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C CANADIANS SPEND A FORTUNE ON HERBS, HYPNOSIS AND OTHER ALTERNATIVE TREATMENTS. ARE WE GETTING VALUE FOR OUR MONEY?

ers

onsumer, heal thyself! But with what? While conventional medicine still covers the lion’s share of our health-care system, more and more of us are turning to hypnosis, homeopathy and numerous other forms of alternative medicine to cure what ails us.

Alternative medicine is now so widely practiced that it verges on mainstream, according to a survey conducted by the Fraser Institute, a Canadian think tank. When the institute asked Canadians in 2006, it found that 54% of us had used at least one alternative therapy during the previous year. All told, we paid more than $5.6 billion to alternative health providers during the 12 months under study.

But do all those billions actually buy us better health? Skeptics complain that advocates for alternative medicine have shied away from testing its effectiveness in tightly controlled clinical studies. Others say there’s simply a lack of evidence either way. “If the evidence is there, then it’s good medicine, whether conventional or alternative,” says Shafiq Qaadri, a Toronto family doctor and member of the provincial legislature. But he

without

borde

by Gabrielle Bauer

adds an all-important caveat: “Your aunt reporting that her joint pain is so much better after seeing that herbalist recommended by her best friend does not count as evidence.”

To help you sort out the placebos from the genuinely useful practices, we’ve researched some of the most common alternative treatments. Here’s our take on how much bang they deliver for your buck.

Acupuncture Illustration by Ulla Puggaard

WHAT IS IT? Acupuncture is the practice of inserting needles in the body to reduce

2

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01/ 28/ 09

pain, alleviate chronic conditions such as migraines, or change your behavior—for instance, helping you to quit smoking. Where the needles are inserted in your body varies depending on the ailment.

DOES IT WORK? Acupuncture gets a cautious thumbs-up from Heather Boon, an associate professor of pharmacy at the University of Toronto who specializes in research on natural health products and complementary therapies. She says the evidence suggests that it can help alleviate some types of pain and nausea. “There’s less evidence for other conditions, which doesn’t mean it has no benefit—just that we don’t know yet,” she says. A similar conclusion comes from the Cochrane Collaboration, an international not-for-profit group dedicated to improving medical decision-making through systematic reviews of health-care interventions. It says that acupuncture is better than no 01/ 28/ 09

NYLON

3

C CANADIANS SPEND A FORTUNE ON HERBS, HYPNOSIS AND OTHER ALTERNATIVE TREATMENTS. ARE WE GETTING VALUE FOR OUR MONEY?

ers

onsumer, heal thyself! But with what? While conventional medicine still covers the lion’s share of our health-care system, more and more of us are turning to hypnosis, homeopathy and numerous other forms of alternative medicine to cure what ails us.

Alternative medicine is now so widely practiced that it verges on mainstream, according to a survey conducted by the Fraser Institute, a Canadian think tank. When the institute asked Canadians in 2006, it found that 54% of us had used at least one alternative therapy during the previous year. All told, we paid more than $5.6 billion to alternative health providers during the 12 months under study.

But do all those billions actually buy us better health? Skeptics complain that advocates for alternative medicine have shied away from testing its effectiveness in tightly controlled clinical studies. Others say there’s simply a lack of evidence either way. “If the evidence is there, then it’s good medicine, whether conventional or alternative,” says Shafiq Qaadri, a Toronto family doctor and member of the provincial legislature. But he

without

borde

by Gabrielle Bauer

adds an all-important caveat: “Your aunt reporting that her joint pain is so much better after seeing that herbalist recommended by her best friend does not count as evidence.”

To help you sort out the placebos from the genuinely useful practices, we’ve researched some of the most common alternative treatments. Here’s our take on how much bang they deliver for your buck.

Acupuncture Illustration by Ulla Puggaard

WHAT IS IT? Acupuncture is the practice of inserting needles in the body to reduce

2

NYLON

01/ 28/ 09

pain, alleviate chronic conditions such as migraines, or change your behavior—for instance, helping you to quit smoking. Where the needles are inserted in your body varies depending on the ailment.

DOES IT WORK? Acupuncture gets a cautious thumbs-up from Heather Boon, an associate professor of pharmacy at the University of Toronto who specializes in research on natural health products and complementary therapies. She says the evidence suggests that it can help alleviate some types of pain and nausea. “There’s less evidence for other conditions, which doesn’t mean it has no benefit—just that we don’t know yet,” she says. A similar conclusion comes from the Cochrane Collaboration, an international not-for-profit group dedicated to improving medical decision-making through systematic reviews of health-care interventions. It says that acupuncture is better than no 01/ 28/ 09

NYLON

3

C CANADIANS SPEND A FORTUNE ON HERBS, HYPNOSIS AND OTHER ALTERNATIVE TREATMENTS. ARE WE GETTING VALUE FOR OUR MONEY?

ers

onsumer, heal thyself! But with what? While conventional medicine still covers the lion’s share of our health-care system, more and more of us are turning to hypnosis, homeopathy and numerous other forms of alternative medicine to cure what ails us.

Alternative medicine is now so widely practiced that it verges on mainstream, according to a survey conducted by the Fraser Institute, a Canadian think tank. When the institute asked Canadians in 2006, it found that 54% of us had used at least one alternative therapy during the previous year. All told, we paid more than $5.6 billion to alternative health providers during the 12 months under study.

But do all those billions actually buy us better health? Skeptics complain that advocates for alternative medicine have shied away from testing its effectiveness in tightly controlled clinical studies. Others say there’s simply a lack of evidence either way. “If the evidence is there, then it’s good medicine, whether conventional or alternative,” says Shafiq Qaadri, a Toronto family doctor and member of the provincial legislature. But he

without

borde

by Gabrielle Bauer

adds an all-important caveat: “Your aunt reporting that her joint pain is so much better after seeing that herbalist recommended by her best friend does not count as evidence.”

To help you sort out the placebos from the genuinely useful practices, we’ve researched some of the most common alternative treatments. Here’s our take on how much bang they deliver for your buck.

Acupuncture Illustration by Ulla Puggaard

WHAT IS IT? Acupuncture is the practice of inserting needles in the body to reduce

2

NYLON

01/ 28/ 09

pain, alleviate chronic conditions such as migraines, or change your behavior—for instance, helping you to quit smoking. Where the needles are inserted in your body varies depending on the ailment.

DOES IT WORK? Acupuncture gets a cautious thumbs-up from Heather Boon, an associate professor of pharmacy at the University of Toronto who specializes in research on natural health products and complementary therapies. She says the evidence suggests that it can help alleviate some types of pain and nausea. “There’s less evidence for other conditions, which doesn’t mean it has no benefit—just that we don’t know yet,” she says. A similar conclusion comes from the Cochrane Collaboration, an international not-for-profit group dedicated to improving medical decision-making through systematic reviews of health-care interventions. It says that acupuncture is better than no 01/ 28/ 09

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3

since 2004. These regulations set out standards for how medicinal herbs are manufactured, labeled and packaged. Unfortunately, those regulations don’t quite settle the question of whether herbs actually work the way the marketers claim. “It’s almost herb by herb and ailment by ailment,” says Boon, the University of Toronto researcher. For instance, “there’s preliminary evidence that black cohosh helps with menopausal symptoms, but no good evidence to support other claims for this herb.” This puts the onus on you to do your homework on a case-by-case basis. (For some good starting points, see A skeptic’s prescription, opposite page.)

Herbs simply aren’t a substitute for most prescription drugs. Respondents to a large Consumer Reports survey found common herbal treatments such as echinacea, St. John’s wort, and saw palmetto to be far less effective than prescription drugs for eight conditions: anxiety, rheumatoid arthritis, depression, high blood pressure, high cholesterol, insomnia, prostate problems, and respiratory problems. You should never attempt to replace prescription drugs with herbal remedies. (For more on potential risks, see The risk factor on page 44.)

“lavender aroma itself, induced relaxation in healthy young women” treatment for short-term relief of lower back pain, but it finds no evidence of it having any benefit for those who want to use it to help them quit smoking.

TYPICAL COURSE AND COST OF TREATMENT TYPICAL COURSE AND COST OF TREATMENT “Some people respond immediately and many will see a benefit, such as pain relief or better mobility, within a few sessions,” according to Ruth Anne Baron, a Toronto naturopath and former chair of the Ontario Association of Naturopathic Doctors, who includes acupuncture in her practice. After an initial consultation, expect to pay about $300 for a set of six half-hour treatments.

cal interventions such as spinal adjustment.

