The recent controversy about health and wellness programs should remind us of the need for evidence about their safety and effectiveness.
Drugs and medical devices must be rigorously tested before they are approved by the U.S. Food and Drug Administration. However, health and wellness programs often include complementary and alternative treatments such as meditation, massage, acupuncture, reiki, and dietary supplements, which are not subject to similar testing and approval.
Complementary and alternative treatments are a big business. About one-third of American adults use one or more of these treatments because they are viewed as natural or holistic or because traditional medical treatment has failed to provide relief.
The only downsides seem to be the time and money involved.
But even seemingly benign complementary or alternative treatments may occasionally have adverse effects, such as feelings of anxiety during meditation, allergic reactions to massage creams, bleeding from acupuncture needles, and liver or kidney damage from dietary supplements.
More importantly, pursuing a complementary or alternative treatment that doesn’t work may delay receiving a truly effective treatment.
The best type of evidence of effectiveness comes from clinical trials that randomly assign participants either to a treatment that is being studied or to a comparison treatment (or sometimes to a placebo).
Our research team recently completed a trial of massage for women who had persistent chest wall pain or limited shoulder mobility one year after breast cancer surgery. We found that women who received deep tissue massages to the affected chest or shoulder for eight weeks had nearly complete resolution of their symptoms. A comparison group of women who received whole body relaxation massages for eight weeks had little change in their pain or mobility.
By contrast, a Seattle clinical trial involving adults with chronic pain due to fibromyalgia found that reiki treatment had no beneficial effect on pain, quality of life, medication use, and physician visits.
These two examples show how clinical trials can help us make decisions about the effectiveness of treatments for specific problems.
How should you determine if a complementary or alternative treatment is effective for a particular problem?
It can be difficult to find out what trials have been done on a particular treatment. I recommend consulting two reliable sources that do not have any financial conflicts.
The National Center for Complementary and Integrative Health, a branch of the National Institutes of Health, has a Health Info section on its website. Clicking on Topics A-Z leads to scientific summaries on the safety and effectiveness of specific complementary and alternative treatments.
The Cochrane Library, an ambitious effort to synthesize the results of clinical trials, allows visitors to its website to enter search terms (such as acupuncture). Clicking on specific search results leads to scientific abstracts followed by plain language summaries about effectiveness and safety.
It is also important for providers of complementary and alternative treatments to be knowledgeable about clinical trials that are relevant to their treatments so they can appropriately inform potential clients.
In addition, providers and their clients should take part in research to study the value of different treatments. For example, more than 65 Northeast Ohio massage therapists recently established a practice-based research network to determine the value of massage treatment for various conditions.
What should you do if few or no trials have been done to determine if a complementary or alternative treatment would be effective for your problem?
Start with your doctor and ask if the treatment is worth considering given your medical history. Next, keep careful notes about any benefits and side effects as you receive the complementary and alternative treatment. Review your notes periodically.
Is your problem getting better? Are the side effects, the time required, and the cost acceptable? Then decide if it is worthwhile to continue the treatment or if you want to try something else.
Most of us pride ourselves on our ability to comparison shop to get the best deal on a new outfit, to pore over restaurant and movie reviews before deciding where to go on date night, and to carefully examine college rankings to figure out where to send our kids. Shouldn’t we invest the same amount of work to select evidence-based health and wellness treatments for ourselves and our loved ones?
To view this op-ed in The Plain Dealer, click here