A SCIENTIFIC LOOK AT ALTERNATIVE MEDICINE
Homeopathy, Naturopathy, Energy Medicine, and Other "Holistic" Approaches
Part 3: Other "Holistic" Approaches: Aromatherapy, Bodywork, Iridology, Reflexology, and Others
Thomas J. Wheeler, Ph.D.
Associate Professor (retired), Department of Biochemistry and Molecular Biology,
University of Louisville School of Medicine, Louisville KY
thomas.wheeler@louisville.edu
Revised 2020
This original version of this material was a part of handout for an elective course given to medical students at the University of Louisville.
Copyright 2020. Permission to copy for non-profit uses is granted as long as proper citation of the source is given.
DISCLAIMER: The material presented here is not medical advice. It represents the author's summary of scientific evidence concerning various topics. For medical advice, see your physician.
A pdf file containing all parts and references can be downloaded from ARTICLES or HOLISTIC.
CONTENTS OF PART 3
"Holistic" medicine - general Iridology
Anthroposophic medicine Lotus birth
Aromatherapy Naprapathy
Bach Flower Remedies Psammotherapy
Balneotherapy Reflexology
Bodywork (including craniosacral therapy) Sauna bathing
Forest bathing Sophrology
Halotherapy
Hydrotherapy References
“HOLISTIC” MEDICINE - GENERAL
Holistic medicine, defined as an approach that considers the whole person (including psychological and emotional needs, the family situation, diet, exercise, lifestyle, etc.), is properly part of modern scientific medicine. Ernst (2005. Focus Altern Complement Ther. 11(4):275-6) noted that "holism has always been at the heart of any type of good medicine." However, in practice, the term “holistic” is used by many alternative practitioners to include unconventional methods of diagnosis and treatment.
Some studies have found that utilization of "holistic" methods is more prevalent among women compared to men, and that women are also more likely to be practitioners of these methods.
Robert Imrie, DVM, has pointed out that many so-called “holistic” modalities do not consider the whole patient, because they ignore modern knowledge in anatomy and physiology (e.g., nervous system, endocrine system), as well as knowledge of the causes of diseases (e.g., microbes). Instead, they rely on outdated and incomplete views of the workings of the human body.
There is an American Holistic Medical Association and an American Holistic Nurses Association. In 2006 holistic nursing was recognized as a specialty by the American Nurses Association.
ANTHROPOSOPHIC MEDICINE
Background
Anthroposophic medicine is based on the spiritual/philosophical teachings of Rudolf Steiner (1861-1925), who split from Theosophy in 1912, and whose ideas are continued through the Waldorf schools.
"The anthroposophic concept of man claims the human organism to be not only formed by physical (cellular, molecular) forces but by altogether four classes of formative forces: (1) formative physical forces; (2) formative vegetative forces which interact with physical forces and bring about and maintain the living form, as in plants; (3) a further class of formative forces (anima, soul) which interact with the vegetative and physical forces, creating the duality of internal-external and the sensory, motor, nervous and circulatory systems, as in animals; (4) and an additional class of formative forces (Geist, spirit) which interact with the three others and enables the manifestation of individual mind with the capacity for reflective thinking, as in humans...The interactions of these forces are understood to vary between different regions and organs in the human body, resulting in a complex equilibrium. This equilibrium can be distorted in various forms of human disease, and is sought to be regulated by anthroposophic therapies. Specific AM therapies include medicinal products, physical therapies such as rhythmical massage therapy, art therapies and movement therapies such as eurythmy therapy" (Baars et al. 2018. Complement Ther Med. 40:145-50).
"AM care is provided by certified medical doctors, nurses, therapists, midwives, psychotherapists, and nutritionists. AM education is provided by specific schools, universities, and other academic institutions" (Kienle et al. 2019. Evid Based Complement Alternat Med. 2019:3706143).
"After training in conventional medicine, interested physicians undergo additional specialized training in AM. This covers a curriculum of 1000 h in total, including theoretical background, supervised clinical treatment of patients, writing of peer-reviewed case reports and a thesis" (Vagedes 2019. Complement Ther Med. 47:102151).
"Currently there are approximately 24 anthroposophic medical institutions, which include hospitals, departments in hospitals, rehabilitation centers, and other inpatient healthcare centers in Germany, Switzerland, Sweden, Italy, The Netherlands, and the United States...In addition to the anthroposophic hospitals, there are more than 180 anthroposophic outpatient clinics worldwide in which anthroposophic physicians and therapists work together...Since 1976, anthroposophic medicine in Germany has been defined, alongside homeopathy and phytotherapy, as a distinct 'special therapy system' (besondere Therapierichtung) in the Medicines Act and is represented in Germany by its own committee at the Federal Institute for Drugs and Medical Devices" (Kienle et al. 2013. Glob Adv Health Med. 2(6):20-31).
Practice and scope
"Plant, mineral, and animal substances are used in anthroposophic medications. Anthroposophic medications are conceived, developed, and produced in accordance with the anthroposophic knowledge of the human being, nature, and substance and are sometimes potentized. The method of production is specified in the German homeopathic pharmacopoeia, in the Swiss Pharmacopoeia, and in the Anthroposophic Pharmaceutical Codex and follows good manufacturing practice" (Kienle et al. 2013. Op. cit.).
"External applications - such as embrocation, compresses...hydrotherapy, and medicinal baths - are used as elements of nursing care and therapy to stimulate, strengthen, or regulate hygiogenic processes. For this purpose, etheric or fatty oils, essences, tinctures, and ointments are used, as well as carbon dioxide in baths. Of particular importance is rhythmical massage..." (ibid.).
"Anthroposophic art therapy employs the following techniques:
Sculptural forming...
Therapeutic drawing and painting...
Music therapy...Melodies, sounds, and rhythms are improvised with the therapist or simply listened to. The choice of instrument depends on the individual circumstances of the patient, according to the severity and stage of the illness.
Anthroposophic speech therapy: This involves using articulation, consonants, vowels, text rhythms, and hexameters...The indications for anthroposophic speech therapy are not only disorders of the voice but also general medical diseases, psychosomatic and psychiatric diseases, and learning and developmental difficulties.
Art therapy is provided as individual therapy, as individual therapy in small groups, or as group therapy" (ibid.).
"Eurythmy therapy (In Greek, eurythmy means 'harmonious rhythm'...) is an exercise therapy involving cognitive, emotional, and volitional elements. It is provided by eurythmy therapists in individual or small group sessions during which patients are instructed to perform specific movements with the hands, the feet, or the whole body. Eurythmy therapy movements are related to the sounds of the vowels and consonants, to music intervals, or to soul gestures (eg sympathy-antipathy). For each patient, one movement is or several movements are selected depending on the patient’s disease, his constitution, and on the therapist’s observation of the patient’s movement pattern. This selection is based on a core set of principles, prescribing specific movements for specific diseases, constitutional types, and movement patterns" (ibid.).
"Rhythmical massage was developed from Swedish massage by Wegman, who was a physician and physiotherapist. Traditional massage techniques are augmented by lifting movements, rhythmically undulating or gliding movements, and complex movement patterns such as lemniscates and by using special loosening techniques from the deeper areas out to the periphery" (ibid.).
"Mistletoe treatment for cancer originated within anthroposophic medicine. It is one of the most commonly prescribed complementary cancer therapies in Central Europe and has been investigated intensely" (ibid.). Mistletoe is marketed as Iscador (see article on cancer therapies).
"One health care approach to providing ICC [integrative cancer care] is anthroposophic medicine (AM), practiced in about 80 countries worldwide, with the widest distribution in Europe and South America. AM cancer care is practiced in specialized cancer centers, hospitals, outpatient settings, and private practices. It integrates conventional cancer treatment with AM medications, such as mistletoe therapy (MT), art therapy, eurythmy therapy, body-based treatments, nursing care, intensive counseling, and psychotherapy. The approach is individualized and encompasses spiritual aspects" (Kienle et al. 2016. Integr Cancer Ther. 15(4):478-94).
Relation to antivaccination movement
In 2019, the International Federation of Anthroposophic Medical Associations published a statement in support of vaccinations. Ernst (2019 Apr 16. Edzard Ernst blog) was not convinced by this, noting that "there are hundreds of anthroposophic texts that seem to contradict this pro-vaccination stance (not least those from Rudolf Steiner himself). Today, anthroposophy enthusiasts are frequently rampant anti-vax...," and in some states the schools with the highest levels of non-medical exemptions from vaccination are Waldorf schools.
Gorski (2018 Nov 20. Respectful Insolence blog) noted that "The antivaccine beliefs flow from Steiner’s philosophy, for example: 'Steiner believed that febrile illnesses such as measles and scarlet fever were related to a child’s spiritual development. Adherents assert that the use of vaccines (especially measles vaccine) deprives infants of the opportunity to benefit from the experience of having those diseases'...Most Waldorf schools don’t specifically teach antivaccine beliefs, but are 'accepting' of whatever decision parents make and serve as magnets for the children of antivaccine parents."
