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Alternative healing methods and placebo

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Our time is experiencing a remarkable upswing in alternative healing methods. Dozens of healing methods are propagated under the slogan “Naturally get well”, all of which are supposed to be characterized by their gentle, holistic character. Today, many doctors are ready to use such methods themselves. But even if you look at the methods of scientifically oriented, so-called conventional medicine with critical eyes, there is no reason to blindly accept alternative methods as sensible or even superior.

There is actually only one single criterion on which the medical work can be oriented. This criterion is: Does my intervention work in favor of the person seeking help? Before alternative methods can be discussed, we must therefore be clear about the definition of the therapeutic benefit.

Basic therapeutic principles

A treatment can be described as useful and meaningful if it prevents, reduces or eliminates health disorders without causing health problems of a serious nature.

Vital benefit
Situations in which medical intervention undoubtedly has a life-saving or life-sustaining character are relatively rare. Successful radical surgery of a malignant tumor and antibiotic treatment of pneumonia can serve as examples of such life-sustaining therapies. In many other cases, the vital benefit of a treatment is lacking or is judged controversially, e.g. in the case of many cytostatic therapies or medicinal cholesterol lowering.
It is certainly one of the most beautiful and most important medical tasks to prevent premature death or serious disability. If procedures of this type exist with a proven benefit, it is imperative that they be applied. It can be accepted that such a treatment also produces unpleasant side effects. However, it is not always easy to determine the extent to which undesirable effects may assume or how the risk-benefit ratio should be assessed. In this regard, the opinion of those affected can differ widely from that of the doctor.
From a medical point of view, however, in these cases there is not the slightest doubt that alternative methods without proven benefit should never be the only therapy.

Symptomatic benefit
A large number of people who seek medical help do so because of benign diseases or because of health problems that cannot be cured, but only alleviated. It would be wrong to underestimate the symptom relief, which is often the main focus in everyday medical practice.
Benign (often referred to as banal) diseases usually heal without medical intervention. Still, medical help is valued, if only because it confirms the harmlessness of a problem. Benign diseases require benign treatment. It is therefore of great importance that in these cases there are no or only minimal side effects. In the case of harmless problems, one can, in good faith, disagree about the most suitable procedure. It is quite possible that in these cases various alternative methods are associated with fewer disadvantages than "aggressive" drug therapy.
Similar considerations also apply to the symptomatic therapy of incurable diseases. Here, compassionate sympathy (“tender loving care”) is of particular importance. Provided that those affected are not deprived of measures of proven vital benefit, alternative procedures cannot be ruled out in these cases either. For any symptomatic therapy, however, undesirable effects are particularly important. Of course, this must also be taken into account with alternative methods.

Alternative methods and conventional medicine are not a contradiction in terms

«An inadequately defined procedure that is used with unpredictable results in cases with an imprecise diagnosis. Rigorous training is required for this procedure. "(1)

Alternative procedures cannot be sharply demarcated from those of "scientifically" oriented medicine. What at one time was considered a generally accepted procedure in conventional medicine may later be assigned to the field of alternative methods. Certain methods, which in some countries are a natural part of "official" medicine, are ridiculed as questionable in other countries. For example, not all of the methods taught at Swiss universities have an undisputed benefit. The quote at the beginning of this section does not refer to foot reflexology or acupuncture, but to medical psychotherapy. Certain surgical interventions (e.g. hysterectomies), balneotherapy and numerous drugs, to name just a few examples from the field of "normal" conventional medicine, are also controversial, questionable or useless.
So it is not surprising that numerous colleagues are trying to meet the “public demand” for gentle, alternative procedures. I cannot prove whether my impression is correct that these doctors often show their patients more individual sympathy.

What does «placebo» mean?

