Are all alternative therapies useless? Not quite. Here are three that work

In my last article I stated that alternative treatments are therapies that either have not been proven to work or have been proven not to work. Like so many quips, this sentence expresses a complex matter succinctly but simplistically.

A similar statement is attributed to Tim Michin: what do we call an alternative medicine that works? We call it medicine! It suggests that all alternative therapies are ineffective. Once an alternative treatment has been proven to work, it swiftly becomes part of conventional medicine. This sounds obvious to many sceptics — but is it really true?

Another witticism contradicts this notion by stating that, in medicine, we make progress ‘from funeral to funeral’. This implies that progress in healthcare is rarely swift and that the old generation of opinion leaders has to retire before a novel approach (such as an effective alternative therapy) will be accepted. To the many fans of alternative medicine, this notion highlights the closed-mindedness of ‘the establishment’. But this assumption might be simplistic too.

Reality hardly ever mimics the little clichés or prejudices we tend to create in order to make sense of the world around us. None of the above bon mots are entirely true, nor are they entirely false; and none of them tell the full story. Let me try to explain this using three alternative treatments as examples.

The first one is tai chi; this meditative exercise regimen has long been used by the elderly in China and now has also become popular in the West. But does it work?

This is, of course, a silly question — work for what? Aspirin works very well, but not for everything. It might reduce my headache but does not cure my baldness. Yet, in alternative medicine, we often encounter claims that this or that therapy cures everything. This is dangerous nonsense; a cure-all is just as implausible as a perpetuum mobile.

Therefore, we need to ask: does tai chi work for a specific condition? Does it, for instance, prevent falls in the elderly? Some might sneer at this question; it is not on the scale of curing cancer, but it is nevertheless hugely important. Many old people fall, break a hip and subsequently need weeks of medical care and attention; some even die in the course of it.

The answer to the above question is crystal clear: tai chi reduces the risk of falling. This is not my opinion; it is the verbatim conclusion of a Cochrane review on the subject which evaluated six tai chi trials. In other words, we have identified our first alternative therapy that works for at least one purpose.

And has this alternative medicine become medicine? No! Why not? Because there is a snag.

You will appreciate it, once you read the full conclusions from the Cochrane review: ‘Group and home-based exercise programmes, and home safety interventions reduce rate of falls and risk of falling. Multifactorial assessment and intervention programmes reduce rate of falls but not risk of falling; tai chi reduces risk of falling. Overall, vitamin D supplementation does not appear to reduce falls but may be effective in people who have lower vitamin D levels before treatment.’ This means that tai chi works but other, more conventional treatments might be more suitable, cheaper or more available.

My second example originated from the plant kingdom and is equally exotic: kava (or Piper methysticum, if you insist). This is a herbal medicine that, about 10 years ago, used to be very popular for managing anxiety. It originates from the South Sea where it has been used as a recreational drug for centuries.

Does kava work for anxiety? The answer is yes. In 2003, we published a Cochrane review of all rigorous studies testing the efficacy of kava as a treatment of anxiety. We were able to include 11 randomised, placebo-controlled trials and concluded that ‘compared with placebo, kava extract appears to be an effective symptomatic treatment option for anxiety. The data available from the reviewed studies suggest that kava is relatively safe for short-term treatment (one to 24 weeks), although more information is required. Further rigorous investigations, particularly into the long-term safety profile of kava, are warranted’.

Great! We have identified another alternative therapy that clearly works. Alas, again there is a problem. For a while, many of us thought that kava was safe and effective. When the first reports of side effects emerged, we were not particularly worried — which medication is totally free of them? But then a flurry of reports was published suggestive of severe liver damage after kava intake. At this stage, many national regulators became seriously concerned and started to investigate. The results seemed to indicate that the commercial kava preparations on the market were indeed liver-toxic. Consequently, kava was banned in many countries.

My third example is garlic. We all know it as a spice, of course. Its medicinal properties are less well appreciated, but nevertheless well documented. For instance, regular intake of garlic supplements has been shown to lower cholesterol level and to normalise elevated blood pressure. Both effects could be highly desirable for preventing cardiovascular disease.

