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Miniglossary of "Alternative" Methods

Stephen Barrett, M.D.

Each of the following approaches has at least one of the following characteristics: (1) its rationale or underlying theory has no scientific basis, (2) it has not been demonstrated safe and/or effective by well-designed studies, (3) it is deceptively promoted, or (4) its practitioners are not qualified to make appropriate diagnoses. This article covers traditional Chinese medicine, acupuncture, ayurvedic medicine, clinical ecology, colonic irrigation, craniosacral therapy, herbalism, iridology, macrobiotics, naturopathy, orthomolecular therapy, and therapeutic touch. Full-length articles on aromatherapy, chelation therapy, chiropractic, and homeopathy are available elsewhere on Quackwatch.

"Chinese medicine," often called "Oriental medicine" or "traditional Chinese medicine (TCM)," encompasses a vast array of folk medical practices based on mysticism. It holds that the body's vital energy (chi or qi) circulates through 14 hypothetical channels, called meridians, that have branches connected to bodily organs and functions. Illness is attributed to imbalance or interruption of chi. Ancient practices such as acupuncture and Qigong are claimed to restore balance by removing the interruptions.

Traditional acupuncture, as now practiced, involves the insertion of stainless steel needles into various body areas. A low-frequency current may be applied to the needles to produce greater stimulation. Acupressure (shiatsu) is a technique that uses finger pressure instead of needles. Some states restrict the use of acupuncture to physicians or persons operating under the direct supervision of physicians, while others permit laypersons to practice without medical supervision.

The treatment is applied to "acupuncture points," which are said to be located throughout the body. Originally there were 365 such points, corresponding to the days of the year, but the number identified by proponents during the past 2,000 years has increased gradually to over 2,000 [1]. Some practitioners place needles at or near the site of disease, while others select points on the basis of symptoms. In traditional acupuncture a combination of points is usually used. However, the existence of "meridians," "acupuncture points," or chi has never been scientifically validated.

Some acupuncturists reject Chinese medicine's trappings and postulate that pain relief occurs through mechanisms such as the production of endorphins (chemicals similar to narcotics). Although acupuncture may relieve pain, such relief tends to be short-lived. The evidence supporting claims that acupuncture is effective consists mostly of practitioners' observations and poorly designed studies. Acupuncture has not been proven to influence the course of any organic disease.

The adverse effects of acupuncture are probably related to the nature of the practitioner's training. A survey of 1,135 Norwegian physicians revealed 66 cases of infection, 25 cases of punctured lung, 31 cases of increased pain, and 80 other cases with complications. A parallel survey of 197 acupuncturists, who are more apt to see immediate complications, yielded 132 cases of fainting, 26 cases of increased pain, 8 cases of pneumothorax, and 45 other adverse results [2]. However, a 5-year study involving 76 acupuncturists at a Japanese medical facility tabulated only 64 adverse event reports (including 16 forgotten needles and 13 cases of transient low blood pressure) associated with 55,591 acupuncture treatments. No serious complications were reported.The researchers concluded that serious adverse reactions are uncommon among acupuncturists who are medically trained [3].

Qigong is also claimed to influence the flow of vital energy. Internal Qigong involves deep breathing, concentration, and relaxation techniques used by individuals for themselves. External Qigong is performed by "Qigong masters" who claim to cure a wide variety of diseases with energy released from their fingertips. However, scientific investigators of Qigong masters in China have found no evidence of paranormal powers and some evidence of deception. Investigators have observed, for example, that a patient lying on a table about eight feet from a Qigong master moved rhythmically or thrashed about as the master moved his hands. But when she was placed where she could no longer see him, her movements were unrelated to his.

The diagnostic process used by TCM practitioners may include questioning (medical history, life-style), observations (skin, tongue, color), listening (breath sounds), and pulse-taking. Medical science recognizes only one pulse, corresponding to the heartbeat, which can be felt in the wrist, neck, feet, and various other places throughout the body. TCM practitioners check six alleged pulses at each wrist and identify more than twenty-five alleged pulse qualities such as "sinking," "slippery," "soggy," "tight," and "wiry." TCM's "pulses" supposedly reflect the type of imbalance, the condition of each organ system, and the status of the patient's "chi."

The herbs prescribed by Chinese medicine practitioners in the United States are not regulated for safety, potency, or effectiveness. There is also the risk that an acupuncturist whose approach to diagnosis is not based on scientific concepts will fail to diagnose a dangerous condition.