Many experts and laypeople tend to classify placebo effects as inferior. The reality is different:
the placebo effect is an integral part of any therapeutic act. A placebo effect corresponds to an effect triggered by the treatment, but not explainable by the specific qualities of the treatment. It is characteristic of placebo effects that they can be triggered in a similar way by very different influences (e.g. medication, psychotherapy, dietary measures).
It is quite obvious that, at least in the area of ​​symptom therapy, many treatment successes can also be mainly attributed to placebo effects in conventional medicine. This applies not only to procedures with no proven benefit - nootropics, chondroprotectives, and the like - but also to scientifically well-founded therapies. How else could it be explained, for example, that an injection occasionally works much better than a (pharmacologically) equipotent oral dose of the same drug?
One often speaks of “placebo responders” and means people who have a particularly pronounced placebo effect. However, it is not certain that there are people who actually consistently display this characteristic (2) and I rather suspect that we are all placebo responders - depending on our current condition and the therapy applied.
A number of definitions are offered for the term “placebo”. The easiest way to define a placebo as a therapy (or a drug) without any detectable pharmacological effect. This definition is often supplemented, e.g. by assigning a psychological effect to the placebo. In view of the fact that placebo effects are not limited to placebos and do not occur exclusively in the case of mental or psychosomatic illnesses, such supplements do not seem sensible.
Pseudo-placebos or impure placebos, on the other hand, are drugs that also have no detectable pharmacological effect, but for which specific effects are postulated. When you consider how many doctors willingly prescribe such drugs - believing that they have more than a placebo effect - it is surprising how vehemently many speak against the prescription of real placebos. Ethical concerns can certainly justifiably be raised against therapy with placebos. However, the same considerations apply to prescribing pseudo-placebos.

Are alternative therapies placebo therapies?

Just as all the methods of conventional medicine do not meet scientific standards, there is no alternative method that can be combined with one another. There are an incredible number of different alternative procedures on offer today. As a scientifically oriented doctor, I can make the following distinction:
1. Processes in which a physico-chemical effect appears possible and plausible
2. Processes which cannot be clearly assigned to specific scientific considerations or which even seem to contradict the known physical-chemical laws.

Process with physico-chemical action
In Table 1, some important treatment methods are listed, the effects of which could fundamentally be explained scientifically. However, there is currently insufficient evidence of the effectiveness of these processes. This is partly due to the fact that it can be extremely difficult to demonstrate certain effects. So it can hardly be doubted that e.g. certain diets have health consequences. However, these may only become manifest after many years; the connection between a dietary measure and a specific physical effect is also difficult to grasp. On the other hand, it is conceivable that other methods that also appear plausible may not actually have a placebo effect. In any case, it should be noted with all these procedures that they are not generally free from undesirable effects!
It is not clear to me how much the advocates of this method care about scientific proof of effectiveness. On the one hand, proof would be linked to the satisfaction of “having always known”. On the other hand, it can be assumed that procedures with a proven effect would quickly be adopted by conventional medicine and thus lose the nimbus of alternatives.

Processes that cannot be interpreted scientifically with certainty

Numerous alternative healing methods cannot be well justified from a scientific point of view or even seem to contradict the known physical-chemical laws. Table 2 contains some important examples of such methods. However, there are enormous differences between the various procedures - some psychological effects are very likely, some only physical effects are conceivable, and some it remains completely unclear how an effect should take place. If, as explained above, the placebo effect is recognized as a (temporarily) inexplicable, but important component of any therapy, then inexplicable alternative methods can be described as placebo procedures without disregard. As a rule, they are characterized by the absence of serious side effects; In addition to beneficial placebo effects, unfavorable, i.e. nocebo, effects can also occur!
Individual procedures of this kind, e.g. homeopathy, can be tested in the same way as conventional medicine. Corresponding studies have so far produced either negative or highly controversial results. If a vital benefit is propagated for alternative methods, correct evidence of this benefit is essential in the interests of the treated persons. On the other hand, I am not convinced that a strict proof of effectiveness should also be demanded for the numerous procedures with exclusively symptomatic benefit. In the field of symptomatic therapy, it is enough for me to be able to tell my patients that the benefit of a treatment is “possible” or actually “proven”. As already explained, conventional medicine also uses numerous procedures, the benefits of which would be better described as “possible” than “proven”.