Chiropractors typically manipulate the spine with their hands with the aim of realigning vertebrae and relieving pressure on nerves.

Aromatherapy WHAT IS IT? Aromatherapy is the administration of fragrant plant oils, usually through massage or inhalation, to make people feel better. “The main focus of aromatherapy is to relieve stress,” says Maureen Curran, a registered aromatherapist in Courtenay, B.C. “Skin conditions that reflect stress may also respond.”

Chelation therapy WHAT IS IT? Chelation therapy is the administration of a chelating or binding agent—most commonly ethylene diamine tetra-acetic acid or EDTA—to remove heavy metals from the body. Traditionally used to treat metal poisoning, chelation therapy has also gained ground as a treatment for atherosclerosis and high blood pressure.

DOES IT WORK? Aromatherapy may improve short-term

WHAT IS IT? Homeopathy is a system

ASK YOUR DOCTOR:

of therapy based on the concept that disease can be treated by taking minute doses of substances that produce the same symptoms in healthy people as the disease itself.

Your doctor may be able to refer you to a reputable alternative practitioner and steer you away from potentially harmful treatments

DOES IT WORK? How can such minute

TYPICAL COURSE AND COST OF TREATMENT Wittel says chelation therapy for

Herbal medicine

TYPICAL COURSE AND COST OF TREATMENT

cardiovascular function typically spans about 20 intravenous treatments, at an average cost of $120 to $250 per treatment. “It’s a tax-deductible expense if provided by a medical physician,” he says.

WHAT IS IT? Herbal medicine refers to the use of herbs

TYPICAL COURSE AND COST OF TREATMENT Curran says some patients come once a week, others just once a month, depending on their condition and personal preference. A blend of oils to apply or inhale at home generally costs between $10 and $15 a bottle.

For a therapeutic massage with the same oils, you’ll likely pay the same as for a regular massage: between $60 and $80.

01/ 28/ 09

Thinking of venturing into alternative terrain? Here’s how to go about it:

tions might respond to just one or two treatments, says Gehrke, while others could take a few weeks or even several months of regular sessions. “If we can’t help a patient after a certain period of time, we reassess or refer,” he says. An initial consultation will probably set you back about $75, followed by $35 or so for each subsequent visit.

ability of chelation therapy to reverse cardiovascular damage. A 2002 study co-authored by the Foothills Medical Centre in Calgary concluded that chelation therapy has no edge over placebo for patients with stable coronary heart disease. However, Vecihi Batuman at the Tulane University Medical Center in New Orleans led a study suggesting that chelation therapy may delay the progression of chronic kidney disease. “I’ve seen it bring people back from the verge of dialysis,” says Dietrich Wittel, a physician in Penticton, B.C., whose practice centres on chelation therapy. On the other hand, “it can cause side effects to the kidney if not administered properly.”

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Homeopathy

quantities have a therapeutic benefit?

They can’t, say many mainstream medical practitioners. On the other hand, Consumer Reports cites a small study that found arnica cream (a homeopathic remedy) to have an edge over placebo in relieving bruising and swelling from a sprained ankle. The Cochrane verdict is that there is no evidence that homeopathy causes any improvement in asthma, dementia, or attention deficit disorder.

DOES IT WORK? A 2007 Cochrane review says the jury is still out on the

psychological well-being in cancer patients, according to a 2004 Cochrane review, but the review also stresses that there is a lack of research in this area.

More positively, a team of researchers at Chiba University in Japan found that lavender aromatherapy reduced cortisol (a marker of stress) and improved blood circulation in healthy men. On the other hand, researchers at the National University of Ireland in Galway found that expectations, rather than the lavender aroma itself, induced relaxation in healthy young women.

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DOES IT WORK? Several studies, including a Canadian survey conducted at the Hillhurst Chiropractic Office in Calgary, have shown that chiropractic treatment can relieve lower back pain. A few researchers suggest it can improve headache and migraine symptoms.

But chiropractic manipulation of the neck can also, in rare cases, trigger a stroke, warns Consumer Reports. Should you be concerned? “Every medical intervention comes with a risk,” says Richard Gehrke, a chiropractor in Rocky Mountain House, Alta. “The risk of harm from neck manipulation is very low— many times lower than the risk of serious side effects from nonsteroidal anti-inflammatory drugs within eight to 10 weeks of treatment.”

If you visit a naturopathic doctor, expect to pay between $125 and $240 for the initial consultation, says Baron, the Toronto naturopath. “Future consultations are generally shorter, less costly, but vary widely in price.”

Baron herself charges $300 for six sessions. The cost of the herbs also vary. “Dandelion root is cheap as dirt, while Maitake mushroom [a purported HOW TO CHECK OUT AN immune enhancer] costs $150 for a ALTERNATIVE THERAPY three-week supply.”

TYPICAL COURSE AND COST OF TREATMENT Some condi-

for their therapeutic value. A naturopathic doctor can guide you in the selection of herbs, which can be found in most health food stores and many pharmacies.

Chiropractic WHAT IS IT? Chiropractic is a health-care specialty that attempts to treat disorders of the nervous and musculoskeletal systems by using mechani-

DOES IT WORK? Health Canada has enforced what are known as the Natural Health Products Regulation

DO YOUR OWN RESEARCH: The National Center for Complementary and Alternative Medicine (www.nccam.nih.gov) and Medline Plus (www.medlineplus.gov) provide free info on many alternative therapies. Also check out CAMline (www.camline.ca), a Canadian website developed by University of Toronto professor Heather Boon and colleagues. It provides free info about numerous herbals and alternative therapies. If you’re willing to pay $19 (U.S.) per year, Consumer Reports Medical Guide (www. consumerreportsmedicalguide.org) is an excellent source of plain-language information about alternative health products and therapies

CHECK YOUR HEALTH PLAN: Ingrid Pincott, a naturopathic doctor practicing in Campbell River, B.C., recommends you go to the Canadian Association of Naturopathic Doctors website to find a naturopathic doctor in your area, then call to find out if the doctor practices homeopathy.

Many cover some alternative therapies

CHECK THE PRACTITIONER’S CREDENTIALS: Make sure the practitioner you have in mind has the proper training and licence. If you’re not sure, check with the national or regional professional association for the therapy in question

01/ 28/ 09

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3

since 2004. These regulations set out standards for how medicinal herbs are manufactured, labeled and packaged. Unfortunately, those regulations don’t quite settle the question of whether herbs actually work the way the marketers claim. “It’s almost herb by herb and ailment by ailment,” says Boon, the University of Toronto researcher. For instance, “there’s preliminary evidence that black cohosh helps with menopausal symptoms, but no good evidence to support other claims for this herb.” This puts the onus on you to do your homework on a case-by-case basis. (For some good starting points, see A skeptic’s prescription, opposite page.)

Herbs simply aren’t a substitute for most prescription drugs. Respondents to a large Consumer Reports survey found common herbal treatments such as echinacea, St. John’s wort, and saw palmetto to be far less effective than prescription drugs for eight conditions: anxiety, rheumatoid arthritis, depression, high blood pressure, high cholesterol, insomnia, prostate problems, and respiratory problems. You should never attempt to replace prescription drugs with herbal remedies. (For more on potential risks, see The risk factor on page 44.)

“lavender aroma itself, induced relaxation in healthy young women” treatment for short-term relief of lower back pain, but it finds no evidence of it having any benefit for those who want to use it to help them quit smoking.

TYPICAL COURSE AND COST OF TREATMENT TYPICAL COURSE AND COST OF TREATMENT “Some people respond immediately and many will see a benefit, such as pain relief or better mobility, within a few sessions,” according to Ruth Anne Baron, a Toronto naturopath and former chair of the Ontario Association of Naturopathic Doctors, who includes acupuncture in her practice. After an initial consultation, expect to pay about $300 for a set of six half-hour treatments.

cal interventions such as spinal adjustment.

Chiropractors typically manipulate the spine with their hands with the aim of realigning vertebrae and relieving pressure on nerves.

Aromatherapy WHAT IS IT? Aromatherapy is the administration of fragrant plant oils, usually through massage or inhalation, to make people feel better. “The main focus of aromatherapy is to relieve stress,” says Maureen Curran, a registered aromatherapist in Courtenay, B.C. “Skin conditions that reflect stress may also respond.”

Chelation therapy WHAT IS IT? Chelation therapy is the administration of a chelating or binding agent—most commonly ethylene diamine tetra-acetic acid or EDTA—to remove heavy metals from the body. Traditionally used to treat metal poisoning, chelation therapy has also gained ground as a treatment for atherosclerosis and high blood pressure.

