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The New Zealand Medical Journal

 Journal of the New Zealand Medical Association, 03-October-2008, Vol 121 No 1283

The responses of alternative practitioners when approached about common childhood illnesses
There has been much debate of late in the New Zealand Medical Journal around alternative practitioners. I was interested to see what the response would be from chiropractors, homeopaths, and acupuncturists to an approach concerning medical conditions in which these treatments have no proven benefits.
Five of each type of practitioner (or fewer if there were not 5)—from the 6 largest cities in New Zealand, who listed either an email address or website on the Yellow Pages website—were selected using a random number generator.
An email was sent from a fictitious grandmother who stated that she had a 7-year-old grandson who suffered from recurrent ear infections and a 13-year-old granddaughter who had asthma. The practitioner was asked if they could recommend something that was proven to work for these conditions and the approximate cost. The response rate after 1 month was 45% (33 out of 73). The use of a fictitious patient is the only way to determine the real-life advice that is given and has been used in similar surveys.1,2
It is beyond the scope of this letter to undertake a detailed systematic review of these three alternative treatments for these two common paediatric conditions. However, the evidence is perhaps best summarised in the book Trick or Treatment by the world-leading authority on evidence-based complementary medicine, Professor Edzard Ernst.3 His review of the literature shows that there is no good evidence that homeopathy can treat any condition; that chiropracty may have small benefits in certain musculoskeletal disorders; and that acupuncture may have small benefits in patients with pain or nausea. This view is consistent with the conclusions of the many major reviews that have been undertaken.4–8
There is no good evidence, and in fact no plausible scientific rationale, to support the use of these treatments for asthma or recurrent ear infections.
The results of the email responses are summarised in Table 1.

Table 1. Responses from chiropractors, homeopaths, and acupuncturists

Alternative practitioners
N (total=35)
Suggested an appointment (n,%)
Gave prices (n,%)
Suggested they could treat asthma (n,%)
Suggested they could treat ear infections (n,%)
Chiropractors
13
12 (92%)
11 (85%)
9 (69%)
8 (62%)
Homeopaths
9
9 (100%)
6 (67%)
9 (100%)
9 (100%)
Acupuncturists
13
12 (92%)
11 (85%)
9 (69%)
8 (62%)

This survey identified that almost all practitioners suggested that the children should have an appointment with them. All of the homeopaths suggested that they could effectively treat both asthma and ear infections, and around two-thirds of chiropractors and acupuncturists suggested that their treatments would work. A number of chiropractors and acupuncturists suggested that the children be brought in for an assessment, even though they did not directly claim that their treatment would help.
Charges for the initial consultation ranged from free to $160, with an average of around $60. For follow-up visits, the charges ranged from $7.50 to $85, with an average charge of around $50, with little difference between the three types of practitioners. Despite never having seen the children, many practitioners recommended a long course of treatment, with one acupuncturist recommending 10 treatments and 30 days of herbal remedies, at a total cost of $810 per child.
The responses generally had a pseudoscientific tone, although no replies referenced any scientific studies.
Some of the more interesting comments from chiropractors included:
  • I personally haven’t seen any children with these conditions not respond phenomenonally well to chiropractic care;
  • ...great response through boosting body function;
  • ...certainly have wonderful results.
Comments of note from some of the homeopaths included:
  • ...works brilliantly for ear infections;
  • ...hundreds of remedies for ear infections and asthma;
  • homeopaths have a success rate nearing 80%.
There are many ethical, regulatory, and safety issues associated with alternative medicine practitioners giving health advice and treating patients; this survey provides local data which contributes to the debate and raises major concerns.
Shaun Holt [BPharm(hons), MBChB(hons)]
Clinicanz
Tauranga
shaun@clinicanz.com

References:
  1. Schmidt K, Ernst E. MMR vaccination advice over the Internet. MMR vaccination advice over the Internet. Vaccine. 2003;21(11–12):1044–7.
  2. Schmidt K, Ernst E. Reflexologists’ responses to a patient with abdominal pain—a survey on Internet advice. Complementary Therapies in Medicine. 2003;11(2):98–102.
  3. Singh S, Ernst E. Trick or Treatment? Alternative medicine on trial. London: Transworld-Publishers; 2008.
  4. McCarney RW, Lasserson TJ, Linde K, Brinkhaus B. An overview of two Cochrane systematic reviews of complementary treatments for chronic asthma: acupuncture and homeopathy. Respir Med. 2004;98(8):687–96.
  5. Martin J, Donaldson AN, Villarroel R, et al. Efficacy of acupuncture in asthma: systematic review and meta-analysis of published data from 11 randomised controlled trials. Eur Respir J. 2002;20(4):846–52.
  6. Balon JW, Mior SA. Chiropractic care in asthma and allergy. Ann Allergy Asthma Immunol. 2004;93(2 Suppl 1):S55–60.
  7. Ernst E. A systematic review of systematic reviews of homeopathy. Br J Clin Pharmacol. 2002;54(6):577–8.
  8. Ernst E. Chiropractic manipulation for non-spinal pain – a systematic review. N Z Med J. 2003;116(1179). http://www.nzma.org.nz/journal/116-1179/539
     
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