Possible areas of application

Treatment methods without a proven benefit do not have to be discarded in general. In many areas of symptom therapy, it is more a question of individual inclination whether you want to recommend a procedure with “possible” benefits or have it applied to yourself. Three application areas for such procedures can be defined schematically:

Diseases or symptoms with a high tendency to self-heal

Benign diseases and harmless symptoms, which usually disappear spontaneously within a short time, do not actually require any treatment. However, if this is desired, processes with “possible” benefits can be used without further ado. The only key consideration here is that the harmful effects of treatment must be avoided. For example, flu-like infections can undoubtedly be treated with “home remedies” without acetylsalicylic acid, codeine, antihistamines and sympathomimetics. Even with cervical tension or pain, nothing stands in the way of using alternative methods, as long as no dangerous manipulations are carried out. (The latter, however, must be underlined - one of my patients has had a permanent worsening of her cervical complaints since an improper manipulation of the cervical spine by an alternative practitioner.)

Diseases with unsatisfactory treatment options

Even today there are still many, especially many chronic diseases, the course of which can hardly be decisively influenced, but which can be treated symptomatically. Examples can be found particularly in the fields of neurology and rheumatology. In these cases, even experts often use procedures with no proven but “possible” benefit (for example so-called chondroprotectives). It is characteristic that many alternative procedures (acupuncture, baths of all kinds, cantharid plasters, chirotherapy, healing clay, Kneipp therapy, metal therapy, moxibustion, neural therapy, etc.) are available for rheumatic ailments. Basically, there is nothing wrong with these treatments with “possible” benefits - again with the restriction that undesirable effects should be observed and avoided. It also seems important to me that symptomatic treatments with proven benefits (e.g. orthopedic interventions) are not neglected or missed.

Illnesses that are incurably fatal

A very large percentage of people who suffer from an incurably fatal disease can also receive alternative treatment: According to a Swiss study, more than half of all cancer patients use alternative means (3) and according to American statistics, 22% of AIDS Phytotherapeutic agents for patients. (4)
Provided that measures with a proven benefit for quality of life and lifespan are not neglected, from a medical point of view there is little objection to alternative procedures.
However, it is not the case that cancer patients only see the disadvantages of aggressive therapy associated with unpleasant side effects. Despite problems (such as nausea, vomiting), chemotherapy can significantly improve the quality of life of those treated. (5) Even an apparently modest gain in lifespan is often assessed much more positively by cancer patients than by outsiders. It is therefore generally not advisable to advise patients without a definite chance of recovery because of possible side effects, e.g. from chemotherapy.
Unfortunately, oncologists are repeatedly confronted with the fact that chemotherapeutic agents, hormones and / or radiotherapy no longer have a convincing palliative effect after initial success. Sick people who turn to alternative procedures in this situation at least deserve our understanding.

Problems with alternative procedures

"Unfortunately, 98% of acupuncture in Switzerland is based on wrong, only old, now absolutely unscientific ideas and ideas that cannot be substantiated by any modern research." (6)

This quote from the Swiss Medical Journal highlights one of the major weaknesses of alternative methods.If a Viennese professor can say that 98% of the acupuncture practiced in our country lack a scientific basis, it is obvious that the basis and application of this method must diverge to an extraordinarily high degree.
This is where the enormous deficit of alternative methods lies: If, for example, I am determined to be treated with an alternative method, how should I be able to judge which method would be the best for me? Even those active in alternative therapy cannot give a satisfactory answer to this question. These procedures are often hardly comparable with each other (and with the methods of conventional medicine). Therefore, in many cases it is not clear how an optimal choice could be made between the various methods.

In addition, most alternative therapies are insufficiently standardized. Even if you have decided on a certain method, it is not yet clear which variant of acupuncture, homeopathy, phytotherapy, etc. would be preferable in the present case.

Another problem is the mistaken belief that alternative methods do not cause relevant adverse effects. In particular for processes for which a physico-chemical effect appears plausible, toxic effects are to be expected. As a student, I learned how close the poisonous and medicinal plants are. However, unfavorable psychological effects are also possible.