DOES IT WORK? Aromatherapy may improve short-term

WHAT IS IT? Homeopathy is a system

ASK YOUR DOCTOR:

of therapy based on the concept that disease can be treated by taking minute doses of substances that produce the same symptoms in healthy people as the disease itself.

Your doctor may be able to refer you to a reputable alternative practitioner and steer you away from potentially harmful treatments

DOES IT WORK? How can such minute

TYPICAL COURSE AND COST OF TREATMENT Wittel says chelation therapy for

Herbal medicine

TYPICAL COURSE AND COST OF TREATMENT

cardiovascular function typically spans about 20 intravenous treatments, at an average cost of $120 to $250 per treatment. “It’s a tax-deductible expense if provided by a medical physician,” he says.

WHAT IS IT? Herbal medicine refers to the use of herbs

TYPICAL COURSE AND COST OF TREATMENT Curran says some patients come once a week, others just once a month, depending on their condition and personal preference. A blend of oils to apply or inhale at home generally costs between $10 and $15 a bottle.

For a therapeutic massage with the same oils, you’ll likely pay the same as for a regular massage: between $60 and $80.

01/ 28/ 09

Thinking of venturing into alternative terrain? Here’s how to go about it:

tions might respond to just one or two treatments, says Gehrke, while others could take a few weeks or even several months of regular sessions. “If we can’t help a patient after a certain period of time, we reassess or refer,” he says. An initial consultation will probably set you back about $75, followed by $35 or so for each subsequent visit.

ability of chelation therapy to reverse cardiovascular damage. A 2002 study co-authored by the Foothills Medical Centre in Calgary concluded that chelation therapy has no edge over placebo for patients with stable coronary heart disease. However, Vecihi Batuman at the Tulane University Medical Center in New Orleans led a study suggesting that chelation therapy may delay the progression of chronic kidney disease. “I’ve seen it bring people back from the verge of dialysis,” says Dietrich Wittel, a physician in Penticton, B.C., whose practice centres on chelation therapy. On the other hand, “it can cause side effects to the kidney if not administered properly.”

NYLON

Homeopathy

quantities have a therapeutic benefit?

They can’t, say many mainstream medical practitioners. On the other hand, Consumer Reports cites a small study that found arnica cream (a homeopathic remedy) to have an edge over placebo in relieving bruising and swelling from a sprained ankle. The Cochrane verdict is that there is no evidence that homeopathy causes any improvement in asthma, dementia, or attention deficit disorder.

DOES IT WORK? A 2007 Cochrane review says the jury is still out on the

psychological well-being in cancer patients, according to a 2004 Cochrane review, but the review also stresses that there is a lack of research in this area.

More positively, a team of researchers at Chiba University in Japan found that lavender aromatherapy reduced cortisol (a marker of stress) and improved blood circulation in healthy men. On the other hand, researchers at the National University of Ireland in Galway found that expectations, rather than the lavender aroma itself, induced relaxation in healthy young women.

4 2

DOES IT WORK? Several studies, including a Canadian survey conducted at the Hillhurst Chiropractic Office in Calgary, have shown that chiropractic treatment can relieve lower back pain. A few researchers suggest it can improve headache and migraine symptoms.

But chiropractic manipulation of the neck can also, in rare cases, trigger a stroke, warns Consumer Reports. Should you be concerned? “Every medical intervention comes with a risk,” says Richard Gehrke, a chiropractor in Rocky Mountain House, Alta. “The risk of harm from neck manipulation is very low— many times lower than the risk of serious side effects from nonsteroidal anti-inflammatory drugs within eight to 10 weeks of treatment.”

If you visit a naturopathic doctor, expect to pay between $125 and $240 for the initial consultation, says Baron, the Toronto naturopath. “Future consultations are generally shorter, less costly, but vary widely in price.”

Baron herself charges $300 for six sessions. The cost of the herbs also vary. “Dandelion root is cheap as dirt, while Maitake mushroom [a purported HOW TO CHECK OUT AN immune enhancer] costs $150 for a ALTERNATIVE THERAPY three-week supply.”

TYPICAL COURSE AND COST OF TREATMENT Some condi-

for their therapeutic value. A naturopathic doctor can guide you in the selection of herbs, which can be found in most health food stores and many pharmacies.

Chiropractic WHAT IS IT? Chiropractic is a health-care specialty that attempts to treat disorders of the nervous and musculoskeletal systems by using mechani-

DOES IT WORK? Health Canada has enforced what are known as the Natural Health Products Regulation

DO YOUR OWN RESEARCH: The National Center for Complementary and Alternative Medicine (www.nccam.nih.gov) and Medline Plus (www.medlineplus.gov) provide free info on many alternative therapies. Also check out CAMline (www.camline.ca), a Canadian website developed by University of Toronto professor Heather Boon and colleagues. It provides free info about numerous herbals and alternative therapies. If you’re willing to pay $19 (U.S.) per year, Consumer Reports Medical Guide (www. consumerreportsmedicalguide.org) is an excellent source of plain-language information about alternative health products and therapies

CHECK YOUR HEALTH PLAN: Ingrid Pincott, a naturopathic doctor practicing in Campbell River, B.C., recommends you go to the Canadian Association of Naturopathic Doctors website to find a naturopathic doctor in your area, then call to find out if the doctor practices homeopathy.

Many cover some alternative therapies

CHECK THE PRACTITIONER’S CREDENTIALS: Make sure the practitioner you have in mind has the proper training and licence. If you’re not sure, check with the national or regional professional association for the therapy in question

01/ 28/ 09

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3

After an initial consultation costing about $150, expect to pay about $100 for each follow-up visit.

“A typical patient might come for treatment once a month for a year or two,” she says.

Hypnosis WHAT IS IT? Hypnosis is the practice of inducing a state of deep physical and mental relaxation that makes the mind more receptive to suggestion.

People typically use hypnosis to drop their bad habits (such as smoking), alleviate their pain or anxieties (such as shyness or fear of flying) and enhance their motivation. “The ideal candidate is a person who really wants to change,” says Georgina Cannon, a Toronto hypnotherapist and director of the Ontario Hypnosis Centre.

“If you’re not ready to change, we send you home.”

THE RISK FACTOR

WHAT IS IT? Your body requires vitamins and co-authored by a researcher at the University of Saskatchewan found cranial manipulation to bolster the benefits of conventional care in adults with asthma.

DOES IT WORK? Hypnosis can make a difference in some people, some of the time. A review of several studies concluded that hypnosis can reduce pregnant women’s use of pain medication by about half. Researchers at the University Hospital of South Manchester in the U.K. have found it to provide lasting relief to people with irritable bowel syndrome. On the other hand, a 2005 Cochrane review found no evidence that hypnosis boosted the six-month success rate of people trying to quit smoking. To complicate matters, 10% to 20% of people cannot enter the state of relaxation needed for hypnosis to work.

TYPICAL COURSE AND COST OF TREATMENT As few as one or two hypnosis sessions can take care of most fears and phobias, says Cannon, while addiction and selfesteem issues may require five or six sessions. Following an initial 90-minute session costing between $150 and $250, the hour-long sessions are typically billed at $80 to $150.

Massage therapy

TYPICAL COURSE AND COST OF TREATMENT with lower back pain. Respondents to a large-scale Consumer Reports survey praised deep-tissue massage for relieving the pain of osteoarthritis and fibromyalgia.

TYPICAL COURSE AND COST OF TREATMENT Parissa Bunin, a naturopathic doctor and registered massage therapist in Fredericton, says that people with acute injuries should have weekly treatments for about a month, then less frequent treatments as needed.

People with chronic conditions may need “maintenance treatments once a month for several years,” she says.

You’ll pay about $60 to $80 for an hour-long session.

Osteopathy WHAT IS IT? A cousin of chiropractic and massage therapy, osteopathy uses muscle energy, joint play, and spinal or cranial therapy to relieve ailments ranging

“one or two hypnosis sessions can take care of most fears and phobias”

WHAT IS IT? Massage therapy is the practice of manipulating the soft tissues of the body to prevent or alleviate pain and promote health. Massage therapy comes in many forms, from gentle Swedish massage to deep, fast-stroked sports massage.