AROMATHERAPY
Background
"Aromatherapy is currently one of the most popular of all alternative therapies. The reason for its popularity seems simple: it is an agreeable, luxurious form of pampering. Whether it truly merits to be called a therapy is debatable" (Ernst 2018 Oct 8. Edzard Ernst blog). It has been used in many ancient Asian cultures, and is recognized in France as a medical specialty.
Essential oils are distilled from flowers, bark, roots, or other plant material. "The practice of administering plant-derived essential oils on the skin, via inhalation of vapors, or internally via ingestion for supposed healing power is commonly called aromatherapy. The oils for aromatherapy are described as 'essential' to refer to the volatile, aromatic components that some people describe as the 'essence' of the plant source, which represents the plant’s 'life force,' 'spirit,' or soul. Aromatherapy is thus rooted in vitalism" (London 2018 Aug 9. Essential considerations about aromatherapy. Skeptical Inquirer).
"Sales of essential oils are dominated by multi-level marketing (MLM) companies that snare potential participants with promises of wealth through a commission system. Unfortunately, this often drives individuals to make outlandish claims about using the oils to treat cancer, autism, Alzheimer’s disease, mononucleosis or arthritis. There seems to be an oil for any condition that potential customers have. The Food and Drug Administration in the United States has sent warning letters to the major MLM companies, resulting in more careful wording of claims, but there is no way to police what parties say in the privacy of a home, where most sales are made" (Schwarcz 2019 Aug 23. The Right Chemistry: The science and pseudoscience of essential oils. Montreal Gazette).
Aromatherapy is recommended by some doctors, as well as by chiropractors, massage therapists, psychotherapists, and cosmeticians. It is promoted by the National Association for Holistic Aromatherapy.
Principles
"The essential oil can be absorbed into the body through three main channels: the skin, the digestive system, and the olfactory system. Sense of smell plays an important role in the physiological function of an individual because the olfaction response is immediate and it is directly extended to the brain; it seems to be related to emotional behavior. The odor molecules of essential oils are transported to the brain by olfactory sensory neurons in the nasal cavity. Thus, they stimulate smell–memory work and influence memory, thoughts, and emotions...The absorption of essential oil via inhalation may affect the autonomic nervous system (ANS) and induce the reaction of the limbic system, hypothalamus, and hormone system. It could affect both parts - the sympathetic nervous system and the parasympathetic nervous system - which function primarily in opposition to each other" (Huang and Capdevila 2017. J Altern Complement Med. 23(3):214-21).
"The oils are alleged to contain hormones, vitamins, antibiotics, and antiseptics and to represent the 'life force,' 'spirit,' or 'soul' of the plant" (Barrett 1994. Skeptical Briefs. 4(1):7, 16).
Burns et al. (BMJ. 325(7376):1312-3 (2002)): “Essential oils contain many terpenes, which are rapidly absorbed through the lungs and cross the blood-brain barrier. In addition, may possess cholinergic activity or act on γ aminobutyric acid receptors.”
"One plausible explanation might be the involvement of the analgesic component of essential oils linalool for lavender, menthol for peppermint, and fenchone for fennel. Another explanation might involve the parasympathetic nervous system related to touch and smell" (Lee et al. 2018. J Clin Med. 2018 Nov 10;7(11). pii: E434).
Practice and scope
"Essential oils are extracted from plants. In their pure form, they are highly concentrated—and sometimes toxic. To make them practical to use, essential oils are typically mixed with diluting carrier oils. Methods of extraction include cold-pressing, steam and water distillation, and the use of chemical solvents" (Ernst 2020 Jan 23. Edzard Ernst blog).
Scents may be inhaled, or oils may be massaged into the skin, to treat medical problems. They may be applied at a location (e.g., in the spine) allegedly corresponding to the problem. Aromatherapy candles are popular.
Aromatherapy is said to be especially effective for psychosomatic or stress-related disorders, to facilitate relaxation, etc. Eucalyptus is inhaled to open sinuses. Other claimed benefits include fighting of infection, healing wounds, elimination of toxins, body toning, mind sharpening, improved memory, opening of lungs, and promotion of circulation.
Practitioners can be "certified" or "accredited" based on correspondence courses, weekend seminars, etc. Many practitioners are licensed in other health professions, such as nursing, massage therapy, or naturopathy.
“Aromatherapists almost always use essential oils as an adjunct to more traditional types of therapy such as massage or acupuncture. It’s almost impossible to find someone who treats exclusively by olfaction, which makes it difficult to assess aromatherapy’s true benefits” (Handel 2003 Jun 15. Los Angeles Times).
In “Raindrop Therapy,” essential oils are dripped on the back and massaged into the skin. It allegedly corrects curvature of the spine. This was promoted by D. Gary Young (died 2018) through his company Young Living Essential Oils.
In aroma-acupressure, oils are massaged at acupuncture points.
Reviews (* = review by Edzard Ernst and colleagues)
Overview (all conditions) - *Lee et al. 2012. Maturitas. 71(3):257-60. "... the evidence is not sufficiently convincing that aromatherapy is an effective therapy for any condition."
Anxiety
*Cooke and Ernst 2000. Br J Gen Pract. 50(455):493-6. Concluded that “aromatherapy massage has a mild, transient anxiolytic effect...the effects of aromatherapy are probably not strong enough for it to be considered for the treatment of anxiety. The hypothesis that it is effective for any other indication is not supported by the findings of rigorous clinical trials.”
Lee et al. 2011. J Altern Complement Med. 17(2):101-8. "Most of the studies indicated positive effects to quell anxiety...It is recommended that aromatherapy could be applied as a complementary therapy for people with anxiety symptoms. Further studies with better quality on methodology should be conducted."
Malcolm and Tallian 2017. Ment Health Clin. 7(4):147-55. "Available trials support the short-term efficacy of the standardized lavender oil extract SLO in the treatment of anxiety disorders, including subsyndromal anxiety disorder (anxiety not otherwise specified), GAD [generalized anxiety disorder], restlessness and agitation with disturbed sleep, and Mixed Anxiety and Depressive Disorder."
Cancer complications - Farahani et al. 2019. Complement Ther Med. 47:102169. "...it seems that the aromatherapy can be used as a proper supplemental treatment to improve complications, although further studies are needed to determine the protocol and the standard dosage."
Dementia
Burns et al. 2002. Op. cit. Concluded that aromatherapy may be effective in managing behavioral problems in dementia. (The studies used lemon balm and lavender oil.)
Fung et al. 2012. Geriatr Gerontol Int. 12(3):372-82. As summarized by London (2018. Op. cit.), the review "reported several positive effects but noted flawed research designs in most of the studies so that '…available evidence in the literature is not sufficient to make a conclusive claim'.”
Depression
Yim et al. 2009. J Altern Complement Med 15(2):187-95. "Although the evidence on the effects of aromatherapy on depressive symptoms is insufficient, it is suggested that it may continue to be used as a complementary and alternative therapy for depression..." It was noted that "Almost all the studies employed aromatherapy massage instead of aromatherapy alone..."
Sánchez-Vidaña et al. 2017. Evid Based Complement Alternat Med. 2017:5869315. "Aromatherapy showed potential to be used as an effective therapeutic option for the relief of depressive symptoms in a wide variety of subjects." However, Ernst (2017 Mar 17. Edzard Ernst blog) wrote, "this paper is irritating because of the almost total lack of critical input. Given that half of the trials were of poor quality...and many totally failed to control for placebo-effects, I think that calling aromatherapy an effective therapeutic option for the relief of depressive symptoms is simply not warranted. In fact, it is highly misleading and, given the fact that depression is a life-threatening condition, it seems unethical and dangerous."
Dysmenorrhea - Lee et al. 2018. J Clin Med. 7(11). pii: E434. "...our systemic review provides a moderate level of evidence on the superiority of aromatherapy (inhalational, massage, or oral use) for pain reduction over placebo in primary dysmenorrhea."
Hypertension - *Hur et al. 2012. J Eval Clin Pract. 18(1):37-41. "The existing trial evidence does not show convincingly that aromatherapy is effective for hypertension."
Nausea and vomiting - Lua and Zakaria 2012. J Altern Complement Med 18(6):534-40. "...a definite conclusion could not be drawn due to methodological flaws in the existing research article...The existing evidence is encouraging but not yet compelling."
Nausea and vomiting (postoperative) - Hines et al. 2018. Cochrane Database Syst Rev. 2018 CD007598. "Overall, for nausea severity at the end of treatment, aromatherapy may have similar effectiveness to placebo and similar numbers of participants were nausea-free. However, this finding is based on low-quality evidence and therefore very uncertain."
Psychological symptoms in postmenopausal and elderly women - Babakhanian et al. 2018. J Menopausal Med. 24(2):127-132. "..may be beneficial in attenuating the psychological symptoms that these women may experience, such as anxiety and depression, but it is not considered as an effective treatment to manage nervousness symptom." However, Ernst (2018 Oct 8. Edzard Ernst blog) wrote "What makes this review truly dismal is the fact that the authors fail to discuss the poor quality of the primary studies. They are of such deplorable rigor that one can really not draw any conclusion at all from them."