But it is worst when an effective therapy (with proven benefits) is missed as a result of blind belief in unfounded healing promises. Unfortunately, completely unjustified promises of success are made in connection with the most varied of alternative therapies. It is undoubtedly one of the medical duties to warn against such genuine charlatanism.

One must also be careful of the addiction of individual alternative therapeutic practitioners to their addiction to profit. In contrast to the doctors, who remain within the framework of conventional medicine and are required by their contracts with the health insurances to also take into account the economic aspects of their therapy, there is a very wide range of possible fees for alternative workers. Certain apparatus-based procedures (e.g. oxygen therapy) are often used as a pretext to justify salted bills.

Therapy experts

Women and men who have studied medicine and have completed their knowledge in long years of training are the people with the best prerequisites for successful therapeutic work. Whether they realize this potential in the context of conventional medicine or with the careful, critical application of alternative methods is of secondary importance. Rather, it is crucial that you as therapists know the limits of your possibilities, maintain a critical distance from all procedures (including your own) and are ready to recognize new developments and apply them to the benefit of the sick.
Alternative procedures are not the monopoly of the medically trained. Naturopaths can also achieve good results with these methods. There are, however, much greater differences between them with regard to their educational background.

Finally, it may be of interest to see how I personally behave towards alternative procedures. Just as I draw my patients' attention to the undesirable effects of medication or other limits to conventional medical therapy, I also express myself critically about alternative methods. I do not use any of these methods myself, but I openly discuss alternative options with anyone who is interested. I think it is important to make it clear that these are treatments with “possible” but not “proven” benefits. If someone tells me about the success of an alternative therapy, I am happy. So I try to protect the interests of the sick and at the same time recognize and support their freedom of choice.

Comments

Although Dr. Gyslings make the appearance of a certain tolerance towards complementary medicine and sound benevolent at times - even if «from above» - then I, as a homoeopathically and anthroposophically trained pharmacist, have to clearly reject it. The text shows a professional ignorance that I had to ask myself time and time again where the author got the right to talk about complementary medicine. It seems pointless to me to go into the details of the article because the space allotted to me would not allow more than to put a counter-assertion next to each assertion. That would underpin the unscientificness with which this is proceeding.
Nevertheless, I would like to put two basic things in perspective:
- Conventional medicine only knows the one physical body in which healthy, sick and medical processes take place (physiology, pathology, pharmacology), so it has its strength in the chemical field.
Genuine complementary medicine such as homeopathy and anthroposophic medicine knows four human bodies, namely in addition to the physical three other invisible bodies, at the level of which healing is initiated. Your strength lies in the energetic field, i.e. in the field of physical forces.
This aspect alone prevents complementary medicine from wanting to be understood and assessed using the criteria of conventional medicine. It is not the complementary healing methods that are unscientific, but rather the unscientific approach that subjects apples to the criteria of pears. - In contrast to conventional medicine, the homeopath and the anthroposophic doctor are specialists in both areas: You cannot become a homeopathic or anthroposophic doctor without having completed an official medical degree at a university. The question now arises to me, under which "category" do I find more charlatans. Among those who blindly believe in suppressing symptoms, or among those who, after studying medicine, embark on the arduous path of searching for real healing methods?
What counts most for me - regardless of his color - is that doctor who is interested in real healing and who puts all his efforts at your service. The homeopathic and the anthroposophic doctor can draw on a multitude of possibilities in this regard and therefore come closer to the healing artist than the pure conventional doctor. When Dr. Gysling is a lot unclear how he writes, so I would like to encourage him to do an apprenticeship again!
Silvia Briggen

Silvia Briggen is a pharmacist; she runs the St. Peter pharmacy in Zurich. For years she has been one of the advocates of homeopathic and anthroposophic medicine.

