Researching Complementary Medicine, ‘Mission Impossible’

· Inaugural Issue


*Complementary Medicine
Peninsula Medical School
Universities of Exeter & Plymouth
25 Victoria Park Road
Exeter EX2 4NT UK


Tel: +44 (0)1392 424989

Fax: +44 (0)1392 427562


Our unit was created 10 years ago with the remit to conduct rigorous research into complementary medicine. As straightforward as this task may seem, it turned out to be not a small order indeed. First, complementary medicine is a huge and highly diverse area (Table 1). Second, applying science to it is fraught with logistical obstacles, methodological problems and ‘ideological’ complications. At the time, there was little agreement other than one: the task was both timely and important. The general population was (and is) in the middle of a romance with all things alternative, and no university chair did (or does) exist in the UK to carry out this ‘mission impossible’.

The research agenda

The first step was to define the most important research question and work out a research strategy. The choice of potential research question seemed endless:

  • Who uses complementary medicine?
  • For what health problems?
  • What types of complementary medicine are particularly popular?
  • Why do people use complementary medicine?
  • What are patients’ expectations?
  • What are patients’ experiences?
  • What are doctors’ attitudes?
  • What are other countries’ experiences?

etc, etc, etc


Considering that complementary medicine is woefully under-researched, I felt that these questions were interesting but not as burning as the following two:

  • Does complementary medicine work?
  • Is complementary medicine safe?

These two issues dominated our research agenda in the years to come. The strategy for making progress was largely determined by them. The most reliable path to conclusive answers was to conduct clinical trials of specific complementary therapies for defined conditions and to produce state of the art reviews of clinical data already published.

Methodological and ‘ideological’ problems

Our strategy remained not without critics. In essence their argument was that reductionist science is not applicable to holistic healthcare. This is clearly not the place to go into the technical details of this debate, but I am as convinced as ever that the scientific evaluation of complementary medicine is both feasible and necessary.

But this is not the same as denying that complementary medicine has numerous characteristics which sets it apart from orthodox medicine and which require thoughtful attention when planning research. Such idiosyncrasies usually can be accounted for within the rules of scientific research. To put it bluntly, there is no ‘alternative science’ and no alternative to science when one aims at finding the truth. Not trying to answer our two main questions means, in my view, failing our patients who have a right to know whether these treatments do more good than harm. Conducting ‘softer’ research, e.g. surveys to show how many patients are satisfied with aromatherapy, healing, etc, would not convince the sceptics and thus generate no progress.

Logistical obstacles

Research is never easy and usually encounters a myriad of problems. By far the most cumbersome obstacle turned out to be the lack of sufficient research funds. All medical researchers suffer from shortage of funds, but in complementary medicine the problem has entirely different dimensions. For instance, the proportion of the medical research budget dedicated by the NHS to this area is 0.08% and the corresponding figure for UK medical charities is 0.05%. Consider that about a third of the UK population uses complementary medicine and that currently even the most fundamental questions remain unanswered, and the enormity of under-funding becomes evident.



Despite these predicaments, considerable progress has been made. Evidently this is not the place to give a comprehensive account of our results. Interested readers can obtain a full report entitled ‘The Evidence So Far’ at a cost price by emailing (

The two areas where we have been most active are acupuncture and herbal medicine. Some of our more noteworthy findings include establishing that acupuncture is a safe procedure when administered by well-trained healthcare professionals. To generate this certainty, we had to carry out the then largest prospective studies in the 3000 year history of acupuncture. Serious adverse effects (e.g. puncturing the heart), even fatalities, have been reported after acupuncture but they are extreme rarities. Mild, transient side-effects, we can now state with confidence, occur in about 7% of all patients. Similarly we have conducted systematic research into the safety of many herbal medicines. They concluded that the following remedies are not usually associated with serious risks: Aloe vera, Artichoke, Asian ginseng, Black cohosh, Chaste tree, Cranberry, Feverfew, Garlic, Ginger , Ginkgo, Green tea, Hawthorn, Horse chestnut, Peppermint, Red clover, Siberian ginseng, St. John’s wort, Valerian

Asserting safety is important, but what about efficacy? We have shown beyond reasonable doubt that acupuncture/acupressure works for:

Back pain

Dental pain

Nausea and vomiting.

Contrary to what many believe, acupuncture is not a panacea. According to our results, it is, for instance, not more effective than a placebo for smoking cessation or weight loss, both indications for which it is popular. And for most other conditions we currently cannot be sure. Essentially this means that we need more and better research.

The results of our research into the efficacy of herbal medicine are much more complex. Obviously each remedy has to be judged on its own merit, and generalisations are not possible. Table 2 is an attempt to summarise the evidence to date.


Future challenges

Few areas of medicine are as much in the public eye as is complementary medicine. During the last 10 years, I found this to be a mixed blessing. On the one hand, publicity can facilitate raising the much-needed funds. On the other hand, this high visibility renders interference from outside a strong possibility. Only a fool would reject true expert advice but the advice I am talking about is often from ‘self-appointed experts’. Thus it is frequently ill-conceived, misleading, driven by various self-interests and unscientific. Add political correctness to all this and you have a powerful but unappetising cocktail which can turn into a significant obstruction to effective research. It was Bert Brecht who once wrote, “the opposite of good is not bad but good intentions”. The challenge for complementary medicine research will be to channel such public interest constructively.

Complementary medicine research must be as scientifically sound as any other research and, at the same time, it should thoughtfully account for the many idiosyncrasies of this field. Scientifically sound means, amongst other things, that investigations should:

  • minimise bias
  • be reproducible
  • seek to establish causal relationships where possible.

