Not so Complementary

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Sean Dixon lies on a treatment table at a clinic in central London as acupuncturist Bernard Nolan inserts 10 tiny needles into his feet, ankles, shins, hands and abdomen. "Can you feel that?" Nolan asks. "Yeah," his patient answers, wincing slightly. Dixon isn't entirely comfortable with needles but he's paid $120 for the weekly sessions since February, after six months of traditional physical therapy failed to cure his strained neck. Six weeks into acupuncture with Nolan, he is feeling much better. "I have no idea why it works," Dixon, 41, says, "but this problem is almost gone." Nolan attributes Dixon's symptoms to an Eastern concept known as a "cold-wind" condition and says the acupuncture treatment rebalances energies in his patient's body.

That explanation may raise haughty eyebrows in the clinics and consulting rooms of mainstream medicine, but increasing numbers of Europeans are embracing alternative treatments such as acupuncture, chiropractic manipulation, homeopathy and osteopathy. Some of these — like acupuncture — were developed in[an error occurred while processing this directive] China thousands of years ago. Others — such as homeopathy, in which small doses of natural substances that cause symptoms are used to alleviate them, or chiropractic and osteopathy, systems of healing based on manipulation of the spine or bones — originated in the West.

In France, they are positively le dernier cri. An estimated 75% of the French use acupuncture, homeopathy or osteopathy at some time in their lives, according to the World Health Organization (who). Germany has a long tradition of complementary therapies and has drawn folks to its thermal baths since Roman times. Today 3 in 4 Germans have tried alternative therapies, up from 52% in 1970. Britain came late to the treatment room. Only 10% of Britons surveyed in 2001 reported using one of five complementary treatments, but practitioners say demand for their services has doubled or tripled since then.

That's New Age music to the ears of proponents of alternative medicine such as Britain's Prince Charles. Last month, the Prince suggested in a speech to the who in Geneva that governments should support "integrated health care" combining conventional and alternative therapies. Not so, argued 13 doctors back in Britain in an open letter published on the day of the Prince's speech that attacked the use of National Health Service (nhs) resources on treatments they said were unproven.

An estimated 3 in 10 local health authorities in Britain offer alternative therapies to patients, and the nhs runs and funds an outpatient clinic and five hospitals that provide homeopathic treatments, including the Royal London Homeopathic Hospital. Doctors there are all trained in orthodox medicine and complementary disciplines. Dr. Saul Berkovitz, who runs the hospital's acupuncture clinic, says their $6.2 million annual allocation from state coffers is well spent. According to patient surveys, more than 60% of the 30,000 treated there each year improve. "It's an absolute fraction of the nhs budget," he says. "It's pretty low-tech and it's probably cost effective."

The hospital offers a range of options including holistic prenatal checkups and homeopathic remedies. In the group acupuncture clinic, Berkovitz uses needles hooked to a current to treat patients with osteoarthritis of the knee. Many improve with eight treatments, and one canceled a knee replacement after successful treatment. "I'm not saying everyone can throw away their crutches, but the potential for savings is there," says Berkovitz.

Some doctors, however, still worry that patients may be throwing away money on alternative treatments — whether the state's or their own. The Lancet, a leading British medical journal, last year called homeopathy "nothing but a placebo." Nicole Priollaud, a spokeswoman for the French Academy of Medicine, says: "For us, it is clear homeopathy has no therapeutic effect." But Dr. Dominique Jeulin, president of France's National Union of Homeopathic Doctors, thinks that position is based on simple prejudice. "In France, like the rest of Europe, the debate over homeopathy has always been emotional," she says.

At the moment, the skeptics are in the ascendant in France. Two years ago, the state-run health insurer, Assurance Maladie, reduced the rate at which it reimburses homeopathy from 65% to 35%. By contrast, health insurers in Germany stump up for a broad range of therapies. "Unconventional" means what it says; treatments include acupuncture and cupping, in which heated cups are placed on the skin to stimulate blood flow. One state-mandated insurer, Securvita, even won a court fight last year allowing it to cover music and painting therapy, and rhythmic massage. "We try to support the demand of our customers for tried-and-trusted complementary and alternative therapies," says Securvita founder Thomas Martens.

There's one enduring oddity to debate about alternative treatments. Some European governments have long funded one form of treatment without much hard evidence to back its efficacy. France, Germany and Italy spend hundreds of millions of euros reimbursing the cost of treatments at thermal baths where the waters, rich in minerals, are thought possibly to alleviate conditions such as rheumatoid arthritis. Even the French Academy of Medicine suspends its skepticism when it comes to the baths; it validates their water quality and therapeutic indications. Assurance Maladie pays out about €158 million a year for treatments at France's 120 authorized thermal-bath centers. Italy's national health system, too, pays for treatments at spas all over the country. "In Europe, thermal therapies have an ancient tradition," says Maria Carla Ottaiano of the Lazio Regional Health Council. Nevertheless, Italy's Ministry of Health proposes to verify scientifically the effectiveness of thermal treatments.

Testing like that might help ease the antagonism between conventional and alternative practitioners. Done properly, it would bestow legitimacy on effective treatments, while weeding out bogus therapies — and the quacks who promote them. A key area is in the licensing and regulation of practitioners, vital to quality control. Dr. Sara Eames, a homeopath at the Royal London Homeopathic Hospital, says the lack of regulation undermines confidence in the whole sector. "There could be people who go off, take a course and think they can take a few crystals and cure anybody," she says.

For its part, Britain requires osteopaths and chiropractors to register with a statutory professional body, but anyone can work as an acupuncturist or homeopath. In Germany, typically only private insurers reimburse the services of state-regulated complementary and alternative practitioners. The situation in France is chaotic. Acupuncturists must study three years at an accredited school, but their work is technically illegal if they are not also medical doctors. That means that acupuncturists like Stéphane Bourquard can only bill private insurers for their fees; they of course pay taxes to the state, but can't collect state pensions because they're considered to be illegally practicing medicine.

How can this muddle be sorted out? With lobbyists prescribing a multiplicity of approaches, European governments can be excused a little confusion. But alternative therapies are often the last resort for patients failed by conventional treatments or suffering chronic conditions. Vulnerable, sometimes in financial hardship because of their illnesses, they're looking for help, not controversy. Time, they say, for the alternative and conventional camps to stop giving each other the needle.