The National Council Against Health Fraud has concluded: (a) acupuncture is an unproven modality of treatment, (b) its theory and practice are based on primitive and fanciful concepts of health and disease that bear no relationship to present scientific knowledge, (c) research during the past 20 years has not demonstrated that acupuncture is effective against any disease, (d) perceived effects of acupuncture are probably due to a combination of expectation, suggestion, counter-irritation, conditioning, and other psychologic mechanisms, (e) the use of acupuncture should be restricted to appropriate research settings, (f) insurance companies should not be required by law to cover acupuncture treatment, (g) licensure of lay acupuncturists should be phased out, and (8) consumers who wish to try acupuncture should discuss their situation with a knowledgeable physician who has no commercial interest [4].

Ayurvedic medicine is set of practices promoted by proponents of transcendental meditation (TM). Ayurveda (meaning "life knowledge") is a traditional Indian approach that includes meditation, "purification" procedures, rejuvenation therapies, herbal and mineral preparations, exercises and dietary advice based on "body type." Its origin is traceable to four Sanskrit books called the Vedas -- the oldest and most important scriptures of India, shaped sometime before 200 BCE. These books attributed most disease and bad luck to demons, devils, and the influence of stars and planets. Ayurveda's basic theory states that the body's functions are regulated by three "irreducible physiological principles" called doshas, whose Sanskrit names are vata, pitta, and kapha. Like the "sun signs" of astrology, these terms are used to designate body types as well as the traits that typify them. Like astrologic writings, ayurvedic writings contain long lists of supposed physical and mental characteristics of each constitutional type. Through various combinations of vata, pitta, and kapha, ten body types are possible. However, one's doshas (and therefore one's body type) can vary from hour to hour and season to season.

Ayurvedic proponents claim that the symptoms of disease are always related to "imbalance" of the doshas, which can be determined by feeling the patient's wrist pulse or completing a questionnaire. Some proponents claim that the pulse can be used to detect diabetes, cancer, musculoskeletal disease, asthma, and "imbalances at early stages when there may be no other clinical signs and when mild forms of intervention may suffice." "Balance" is supposedly achieved through a multitude of procedures and products, many of which are said to be specific for specific body types. The full Maharishi Ayur-Ved program for "creating healthy individuals and a disease-free society" has 20 components: development of higher states of consciousness through advanced meditation techniques, use of primordial sounds, correction of "the mistake of the intellect," strengthening of emotions, Vedic structuring of language, music therapy, enlivening of the senses, pulse diagnosis, psychophysiological integration, neuromuscular integration, neurorespiratory integration, purification (to remove "impurities due to faulty diet and behavioral patterns"), dietary measures, herbal food supplements, other herbal preparations, daily behavioral routines, prediction of future imbalances, religious ceremonies, nourishing the environment, and promoting world health and world peace. Most of these cost several hundred dollars, but some cost thousands and require the services of an ayurvedic practitioner

TM is a technique in which the meditator sits comfortably with eyes closed and mentally repeats a Sanskrit word or sound (mantra) for 15 to 20 minutes, twice a day. It is alleged to help people think more clearly, improve their memory, recover immediately from stressful situations, reverse their aging process, and enjoy life more fully. Proponents also claim that "stress is the basis of all illness" and that TM is "the single most effective thing you can do to improve all aspects of health and to increase inner happiness and learning ability."

Deepak Chopra, M.D., a leading ayurveda proponent, claims that "If you have happy thoughts, then you make happy molecules. On the other hand, if you have sad thoughts, and angry thoughts, and hostile thoughts, then you make those molecules which may depress the immune system and make you more susceptible to disease." Chopra promises "perfect health" to those who can harness their consciousness as a healing force. Meditation may temporarily relieve stress -- as would many types of relaxation techniques -- but the rest of these claims have no scientific basis.

Clinical ecology, which proponents also misrepresent as "environmental medicine," is not a recognized medical specialty. It is based on the notion that multiple common symptoms are triggered by hypersensitivity to common foods and chemicals. Proponents typically suggest that the immune system is like a barrel that continually fills with chemicals until it overflows, signaling the presence of disease. However, some also say that "immune system dysregulation" can be triggered by a single serious episode of infection, stress, or chemical exposure. Potential stressors include practically everything that modern humans encounter, such as urban air, diesel exhaust, tobacco smoke, fresh paint or tar, organic solvents and pesticides, certain plastics, newsprint, perfumes and colognes, medications, gas used for cooking and heating, building materials, permanent press and synthetic fabrics, household cleaners, rubbing alcohol, felt-tip pens, cedar closets, tap water, and electromagnetic forces.