If that is so, why do doctors rarely prescribe garlic supplements for their patients at risk of cardiovascular disease? The reason is simple: both effects are statistically significant but not necessarily clinically all that relevant; in fact, they are relatively small, and we have plenty of much more effective drugs that can achieve both aims reliably, safely and cheaply. In other words, garlic may work, but it works less well than conventional medicines.

What do these three examples tell us?

They show, I think, that some alternative therapies do indeed work. And yet, they have not become part of mainstream medicine. The reasons for this can be complex and varied. In the case of tai chi, they have to do with the fact that there might be other options that are easier to access. In the case of kava, they are based on concerns about the safety of the treatment. In the case of garlic, they relate to the fact that more effective medicines are available. In none of these instances, they include the closed-mindedness of doctors.

So yes, some alternative medicines do work in the sense that they are better than a placebo. But this fact does not necessarily mean that they are the best option currently on offer. I have been in this business for a very long time now, I have published more papers on alternative medicine than any other researcher on this planet — and yet, I have never come across an alternative therapy that clearly and demonstrably out-performs conventional medicine. And in that sense, the bon mot that ‘alternative treatments are therapies that either have not been proven to work or have been proven not to work’ does make sense after all.


  • Nick

    I would expect more research from you, Edzard Ernst, before posting such an article. Your concerns of kava being liver toxic have long been disproved with European lifiting their bans within the last two years due to many new studies being concluded asserting its safety.

  • Tony

    Tai Chi is exercise. That is not alternative. If used to treat balance problems it falls in the field of physiotherapy.

  • Edmond OFlaherty

    The treatment of depression and anxiety is largely confined to SSRI antidepressants. They work quite well for many patients but they are prone to have side effects and sometimes make the condition worse. In 2006 I went to Sydney to learn all about nutrient therapy in mental health. Having seen a few thousand cases since I enjoy my work far more than before and the patients love to be on less medication and quite often on nutrients only-individualised doses of vitamins, minerals and other nutrients. Most people benefit but not all. Recently I got a phone call from a British consultant psychiatrist who plans to introduce this type of treatment in the university hospital. I hope that this knowledge will spread across the country. It is far more successful in my experience than medication alone. Although I am a GP in Dublin I have seen patients from all over Europe and beyond due to word of mouth.

  • jazzfan47

    Pure sophism at its worst. This is pure gibberish. The examples used have nothing to do with actual alternative treatments that work better than conventional medicine.

  • ichthyic

    article is a bait and switch.

    example:

    Talks about Tai Chi and it’s value to balance. What does it compare it to? standard physical therapy? Why no… it compares it to VITAMIN D therapy.

    are you kidding me?

    it’s beyond intellectually dishonest and gets into downright lying territory.

    author should hang their head in shame.

  • Garlic and Tai-Chi may work for some, but like many old treatments, it’s difficult to secure patents. Many conventional medicine GPs are likely to discuss lifestyle issues … if they have time !

  • Kathie Alexander

    It would be a great breakthrough to find a one-size-fits-all cure for different types of cancer. But each individual is unique and the way people respond to treatment also varies. Not everyone who has undergone a chemotherapy was cured nor everyone who prefers alternative treatment was cured as well. Depending on the complete medical treatment that you will be receiving or undergoing, you need to be aware and informed which are the most appropriate for your condition. Claiming that none of the alternative treatment method works is somewhat misleading. If in case you are receiving medication such as blood thinner or you suffer from low blood counts, then acupuncture is not a suitable treatment to ease nausea after a chemotherapy. This is why New Hope Unlimited advised that patients have a complete rundown of medical treatment, so specialist can create a unique approach for their condition. Lets say for example, if you have bone-related illness, then even a simple massage is not recommended for you. So instead of focusing on just alternative treatment method for cancer, New Hope Unlimited prefers a multi-disciplinary approach where they combine both alternative and conventional depending on the patient’s unique case.

  • Callipygian

    Tai chi will reduce risk of falling (badly) as ALL body-aware behaviours will reduce it — and that includes yoga, bellydance, Pilates, ballet, and any exercise that builds balance and proprioception. For all its benefits, that does not include weight training, bodybuilding, or other more static exercise (such as stationary bicycling or ‘spinning’).

    Health requires strength, responsiveness, and the fullest possible range of motion — and the functionality that goes with it. There are many ways to build this. Most people don’t bother, and so they age less well than they could.