DOES IT WORK? A 2002 Cochrane review found that massage therapy, when delivered by a licensed therapist and combined with exercise and education, can relieve symptoms and improve function in patients 6 2

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01/ 28/ 09

Vitamins

from sports injuries and arthritis to asthma and menstrual pain. “I use osteopathy to treat children’s conditions such as colic and ear infections, says Barbara Schultze, a massage therapist in Regina who recently completed her osteopathy training. “The techniques are similar to massage therapy, but they look at the source of a problem and the relationships between different body systems.”

DOES IT WORK? Consumer Reports states that lower back pain from a slipped disk may improve with spinal manipulation. A recent study

Schultze says you should start to see some results within two to six visits, though you may need additional sessions for more complex ailments. After an initial paid consultation, expect to pay $80 to $100 for 45-minute follow-up sessions.

Reflexology WHAT IS IT? Reflexology is the practice of applying pressure or stimulation to various points on the feet (sometimes the hands or ears as well) to alleviate pain and improve health. Reflexology rests on the premise that specific areas in our extremities are linked to specific internal organs and bodily systems through reflex points and “meridian lines.”

DOES IT WORK? A scarcity of clinical studies of reflexology means the jury’s still out. A 2004 Cochrane review unearthed only a single reflexology trial that yielded some positive but short-term effects on anxiety.

TYPICAL COURSE AND COST OF TREATMENT A typical treatment lasts 40 to 60 minutes.

Sherri Gunn, a reflexologist in Winnipeg, says most of her patients notice a change after three to five treatments, and some continue indefinitely with monthly treatments. The cost of a single treatment varies widely, she says: as little as $20 in the Prairies and upwards of $60 in the largest urban centres.

YOU SHOULD NEVER VIEW ALTERNATIVE MEDICINE AS A SUBSTITUTE FOR THE REAL THING Many alternative therapies have only weak or inconsistent evidence standing behind them. But can they actually do you harm?

In most cases, no. “Alternative methods [such as acupuncture, chiropractic and herbal medicine]… rarely cause substantial adverse effects, provided they’re performed properly on appropriate patients by qualified practitioners,” states the Consumer Reports website.

The risk creeps in when patients forgo medical treatment and prescription-level medication in favor of alternative therapies, says Toronto family physician and Ontario MPP Dr. Shafiq Qaadri. “I’ve had patients disappear for months at a time and return in much worse shape than before,” he says. In one instance, a diabetic patient took a break from doctor visits and consulted an alternative health practitioner who neglected to monitor her blood sugar. “By the time I saw her, her levels had doubled,” Dr. Qaadri recalls. “She’s now at greater risk of serious diabetes complications.”

Mixing herbal products with operations poses another potential risk, as many popular herbs can trigger problems during or after an operation and delay recovery time. Consumer Reports advises stopping herbal remedies a week before surgery.

minerals to operate normally. Many of us can get sufficient vitamins and minerals simply by eating our fruits and veggies, but some circumstances call for supplements. For example, “the new Canada Food Guide has outlined the need for Vitamin D supplementation in all adults over 50,” says Janet Holbrook, a dietitian in Vernon, B.C. “Many older people also need vitamin B12 and calcium supplementation.” What’s more, “a great many Canadians rely on multivitamins to cover a less-than-perfect diet.” Specific conditions call for specific supplements, such as iron for anemia.

DOES IT WORK? According to Holbrook, supplementing your diet with the right vitamins and minerals may speed up healing after surgery, mitigate bone loss, and correct nutritional defi ciencies in people with poor diets or absorption.

“One way or another, you need your vitamins and minerals,” she says.

TYPICAL COURSE AND COST OF TREATMENT Don’t start taking supplements without consulting a doctor, pharmacist or dietician, says Cara Rosenbloom, a registered dietitian in Toronto: “Some supplements can be toxic at high doses or interfere with other medications.” The good news is that vitamin pills won’t bankrupt you.

You’ll pay about $4 for a month’s supply of iron and $6 for vitamin B12.

01/ 28/ 09

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After an initial consultation costing about $150, expect to pay about $100 for each follow-up visit.

“A typical patient might come for treatment once a month for a year or two,” she says.

Hypnosis WHAT IS IT? Hypnosis is the practice of inducing a state of deep physical and mental relaxation that makes the mind more receptive to suggestion.

People typically use hypnosis to drop their bad habits (such as smoking), alleviate their pain or anxieties (such as shyness or fear of flying) and enhance their motivation. “The ideal candidate is a person who really wants to change,” says Georgina Cannon, a Toronto hypnotherapist and director of the Ontario Hypnosis Centre.

“If you’re not ready to change, we send you home.”

THE RISK FACTOR

WHAT IS IT? Your body requires vitamins and co-authored by a researcher at the University of Saskatchewan found cranial manipulation to bolster the benefits of conventional care in adults with asthma.

DOES IT WORK? Hypnosis can make a difference in some people, some of the time. A review of several studies concluded that hypnosis can reduce pregnant women’s use of pain medication by about half. Researchers at the University Hospital of South Manchester in the U.K. have found it to provide lasting relief to people with irritable bowel syndrome. On the other hand, a 2005 Cochrane review found no evidence that hypnosis boosted the six-month success rate of people trying to quit smoking. To complicate matters, 10% to 20% of people cannot enter the state of relaxation needed for hypnosis to work.

TYPICAL COURSE AND COST OF TREATMENT As few as one or two hypnosis sessions can take care of most fears and phobias, says Cannon, while addiction and selfesteem issues may require five or six sessions. Following an initial 90-minute session costing between $150 and $250, the hour-long sessions are typically billed at $80 to $150.

Massage therapy

TYPICAL COURSE AND COST OF TREATMENT with lower back pain. Respondents to a large-scale Consumer Reports survey praised deep-tissue massage for relieving the pain of osteoarthritis and fibromyalgia.

TYPICAL COURSE AND COST OF TREATMENT Parissa Bunin, a naturopathic doctor and registered massage therapist in Fredericton, says that people with acute injuries should have weekly treatments for about a month, then less frequent treatments as needed.

People with chronic conditions may need “maintenance treatments once a month for several years,” she says.

You’ll pay about $60 to $80 for an hour-long session.

Osteopathy WHAT IS IT? A cousin of chiropractic and massage therapy, osteopathy uses muscle energy, joint play, and spinal or cranial therapy to relieve ailments ranging

“one or two hypnosis sessions can take care of most fears and phobias”

WHAT IS IT? Massage therapy is the practice of manipulating the soft tissues of the body to prevent or alleviate pain and promote health. Massage therapy comes in many forms, from gentle Swedish massage to deep, fast-stroked sports massage.

DOES IT WORK? A 2002 Cochrane review found that massage therapy, when delivered by a licensed therapist and combined with exercise and education, can relieve symptoms and improve function in patients 6 2

NYLON

01/ 28/ 09

Vitamins

from sports injuries and arthritis to asthma and menstrual pain. “I use osteopathy to treat children’s conditions such as colic and ear infections, says Barbara Schultze, a massage therapist in Regina who recently completed her osteopathy training. “The techniques are similar to massage therapy, but they look at the source of a problem and the relationships between different body systems.”

DOES IT WORK? Consumer Reports states that lower back pain from a slipped disk may improve with spinal manipulation. A recent study

Schultze says you should start to see some results within two to six visits, though you may need additional sessions for more complex ailments. After an initial paid consultation, expect to pay $80 to $100 for 45-minute follow-up sessions.

Reflexology WHAT IS IT? Reflexology is the practice of applying pressure or stimulation to various points on the feet (sometimes the hands or ears as well) to alleviate pain and improve health. Reflexology rests on the premise that specific areas in our extremities are linked to specific internal organs and bodily systems through reflex points and “meridian lines.”

DOES IT WORK? A scarcity of clinical studies of reflexology means the jury’s still out. A 2004 Cochrane review unearthed only a single reflexology trial that yielded some positive but short-term effects on anxiety.

TYPICAL COURSE AND COST OF TREATMENT A typical treatment lasts 40 to 60 minutes.

Sherri Gunn, a reflexologist in Winnipeg, says most of her patients notice a change after three to five treatments, and some continue indefinitely with monthly treatments. The cost of a single treatment varies widely, she says: as little as $20 in the Prairies and upwards of $60 in the largest urban centres.

YOU SHOULD NEVER VIEW ALTERNATIVE MEDICINE AS A SUBSTITUTE FOR THE REAL THING Many alternative therapies have only weak or inconsistent evidence standing behind them. But can they actually do you harm?

In most cases, no. “Alternative methods [such as acupuncture, chiropractic and herbal medicine]… rarely cause substantial adverse effects, provided they’re performed properly on appropriate patients by qualified practitioners,” states the Consumer Reports website.