Clinical ecologists typically base their diagnoses on "provocation-neutralization" testing. In this test, the patient reports symptoms that develop within ten minutes after various concentrations of suspected substances are administered under the tongue or injected into the skin. If any symptoms occur, the test is considered positive and lower concentrations are given until a dose is found that "neutralizes" the symptoms.

Treatment requires avoidance of suspected substances and involves lifestyle changes that can range from minor to extensive. Generally, patients are instructed to modify their diet and to avoid such substances as scented shampoos; after-shave products; deodorants; cigarette smoke; automobile exhaust fumes; and clothing, furniture, and carpets that contain synthetic fibers. Extreme restrictions can involve staying at home for months or avoiding physical contact with family members. In many cases the patient's life becomes centered around the illness.

Researchers at the University of California have demonstrated that provocation- neutralization testing is not valid. In a double-blind study, each of 18 patients received three injections of suspected food extracts and nine of dilute salt water over a three-hour period. The tests were carried out in the offices of proponents who had been treating the patients. In nonblinded tests, these patients had consistently reported symptoms when exposed to food extracts and no symptoms when given salt-water injections. But during the experiment, the patients reported as many symptoms following one type of injection as they did after the other, indicating that their symptoms were nothing more than placebo reactions. The symptoms included itching of the nose, watery or burning eyes, plugged ears, a feeling of fullness in the ears, ringing ears, dry mouth, scratchy throat, an odd taste in the mouth, fatigue, headache, nausea, dizziness, abdominal discomfort, tingling of the face or scalp, tightness or pressure in the head, disorientation, difficulty breathing, depression, chills, coughing, nervousness, intestinal gas or rumbling, and aching legs. Clinical ecologists also claim that "neutralizing" doses of offending allergens can relieve the patient's symptoms. However, the patients who were treated during the experiment had equivalent responses to extracts and salt water [5].

The American Academy of Allergy and Immunology (AAAI), the nation's largest professional organization of allergists, has warned:

Although the idea that the environment is responsible for a multitude of health problems is very appealing, to present such ideas as facts, conclusions, or even likely mechanisms without adequate support, is poor medical practice [6].

Colonic irrigation -- also called colon hydrotherapy -- is typically performed by passing a rubber tube into the rectum for a distance of up to 20 or 30 inches. Warm water is pumped in and out through the tube, a few pints at a time, typically using 20 or more gallons. Some practitioners add herbs, coffee, or other substances to the water. The procedure is said to "detoxify" the body. Its advocates claim that, as a result of intestinal stasis, intestinal contents putrefy, and toxins are formed and absorbed, which causes chronic poisoning of the body. This "autointoxication" theory was popular around the turn of the century but was abandoned by the scientific community during the 1920s. No such "toxins" have ever been identified, and careful observations have shown that individuals in good health can vary greatly in bowel habits. Proponents may also suggest that fecal material collects on the lining of the intestine and causes trouble unless removed by laxatives, colonic irrigation, special diets, and/or various herbs or food supplements that "cleanse" the body. The falsity of this notion is obvious to doctors who perform intestinal surgery or peer within the large intestine with a diagnostic instrument. Fecal material does not adhere to the intestinal lining. Colonic irrigation is not only therapeutically worthless but can cause fatal electrolyte imbalance [7]. Cases of death due to intestinal perforation and infection (from contaminated equipment) have also been reported [8-10].

Craniosacral therapy, also called craniopathy and cranial osteopathy, is based on the notion that bones of the skull are moveable and can be manipulated. Some practitioners claim to attune themselves to the patient's "rhythm" while holding the patient's skull in their hands. Some claim to improve the flow of "life energy," thereby curing or preventing a wide variety of health problems. Some claim to remove blockages to the flow of cerebrospinal fluid. Some claim to realign the skull bones. Actually, the bones of the skull fuse early in life and cannot be moved independently.

Herbalism is practiced mainly by naturopaths, chiropractors, acupuncturists, iridologists, and unlicensed "herbalists," many of whom prescribe herbs for virtually every health problem. While some attempt to base their prescriptions on research findings, others are guided by such perceptions as "astrological influences" and the "Doctrine of Signatures" (the ancient belief that the form and shape of a drug source determine its therapeutic value). Many herbs contain hundreds or even thousands of chemicals that have not been completely catalogued. While some of these may turn out to be useful as therapeutic agents, others could well prove toxic. Most herbal products sold in the United States are not standardized, which means that determining the exact amounts of their ingredients can be difficult or impossible. With safe and effective medicines available, treatment with herbal products makes little sense. Moreover, many herbal practitioners are not physicians and lack adequate training in the diagnosis and treatment of disease.