Sleep quality
Hwang and Shin 2015. J Altern Complement Med. 21(2):61-8. "Readily available aromatherapy treatments appear to be effective and promote sleep."
Lin et al. 2019. Complement Ther Med. 45:156-66. "The results showed that aromatherapy can be applied by clinical staff to effectively improve sleep quality. However, because there was a high degree of heterogeneity among studies, the inferences of the results need to be applied with caution."
Surgical patients (cardiac surgery) - Abdelhakim et al. 2020. Complement Ther Med. 48:102256. "Inhalation aromatherapy administration especially with lavender can significantly reduce anxiety, pain, and heart rate in patients performed cardiac surgery. However, it is not associated with significant differences in systolic and diastolic blood pressure."
Adverse effects
Some oils applied directly to skin can cause irritation and other problems. A review by Posadzki et al. (2012. Int J Risk Saf Med. 24(3):147-6) concluded "Aromatherapy has the potential to cause adverse effects some of which are serious. Their frequency remains unknown. Lack of sufficiently convincing evidence regarding the effectiveness of aromatherapy combined with its potential to cause adverse effects questions the usefulness of this modality in any condition." Henley and others (2007. N Engl J Med. 356(5):479-85) reported cases of pre-pubertal breast development in males as a result of application of lavender and tea tree oils.
"Few essential oil manufacturers educate consumers on proper dosage or contraindications, which can lead to accidental misuse and illness. Children are particularly sensitive to many oils and yet most manufacturers fail to warn against applying oils to children’s skin" (Ernst 2020 Jan 23. Edzard Ernst blog).
A story by Nashville station WKRN (2016 May 10. Essential oil exposure doubled over last 4 years) reported an increase in poisoning of children. "Children are at risk for poisoning because they may try to ingest essential oils from the container. 'Tea tree oil is commonly cited, and most of those cases are accidental ingestions by children,' said Justin Loden, PharmD, certified specialist in Poison Information...Most have a pleasant smell but bitter taste, so children easily choke on them and aspirate the oil to their lungs, Loden said. Children are also at risk because their thin skin readily absorbs essential oils, and the protective barrier that covers their brain is easily penetrated. Several essential oils such as camphor, clove, lavender, eucalyptus, thyme, tea tree, and wintergreen oils are highly toxic."
Chuang and others (2012. Eur J Prev Cardiol. 21(7):823-8) found that exposure to essential oil vapors for more than one hour increased heart rate and blood pressure, and thus "may be harmful to cardiovascular health among spa workers."
Scientific critique
"Genuinely scientific, peer-reviewed studies of essential oils have primarily focused on using aromatherapy as an adjunct to conventional medical treatment. Science has confirmed that when inhaled, essential oil molecules travel quickly to the brain - specifically the limbic region, which controls pulse, respiration, sexual arousal, and other autonomic functions. Emotional responses like fear and motivation originate in the limbic system. The most promising applications of aromatherapy appear to be in diminishing stress and offering pain relief. But actual clinical trials into such topics as reducing nausea in by chemotherapy patients, relieving anxiety during childbirth, alleviating headaches, and improving sleep have been inconclusive.
"Other studies have focused on the subject of inflammation, which is known to contribute to a wide range of medical problems. Essential oils derived from the thyme, clove, rose, eucalyptus, fennel, and bergamot have been demonstrated through one study to activate chemicals in the body which suppress inflammation and suppress chemicals that activate it.
"Researchers are also exploring the potential of essential oils as antibacterial agents. Parts of the juniper, cumin, coriander and lavender plants may be effective in battling E coli, while cinnamon may prove useful in treating strep throat and pneumonia.
"As ancient and traditional as their use may be in certain cultures, the scientific reality is it’s too early to tell how effective essential oils are in treating the wide range of conditions they are theorized (and now, commonly advertised) to treat" (Ernst 2020 Jan 23. Edzard Ernst blog).
While a link of the sense of smell to emotions and memories is recognized, the relationship of this to healing is unclear.
Aromatherapy attributes to a particular oil the benefits that might come simply from its method of administration (e.g., massage or a warm bath).
"Evaluating individual products made with essential oils is challenging because there are thousands of brands on the market. Neither the extraction methods used or the potency of the products - let alone, testing methods - are standardized. Manufacturers’ ambitious marketing claims, which often rely on ambiguous language, further obscure consumers’ ability to judge for themselves which oils are best suited to their purposes" (Ernst 2020 Jan 23. Edzard Ernst blog).
The benefits are described in vague and pseudoscientific terminology (e.g., "restoring harmony and balance," "driving out evil spirits").
A study by Kiecolt-Glaser and others (2008. Psychoneuroendocrinology. 33(3):328-39) found that while lemon enhanced mood, neither lemon nor lavender produced changes in physiological measures of pain, stress, or immune response. "The scent of lavender seems to have a calming effect on some people and helps with sleep, but it can cause headaches in others" (Schwarcz 2019. Op. cit.).
Novella (2018 May 9. Science-Based Medicine blog) wrote:
There are also many studies looking at the properties of specific essential oils in vitro. These are interesting basic science studies, which basically show that the oils are drugs (because they are) with pharmacological properties. None of these studies, however, can be used as a basis for clinical claims. We know from a century of experience that such basic science studies rarely translate to a clinical application.
One main reason is bioavailability. When you directly expose cells in a culture to a compound, what happens in that setting may say nothing about what happens when the same substance is taken by a living organism. Little or none of the compound may get absorbed or find its way to the target tissue. In the case of essential oils, they are often delivered by aromatherapy – smelling. Who knows what the bioavailability is of each of these compounds by this particular route of administration?
All the individual studies I found had serious methodological flaws. Few are double-blind, some are single-blind, and most are unblinded. The better designed studies tend to have mixed results, and reek of p-hacking.
There are several systematic reviews of specific essential oils for various types of pain. They also show the same kind of results as acupuncture reviews. The reviews are negative, meaning that no specific treatment has crossed the threshold of evidence where we can honestly say that it has been shown to work. Rather, all the reviews report that the evidence is not sufficient, and the precise spin depends on the reviewers and the journal. Cochrane reviews give the typical, “More and better quality research is needed.” Alternative medicine journals call the treatments, “promising” or similar.
London (2018. Op. cit.) summarized: "I acknowledge that some people enjoy the aromas of essential oils. As long as aromatherapy is offered inexpensively to consumers, I’m not sure that rigorous studies are needed to verify modest, nonmedical claims such as: people experience transient mood improvement when they are exposed to aromas they like. Perhaps there is a role for some approaches to aromatherapy in providing care and comfort to people with specific health challenges. But I see no reason to expect any type of aromatherapy to alter the course of any disease or have vitalistic actions such as 'balancing body energies,' as promoted by some enthusiasts.
"Aromatherapy isn’t necessarily inexpensive. Essential oils have been promoted through multilevel marketing, which inflates product prices so that distributors at each level can receive a portion of payments. Consumers should be wary when distributors of multilevel marketing companies hype essential oils and other products using testimonials."
Other points
"In 2014, the FDA issued warnings to three companies, including Utah-based doTERRA - one of the largest companies that produces essential oils - about the medical claims distributors had made about their products. In its warning letter to doTERRA, the FDA stated that at least 15 of its essential oil compounds were being 'promoted for conditions that cause them to be [classified as] drugs' by certain distributors. Those conditions included Ebola, cancer, brain injury, autism, Alzheimer's Disease, tumor reduction, and ADHD" (Jaeger 2017 Jan 28. The FDA has warned essential oil companies. Attn.com).
BACH FLOWER REMEDIES
Invented by Edward Bach (1880-1936) in England. Bach Flower Remedies consist of a set of 38 highly-diluted plant preparations. Sun-warmed dew allegedly absorbs the healing energy of plant. They are used for psychological conditions. The approach is based in part on the doctrine of signatures (parts of plants resembling parts of the body can be used to treat disorders in those parts). The treatments are scientifically unsupported.
"Bach Flower Remedies are made by soaking flowers in water and exposing them to full sunlight for three hours or by boiling them in water (and left to cool, outdoors of course). They are then diluted in '40% proof' [sic] brandy, diluted further with grape alcohol and then bottled. The final product typically contains 27% by volume of alcohol.
"The most well known one is, of course, Rescue Remedy® (a combination of five different flower remedies), used by many to calm their nerves in times of stress, or as the manufacturer, Nelsons, puts it:
…provide comfort and reassurance for daily stressful situations.
"...There are now over 50 producers of flower remedies in the UK, but Nelsons is probably the most well-known one, selling products under the Bach Original Flower Remedies brand name...
"The 'remedies' are divided into seven categories and have been given new names in recent years:
Old name → New name
Fear → Face your fears
Uncertainty → Know your own mind
Insufficient Interest in Present Circumstances → Live the day
Loneliness → Reach out to others
Oversensitivity to influences and ideas → Stand your ground
Despondency and Despair → Find joy and hope"
(Anon. 2014 Feb 2. Bach Flower Remedies: foods, not medicines. Nightingale Collaboration)
A review of Bach Flower Remedies (Ernst 2010. Swiss Med Wkly. 140:w13079) found "All placebo-controlled trials failed to demonstrate efficacy. It is concluded that the most reliable clinical trials do not show any differences between flower remedies and placebos."