The risk creeps in when patients forgo medical treatment and prescription-level medication in favor of alternative therapies, says Toronto family physician and Ontario MPP Dr. Shafiq Qaadri. “I’ve had patients disappear for months at a time and return in much worse shape than before,” he says. In one instance, a diabetic patient took a break from doctor visits and consulted an alternative health practitioner who neglected to monitor her blood sugar. “By the time I saw her, her levels had doubled,” Dr. Qaadri recalls. “She’s now at greater risk of serious diabetes complications.”

Mixing herbal products with operations poses another potential risk, as many popular herbs can trigger problems during or after an operation and delay recovery time. Consumer Reports advises stopping herbal remedies a week before surgery.

minerals to operate normally. Many of us can get sufficient vitamins and minerals simply by eating our fruits and veggies, but some circumstances call for supplements. For example, “the new Canada Food Guide has outlined the need for Vitamin D supplementation in all adults over 50,” says Janet Holbrook, a dietitian in Vernon, B.C. “Many older people also need vitamin B12 and calcium supplementation.” What’s more, “a great many Canadians rely on multivitamins to cover a less-than-perfect diet.” Specific conditions call for specific supplements, such as iron for anemia.

DOES IT WORK? According to Holbrook, supplementing your diet with the right vitamins and minerals may speed up healing after surgery, mitigate bone loss, and correct nutritional defi ciencies in people with poor diets or absorption.

“One way or another, you need your vitamins and minerals,” she says.

TYPICAL COURSE AND COST OF TREATMENT Don’t start taking supplements without consulting a doctor, pharmacist or dietician, says Cara Rosenbloom, a registered dietitian in Toronto: “Some supplements can be toxic at high doses or interfere with other medications.” The good news is that vitamin pills won’t bankrupt you.

You’ll pay about $4 for a month’s supply of iron and $6 for vitamin B12.

01/ 28/ 09

NYLON

7 3

Photograph by Bark Dbaxg

ing

Doctor

without borders Canadians spend a fortune on herbs, hypnosis and other alternative treatments. Are we getting value for our money?

by Gabrielle Bauer CONSUMER, HEAL THYSELF! BUT WITH WHAT? WHILE CONVENTIONAL medicine still covers the lion’s share of our health-care system, more and more of us are turning to hypnosis, homeopathy and numerous other forms of alternative medicine to cure what ails us.

Alternative medicine is now so widely practiced that it verges on mainstream, according to a survey conducted by the Fraser Institute, a Canadian think tank.

When the institute asked Canadians in 2006, it found that 54% of us had used at least one alternative therapy during the previous year. All told, we paid more than $5.6 billion to alternative health providers during the 12 months under study.

But do all those billions actually buy us better health? Skeptics complain that advocates for alternative medicine have shied away from testing its effectiveness in tightly controlled clinical studies.

Others say there’s simply a lack of evidence either way. “If the evidence is there, then it’s good medicine, 2

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January 28, 2009

whether conventional or alternative,” says Shafiq Qaadri, a Toronto family doctor and member of the provincial legislature. But he adds an all-important caveat: “Your aunt reporting that her joint pain is so much better after seeing that herbalist recommended by her best friend does not count as evidence.”

To help you sort out the placebos from the genuinely useful practices, we’ve researched some of the most common alternative treatments. Here’s our take on how much bang they deliver for your buck.

ACUPUNCTURE What is it?

Acupuncture is the practice of inserting needles in the body to reduce pain, alleviate chronic conditions such as migraines, or change your behavior—for instance, helping you to quit smoking.

Where the needles are inserted in your body varies depending on the ailment.

Does it work?

Acupuncture gets a cautious thumbs-up

from Heather Boon, an associate professor of pharmacy at the University of Toronto who specializes in research on natural health products and complementary therapies. She says the evidence suggests that it can help alleviate some types of pain and nausea. “There’s less evidence for other conditions, which doesn’t mean it has no benefit—just that we don’t know yet,” she says. A similar conclusion comes from the Cochrane Collaboration, an international not-for-profit group dedicated to improving medical decision-making through systematic reviews of health-care interventions. It says that acupuncture is better than no treatment for short-term relief of lower back pain, but it finds no evidence of it having any benefit for those who want to use it to help them quit smoking.

Typical course and cost of treatment “Some people respond immediately and many will see a benefit, such as pain relief or better mobility, within a few sessions,” according to Ruth Anne Baron, a Toronto naturopath and former chair of January 28, 2009

FORTUNE

3

Photograph by Bark Dbaxg

ing

Doctor

without borders Canadians spend a fortune on herbs, hypnosis and other alternative treatments. Are we getting value for our money?

by Gabrielle Bauer CONSUMER, HEAL THYSELF! BUT WITH WHAT? WHILE CONVENTIONAL medicine still covers the lion’s share of our health-care system, more and more of us are turning to hypnosis, homeopathy and numerous other forms of alternative medicine to cure what ails us.

Alternative medicine is now so widely practiced that it verges on mainstream, according to a survey conducted by the Fraser Institute, a Canadian think tank.

When the institute asked Canadians in 2006, it found that 54% of us had used at least one alternative therapy during the previous year. All told, we paid more than $5.6 billion to alternative health providers during the 12 months under study.

But do all those billions actually buy us better health? Skeptics complain that advocates for alternative medicine have shied away from testing its effectiveness in tightly controlled clinical studies.

Others say there’s simply a lack of evidence either way. “If the evidence is there, then it’s good medicine, 2

FORTUNE

January 28, 2009

whether conventional or alternative,” says Shafiq Qaadri, a Toronto family doctor and member of the provincial legislature. But he adds an all-important caveat: “Your aunt reporting that her joint pain is so much better after seeing that herbalist recommended by her best friend does not count as evidence.”

To help you sort out the placebos from the genuinely useful practices, we’ve researched some of the most common alternative treatments. Here’s our take on how much bang they deliver for your buck.

ACUPUNCTURE What is it?

Acupuncture is the practice of inserting needles in the body to reduce pain, alleviate chronic conditions such as migraines, or change your behavior—for instance, helping you to quit smoking.

Where the needles are inserted in your body varies depending on the ailment.

Does it work?

Acupuncture gets a cautious thumbs-up

from Heather Boon, an associate professor of pharmacy at the University of Toronto who specializes in research on natural health products and complementary therapies. She says the evidence suggests that it can help alleviate some types of pain and nausea. “There’s less evidence for other conditions, which doesn’t mean it has no benefit—just that we don’t know yet,” she says. A similar conclusion comes from the Cochrane Collaboration, an international not-for-profit group dedicated to improving medical decision-making through systematic reviews of health-care interventions. It says that acupuncture is better than no treatment for short-term relief of lower back pain, but it finds no evidence of it having any benefit for those who want to use it to help them quit smoking.

Typical course and cost of treatment “Some people respond immediately and many will see a benefit, such as pain relief or better mobility, within a few sessions,” according to Ruth Anne Baron, a Toronto naturopath and former chair of January 28, 2009

FORTUNE

3

the Ontario Association of Naturopathic Doctors, who includes acupuncture in her practice. After an initial consultation, expect to pay about $300 for a set of six half-hour treatments.

AROMATHERAPY What is it?

Aromatherapy is the administration of fragrant plant oils, usually through massage or inhalation, to make people feel better. “The main focus of aromatherapy is to relieve stress,” says Maureen Curran, a registered aromatherapist in Courtenay, B.C. “Skin conditions that reflect stress may also respond.”

Does it work?

Aromatherapy may improve short-term psychological well-being in cancer patients, according to a 2004 Cochrane review, but the review also stresses that there is a lack of research in this area.

More positively, a team of researchers at Chiba University in Japan found that lavender aromatherapy reduced cortisol (a marker of stress) and improved blood circulation in healthy men. On the other hand, researchers at the National University of Ireland in Galway found that expectations, rather than the lavender aroma itself, induced relaxation in healthy young women.

Typical course and cost of treatment Curran says some patients come once a week, others just once a month, depending on their condition and personal preference. A blend of oils to apply or inhale at home generally costs between $10 and $15 a bottle. For a therapeutic massage with the same oils, you’ll likely pay the same as for a regular massage: between $60 and $80.

CHELATION THERAPY What is it?

Chelation therapy is the administration of a chelating or binding agent—most commonly ethylene diamine tetra-acetic acid or EDTA—to remove heavy metals from the body. Traditionally used to treat 24

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January 28, 2009

A SKEPTIC’S PRESCRIPTION metal poisoning, chelation therapy has also gained ground as a treatment for atherosclerosis and high blood pressure.

