled trial of acupuncture and counselling for patients presenting with depression, after having consulted their general practitioner in primary care, showed that both interventions were associated with significantly reduced depression at three months when compared to usual care alone.’
Closer inspection reveals that the trial in question made no attempt to control for placebo effects. In reality, therefore, its findings are consistent with the view of those experts who claim that acupuncture is nothing more than a theatrical placebo.
These three examples demonstrate much of what is currently wrong with the promotion of specifically acupuncture and alternative therapies in general. Of course, the ANF is just one organisation, but we have researched this area repeatedly and found invariably that websites offering information on alternative medicine are a risk factor to our health. In 2004, for instance, we published an assessment of websites offering alternative treatments for cancer and concluded: ‘The most popular websites on complementary and alternative medicine for cancer offer information of extremely variable quality. Many endorse unproven therapies and some are outright dangerous.’
Most consumers who are tempted to try alternative medicine want to obtain reliable information about their chosen therapy. If they ask their conventional healthcare professionals for help, they are likely to find that most of them know too little about alternative medicine to provide reliable advice. The internet is, of course, full of sites on alternative medicine — currently more than 50 million! — but the vast majority of these websites in question are lamentably promotional and many are overtly advertising dubious products for a healthy profit.
Eventually, the increasingly desperate consumer might come across one of the seemingly trustworthy websites — like the website of the ANF, claiming to work ‘for the good of patients and the future of health care’. This sounds impressive — but, as we have just seen from the examples I provided, in truth it is little more than promotional spin for the business of alternative practitioners. What looks like reliable information is not.
And what is the solution? How can we prevent consumers from taking therapeutic decisions based on misinformation? The obvious answer is by directing them to sources that are independent, non-commercial, objective, transparent and reliable. As I said, they are rare, but here are a few that I might recommend:
Edzard Ernst, emeritus professor at the University of Exeter, is the author of Homeopathy: The Undiluted Facts and the awardee of the John Maddox Prize 2015 for standing up for science. He blogs at edzardernst.com.