E. Gysling's article is characterized by its pragmatic and open approach. You can even feel the interest in viewpoints and shades that result from a complementary perspective on the topic.
I would expand the criterion of medical therapy a little: Does the intervention work in favor of the current situation and the future development of the person seeking help? Does she respect this person as a responsible person? Is it socially acceptable? Can the information obtained in this way be systematically combined with other experiences? With the last addition, I almost seem to be speaking against complementary methods. However, this only seems to be so to those for whom complementary methods cannot be anything other than chaotic.
I add a second shade when discussing chronic incurable diseases. Chronic and incurable is always to be seen in relation to the medical status and a medical method. An example from homeopathy: With its possibility of constitutional treatment, it assesses many conditions, which in conventional medicine seem to be chronic diseases only accessible to symptomatic treatment, as definitely curable. Then it is also important to consider the patient's situation. He is exposed to the polarity between accepting suffering and the struggle for healing and does not give up hope that he can still be cured with a method. If the doctor wants to accompany the patient in this polarity, he will have a keen eye for alternatives.
Now to the term placebo, which Gysling already uses in the title. First of all, this term serves to distinguish proven pharmacological effects from other phenomena. It will be used later when a distinction is to be made between processes that can be interpreted physically and chemically and other phenomena. The placebo-controlled double-blind test is known, in which the material effect on the placebo zero line is clearly and simply added up because these areas are separated. There are many complementary methods in which the separation of matter and spirit, body and soul is not worked out. This is where the term placebo loses its relevance. The space is left free for other aspects of therapy such as: Does its character correspond to the character of the therapeutic problem? The type of therapy corresponds to life-threatening situations, which has proven itself in the verification procedure of conventional medicine. In other situations, the sick individual's ability to integrate his or her areas of life is required. Methods that require action (e.g. rubbing in), which contain different substances (e.g. alkaloids), which appeal to the senses (e.g. smell), but which are also symbols (e.g. plants as guarantors of our connection to the living cosmos) prove themselves.

What is the bottom line of this different approach? In the field of drug approval and clinical research, alternatives would be necessary. In the area of ​​the doctor's activity, you come to almost the same areas of application for complementary methods as with the pragmatic approach in Gysling's article, from which I use the last two sentences: When someone tells me about the success of a conventional therapy , I am pleased. I try to protect the interests of the sick and at the same time recognize and support their freedom of choice.
Klemens Brühwiler

Dr. med. Klemens Brühwiler practices in Wil (SG) and is President of the Swiss Medical Society for Phytotherapy.

God knows, the problem of alternative healing methods is not new. There are developments of this kind in every trade that is not tightly organized by the state with regard to what the lex artis is. For example, you can fall into the hands of a stupid or even (morally) bad lawyer. But when it comes to his patterns of action, pretty much everything is precisely defined. In the freer trades it is much more complicated as far as the freedom of action is concerned.
How should it look different in medicine if not even the experts there can agree on what health really is? So who is surprised that there are alternatives for maintaining or achieving what we call health? The personal conviction of the person concerned certainly also plays a major role, whose suffering is to be alleviated and whose health is to be restored. But in the whole procedure of the relationship between doctor and patient, where are the possibilities for those affected to express or even enforce their will? There may still be one or the other conceivable possibility for this with private patients. I don't see any leeway here for the social insured. It has always been customary to describe the "layman" as incompetent and to point out to him as much as possible that a responsible doctor is not only trustworthy, but otherwise will fix everything. This axiom is slowly being reconsidered.
I already praise the doctor, for example the specialty of ear, nose and throat, who explains to the indisposed patient from the singing and speaking professions that he has no other chance than to get through the cold and its annoying expressions first of all, whereby he can count on the methods of alleviating his complaints that are available with the currently available healing methods for coping with a common cold. For the moment there is certainly still help with various eye and nasal sprays and, if necessary, even local anesthetics, with which the voice can at least be restored to the extent that the current obligations can be fulfilled. This is associated with these and those dangers that occur very rarely, but at least occasionally.
There is an alternative treatment for almost every ailment, and from this it can be inferred that the doctor has an obligation and the layperson has the right to be informed about the alternatives. How about if the health insurance companies thought about it? For example, I could well imagine that they would sign doctors for certain types of therapy. This would also solve the annoying problem once and for all that one of us always has to take a position on such therapeutic directions. The useless reports would disappear from our desks, for example on whether a terminally ill tumor patient who refuses chemotherapy to prolong life has the right to claim only "compassionate participation", possibly still using homeopathic and / or anthroposophic drugs Direction. So that I am not misunderstood: under different circumstances, a patient can very well choose to take advantage of life-prolonging therapy, and with good reason.
Wolfgang Forth