Iridology is based on the notion that each area of the body is represented by a corresponding area in the iris of the eye (the colored area surrounding the pupil). Iridologists claim that states of health and disease can be diagnosed according to the color, texture, and location of various pigment flecks in the eye. Iridology practitioners purport to diagnose "imbalances" and treat them with vitamins, minerals, herbs, and similar products. They may also claim that the eye markings can reveal a complete history of past illnesses as well as previous treatment. Most iridology practitioners are chiropractors and naturopaths, but laypersons who do "nutrition counseling" also are involved. Bernard Jensen, D.C., the leading American iridologist, states that "Nature has provided us with a miniature television screen showing the most remote portions of the body by way of nerve reflex responses." He also claims that iridology analyses are more reliable and "offer much more information about the state of the body than do the examinations of Western medicine." However, in two large studies, Jensen and seven other prominent iridologists could not distinguish between patients who had kidney or gallbladder disease and those who were healthy. Nor did they agree with each other about which was which [11,12]. This is not surprising, because there is no known way that body organs could be represented at specific locations in the iris.

Macrobiotics is a quasireligious approach centered around a semivegetarian diet claimed to improve health and prolong life. Proponents suggest that the diet is effective in preventing and treating cancer, AIDS, and other serious diseases. There is no scientific evidence to support these claims. Macrobiotic proponents base their recommendations for foods on the amount of "yin" or "yang" (alleged "energy modes") rather than nutrient content. Macrobiotic practitioners may base their recommendations on pulse diagnosis and other unscientific procedures related to Chinese medicine. These include "ancestral diagnosis," "astrological diagnosis," "aura and vibrational diagnosis," "environmental diagnosis" (including consideration of celestial influences" and tidal motions), and "spiritual diagnosis" (an evaluation of "atmospheric vibrational conditions" to identify spiritual influences, including memories and "visions of the future").

The leading proponent has been Michio Kushi, founder and president of the Kushi Institute in Brookline, Massachusetts. According to Institute publications, the macrobiotic way of life should include chewing food at least 50 times per mouthful (or until it becomes liquid), not wearing synthetic or woolen clothing next to the skin, avoiding long hot baths or showers, having large green plants in your house to enrich the oxygen content of the air, and singing a happy song every day. Kushi claims that cancer is largely due to improper diet, thinking, and way of life, and can be influenced by changing these factors. He recommends "yin foods" for cancers due to excess yang, and "yang foods" for tumors that are predominantly yin. His books contain case histories of people whose cancers have supposedly disappeared after they adopted macrobiotic eating. However, the only reports of efficacy are testimonials by patients, many of whom received conventional cancer therapy. The diet itself can cause cancer patients to undergo serious weight loss [13]. Some versions of macrobiotic diets contain adequate amounts of nutrients, but others do not. Studies of children living in several macrobiotic communities have found that they tended to be smaller, shorter, and to weigh less than children fed normal diets. Deficiencies of vitamin B12, iron, and vitamin D have also been reported.

Naturopathy is based on the belief that the cause of disease is violation of nature's laws. Naturopaths claim to remove the underlying causes of disease and to stimulate the body's natural healing processes. They state that diseases are the body's effort to defend itself and that cures result from increasing the patient's "vital force" by ridding the body of waste products and "toxins." Like some chiropractors, many naturopaths believe that virtually all ailments fall within the scope of their practice. Naturopathic treatments can include "natural food" diets, vitamins, herbs, tissue minerals, cell salts, manipulation, massage, exercise, diathermy, colonic enemas, acupuncture, and homeopathy. Although naturopaths claim that they stress prevention of disease, they tend to oppose immunization procedures.

Natural hygiene is an offshoot of naturopathy that emphasizes fasting; a raw-food diet of vegetables, fruits, and nuts; and food-combining, a dietary practice based on the incorrect notion that certain food combinations can cause or correct ill health. Natural hygienists oppose immunization, fluoridation, and food irradiation and eschew most forms of medical treatment.