Does it work?

A 2007 Cochrane review says the jury is still out on the ability of chelation therapy to reverse cardiovascular damage.

A 2002 study co-authored by the Foothills Medical Centre in Calgary concluded that chelation therapy has no edge over placebo for patients with stable coronary heart disease. However, Vecihi Batuman at the Tulane University Medical Center in New Orleans led a study suggesting that chelation therapy may delay the progression of chronic kidney disease.

“I’ve seen it bring people back from the verge of dialysis,” says Dietrich Wittel, a physician in Penticton, B.C., whose practice centres on chelation therapy. On the other hand, “it can cause side effects to the kidney if not administered properly.”

Typical course and cost of treatment Wittel says chelation therapy for cardiovascular function typically spans about 20 intravenous treatments, at an average cost of $120 to $250 per treatment. “It’s a tax-deductible expense if provided by a medical physician,” he says.

CHIROPRACTIC What is it?

Chiropractic is a health-care specialty that attempts to treat disorders of the nervous and musculoskeletal systems by using mechanical interventions such as spinal adjustment. Chiropractors typically manipulate the spine with their hands with the aim of realigning vertebrae and relieving pressure on nerves.

Does it work?

Several studies, including a Canadian survey conducted at the Hillhurst Chiropractic Office in Calgary, have shown that chiropractic treatment can relieve lower back pain. A few researchers suggest it can improve headache and migraine symptoms. But chiropractic manipulation of the neck can also, in rare cases, trigger a stroke, warns Consumer Reports Should you be concerned? “Every medical intervention comes with a risk,” says Richard Gehrke, a chiropractor in Rocky Mountain House, Alta. “The risk of harm from neck manipulation is very low—many times lower than the risk of serious side effects from nonsteroidal anti-inflammatory drugs within eight to 10 weeks of treatment.”

Typical course and cost of treatment Some conditions might respond to just one or two treatments, says Gehrke, while others could take a few weeks or even several months of regular sessions.

“If we can’t help a patient after a certain period of time, we reassess or refer,” he says. An initial consultation will probably set you back about $75, followed by $35 or so for each subsequent visit.

HERBAL MEDICINE What is it?

Herbal medicine refers to the use of herbs for their therapeutic value. A naturopathic doctor can guide you in the selection of herbs, which can be found in most health food stores and many pharmacies.

Does it work?

Health Canada has enforced what are known as the Natural Health Products Regulation since 2004. These regulations set out standards for how medicinal herbs are manufactured, labeled and packaged. Unfortunately, those regulations don’t quite settle the question of whether herbs actually work the way the marketers claim. “It’s almost herb

by herb and ailment by ailment,” says Boon, the University of Toronto researcher. For instance, “there’s preliminary evidence that black cohosh helps with menopausal symptoms, but no good evidence to support other claims for this herb.” This puts the onus on you to do your homework on a case-by-case basis.

(For some good starting points, see A skeptic’s prescription, opposite page.)

Herbs simply aren’t a substitute for most prescription drugs. Respondents to a large Consumer Reports survey found common herbal treatments such as echinacea, St. John’s wort, and saw palmetto to be far less effective than prescription drugs for eight conditions: anxiety, rheumatoid arthritis, depression, high blood pressure, high cholesterol, insomnia, prostate problems, and respiratory problems. You should never attempt to replace prescription drugs with herbal remedies. (For more on potential risks, see The risk factor on page 44.)

Typical course and cost of treatment If you visit a naturopathic doctor, expect to pay between $125 and $240 for the initial consultation, says Baron, the Toronto naturopath. “Future consulta-

How to check out an alternative therapy Thinking of venturing into alternative terrain?

Here’s how to go about it: Ask your doctor: Your doctor may be able to refer you to a reputable alternative practitioner and steer you away from potentially harmful treatments Do your own research: The National Center for Complementary and Alternative Medicine (www.nccam.nih.gov) and Medline Plus (www.medlineplus.gov) provide free info on many alternative therapies.

Also check out CAMline (www.camline. ca), a Canadian website developed by University of Toronto professor Heather Boon and colleagues. It provides free info about numerous herbals and alternative therapies. If you’re willing to pay $19 (U.S.) per year, Consumer Reports Medical Guide (www.consumerreportsmedicalguide.org) is an excellent source of plain-language information about alternative health products and therapies.

Check your health plan: Many cover some alternative therapies Check the practitioner’s credentials: Make sure the practitioner you have in mind has the proper training and licence.

If you’re not sure, check with the national or regional professional association for the therapy in question January 28, 2009

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3

the Ontario Association of Naturopathic Doctors, who includes acupuncture in her practice. After an initial consultation, expect to pay about $300 for a set of six half-hour treatments.

AROMATHERAPY What is it?

Aromatherapy is the administration of fragrant plant oils, usually through massage or inhalation, to make people feel better. “The main focus of aromatherapy is to relieve stress,” says Maureen Curran, a registered aromatherapist in Courtenay, B.C. “Skin conditions that reflect stress may also respond.”

Does it work?

Aromatherapy may improve short-term psychological well-being in cancer patients, according to a 2004 Cochrane review, but the review also stresses that there is a lack of research in this area.

More positively, a team of researchers at Chiba University in Japan found that lavender aromatherapy reduced cortisol (a marker of stress) and improved blood circulation in healthy men. On the other hand, researchers at the National University of Ireland in Galway found that expectations, rather than the lavender aroma itself, induced relaxation in healthy young women.

Typical course and cost of treatment Curran says some patients come once a week, others just once a month, depending on their condition and personal preference. A blend of oils to apply or inhale at home generally costs between $10 and $15 a bottle. For a therapeutic massage with the same oils, you’ll likely pay the same as for a regular massage: between $60 and $80.

CHELATION THERAPY What is it?

Chelation therapy is the administration of a chelating or binding agent—most commonly ethylene diamine tetra-acetic acid or EDTA—to remove heavy metals from the body. Traditionally used to treat 24

FORTUNE

January 28, 2009

A SKEPTIC’S PRESCRIPTION metal poisoning, chelation therapy has also gained ground as a treatment for atherosclerosis and high blood pressure.

Does it work?

A 2007 Cochrane review says the jury is still out on the ability of chelation therapy to reverse cardiovascular damage.

A 2002 study co-authored by the Foothills Medical Centre in Calgary concluded that chelation therapy has no edge over placebo for patients with stable coronary heart disease. However, Vecihi Batuman at the Tulane University Medical Center in New Orleans led a study suggesting that chelation therapy may delay the progression of chronic kidney disease.

“I’ve seen it bring people back from the verge of dialysis,” says Dietrich Wittel, a physician in Penticton, B.C., whose practice centres on chelation therapy. On the other hand, “it can cause side effects to the kidney if not administered properly.”

Typical course and cost of treatment Wittel says chelation therapy for cardiovascular function typically spans about 20 intravenous treatments, at an average cost of $120 to $250 per treatment. “It’s a tax-deductible expense if provided by a medical physician,” he says.

CHIROPRACTIC What is it?

Chiropractic is a health-care specialty that attempts to treat disorders of the nervous and musculoskeletal systems by using mechanical interventions such as spinal adjustment. Chiropractors typically manipulate the spine with their hands with the aim of realigning vertebrae and relieving pressure on nerves.

Does it work?

Several studies, including a Canadian survey conducted at the Hillhurst Chiropractic Office in Calgary, have shown that chiropractic treatment can relieve lower back pain. A few researchers suggest it can improve headache and migraine symptoms. But chiropractic manipulation of the neck can also, in rare cases, trigger a stroke, warns Consumer Reports Should you be concerned? “Every medical intervention comes with a risk,” says Richard Gehrke, a chiropractor in Rocky Mountain House, Alta. “The risk of harm from neck manipulation is very low—many times lower than the risk of serious side effects from nonsteroidal anti-inflammatory drugs within eight to 10 weeks of treatment.”

Typical course and cost of treatment Some conditions might respond to just one or two treatments, says Gehrke, while others could take a few weeks or even several months of regular sessions.

“If we can’t help a patient after a certain period of time, we reassess or refer,” he says. An initial consultation will probably set you back about $75, followed by $35 or so for each subsequent visit.

HERBAL MEDICINE What is it?

Herbal medicine refers to the use of herbs for their therapeutic value. A naturopathic doctor can guide you in the selection of herbs, which can be found in most health food stores and many pharmacies.

