What are Alternative Therapies ?

Alternative or complementary therapies are used in addition to standard medical treatment to improve wellbeing, prevent illness, reduce stress, and prevent or reduce side effects and symptoms. Treatments often address the client as a whole, rather than individual physical symptoms.

What sort of person becomes an alternative therapist?

As well as being interested in people and their health, it’s important you have:

* excellent communication skills
* a desire to help people
* a logical approach to problem solving
* a neat and tidy appearance
* maturity and the emotional stability to deal with sensitive issues
Working as any kind of therapist can be demanding and personally draining as you may be dealing with people's personal and painful experiences. You'll need to be sensitive to your clients' needs while keeping a professional distance. It is also essential to recognise when to refer a client to a medical doctor.

What about future prospects?

Alternative therapy is a growing industry with a wide range of career paths. When you’ve successfully completed a recognised qualification you can continue with further study or become self employed. You could work on a cruise liner, health farm, luxury hotel, health club or beauty salon. Some therapists work in hospitals, hospices, or are attached to a GP surgery or natural health centre.What sort of jobs are there? You'll need to decide whether you prefer a "hands on" job such as massage, reflexology or acupuncture or if you'd prefer to help clients deal with personal issues using counselling, psychotherapy and hypnotherapy. We've selected a few jobs below but if you'd like to find out more visit the alternative therapies section of our job profiles.

Acupuncturist

Acupuncture is part of the 3000-year old system of traditional Chinese medicine, which believes that life energy (chi) flows along invisible channels in the body
known as meridians. Acupuncturists use these channels to regulate their clients' healing process and help restore health. [more info]

Chiropractor

Chiropractors specialise in the diagnosis, treatment and management of conditions due to problems with the joints, ligaments, tendons and nerves of the body, particularly those of the spine. Treatment uses manipulation to improve the function of the joints, relieving pain and muscle spasm. [more info]

Colon hydrotherapist

Colon hydrotherapy, also known as colonic irrigation, is a treatment to cleanse the colon of waste products and toxins. The therapist gently fills the colon with warm filtered water. When the water is flushed out, it carries with it material that has built up in the intestine. [more info]
CounsellorCounsellors help people to explore their problems from a different perspective for personal development or during times of crisis or distress. They provide time and attention, together with a safe environment, to help their clients find their own solutions. [more info]
Medical herbalistMedical herbalists use plant remedies to treat disease and balance the metabolism. The remedies used may include infusions, tablets, tinctures, powders, lotions, creams and ointments. [more info]

Homeopath

Homeopaths use minute quantities of a substance, which, if given in full strength to a healthy person, would produce similar symptoms to the patient's. The remedy
stimulates the body's own natural healing powers. [more info]

Hypnotherapist

Hypnotherapists help clients to overcome depression, stress, anxiety or addictions. They put clients into a trance-like state with the aim of changing negative behaviour or thinking. [more info]

Psychotherapist

Psychotherapists help people to deal with stress, emotional problems, relationship problems or troublesome habits. Treatments are based on talking and therapists can work with individuals, couples or families. [more info]

Reflexologist

Based on the principle of reflex areas in the feet and hands that correspond to parts of the body, reflexologists stimulate the healing process using thumb and finger pressure on different points of their clients' feet and hands. [more info]

Yoga therapist

Yoga therapists use the ancient art of yoga in order to promote good health and a sense of inner peace and relaxation. Treatment involves a combination of simple movements and postures, breathing exercises and relaxation techniques. [more info]

No Evidence for Music Therapy in Dimensia

the published literature demonstrates that music/music therapy is an effective method overall for symptoms of dementia". This is the conclusion of a meta-analysis [1]. But is it right?

Methods

The search was extensive and looked at published studies in peer-reviewed journals that empirically addressed the use of music therapy for dementia. Twenty-one studies were included with study numbers from 3 to 40 patients. Twelve studies had fewer than 15 subjects, and only one had more than 30.

Result

Extensive and impenetrable statistical analysis concluded that music therapy was beneficial. What it was beneficial for was not stated specifically, but could have been as varied as agitation during bathing to sleeping.

Problem

There is no mention in the paper nor in the titles of the included papers, of the key words randomisation or blinding. Although we don't know it for a fact, it is highly likely that most of these studies were neither randomised nor blind. In the absence of information on two of the most important sources of study bias, with more than half the studies with trivial size, with no stated outcome and no clear indication of the intervention, what can we conclude? Only that the conclusion of the meta-analysis is dangerous and probably wrong. At best we can conclude that there is no hard evidence that music therapy is of any value in dementia.

Round the World with Acupuncture

Bandolier was a guest at a discussion on alternative medicine. One comment made was that
"The Chinese have been doing this sort of thing for thousands of years: surely it can't be wrong?"The immediate reaction was that the Chinese suffered to the same extent as everyone else from the great plagues of the 6 th and 14 th centuries, and Chinese historians record many, many major depredations over the centuries. Perhaps it all comes down to how you look at things, standards set, and societal values. A systematic review [1] set out to answer the question whether some countries produce only positive results.