Prof. Dr. Wolfgang Forth is a pharmacologist. He heads the Walther Straub Institute for Pharmacology and Toxicology at the Ludwig Maximilians University in Munich.

Gysling assesses homeopathy based on its own scientific understanding, which is expressed in terms such as “symptomatic benefit”, “benign diseases”, etc. Homeopathy and allopathy (conventional medicine) are two fundamentally different systems, which differ not only in terms of the medication (as is often assumed), but also in their concept of health and illness, in the use of the medication and in the therapeutic goal. Homeopathy is not satisfied with the superficial disappearance of symptoms; Healing means the successful treatment of an acute illness and the tendency to relapse, as well as a chronic illness. The homeopathic conception of illness implies a criticism of conventional medicine, which, with a large number of its interventions, is a direct contributor to chronic, recurrent, chronic diseases and immune disorders. To name just one example: Antibiotics kill the pathogen of an infectious disease, but at the same time they change a large number of other factors in the human organism that are directly or indirectly related to the immune process (e.g. the germs of the mucous membranes living in symbiosis) and, in turn, the The tendency to relapse and / or chronicity as well as a shift of symptoms to other organs can result.
The success of homeopathic therapy indirectly confirms the validity of these theses. The placebo effect is of limited duration with a rapid decrease in effect. In this sense it is also known in homeopathic therapy. Healings or healing processes with predictable processes over months and years, as observed in homeopathy, cannot be attributed to placebo effects. Homeopathy also successfully treats infants, toddlers and animals without these treatment successes being explained by the placebo effect.
For a discussion of the scientific verifiability of homeopathic therapy, I refer to the work of Righetti, (1,2) Walach, (3) and Kleijnen. (4) Without knowledge of the basics of homeopathy, there can be no correct assessment of your research results. We are still forced to lead the discussion about homeopathy with unreflected prejudices on the part of the critics.Anyone who wants to enter into a serious discussion with us should finally read the relevant papers and take note of their significance.
Klaus Halter

Dr. med. Klaus A. Halter is a specialist in internal medicine FMH and President of the Swiss Association of Homeopathic Doctors. He practices in Therwil.

Placebo is certainly not a bad thing and is probably partly responsible for every effect of a drug or our success as a doctor. For most of the methods of "conventional medicine", an objective, reproducible effect has been proven, with a known risk / benefit ratio, while for "alternative" methods such evidence is either lacking or insufficient. This does not prevent many patients and many doctors from using such methods, especially in the case of incurable and chronic diseases, but also in part when there is a need to "expand" this medicine in the sense of the supernatural, that which cannot be fully rationally grasped, occasionally also in the "numismatic ». Such an alternative or perhaps more additive method can be quite sensible and helpful, as long as the doctor believes in it himself and does not apply it in liquid form and does not arouse false hopes in the patient. Above all, it is important to maintain healthy criticism and self-criticism, with every method (!), And not to ignore new knowledge. Basically, it is always a matter of staying away from the “autistic undisciplined thinking” so succinctly described by Bleuler, which takes no account of the limits of experience and does not control the results against reality and does without logical criticism. If one remains critical and honest, such methods can undoubtedly help many patients.
Felix Jungi

Dr. med. Until recently, Felix Jungi was a full-time senior doctor for oncology at the St.Gallen Cantonal Hospital. He is now the canton doctor for the canton of St.Gallen.