BALNEOTHERAPY
"Balneotherapy is defined as the use of baths containing thermal mineral waters from natural springs at a temperature of at least 20 °C and with a mineral content of at least 1 g/l. More so, it is more common that the temperature of the thermal water is approximately 34°. Balneotherapy has been used not only in the ancient years in the treatment of various illnesses but also in modern times.
"Under the broad term balneotherapy (in contrast to the strict definition given above), various treatment methods are included: Dead Sea salt or mineral baths, sulphur baths, radon-carbon dioxide baths. Balneotherapy is either provided as the solitary component of the therapeutic approach or in the context of spa therapy...while some researchers have regarded balneotherapy and spas as more or less interchangeable terms, others disagree. More so one has to acknowledge that the composition of the mineral water differs in its content in cations and anions, and thus assessing which is the specific therapeutic component is difficult" (Falagas et al. 2009. Int J Clin Pract. 63(7):1068-84). Thermal mud may also be employed. When hot dry sand is employed, the practice is called psammotherapy (see separate section below).
Reviews
Rheumatological and other diseases:
Falagas et al. 2009. Int J Clin Pract. 63(7):1068-84. "The available data suggest that balneotherapy may be truly associated with improvement in several rheumatological diseases. However, existing research is not sufficiently strong to draw firm conclusions."
Verhagen et al. 2015. Cochrane Database Syst Rev. CD000518. "Overall evidence is insufficient to show that balneotherapy is more effective than no treatment, that one type of bath is more effective than another or that one type of bath is more effective than mudpacks, exercise or relaxation therapy."
BODYWORK
"An umbrella term for many treatments that involve touching, manipulating, and/or exercise of the body and, in most cases, supposed alignment of the body's 'energy field' or removal of blockages to the flow of 'energy.' Bodywork encompasses massage therapy, body-centered psychotherapy, and touch therapy. 'Touch therapy' and 'touch healing' are generic terms for the laying on of hands and its variants, including OMEGA, reiki, and therapeutic touch...Unlike scientific physical therapists, proponents recommend bodywork for many health problems beyond pain, physical dysfunction, and physical injury. Not all forms of bodywork are supernatural, but most are unscientific" (Raso 1994. Op. cit.).
Some varieties
Airrosti (Applied Integration for Rapid Recovery of Soft Tissue Injuries) - "They claim to have special knowledge about the underlying cause of soft tissue injuries and pain problems and how to treat them...The providers are chiropractors who have been trained by the company in their special methods…whatever they are. Their website is vague about what their modality actually consists of...They offer quality 1-on-1 care for an entire hour, with detailed examination, hands-on soft tissue therapy, foam rolling, instruction in exercise and rehabilitation, and Kinesio Taping...their treatment appears to be centered on myofascial release (MFR)" (Hall 2014 Nov 4. Science-Based Medicine).
Alexander Technique - "...a murky 'body/mind' method focusing on posture improvement. Proponents claim that maintaining alignment of the head, neck, and back lead to optimum overall physical fitness. They further claim that it is useful in the treatment of a variety of diseases, including asthma, hypertension, peptic ulcer disease, and ulcerative colitis" (Raso 1994. Op. cit.).
"AT is a psychophysical method, developed by Frederick Matthias Alexander (1869–1955). It uses enhanced kinaesthetic awareness and voluntary inhibition to prevent non-beneficial movement patterns. The primary focus is put on the relationship between head, neck and back as crucial in effecting an overall integrated pattern of coordinated behaviour. Through this conscious re-education of thinking and moving unnecessary muscle tension is released, which leads to more ease in movement and breathing and a better coordinated 'use' (technical AT term describing the manner in which a person moves and behaves). AT is usually taught one-to-one by licensed teachers and combines verbal instructions with hands-on guidance. The psychophysical connection through hands-on work is specific for AT and distinguishes it from bodywork techniques" (Klein et al. 2014. BMC Complement Altern Med. 14:414).
"Lessons in the Alexander technique offer an individualised approach designed to develop lifelong skills for self care that help people recognise, understand, and avoid poor habits affecting postural tone and neuromuscular coordination. Lessons involve continuous personalised assessment of the individual patterns of habitual musculoskeletal use when stationary and in movement; paying particular attention to release of unwanted head, neck, and spinal muscle tension, guided by verbal instruction and hand contact, allowing decompression of the spine; help and feedback from hand contact and verbal instruction to improve musculoskeletal use when stationary and in movement; and spending time between lessons practising and applying the technique..." (Little et al. 2008. BMJ. 337:a884).
Bowen technique (Bowenwork, Bowen therapy) - "Bowenwork was first introduced in the early 1950s by Thomas Bowen (1916–1982) of Geelong, Victoria, Australia. Mr. Bowen was influenced by early osteopathic soft-tissue manipulation, but created his approach largely through trial and error over a period of 30 years...Bowenwork is also known as Bowen, Bowen Therapy, Bowtech, and Bowen Technique in the literature, though Bowenwork is the official name trademarked by the Bowen Therapy Academy of Australia. Bowenwork is a relatively new form of 'manipulative/body-based practice,' in the same category as osteopathy and massage. Bowenwork is a noninvasive technique that uses a gentle series of hand movements over muscles to stimulate nerve pathways. A treatment consists of multiple combinations of moves over specific areas depending on the symptoms the person is experiencing. The precise movement gently stretches the muscle and fascia with a continuous movement over the muscle from one side to the other. It is postulated that this movement causes a transitional state of realignment of microfibers within the nervous system to stimulate healing pathways...
"It is postulated that Bowenwork is closely linked to the autonomic nervous system and involves stimulation of stretch receptors in muscles that include the Golgi tendons and spindle cells. The activated fibers of the proprioceptive system, an internal awareness of sensory stimulation, initiates a brain response, which in turn sends nervous system messages back to the fascia to normalize the resting rate of the tissues. An essential component of the technique is a 2- to 5-minute pause between sets of moves, which allows for the integration of the messages and the nervous system response. As the tension level is normalized, fluid movements of lymph and blood are increased in the area, which enhances tissue repair in injury sites" (Hansen and Taylor-Piliae 2011. J Altern Complement Med. 17(11):1001-6).
Ernst (2017 May 10. Edzard Ernst blog) noted that "there is no evidence whatsoever that Bowen Technique is helpful for patients suffering from any condition. This clearly means that therapeutic claims made for it are bogus..."
Craniosacral therapy - "also called craniopathy, cranial osteopathy, cranial therapy, sacro-occipital technique, and bio-cranial therapy. The method typically is used by practitioners with dubious credentials (e.g., chiropractors) but also by seemingly credible individuals such as physical therapists, massage therapists, osteopaths, and dentists" (Travers 2020. Skeptical Inquirer. 44(1):37).
"Craniosacral therapy is an alternative and complementary therapy based on the theory that restricted movement at the cranial sutures of the skull negatively affect rhythmic impulses conveyed through the cerebral spinal fluid from the cranium to the sacrum. Restriction within the craniosacral system can affect its components: the brain, spinal cord, and protective membranes. The brain is said to produce involuntary, rhythmic movements within the skull. This movement involves dilation and contraction of the ventricles of the brain, which produce the circulation of the cerebral spinal fluid. The theory states that this fluctuation mechanism causes reciprocal tension within the membranes, transmitting motion to the cranial bones and the sacrum.
"Craniosacral therapy and cranial osteopathic manual therapy originate from the observations made by William G. Sutherland, who said that the bones of the human skeleton have mobility. These techniques are based mainly on the study of anatomic and physiologic mechanisms in the skull and their relation to the body as a whole, which includes a system of diagnostic and therapeutic techniques aimed at treatment and prevention of diseases. These techniques are based on the so-called primary respiratory movement, which is manifested in the mobility of the cranial bones, sacrum, dura, central nervous system, and cerebrospinal fluid. The main difference between the two therapies is that cranial osteopathy, in addition to a phase that works in the direction of the lesion (called the functional phase), also uses a phase that worsens the injury, which is called structural phase" (Castro-Sánchez et al. 2016. J Altern Complement Med. 22(8):650-7).
"John Upledger, an osteopath based in Palm Beach Gardens, Fla., is the founder of this form of nontraditional medicine...while assisting in a spinal operation in the 1970s, Upledger has said he was startled to see a strong pulse in the membranes surrounding the patient's spinal cord. He said he determined the pulse was coming from the cerebrospinal fluid and came to believe that anything that blocked its flow could cause physical and mental distress. So he developed a technique for applying light resistance to parts of the body, including the bones of the skull, which he thinks remain mobile through life" (Stahl 2003 May 15. A light touch can ease pain in the head, neck and spine. Louisville Courier-Journal).
"Craniosacral therapy has been used in the treatment of fibromyalgia, temporomandibular disorders, migraine, lateral epicondilitis, individuals with dementia, lower urinary tract signs and symptoms in multiple sclerosis, several types of disabilities, and disabilities in children" (Castro-Sánchez et al. 2016. Op. cit.).