Orthomolecular therapy is defined by its proponents as "the treatment of disease by varying the concentrations of substances normally present in the human body." It dates back to the early 1950s when a few psychiatrists began adding massive doses of nutrients to their treatment of severe mental problems. The original substance was vitamin B3 (nicotinic acid or nicotinamide), and the therapy was termed "megavitamin therapy." Later the treatment regimen was expanded to include other vitamins, minerals, hormones, and diets, any of which may be combined with conventional drug therapy and electroshock treatments. A few hundred physicians now use this approach to treat a wide variety of conditions, both mental and physical.

The human body has limited capacity to use vitamins in its metabolic activities. When vitamins are consumed in excess of the body's physiological needs, they function as drugs rather than vitamins. A few situations exist in which high doses of vitamins are known to be beneficial, but they must still be used with caution because of potential toxicity. For example, large doses of niacin can be very useful as part of a comprehensive, medically supervised program for controlling abnormal blood cholesterol levels. "Orthomolecular" practitioners go far beyond this, however, by prescribing large amounts of supplements to all or most of the patients they treat.

Reflexology, also called zone therapy, is based on beliefs that each body part is represented on the hands and feet and that pressing on specific areas on the hands or feet can have therapeutic effects in other parts of the body. Proponents claim that the body is divided into ten zones that begin or end in the hands and feet, and that each organ or body part is "represented" on the hands and feet. Proponents also claim that abnormalities can be diagnosed by feeling the feet and that pressing each area can stimulate the flow of energy, blood, nutrients, and nerve impulses to the corresponding body zone. The pathways postulated by reflexologists have not been anatomically demonstrated.

Most reflexologists claim that their foot massages can relieve stress, which presumably is correct but does not require the services of a "certified reflexologist" for $35 to $100 per session. Many practitioners claim foot reflexology can cleanse the body of toxins, increase circulation, assist in weight loss, and improve the health of organs throughout the body. Some claim that reflexology is effective against a large number of serious diseases. There is no scientific support for these assertions.

Therapeutic touch is a method in which the hands are used to "direct human energies to help or heal someone who is ill." Proponents claim that healers can detect and correct "energy imbalances" by stroking the body or placing their hands above the afflicted part. Healing supposedly can result from a transfer of "excess energy" from healer to patient. Neither the forces involved nor the alleged therapeutic benefits have been demonstrated by scientific testing [14]. It is safe to assume that any reactions to the procedure are psychological responses to the "laying on of hands." A recent study of 21 TT practitioners found no evidence that they could actually detect a human energy field." [14]

References

  1. Skrabanek P. Acupuncture: Past, present, and future. In Stalker D, Glymour C, editors. Examining Holistic Medicine. Amherst, NY: Prometheus Books, 1985.
  2. Norheim JA, Fennebe V. Adverse effects of acupuncture. Lancet 345:1576, 1995.
  3. Yamashita H and others. Adverse events related to acupuncture. JAMA 280:1563-1564, 1998.
  4. Sampson W and others. Acupuncture: The position paper of the National Council Against Health Fraud. Clinical Journal of Pain 7:162-166, 1991.
  5. Jewett DL, Fein G, Greenberg MH. A double-blind study of symptom provocation to determine food sensitivity. New England Journal of Medicine 323:429-433, 1990.
  6. Anderson JA and others. Position statement on clinical ecology. Journal of Allergy and Clinical Immunology 78:269-270, 1986.
  7. Eisele JW, Reay DT. Deaths related to coffee enemas. JAMA 244:1608-1609, 1980.Amebiasis associated with colonic irrigation - Colorado. Morbidity and Mortality Weekly Report 30:101-102, 1981.
  8. Amebiasis associated with colonic irrigation - Colorado. Morbidity and Mortality Weekly Report 30:101-102, 1981.
  9. Istre GR and others. An outbreak of amebiasis spread by colonic irrigation at a chiropractic clinic. New England Journal of Medicine 307:339-342, 1982.
  10. Benjamin R and others. The case against colonic irrigation. California Morbidity, Sept 27, 1985.
  11. Simon A and others. An evaluation of iridology. JAMA 242:1385­1387, 1979.
  12. Knipschild P. Looking for gall bladder disease in the patient's iris. British Medical Journal 297:1578­1581, 1988.
  13. Dwyer J. The macrobiotic diet: No cancer cure. Nutrition Forum 7:9-11, 1990.
  14. Rosa L, Rosa E, Sarner L, Barrett S. A Close Look at Therapeutic Touch. JAMA 279:1005-1010, 1998. To obtain a reprint of this article, send a self-addressed stamped envelope to the National Therapeutic Touch Study Group, 711 W. 9th St., Loveland, CO 80537.

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This article was revised on June 23, 2004.