Search and inclusion

There were two searches. The first used MEDLINE to retrieve papers on acupuncture with abstracts available over 30 years. Papers had to have patients receiving acupuncture who were compared with patients receiving placebo, no treatment or a no acupuncture control. The second search looked for randomised or controlled clinical trials published in China, Taiwan, Japan or Russia/USSR between 1991 and 1995. In addition, 330 most recent randomised or controlled trials published in England were sought. These studies had to have patients receiving a treatment other than acupuncture compared with patients receiving a control intervention.

Outcomes

Reviewers blinded to the country of origin then retrieved and abstracts examined. The outcome was a superiority of treatment over control based on:
Author statement
At least one statement of statistical superiority
At least one outcome described as superior to control
ResultsFor acupuncture, there was a wide discrepancy between countries of origin and the proportion of trials showing superiority of acupuncture. Countries in North America, Western Europe and Australasia were positive for acupuncture about half the time, or less. Those from Eastern Europe and especially East Asia were positive nearly all the time (Figure).
Figure: Proportion of controlled trials of acupuncture showing superiority of acupuncture from five regions, with number of studies

The four countries which had 100% positive rates for acupuncture were compared with England for positive rates for randomised or controlled trials where acupuncture was not being tested. They also had very high rates of positive trials here as well (Table), as high as 97% for Russia/USSR and 99% for China. Rates for England were consistently lower.
Table: Proportion of trials with treatment better than control for randomised or controlled nonacupuncture studies, and from acupuncture studies, from five countries

Comment

The authors of this review did a terrific job in trying to eradicate bias from their analysis. They acknowledge that because they included controlled trials, and looked only at abstracts, they will have included studies with known methodological bias. They also acknowledge that authors can and do make misleading or mistaken comments about trial results in abstracts. That having been said, there remains a gulf between studies reported from different parts of the world. Bias may be institutionalised in some places, or may just be harder to detect in others. The reason randomisation schedules for patients are often described as being enclosed in metallised envelopes is because people have been known to X-ray envelopes to break the code before allocation. The inference is obvious. Quality is much more important than quantity. No matter how many trials of inadequate or biased design we have, they do not match up to one trial of adequate size and methodological rigor. Quality is first, and everything else is nowhere. "All was wrong because not all was right" is a useful quotation from George Crabbe that might usefully govern the interpretation of evidence. It applies to all therapies.

Why bogus therapies seem to work

There is a website worth visiting if you are concerned about the benefits or otherwise of alternative therapies (http://www.quackwatch.com/), but note that Bandolier does not endorse the contents of the site or its conclusions). One page is devoted to why 'bogus' therapies seem to work. The points are well made and some apply just as much to conventional as alternative therapies. Most of the points are where non scientific belief can be nullified by proper scientific method. That is the main reason why high quality studies of alternative therapies are negative, while lower quality studies are positive. If bias exists in the usual clinical situation, it is even more relevant for alternative therapies where belief in the value of the therapy is very strong.
Many diseases are self-limitingThe old saying is that a cold will go away in a week or in seven days if you treat it. Determining whether an intervention has made a difference is therefore difficult. Unless rigorous study methods are applied, an apparent benefit cannot be ascribed to the intervention or the natural course of the disease.
Many diseases are cyclicalAllergies, multiple sclerosis, arthritis and gastrointestinal problems like irritable bowel syndrome all have their ups and downs. Sufferers may seek therapy on a down, so that when an up comes that has to be due to the therapy, doesn't it. Again, only rigorous study design combats this.
Placebo effectBoth the above contribute to what is called a placebo effect. It can be seen as the natural course of things. For instance, some people need no pain relief after surgery [1], making a pre-emptive intervention which claims to reduce pain after surgery a sure win. There will always be some people publicly to declaim its value. Natural "placebo" rates depend on what the problem is and what the benefit is. There will always be some people who benefit without an intervention.
Bets are "hedged""My auntie was under the doctor for six months, but it was only when she started on homeopathy that she got better". The fact that the poor infantry slaved away for six months is forgotten in the glamour of magic.
Original diagnosis may be wrongBandolier has highlighted the difficulty of diagnosis. If the diagnosis is wrong, then miraculous cures are less miraculous.
Mood improvement or cureAlternative healers often have much more time to spend with their patient than a harassed GP loaded down with kilograms of guidelines and tight prescribing budgets. Is it any wonder that alternative healers can make patients feel better? That mood change is sometimes seen as the cure.
Psychological investment in alternativesAlternative healing can be as simple as some herbal remedy bought from a shop. Sometimes it can involve huge amounts of time, massive involvement of the family, and an intense psychological investment in believing that something (anything) will work. It is not surprising, then, that many people find some redeeming value in the treatment.