"CST practitioners assert that physical and even emotional traumas can become embedded in the connective tissue surrounding the central nervous system...Very gentle (<5 g) pressure applied by the therapist to the skull facilitates the 'release' of these restrictions in the dura mater and the dural tube. This release is felt by the CST therapists as a change in balance, force, and rate of the cranial rhythm. It is typically accompanied by feelings of relaxation and comfort in the patient, a process called 'somato-emotional release' by practitioners.
"Over 10,000 CST practitioners have been certified by UI [Upledger Institute] in America alone...As a result, many physical therapists and osteopaths are able to administer this treatment under insurance coverage. Nevertheless, the clinical research base for CST is surprisingly sparse" (Leskowitz 2017. J Altern Complement Med. 23(12):905-6).
Reviews
All conditions - Ernst 2012. Focus Altern Complement Ther. 17(4):197-201. "The notion that CST is associated with more than non-specific effects is not based on evidence from rigorous RCTs [randomized controlled trials]."
Chronic pain - Haller et al. 2020. BMC Musculoskelet Disord. 21(1):1. "... this meta-analysis suggests significant and robust effects of CST on pain and function lasting up to six months." However, Ernst (2020 Jan 7. Edzard Ernst blog) wrote, "a bit of critical thinking quickly discloses numerous problems, not with this (technically well-made) review, but with the interpretation of its results and the conclusions...Considering all this plus the rather important fact that CST completely lacks biological plausibility, I do not think that the conclusions of the review are warranted."
Scientific critique: Contrary to assertions of craniosacral therapists, the skull bones are fused during infancy so it is unlikely that any effect could be produced by craniosacral therapy. The existence of a rhythm in the cerebrospinal fluid is also dubious.
A review by the British Columbia Office of Health Technology Assessment (1999) concluded that there was doubt concerning “the existence of the underlying phenomenon being measured” and on “practitioner’s ability to measure it.” There was a lack of “valid scientific evidence that craniosacral therapy provides a benefit to patients.” Controlled trials have shown that craniosacral therapy lacks interexaminer reliability (different practitioners determine different rhythms on the same patient).
Barrett (2004. Why cranial therapy is silly. Quackwatch) reported two deaths attributed to craniosacral therapy: one due to substitution for needed conventional therapy, the other from a hematoma in a treated 2-day old infant.
Etiopathy - "Founded in 1963 by the French Christian Trédaniel, etiopathy is a method of reasoning to determine the causes of a health problem and remove them acting on them. Etiopathy seems particularly popular in France, but is now slowly making inroads also elsewhere" (Ernst 2019 Dec 5. Edzard Ernst blog).
"Etiopathy is an alternative medicine which aims to treat everyday ailments without medication, using only manual techniques...The word etiopathy comes from the Greek word 'aïtia', which means 'cause' and 'pathos,' which means 'suffering.' In short, etiopathy prioritises trying to find the cause for a pathology rather than getting rid of its symptoms. The ethos of etiopathy is that the only way to prevent a problem from recurring is to treat it at the cause. According to this approach, if we don’t go back to the true source of the problem, patients run the risk of relapse. The emphasis on diagnosis in etiopathy allows practitioners to treat the majority of common pathologies, thanks to an exclusively manual treatment approach, involving massage of particular points and thus avoiding medication and side effects" ("Sarah" n. d. What is etiopathy? And what are the benefits? Health & Wellness).
Feldenkrais - "The Feldenkrais method, commonly known as 'Feldenkrais,' is a movement–education technique designed to promote physical function and well-being...The core principle of Feldenkrais is to first improve one’s kinesthetic and proprioceptive self-awareness via guided practice sessions, and ultimately to transform unhealthy habits, movements, and postures into movement patterns that offer the individual greater comfort and ease during performance of physical tasks.
"The Feldenkrais method includes both group and individual learning strategies. The group method is also called awareness through movement (ATM). Somewhat like children learning to walk, participants are encouraged to move at their own pace and to increase awareness of their own movements. Often while lying or sitting, they are guided through specific sequences of relatively comfortable movements, learning to eliminate extraneous movement or inefficiency while discovering more comfortable and effective alternatives. Individual lessons, also called functional integration, take a similar approach, with the instructor providing more active assistance with the discovery process by gently and precisely moving the student.
"Feldenkrais sessions can provide patients with new insights by challenging common perceptions of pain. The idea that the patient’s own stiffness or inefficient movements are contributing to or even causing pain, rather than the consequence of pain, is explored. Feldenkrais sessions are then used to discover and analyze these problems, and to correct them by means of conscious effort" (Plastaras et al. 2013. Curr Rheumatol Rep. 15(7):339).
Polarity Therapy - "encompasses counseling, craniosacral balancing...'energetic nutrition,' guided imagery, polarity yoga (polarity exercise), and reflexology...Polarity theory holds that the top and right side of the body have a positive charge, and that the feet and the left side of the body have a negative charge. Thus, practitioners place their right hand (+) on 'negatively charged' parts of the client's body, and their left hand (-) on 'positively charged' parts" (Raso 1994. Op. cit.).
Polarity therapy "was developed by Randolph Stone, a chiropractor, osteopath, and naturopath, who began training others in the 1960s...The American Polarity Therapy Association oversees training programs and certification in the technique" (Anderson and Gaylor 2012. Clin J Oncol Nurs. 16(1):43-8).
Rolfing - Also known as structural integration. "Rolfing was named after its founder, an American biochemist named Ida Rolf. Her own health problems led her to believe that deep tension - even mild physical deformities in children, like pigeon toes - could be relieved by pressing into a type of tissue called fascia." Rolfers "believe stretching out the fascia - getting it to be more soft and pliable - can improve posture and strength, and over time, reduce aches and pain" (Varney 2010 Dec 6. Rolfing back in vogue, but with shaky evidence. NPR Morning Edition).
Rolf organized her "ideas around her own conviction that the adequacy of the individual's adaptation to gravity - an ubiquitous, unrelenting force to which all human structures must adapt throughout their lifecycle - was a key determinant of physical and psychologic health. The explicit goal of her method was the integration of the individual's energy field with that of gravity. This was to be achieved by aligning their physical structure around the vertical vector that gravity defines. The individual's relationship with gravity would then be transformed from one of struggle and eventual collapse, to one in which the integrity of their physical structure - as well as their character - was 'reinforced' by a balanced 'flow' of gravitational energy. The individual who was 'integrated with gravity' would manifest a higher level of 'maturity.'
"Central to Rolf's clinical method was the idea that the balance or imbalance in tone of fascial structures was a potent determinant of bony alignment and joint function (i.e., that the human body was in important respects a tensegrity structure). Improving 'equipoise' of fascial tone throughout the body would allow its central axis to align more closely with the gravitational vertical and even to extend upward by more fully evoking the antigravity reflex. This could be achieved by increasing the pliability of selected fascias through skilled manipulation. Rolf also taught other hallmarks of biomechanical excellence to guide clinical practice. These include bilateral symmetry, anterior-posterior 'horizontality' of the major body segments...and 'grace' in movement, most easily observed in the extent of cross-extensor activation in walking. Education and awareness exercises designed to increase the individual's ability to sense the difference between postures and movements that more versus less closely approximate these ideals were an essential supplement to the manual therapy...
"Although Rolf intended SI to be a method by which healthy individuals could approximate structural ideals that were distinctly beyond the norm, it has been of increasing resort for the treatment for musculoskeletal pain and dysfunction, a trend that has been promoted by reimbursement for SI when billed as a type of massage therapy by Workmen's Compensation boards and insurance companies in several states" (Jacobson 2011. J Complement Altern Med. 17(9):775-80).
Some practitioners attempt to balance the body's "energy."
Former Rolfing instructor turned medical researcher Robert Schleip "turned to the scientific literature on fascia. 'When I did my homework, I discovered that some of [the Rolfing dogma] didn't look so good.' For example, as part of their training, Rolfers assume that if they apply enough force to an area of fascia, they can lengthen it and remove tension. 'But the science says you would have to apply a ton of pressure to effect these changes,' Schleip says" (Grimm 2007. Science. 318(5854):1234-5). "According to [physician Wolf] Mehling and other researchers, the few studies that have been done are too limited or flawed to draw any conclusions about Rolfing's effectiveness" (Varney 2010. Op. cit.).
Rosen Method - "a massage-based CAM therapy method, about which many clients have informally expressed positive treatment effects. It is often described by therapists as a method of 'preventive health care’ or advertised as a '‘pleasant relaxation method which can lead to improved self-knowledge'...The therapy method was developed by the German-American physiotherapist Marion Rosen (born in 1914). The fundamental principle behind the treatment is that there is a special connection between the physical body and the mind. Bodily problems such as muscle tension are assumed to reflect unresolved emotional problems, suppressed traumatic experiences, or excessive social demands. The treatment focuses on the body, which is seen as a 'gate' to reach unconscious emotional causes of muscular tension. A typical therapy session is set up in a calm environment and begins with a short conversation, during which the therapist pays particular attention to the client’s voice, body posture, and movements. The therapist examines the client’s body, looking for areas of unbalances, and initiates the treatment by slowly and gently touching the client’s body, applying light pressure on tense areas. In most cases, the touching causes the client to relax deeply. The therapist observes continually subtle changes in muscle tension, shifts in breathing, or other reactions, and responds to every change by touching the client or by responding verbally. During the process, hidden memories or emotions may come to mind, something that is assumed to provide valuable insights and assist the client in understanding the connection between body and mind" (Hoffren-Larsson et al. 2009. J Altern Complement Med. 15(9):995-1000).