The challenge, in my view, is to conduct research in such a way that it even convinces critics.

We also should be clear about the best strategy for making progress. ‘Integrated medicine’ has fast become the new buzz word in complementary medicine. It stands for two different principles: firstly whole person medicine, and secondly the incorporation of complementary medicine into medical routine. In my view, this dual concept is superfluous, misleading and counter-productive. It is superfluous because all good medicine has always adopted a whole person approach. It is misleading because incorporation of well-documented treatments of any type is not ‘integrated’ but evidence-based medicine, a concept already well-established worldwide. And it is counter-productive because integration of unproven therapies (which many complementary therapies unquestionably are) would render healthcare only less effective and more expensive. The challenge with respect to new, fashionable terminology or concepts is to adequately scrutinise their validity before adopting them.



Is rigorous research into complementary medicine a “mission impossible”? Obviously not. It is fraught with difficulties but it is both feasible and important. I would even go one step further: vis a vis the current popularity of this sector it has become an ethical imperative to determine which treatments generate more good than harm. To do this work to a different standard than conventional medical research would be failing all concerned, not least the consumer/patient.


Table 1: Some popular methods used in complementary medicine

Name Principle Conditions used for Efficacy Safety Risk-benefit balance*
Acupuncture Needle insertion into acupuncture points for health purposes Various (used as a panacea in China) See text See text Positive (for some conditions only)
Alexander technique Training process of ideal body posture and movement; developed by FM Alexander Musculoskeletal problems Few clinical trials exist, no final verdict possible No serious adverse effects Uncertain
Applied kinesiology Diagnostic technique using muscle strength as an indicator; developed by G Goodheart Various (e.g. allergies) Repeatedly shown to be not valid Can delay reliable diagnoses, danger of false diagnoses Negative
Aromatherapy Application of essential oils usually through gentle massage techniques; developed by RM Gatttefossé Relaxation Systematic review was inconclusive Allergic reactions to oils Uncertain
Autogenic training Form of self-hypnosis for relaxation and stress reduction; developed by J Schultz Stress management Encouraging evidence No serious adverse effects Positive
Name Principle Conditions used for Efficacy Safety Risk-benefit balance*
Chelation therapy Intravenous infusion of EDTA used for ‘deblocking’ arteries from arteriosclerotic lesions Circulatory disorders Repeatedly shown in rigorous clinical trials to be ineffective Serious adverse effects reported Negative
Chiropractic Popular manual therapy based on the assumption that most health problems are due to malalignments of the spine and treatable through spinal manipulation; developed by DD Palmer Back pain Conclusions of systematic reviews of chiropractic for back pain are not uniform. The methodologically best are not positive Serious adverse effects have been reported, their exact incidence is not known Negative
Colonic irrigation (or colon therapy) Cleansing of the colon through water enemas, e.g. to ‘free the system of toxins’ Various No sound evidence Serious adverse effects reported Negative
Herbal medicine Medical use of preparations containing exclusively plant material Various (depending on herb used) See text See text Positive (for some conditions only)
Homoeopathy Medical use of diluted remedies according to the ‘like cures like’ principle Various (mostly benign, chronic conditions) No sound evidence No serious adverse effects Negative
Name Principle Conditions used for Efficacy Safety Risk-benefit balance*
Hypnotherapy Induction of trance-like state to influence the unconscious mind Various Some evidence Adverse effects probably infrequent Positive
Iridology Diagnostic technique using signs and impurities on the iris Various, including predispositions to diseases Shown to be not valid Can delay reliable diagnosis Negative
Macrobiotic diet Diet based on the yin/yang principle using whole grains and vegetables Disease prevention Positive effects on cardiovascular risk factors Serious adverse effects reported Negative
Massage Various techniques of manual stimulation of cutaneous, subcutaneous, or muscular structures Musculoskeletal problems Some evidence for effectiveness in musculoskeletal and psychological problems Few serious adverse effects Positive
Osteopathy Various techniques of spinal mobilisation; developed by T Still Back pain Systematic reviews of osteopathy for back pain are inconclusive Adverse effects less than with chiropractic Inconclusive
Reflexology Internal organs correspond to areas on the sole of the feet and can be influenced through massaging these Relaxation Systematic review was inconclusive No serious adverse effects Inconclusive
Name Principle Main indications Efficacy Safety Risk-benefit balance*
Spiritual healing Umbrella term for techniques of channelling of ‘healing energy’ through a healer into a patient Re-establishing a wholesome balance Clinical studies highly contradictory; the best recent studies are negative No serious adverse effects Negative
Yoga Meditative, postural, and breathing techniques from ancient India Various Promising evidence for effectiveness in asthma, cardiovascular risk factors and other conditions No serious adverse effects Positive


*   for the most favourable indication


Table 2: Efficacy of herbal medicines

Common name of plant

Condition treated


Aloe vera Various Efficacy not proven
Asian Ginseng Various Efficacy not proven
Feverfew Prevention of migraine Efficacy likely
Garlic Hypercholesterolemia Efficacy proven
Ginkgo Tinnitus Efficacy not proven
Ginkgo Dementia Efficacy proven
Ginkgo Peripheral arterial disease Efficacy proven
Hawthorn Chronic heart failure Efficacy proven
Horse chestnut Varicose veins Efficacy proven
Kava Anxiety Efficacy proven
Peppermint Irritable bowel syndrome Efficacy likely
Valerian Insomnia Efficacy likely