Does it work?

Health Canada has enforced what are known as the Natural Health Products Regulation since 2004. These regulations set out standards for how medicinal herbs are manufactured, labeled and packaged. Unfortunately, those regulations don’t quite settle the question of whether herbs actually work the way the marketers claim. “It’s almost herb

by herb and ailment by ailment,” says Boon, the University of Toronto researcher. For instance, “there’s preliminary evidence that black cohosh helps with menopausal symptoms, but no good evidence to support other claims for this herb.” This puts the onus on you to do your homework on a case-by-case basis.

(For some good starting points, see A skeptic’s prescription, opposite page.)

Herbs simply aren’t a substitute for most prescription drugs. Respondents to a large Consumer Reports survey found common herbal treatments such as echinacea, St. John’s wort, and saw palmetto to be far less effective than prescription drugs for eight conditions: anxiety, rheumatoid arthritis, depression, high blood pressure, high cholesterol, insomnia, prostate problems, and respiratory problems. You should never attempt to replace prescription drugs with herbal remedies. (For more on potential risks, see The risk factor on page 44.)

Typical course and cost of treatment If you visit a naturopathic doctor, expect to pay between $125 and $240 for the initial consultation, says Baron, the Toronto naturopath. “Future consulta-

How to check out an alternative therapy Thinking of venturing into alternative terrain?

Here’s how to go about it: Ask your doctor: Your doctor may be able to refer you to a reputable alternative practitioner and steer you away from potentially harmful treatments Do your own research: The National Center for Complementary and Alternative Medicine (www.nccam.nih.gov) and Medline Plus (www.medlineplus.gov) provide free info on many alternative therapies.

Also check out CAMline (www.camline. ca), a Canadian website developed by University of Toronto professor Heather Boon and colleagues. It provides free info about numerous herbals and alternative therapies. If you’re willing to pay $19 (U.S.) per year, Consumer Reports Medical Guide (www.consumerreportsmedicalguide.org) is an excellent source of plain-language information about alternative health products and therapies.

Check your health plan: Many cover some alternative therapies Check the practitioner’s credentials: Make sure the practitioner you have in mind has the proper training and licence.

If you’re not sure, check with the national or regional professional association for the therapy in question January 28, 2009

FORTUNE

3

tions are generally shorter, less costly, but vary widely in price.” Baron herself charges $300 for six sessions. The cost of the herbs also vary. “Dandelion root is cheap as dirt, while Maitake mushroom [a purported immune enhancer] costs $150 for a three-week supply.”

HOMEOPATHY What is it?

Homeopathy is a system of therapy based on the concept that disease can be treated by taking minute doses of substances that produce the same symptoms in healthy people as the disease itself.

Does it work?

How can such minute quantities have a therapeutic benefit? They can’t, say many mainstream medical practitioners. On the other hand, Consumer Reports cites a small study that found arnica cream (a homeopathic remedy) to have an edge over placebo in relieving bruising and swelling from a sprained ankle. The Cochrane verdict is that there is no evidence that homeopathy causes any improvement in asthma, dementia, or attention deficit disorder.

Typical course and cost of treatment Ingrid Pincott, a naturopathic doctor practicing in Campbell River, B.C., recommends you go to the Canadian Association of Naturopathic Doctors website to find a naturopathic doctor in your area, then call to find out if the doctor practices homeopathy. After an initial consultation costing about $150, expect to pay about $100 for each follow-up visit. “A typical patient might come for treatment once a month for a year or two,” she says.

HYPNOSIS What is it?

Hypnosis is the practice of inducing a state of deep physical and mental relaxation that makes the mind more receptive to suggestion. People typically use hypnosis to drop their bad habits (such as smoking), alleviate their pain or anxieties 62

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January 28, 2009

(such as shyness or fear of flying) and enhance their motivation. “The ideal candidate is a person who really wants to change,” says Georgina Cannon, a Toronto hypnotherapist and director of the Ontario Hypnosis Centre. “If you’re not ready to change, we send you home.”

Does it work?

Hypnosis can make a difference in some people, some of the time. A review of several studies concluded that hypnosis can reduce pregnant women’s use of pain medication by about half. Researchers at the University Hospital of South Manchester in the U.K. have found it to provide lasting relief to people with irritable bowel syndrome. On the other hand, a 2005 Cochrane review found no evidence that hypnosis boosted the sixmonth success rate of people trying to quit smoking. To complicate matters, 10% to 20% of people cannot enter the state of relaxation needed for hypnosis to work.

Typical course and cost of treatment As few as one or two hypnosis sessions can take care of most fears and phobias, says Cannon, while addiction and selfesteem issues may require five or six sessions. Following an initial 90-minute session costing between $150 and $250, the hour-long sessions are typically billed at $80 to $150.

MASSAGE THERAPY What is it?

Massage therapy is the practice of manipulating the soft tissues of the body to prevent or alleviate pain and promote health. Massage therapy comes in many forms, from gentle Swedish massage to deep, fast-stroked sports massage.

Does it work?

A 2002 Cochrane review found that massage therapy, when delivered by a licensed therapist and combined with exercise and education, can relieve symptoms and improve function in patients with lower back pain. Respondents to a large-scale Consumer Reports survey praised deeptissue massage for relieving the pain of osteoarthritis and fibromyalgia.

Typical course and cost of treatment Parissa Bunin, a naturopathic doctor and registered massage therapist in Fredericton, says that people with acute injuries should have weekly treatments for about a month, then less frequent treatments as needed. People with chronic conditions may need “maintenance treatments once a month for several years,” she says.

You’ll pay about $60 to $80 for an hour-long session.

OSTEOPATHY What is it?

A cousin of chiropractic and massage therapy, osteopathy uses muscle energy, joint play, and spinal or cranial therapy to relieve ailments ranging from sports injuries and arthritis to asthma and menstrual pain. “I use osteopathy to treat children’s conditions such as colic and

ear infections, says Barbara Schultze, a massage therapist in Regina who recently completed her osteopathy training.

“The techniques are similar to massage therapy, but they look at the source of a problem and the relationships between different body systems.”

Does it work?

Consumer Reports states that lower back pain from a slipped disk may improve with spinal manipulation. A recent study co-authored by a researcher at the University of Saskatchewan found cranial manipulation to bolster the benefits of conventional care in adults with asthma.

Typical course and cost of treatment Schultze says you should start to see some results within two to six visits, though you may need additional sessions for more complex ailments. After an initial paid consultation, expect to pay $80 to $100 for 45-minute follow-up sessions.

REFLEXOLOGY What is it?

Reflexology is the practice of applying pressure or stimulation to various points on the feet (sometimes the hands or ears as well) to alleviate pain and improve health. Reflexology rests on the premise that specific areas in our extremities are linked to specific internal organs and bodily systems through reflex points and “meridian lines.”

Does it work?

A scarcity of clinical studies of reflexology means the jury’s still out. A 2004 Cochrane review unearthed only a single reflexology trial that yielded some positive but short-term effects on anxiety.

Typical course and cost of treatment A typical treatment lasts 40 to 60 minutes.

Sherri Gunn, a reflexologist in Winnipeg, says most of her patients notice a change after three to five treatments, and some continue indefinitely with monthly treatments. The cost of a single treatment varies widely, she says: as little as $20 in the Prairies and upwards of $60 in the largest urban centres.

VITAMINS What is it?

Your body requires vitamins and minerals to operate normally. Many of us can get sufficient vitamins and minerals simply by eating our fruits and veggies, but some circumstances call for supplements.

For example, “the new Canada Food Guide has outlined the need for Vitamin D supplementation in all adults over 50,” says Janet Holbrook, a dietitian in Vernon, B.C. “Many older people also need vitamin B12 and calcium supplementation.” What’s more, “a great many Canadians rely on multivitamins to cover a less-than-perfect diet.” Specific conditions call for specific supplements, such as iron for anemia.

Does it work?

According to Holbrook, supplementing your diet with the right vitamins and minerals may speed up healing after surgery, mitigate bone loss, and correct nutritional deficiencies in people with poor diets or absorption. “One way or another, you need your vitamins and minerals,” she says.

Typical course and cost of treatment Don’t start taking supplements without consulting a doctor, pharmacist or dietician, says Cara Rosenbloom, a registered dietitian in Toronto: “Some supplements can be toxic at high doses or interfere with other medications.”

The good news is that vitamin pills won’t bankrupt you. You’ll pay about $4 for a month’s supply of iron and $6 for vitamin B12.