Therapeutic touch, healing touch, reiki - see the section on energy medicine in Holistic Part 4.
General scientific critique of bodywork: many of these techniques involve concepts of "energy" that are inconsistent with scientific knowledge. Some are inconsistent with knowledge of anatomy and physiology.
FOREST BATHING
"Shinrin-yoku means 'taking in the forest atmosphere' or 'forest bathing.' It was developed in Japan during the 1980s and has, according to its proponents, become a cornerstone of preventive health care and healing in Japanese medicine" (Ernst 2017 Sep 9. Edzard Ernst blog).
HALOTHERAPY
"Eastern Europeans have long thought that just sitting in naturally occurring salt caves could relieve allergies, asthma, eczema, hypertension, ulcers and stress. Recently, they've built simulated caves in the U.S. The Chicago area, because of its large Polish population, is the epicenter of the trend. Several spas in other parts of the country have installed salt breathing rooms. And the Florida-based Silesia Group builds salt rooms for private homes and sells portable salt caves for the backyard" (Lee-St. John 2008 Apr 7. Time). Sitting in a natural salt cave is also known as speleotherapy.
"Like all such fake treatments, it’s good for what ails you. The list of claimed benefits is long enough to essentially include everyone, in order to maximize the potential target customer base. Some spas are careful not to make any actual health claims, using the pseudoscience buzzwords of 'detox' and 'supports X function.' Some, however, will make specific claims. Since halotherapy 'works' because of the negative ions and trace minerals users are allegedly breathing in, marketing is often targeted at respiratory problems...There is, as you might suspect, a complete lack of any credible scientific evidence for any of these claims...Some spa entrepreneurs will hunt for any scientific study they can use to support their therapy, and then such claims get spread around. In the case of halotherapy promoters will often cite a 2006 NEJM study that found that inhaling hypertonic saline mist may help improve symptoms in patients with cystic fibrosis. They extrapolate from this one study to support the claim that sitting in a salt cave is good for all respiratory symptoms. First, sitting in a salt cave, even if they add some salt to the air, is not the same as breathing in a hypertonic mist. Further, in the study patients were pretreated with a bronchodilator. And of course cystic fibrosis is a very specific illness, and any results do not necessarily apply to other respiratory disorders" (Novella 2018 Jun 13. Science-Based Medicine blog).
HYDROTHERAPY
"Hydrotherapy is the external or internal use of water in any of its forms (water, ice, steam) for health promotion or treatment of various diseases with various temperatures, pressure, duration, and site. It is one of the naturopathic treatment modality used widely in ancient cultures including India, Egypt, China, etc. Though many countries used water to produce different physiological/therapeutic effects on different part of the system for maintaining health, preventing, and treating the diseases, the scientific evidence-based effects are not well documented" (Mooventhan and Nivethitha 2014. N Am J Med Sci. 6(5):199-209). Also referred to as water therapy, aquatic therapy, or pool therapy. Balneotherapy (see separate section) involves hot mineral baths.
IRIDOLOGY
Overview
"Iridology is an alternative medicine science which correlates iris patterns, colors, tissue weakness, breakage and other characteristics, which can acquires evidence about patient's systemic health. It reveals weakness or brakeage [sic] in tissues long before the symptoms appears" (Samant and Agarwal 2018. Comput Methods Programs Biomed. 157:121-8).
Iridology was developed by Ignatz von Peczely in Hungary around 1866. It was promoted in U.S. by Bernard Jensen (died 2001).
Principles: "Via the direct neural connection of the surface layers of the iris with the cervical ganglion of the sympathetic nervous system, impressions from all over the body are conveyed to the iris" (Wolf 1979. Applied Iridology, quoted by Worrall 1983. Skeptical Inquirer 7(3):23-35). This provides a means to monitor conditions throughout the body by examination of the iris.
Iridologists consult detailed eye charts (possibly using a computer) with maps of correspondences of parts of body with parts of retina in making diagnoses. They may also make recommendations for treatment, e.g., with diet, exercise, herbs.
"A typical iris chart usually divides the iris into approximately 90 zones, each corresponding to a different part of the human body...For iridologists, color variations in the iris (sparkles and rings) carry specific significance and can even indicate whether a suspected condition is acute/inflammatory, chronic/inflammatory, or allergic. Some iridologists further divide organ system dysfunction by iris color. They believe that lymphatic-related disease is associated with a blue or blue-gray iris and that these individuals are prone to atopic conditions; hematogenous-related pathology is linked to brown-eyed individuals who are more prone to anemia and endocrine disorders; biliary disease is associated with both blue and brown irises, and is indicative of gastric deficiencies" (Sego 2013. Iridology: Detecting impaired organ function with the iris. Clinical Advisor).
Arguments in favor
Iridology has anecdotal support, with some satisfied patients.
An iridologist may recommend programs that include exercise and good diet, thus benefitting patients.
There have been some small studies showing an association of hypertension with iris characteristics.
Scientific critique
Iridology is inconsistent with the known anatomy of the nervous system.
Many of the various charts being used are inconsistent in their details.
Controlled clinical studies, using iris photos, show iridologists are unable to detect disease:
Simon et al. 1979. JAMA. 242(13):1385-9 - kidney disease
Cockburn 1981. Austral J Optom. 64(4):154-7 - before/after photos of subjects with acute disease.
Knipschild 1988. BMJ. 297(6663):1578-81 - gallbladder disease
Steinberg et al. 2002. Sci Rev Altern Med. 6(2) - orthopedic trauma
Münstedt et al. 2005. J Altern Complement Med. 11(3):515-9 - cancer
Herber et al. 2008. Ophthalmologe. 105(6):570-4 - colorectal cancer.
Most diseases diagnosed by iridology are vaguely defined, such that spontaneous improvement or psychological aspects could be involved in reported successes.
Successful diagnoses could involve "cold reading," such as employed by fortune-tellers, in which a combination of educated guesses and feedback from patient are used to give the impression that the reader has access to hidden information.
Claims to make subclinical evaluations (conditions which do not yet have symptoms; therefore success can be claimed if advice is followed and the condition does not develop)
Adverse effects
Delay in treatment when harmful conditions are not diagnosed
Mental distress of false diagnosis
Expense of worthless diagnosis and further unneeded tests or treatments
LOTUS BIRTH
"Known in proponent circles as 'lotus birth,' umbilical nonseverance is a practice in which the umbilical cord is not cut post-birth, leaving the baby attached to the placenta until the cord dries and eventually detaches from the navel - usually a period of three to ten days. Little information has been published on the safety or medical benefit of this practice. Those engaging in lotus birth often keep the placenta in a pouch or a bowl to dry, with salt and optional dried herbs and essentials oils to aid in the drying process and to mask the odor of the decomposing placenta. These supplies are sold in kits from local sellers or through online shops like Etsy, though lotus birthers also share tips on how to prepare concoctions at home. Some proponents distinguish between 'full' and 'short term' lotus births, in which the cord is cut four to forty-eight hours following birth...Considered a recent alternative birth phenomenon, the roots of lotus birth as currently practiced can be traced just a few decades back. With a vague but unconfirmed notion that some non-human primates don’t sever the umbilical cord, a pregnant woman named Clair Lotus Day from California began to question routine cutting of the cord back in the 1970s...The practice has been growing since 1974, with the late yoga master and midwife Jeannine Parvati Baker credited with popularizing lotus birth in the United States and midwife Shivam Rachana, founder of the International College of Spiritual Midwifery and author of the book Lotus Birth (2000), spreading the practice in Australia. The 'prolonged contact' with the placenta that a lotus birth provides 'can be seen as a time of transition, allowing the baby to slowly and gently release their attachment to the mother’s body,' writes [proponent Sarah] Buckley.
"Aside from spiritual benefits, lotus birthers and proponents also believe in medical benefits. Popular Australian parenting site BellyBelly shares a few purported benefits ('Lotus Birth: 7 Reasons' 2018), including optimal blood transfer: 'The placenta is placed at the same level with the baby to ensure the blood transfer. An extra 80-100mL of the oxygenated blood can contribute towards their brain development within the first year'" (Senapathy 2018. Skeptical Inquirer. 42(4):44-6).