I also occasionally prescribe pseudoplacebos. The German pharmacist can produce pure placebos at the request of a doctor and give them to the patient, but they must not be prescribed in writing. In addition, the patient will search in vain for the indication for "his" disease on the package insert and may lose confidence in the doctor if he discovers the prescription of the dummy drug.
Much more important to me, however, is the question of whether the therapist consciously uses certain preparations as placebos or, under certain circumstances, believes in their effectiveness themselves (and thus perhaps enhances the effect on their patients?). The range of prescriptions in Germany suggests the latter, but is perhaps also an expression of the feared loss of income by doctors, if patients who are only recommended home remedies for disorders, see no reason to come to the practice next time.
I have integrated pseudoplacebos into my individual positive list, which has been maintained for over 10 years, and added the "Placebo?" marked. This label reminds me of the “efficacy status” of a substance, but it also reminds me that proof of efficiency might still be obtained in individual cases. The list contains 293 substances or substance combinations in 63 indication groups. 24 of the 63 indication groups contain “placebos?”: 7 chemically defined preparations, 16 phytopharmaceuticals and 18 homeopathic drugs. The latter are only used as “experiential homeopathics”, which “real” homeopaths probably use to clap their hands over their heads. Although placebo therapy cannot be avoided in general practice in my opinion, it must not become an unreflected routine, but must be weighed up in each individual case. The following criteria might help, according to which the use of such preparations should be considered: 1. If a drug therapy would be desirable, but no drug with documented efficacy and suitability for the individual patient is available; 2. the patient insists on a drug and if the patient refuses, the doctor-patient relationship is endangered; 3. the selected pseudoplacebo is almost free of undesirable effects; and finally 4. the pseudo-placebo treatment causes reasonable costs (pragmatically, I once set daily therapy costs of less than DM 1). However, I have to leave it open whether such an inexpensive placebo is less effective than a more expensive preparation. This question always seems to me to be worth clarifying.
Michael M. Cooking

Prof. Dr. Michael M. Cooking is head of the general medicine department at the Georg-August University in Göttingen. He has been dealing with various aspects of drug therapy in practice for years.

In Table 1, chiropractic is mentioned as an example of “alternative procedures with plausible physical-chemical effects”. It should be added that chiropractic in Switzerland has been anchored in the KUVG since 1964 and that its services have been covered in full as compulsory benefits by health insurers since 1965 and, since 1978, also by accident insurers and military insurance. This fact assumes that chiropractic is a scientifically founded healing method and states that chiropractors are medical professionals within the meaning of the law. Chiropractic is therefore not to be classified under the alternative procedures and the thoughts expressed later in the text regarding profit-oriented work do not apply here.
I fully share the concerns about improper manipulations and would like to point out that chiropractic manipulations are only reserved for chiropractors and the specially trained manual medicine specialists.

Like the various methods of conventional medicine, chiropractic also strives for the greatest possible therapeutic effect with the least risk of negative side effects. The relationship between the actual and the placebo effect is roughly in the same range for this and that procedure. Heini Kohler

Dr. Heini Kohler practices in Lucerne; he is President of the Swiss Chiropractor Society.

literature

  1. 1) Shepherd M. Br Med J 1984; 288: 809
  2. 2) Blanz M. in Feiereis H, Saller R (eds.), Drei heisse Eisen, 1992; Hans Marseille Munich, 119-32
  3. 3) Morant R et al. Switzerland Med Wochenschr 1991; 121: 1029-34
  4. 4) Kassler WJ et al. Arch Intern Med 1991; 151: 2281-8
  5. 5) Coates A et al. N Engl J Med 1987; 317: 1490-5
  6. 6) Bischko J. Schweiz Ärztezeitg 1992; 73: 46
  7. 7) Righetti M. Research in Homeopathy. Göttingen: Burgdorf Verlag 1986
  8. 8) Righetti M. Natur Ganzheitsmed 1990; 3: 331-5
  9. 9) Wallach. Homeopathy as a basic therapy. Heidelberg: Haug Verlag 1986
  10. 10) Kleijnen J. Br Med J 1991; 302: 316-23

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Alternative Medicines and Placebo (April 28, 1992)
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