THE RISK FACTOR: You should never view alternative medicine as a substitute for the real thing Many alternative therapies have only weak or in- patients disappear for months at a time and return consistent evidence standing behind them. But can in much worse shape than before,” he says. In one they actually do you harm? instance, a diabetic patient took a break from doctor In most cases, no. “Alternative methods [such visits and consulted an alternative health practias acupuncture, chiropractic and herbal medicine]… tioner who neglected to monitor her blood sugar. rarely cause substantial adverse effects, provided “By the time I saw her, her levels had doubled,” Dr. they’re performed properly on appropriate patients Qaadri recalls. “She’s now at greater risk of serious by qualified practitioners,” states the Consumer diabetes complications.”

Reports website.

Mixing herbal products with operations poses The risk creeps in when patients forgo medical another potential risk, as many popular herbs can treatment and prescription-level medication in favor trigger problems during or after an operation and of alternative therapies, says Toronto family physi- delay recovery time. Consumer Reports advises cian and Ontario MPP Dr. Shafiq Qaadri. “I’ve had stopping herbal remedies a week before surgery.

January 28, 2009

FORTUNE

3

tions are generally shorter, less costly, but vary widely in price.” Baron herself charges $300 for six sessions. The cost of the herbs also vary. “Dandelion root is cheap as dirt, while Maitake mushroom [a purported immune enhancer] costs $150 for a three-week supply.”

HOMEOPATHY What is it?

Homeopathy is a system of therapy based on the concept that disease can be treated by taking minute doses of substances that produce the same symptoms in healthy people as the disease itself.

Does it work?

How can such minute quantities have a therapeutic benefit? They can’t, say many mainstream medical practitioners. On the other hand, Consumer Reports cites a small study that found arnica cream (a homeopathic remedy) to have an edge over placebo in relieving bruising and swelling from a sprained ankle. The Cochrane verdict is that there is no evidence that homeopathy causes any improvement in asthma, dementia, or attention deficit disorder.

Typical course and cost of treatment Ingrid Pincott, a naturopathic doctor practicing in Campbell River, B.C., recommends you go to the Canadian Association of Naturopathic Doctors website to find a naturopathic doctor in your area, then call to find out if the doctor practices homeopathy. After an initial consultation costing about $150, expect to pay about $100 for each follow-up visit. “A typical patient might come for treatment once a month for a year or two,” she says.

HYPNOSIS What is it?

Hypnosis is the practice of inducing a state of deep physical and mental relaxation that makes the mind more receptive to suggestion. People typically use hypnosis to drop their bad habits (such as smoking), alleviate their pain or anxieties 62

FORTUNE

January 28, 2009

(such as shyness or fear of flying) and enhance their motivation. “The ideal candidate is a person who really wants to change,” says Georgina Cannon, a Toronto hypnotherapist and director of the Ontario Hypnosis Centre. “If you’re not ready to change, we send you home.”

Does it work?

Hypnosis can make a difference in some people, some of the time. A review of several studies concluded that hypnosis can reduce pregnant women’s use of pain medication by about half. Researchers at the University Hospital of South Manchester in the U.K. have found it to provide lasting relief to people with irritable bowel syndrome. On the other hand, a 2005 Cochrane review found no evidence that hypnosis boosted the sixmonth success rate of people trying to quit smoking. To complicate matters, 10% to 20% of people cannot enter the state of relaxation needed for hypnosis to work.

Typical course and cost of treatment As few as one or two hypnosis sessions can take care of most fears and phobias, says Cannon, while addiction and selfesteem issues may require five or six sessions. Following an initial 90-minute session costing between $150 and $250, the hour-long sessions are typically billed at $80 to $150.

MASSAGE THERAPY What is it?

Massage therapy is the practice of manipulating the soft tissues of the body to prevent or alleviate pain and promote health. Massage therapy comes in many forms, from gentle Swedish massage to deep, fast-stroked sports massage.

Does it work?

A 2002 Cochrane review found that massage therapy, when delivered by a licensed therapist and combined with exercise and education, can relieve symptoms and improve function in patients with lower back pain. Respondents to a large-scale Consumer Reports survey praised deeptissue massage for relieving the pain of osteoarthritis and fibromyalgia.

Typical course and cost of treatment Parissa Bunin, a naturopathic doctor and registered massage therapist in Fredericton, says that people with acute injuries should have weekly treatments for about a month, then less frequent treatments as needed. People with chronic conditions may need “maintenance treatments once a month for several years,” she says.

You’ll pay about $60 to $80 for an hour-long session.

OSTEOPATHY What is it?

A cousin of chiropractic and massage therapy, osteopathy uses muscle energy, joint play, and spinal or cranial therapy to relieve ailments ranging from sports injuries and arthritis to asthma and menstrual pain. “I use osteopathy to treat children’s conditions such as colic and

ear infections, says Barbara Schultze, a massage therapist in Regina who recently completed her osteopathy training.

“The techniques are similar to massage therapy, but they look at the source of a problem and the relationships between different body systems.”

Does it work?

Consumer Reports states that lower back pain from a slipped disk may improve with spinal manipulation. A recent study co-authored by a researcher at the University of Saskatchewan found cranial manipulation to bolster the benefits of conventional care in adults with asthma.

Typical course and cost of treatment Schultze says you should start to see some results within two to six visits, though you may need additional sessions for more complex ailments. After an initial paid consultation, expect to pay $80 to $100 for 45-minute follow-up sessions.

REFLEXOLOGY What is it?

Reflexology is the practice of applying pressure or stimulation to various points on the feet (sometimes the hands or ears as well) to alleviate pain and improve health. Reflexology rests on the premise that specific areas in our extremities are linked to specific internal organs and bodily systems through reflex points and “meridian lines.”

Does it work?

A scarcity of clinical studies of reflexology means the jury’s still out. A 2004 Cochrane review unearthed only a single reflexology trial that yielded some positive but short-term effects on anxiety.

Typical course and cost of treatment A typical treatment lasts 40 to 60 minutes.

Sherri Gunn, a reflexologist in Winnipeg, says most of her patients notice a change after three to five treatments, and some continue indefinitely with monthly treatments. The cost of a single treatment varies widely, she says: as little as $20 in the Prairies and upwards of $60 in the largest urban centres.

VITAMINS What is it?

Your body requires vitamins and minerals to operate normally. Many of us can get sufficient vitamins and minerals simply by eating our fruits and veggies, but some circumstances call for supplements.

For example, “the new Canada Food Guide has outlined the need for Vitamin D supplementation in all adults over 50,” says Janet Holbrook, a dietitian in Vernon, B.C. “Many older people also need vitamin B12 and calcium supplementation.” What’s more, “a great many Canadians rely on multivitamins to cover a less-than-perfect diet.” Specific conditions call for specific supplements, such as iron for anemia.

Does it work?

According to Holbrook, supplementing your diet with the right vitamins and minerals may speed up healing after surgery, mitigate bone loss, and correct nutritional deficiencies in people with poor diets or absorption. “One way or another, you need your vitamins and minerals,” she says.

Typical course and cost of treatment Don’t start taking supplements without consulting a doctor, pharmacist or dietician, says Cara Rosenbloom, a registered dietitian in Toronto: “Some supplements can be toxic at high doses or interfere with other medications.”

The good news is that vitamin pills won’t bankrupt you. You’ll pay about $4 for a month’s supply of iron and $6 for vitamin B12.

THE RISK FACTOR: You should never view alternative medicine as a substitute for the real thing Many alternative therapies have only weak or in- patients disappear for months at a time and return consistent evidence standing behind them. But can in much worse shape than before,” he says. In one they actually do you harm? instance, a diabetic patient took a break from doctor In most cases, no. “Alternative methods [such visits and consulted an alternative health practias acupuncture, chiropractic and herbal medicine]… tioner who neglected to monitor her blood sugar. rarely cause substantial adverse effects, provided “By the time I saw her, her levels had doubled,” Dr. they’re performed properly on appropriate patients Qaadri recalls. “She’s now at greater risk of serious by qualified practitioners,” states the Consumer diabetes complications.”

Reports website.

Mixing herbal products with operations poses The risk creeps in when patients forgo medical another potential risk, as many popular herbs can treatment and prescription-level medication in favor trigger problems during or after an operation and of alternative therapies, says Toronto family physi- delay recovery time. Consumer Reports advises cian and Ontario MPP Dr. Shafiq Qaadri. “I’ve had stopping herbal remedies a week before surgery.

January 28, 2009

FORTUNE

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