It is true that the cord should not be cut immediately, and current medical recommendations are to wait until 30 seconds or a couple of minutes before clamping. However, "Dr Patrick O’Brien, RCOG [Royal College of Obstetricians & Gynaecologists] spokesperson, said: 'If left for a period of time after the birth, there is a risk of infection in the placenta which can consequently spread to the baby. The placenta is particularly prone to infection as it contains blood. Within a short time after birth, once the umbilical cord has stopped pulsating, the placenta has no circulation and is essentially dead tissue.'...Though lotus birth is not well-documented as a practice in medical literature, negative health outcomes have been documented, including infection and idiopathic neonatal hepatitis (Tricarico et al. 2017). Lotus birthing also requires the primary caregiver - almost always the mother - to remain close to a bag of decomposing flesh, and it keeps her homebound as she cares for the newborn until the umbilical cord detaches. Dubbing it 'the wackiest childbirth practice ever,' Dr. Amy Tuteur, a vocal critic of the natural childbirth movement, describes lotus birth as 'a bizarre practice with no medical benefit and considerable risk, particularly the risk of massive infection'" (Senapathy 2018. Op. cit.).
"It is not a magical, historical or cultural practice forcibly torn away from women by an uncaring patriarchy; it was something a woman dreamed up after hearing about chimpanzees. To brand this as a modern ritual is nothing but predatory marketing" (Gunter 2017 Aug. 29. Dr. Jen Gunter blog).
NAPRAPATHY
"The chiropractor Oakley Smith had graduated under D D Palmer in 1899. Smith was a former Iowa medical student who also had investigated Andrew Still’s osteopathy in Kirksville, before going to Palmer in Davenport. Eventually, Smith came to reject the Palmer concept of vertebral subluxation and developed his own concept of 'the connective tissue doctrine' or naprapathy. Today, naprapathy is a popular form of manual therapy, particularly in Scandinavia and the US. But what exactly is naprapathy? This website [http://www.spineteam.net/what-is-naprapathy/] explains it quite well: Naprapathy is defined as a system of specific examination, diagnostics, manual treatment and rehabilitation of pain and dysfunction in the neuromusculoskeletal system. The therapy is aimed at restoring function through treatment of the connective tissue, muscle- and neural tissues within or surrounding the spine and other joints. Naprapathic treatment consists of combinations of manual techniques for instance spinal manipulation and mobilization, neural mobilization and Naprapathic soft tissue techniques, in additional to the manual techniques Naprapaths uses different types of electrotherapy, such as ultrasound, radial shockwave therapy and TENS. The manual techniques are often combined with advice regarding physical activity and ergonomics as well as medical rehabilitation training in order to decrease pain and disability and increase work ability and quality of life. A Dr. of Naprapathy is specialized in the diagnosis of structural and functional neuromusculoskeletal disorders, treatment and rehabilitation of patients with problems of such origin as well as to differentiate pain of other origin...
"The National College of Naprapathic Medicine is chartered by the State of Illinois and recognized by the State Board of Higher Education to grant the degree, Doctor of Naprapathy (D.N.). Graduates of the College are eligible to take the Naprapathic Medicine examination for licensure in the State of Illinois...
"If you ask me, naprapathy is something between chiropractic (without some of the woo) and physiotherapy (without its expertise). There is no good evidence that it works. Crucially, there is no evidence that it is superior to other therapeutic options...A LOT OF NAPRAPATHY LOOKS VERY MUCH LIKE QUACKERY TO ME" (Ernst 2018 Feb 21. Edzard Ernst blog).
PSAMMOTHERAPY
"Psammotherapy is a traditional therapeutic practice in which baths with hot sand are used for the treatment of several chronic conditions, mainly rheumatic musculoskeletal diseases. Psammotherapy is defined as an 'external thermal therapy that uses dry heat' and may be classified as a balneological intervention, along with balneotherapy, mud therapy, and hay baths. Psammotherapy has long been practiced in several coastal and desert regions, mainly depending on local traditions and availability of sand as a natural resource, and evidence of its use dates back to ancient Rome. Sand baths are still practiced today in several countries, including Italy, Portugal, Japan, China, Iran, Morocco, and Egypt.
"Psammotherapy is a multicomponent treatment which combines the action of high-temperature thermal therapy with the effects of a chemo-physical and bioclimatic therapy. Sand baths are often administered outdoor and each session lasts 20-40 min, followed by a resting 'reaction' period of 20 min. Patients lay in 2 x 1m sand holes with a depth of 20-30 cm and are covered with a 3-7 cm layer of dry hot sand which is ready to use when its temperature under the surface reaches 50-60°C due to solar heating. Head, neck and sometimes even the anterior part of the thorax are not covered with sand. Psammotherapy is sometimes combined with other spa treatments such as thalassotherapy, namely sea water baths, even thanks to the availability of both hot sand and sea water in maritime regions. Sand composition varies according to geologic and environmental characteristics, although it is usually rich in silicate and carbonate minerals containing elements like calcium, potassium, sodium, aluminum, silicon, magnesium, and iron.
"Although few studies have been carried out to assess the efficacy of psammotherapy, its traditional indications are osteoarthritis, traumatic injury outcomes, articular or extra-articular chronic rheumatic conditions, osteoporosis, gout, and fibromyalgia syndrome" (Antonelli and Donelli 2019. Complement Ther Med. 42:1-6).
The review by Antonelli and Donelli (2019) noted that "Based on available data, no conclusions can be driven on the clinical efficacy of psammotherapy. However, very limited evidence suggests that hot sand baths might be useful in improving symptoms and functionality of patients with some rheumatic and respiratory chronic illnesses."
REFLEXOLOGY
"Reflexology is a systematic practice in which applying some pressure to any particular points on the feet and hands give impacts on the health of related parts of the body. Each point of the pressure acts as the sensors on the feet and hands and is links with different parts of body specifically. These sensors will be stimulated by applying the reflexology technique in order to improve the blood and energy circulation, give sense of relaxation, and maintain the homoeostasis. Reflexology session can be improved by other elements such as aromatherapy, peaceful music, and good environment settings" (Embong et al. 2015. J Tradit Complement Med. 5(4):197-206). "Reflexology allegedly can relieve asthma, constipation, migraines, sinus congestion, and diseases of the kidney, liver, and pancreas" (Raso 1994. "Alternative" Healthcare: A Comprehensive Guide).
"It is speculated that the mechanisms by which foot reflexotherapy affect body functions are due to the mediation of balance between sympathetic and parasympathetic divisions of the autonomic nervous system, and also, stimulation of the release of mediators that act on local and distant sites to regulate physiological processes" (Unal et al. 2018. Complement Ther Med. 38:42-7). Among these might be endorphins, bringing about pain reduction and a feeling of wellbeing. Another possibility is increased blood flow to the selected organ. Changes in the flow of "energy" have also been proposed.
"Reflex zone therapy is where the body is divided into ten longitudinal zones from head to toe. In the reflex zone therapy, there are five zones on both sides of the body in which each zone diverge down the particular arm, and also continue straight down the body and down the particular leg to line up with a toe on the respective foot. Practitioners usually choose the suitable technique to be applied to the reflex zone therapy to gain optimized efficiency and impact" (Embong et al. 2015. Op. cit.).
Reflexology using the foot is the most common. Auriculotherapy is a type of reflexology focused on the ear (see the article on Eastern approaches). Some "modern" or "integrative" reflexologists may combine classical reflexology with other approaches, such as meridians from traditional Chinese medicine.
"The emergence of zone therapy was first described by Dr. William Fitzgerald, but Eunice Ingham is considered the mother of reflexology who mapped the body on the foot. Development of reflexology technique has developed, for example using precision reflexology that involves holding discrete reflexes on the feet, vertical reflexology and meridian focused reflexology. Reflexology is not only a method based on stimulating the reflex points at the bottom of the foot but also similar to massage in that it manipulates soft tissue for therapeutic purposes. But also differs from massage in that it involves a more superficial contact and a deeper pressure on certain parts of the foot, and it resembles a caterpillar-like movement" (Őztürk et al. 2018. Complement Ther Med. 36:107-12).
"Two methods of reflexology that have been accepted internationally are Ingham method and Rwo Shur method. The first method does not use any tools in its practice and the second method utilizes the use of tools such as a wooden stick" (Embong et al. Op. cit.).
"Its effectiveness in treating the root of some diseases may lead to many benefits in health concern such as it helps in easing day-to-day stresses and alleviates the effects from injury and illness...Reflexology offers common benefits and one of them is reducing stress by applying pressure to the specific area at feet and hands which may induce general relaxation while relaxing the targeted area concurrently. Reflexology is one of the ways to interrupt the pattern of repetitive stress that people usually have according to their lifestyle. They will operate more effective with a number of reflexology sessions because the first application will intervene the stress operation and further sessions will improve the body condition" (Embong et al. Op. cit.).
"While no firm scientific evidence for the effective and efficacious use or 'mode of action' of reflexology has been established, it is nonetheless currently being used in healthcare settings around the world including hospices, nursing homes, and maternity departments" (McCullough et al. 2014. Evid Based Complement Alternat Med. 2014:502123).
In some states and cities, a practitioner of reflexology must be licensed in massage therapy or in another health-related profession.
Scientific critique
In general, these approaches are inconsistent with scientific knowledge of anatomy and physiology. For example, foot reflexologists assign a key regulatory role over numerous body functions to the foot.
Some benefits could arise if massage relieves stress related to problems elsewhere. Relaxing music is often played during reflexology sessions, possibly contributing to the perceived benefits.
A review by Ernst et al. (2011. Maturitas. 68(2):116-20) concluded that "the best clinical evidence does not demonstrate convincingly reflexology to be an effective treatment for any medical condition."
"Given the importance of the claim of a specific two-way connection between points on the feet and the internal organs, there is a surprising lack of consistency of reflex point locations in published reflexology foot maps. There are many different reflexology foot charts available, ranging from maps produced by individual therapist trainers right through to charts or maps published and marketed by larger professional reflexology organizations...The vast majority of maps appear to be based on the original Ingham foot chart, but many of the organ-related reflex points on subsequent maps appear in inconsistent places, depending on the beliefs or constructs of the map provider. This inconsistency of published maps presents a serious methodological research challenge if the intention is to isolate a specific treatment-related hemodynamic effect and create a reproducible reflexology intervention. The majority of existing reflexology studies do not provide details of which reflexology map the intervention is founded upon, which means that some of the studies are, in theory, using different reflexology points on which to base the supposedly same intervention" (Jones et al. 2013. J Altern Complement Med. 19(3):232-4).
Song et al. (2015. Complement Ther Med. 23(1):79-89) reviewed self-administered foot reflexology for subjects without a specific disease diagnosis, and found no randomized controlled trials. Non-randomized trials found improvement in subjective but not objective outcomes.
A review by McVicar and others (2016. J Altern Complement Med. 22(9):739-50) found that psychometric responses (related to pain, stress, etc.) were more likely to be significant if compared to a non-massage control rather than to a massage control. This suggests that most effects are due to massage rather than to anything particular to reflexology.
While reflexologists propose that stimulation of a reflex point increases blood supply to the corresponding organ, a review by Jones et al. (2013. J Altern Complement Med. 19(4):319-28) found no evidence for treatment-specific hemodynamic effects.
SAUNA BATHING
A large cohort study found that "Sauna bathing is associated with reduced cardiovascular mortality" (Laukkanen et al. 2018. BMC Med. 16(1):219). Another study found favorable changes in heart rate variability (Laukkanen et al. 2019. Complement Ther Med. 45:190-7).
SOPHROLOGY
"Sophrology is a non medication-based method which involves both the body and mind. It combines relaxing the muscles, increasing awareness of breathing and positive thinking, and leads to the search for improved well-being through the integration of the body percept. It generates a feeling of 'letting go' and helps to relieve physical, psychological and spiritual suffering, in particular in geriatrics" (Tocheport. Soins. 2012 Mar;(763):16-20). It was invented by Alfonso Caycedo. According to Ernst (2019 May 23. Edzard Ernst blog), "Sophrology is big in France, but almost unknown in English-speaking countries."
REFERENCES
Anthroposophic medicine
Kienle GS, Albonico HU, Baars E, Hamre HJ, Zimmermann P, Kiene H. 2013. Anthroposophic medicine: an integrative medical system originating in Europe. Glob Adv Health Med. 2(6):20-31
Ernst E. 2018 Feb 27. Anthroposophic medicinal products (AMPs) are truly mysterious. Edzard Ernst
Gorski D. 2018 Nov 20. Another Waldorf School, another outbreak. Quelle surprise! Respectful Insolence
Ernst E. 2019 Apr 16. Are anthroposophy-enthusiasts for or against vaccinations? Edzard Ernst
Aromatherapy - overview
London WM. 2018 Aug 9. Essential considerations about aromatherapy. Skeptical Inquirer
Schwarcz J. 2019 Aug 23. The Right Chemistry: The science and pseudoscience of essential oils. Montreal Gazette
Aromatherapy - scientific critiques
Barrett S. 2001. Aromatherapy: Making dollars out of scents. Quackwatch
McCutcheon L. 1996. What’s that I smell? The claims of aromatherapy. Skeptical Inquirer. 20(3):35-7
Vickers, A. 2000. Why aromatherapy works (even if it doesn’t) and why we need less research. Br J Gen Pract. 50(455):444-5
Ohio State University. 2008 Mar 4. Aromatherapy may make you feel good, but it won't make you well, study shows. ScienceDaily
Ernst E. 2017 Mar 17. Aromatherapy for depression? Smells fishy, if you ask me! Edzard Ernst
Hall H. 2017 Jun 13. On Guard, DoTERRA, essential oils, and a lesson in reading research studies. Science-Based Medicine
Novella S. 2018 May 9. Essential oils in the ambulance. Science-Based Medicine
London WM. 2019 Jan 9. D. Gary Young (1949–2018), diploma mill naturopath and promoter of essential oils. Skeptical Inquirer
Hall H. 2020 Jan 7. The parasympathetic state. Science-Based Medicine [Vibrant Blue Oils Parasympathetic]
Ernst E. 2020 Jan 23. Are essential oils a con? Edzard Ernst
Gorski D. 2020 Jan 28. doTERRA Center for Integrative Oncology: St. Elizabeth Healthcare sells out to an MLM company hawking essential oils. Respectful Insolence
Bach Flower Remedies
Anon. 2014 Feb 2. Bach flower remedies: foods, not medicines. Nightingale Collaboration
Ernst E. 2017 Jun 24. Terminal stupidity about ADHD and Bach flower remedies. Edzard Ernst
Ernst E. 2019 Sep 3. Bach flower remedies for disruptive children? How can "peer-review, critical study and clinical scholarship" produce such BS? Edzard Ernst
Bodywork
Hall H. 2014 Nov 4. Can Airrosti really resolve most chronic pain in just three visits? Science-Based Medicine
Ernst E. 2017 May 10. Is the Royal College of Nursing promoting quackery? Edzard Ernst [Bowen technique]
Barrett S. 2018. Why cranial therapy is silly. Quackwatch
Moran RW, Gibbons P. 2001. Intraexaminer and interexaminer reliability for palpation of the cranial rhythmic impulse at the head and sacrum. J Manipulative Physiol Ther 24(3):183-90 [abstract]
Ernst E. 2016 Aug 23. Cranio-sacral therapy: misleading? dishonest? unethical? Edzard Ernst
Ernst E. 2018 Feb 17. A new RCT of craniosacral therapy...for once, I am really embarrassed. Edzard Ernst
Ernst E. 2020 Jan 7. Craniosacral therapy is effective for treating chronic pain...but only if one completely "forgets" to think critically. Edzard Ernst
Ernst E. 2019 Dec 5. Etiopathy: a SCAN like so many others. Edzard Ernst
Varney S. 2010 Dec 6. Rolfing back in vogue, but with shaky evidence. NPR Morning Edition
Jacobson E. 2011. Structural integration: Origins and development. J Altern Complement Med. 17(9):775-80 [first page]
Forest bathing
Ernst E. 2017 Sep 9. “Forest bathing”: an alternative therapy you probably never heard of. Edzard Ernst
Halotherapy
Novella S. 2018 Jun 13. Halotherapy - the latest spa pseudoscience. Science-Based Medicine
Iridology
Sego S. 2013 Jan 8. Iridology: Detecting impaired organ function with the iris. Clinical Advisor
Barrett S. 2015. Iridology is nonsense. Quackwatch
Ernst E. 2000. Iridology: Not useful and potentially harmful. Arch Ophthalmol. 118(1):120-1
Lotus birth
Gunter 2017 Aug 29. A lotus birth is leaving a newborn attached to a decomposing placenta. Dr. Jen Gunter
Senapathy K. 2018. Lotus Birth. Skeptical Inquirer. 42(4):44-6 [subscription required]
Jones C. 2018 Dec 28. Lotus birth: No benefit, plenty of risk. Science-Based Medicine
Naprapathy
Ernst E. 2018 Feb 21. Naprapathy: a lot of it looks just like quackery to me. Edzard Ernst
Reflexology
Barrett S. 2015. Reflexology: A close look. Quackwatch
Embong NH, Soh YC, Ming LC, Wong TW. 2015. Revisiting reflexology: Concept, evidence, current practice, and practitioner training. J Tradit Complement Med. 5(4):197-206
Gorski D. 2018 Feb 23. What’s more quackademic medicine than Harvard’s acupuncture course? Maybe Duke’s reflexology course! Respectful Insolence
Hall H. 2018 Apr 10. Modern reflexology: Still as bogus as pre-modern reflexology. Science-Based Medicine
Ernst E. 2018 Apr 26. Reflexology works – but not as reflexologists think. Edzard Ernst
Sauna bathing
Ernst E. 2018 Dec 6. Sauna bathing reduces cardiovascular disease mortality. Edzard Ernst
Sophrology
Ernst E. 2019 May 23. Sophrology: the Fench [sic] love it, but does it work? Edzard Ernst
MAIN PAGE HOLISTIC
OTHER PARTS:
Part 1: Homeopathy Holistic Part 1
Part 2: Naturopathy Holistic Part 2
Part 4: Energy medicine and "New Age" healing Holistic Part 4