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this kind of cam, as one of the provisions of a compnzhens- ive health care system But until this can be achieved, unproven and possibly damaging alternative therapies will continue to have their appeal.

J.A. Cosh MD, FRCP

Consultant Physician (retired)

Gloerfeld, H. Brauchen wir eine alternative Medizin? Fortschrittkhe Kierferorthopaedie 1992: 53( 1): 61-66 (in German).

The title promises an answer to the question ‘Do we need an alternative medicine?’ Unfortunately the article does not redeem this promise. Nonetheless, it does provide some stimulating comment.

It begins by stating a curious dichotomy. On the one hand, there is the constant urging by practitioners of nonconventional medical methods to have these methods validated by orthodox medicine, or at least to have them accepted as therapeutically indicated procedures in given circumstances. Yet on the other, a caveat is always ap- pended, claiming that there are fundamental conceptual differences between medical non-orthodoxy and the es- tablis hed position of the natural sciences and, in particular, of mainstream medicine. This makes exactly such an evaluation impossible. In fact, Gloerfeld says, this caveat is the one obstruction blocking any constructive debate.

Gloerfeld also disputes the claim by alternative medical practitioners that they alone treat either holistically or polycausally. He says that practitioners of alternative medicine routinely accuse conventional medical practi- tioners of being slavishly devoted to ‘mechanistic scient- ism’, whereas they, by contrast, fancy themselves as free to work ‘cybernetically, energetically and teleologically’. His tone is clearly sceptical.

He lists ten putative failings of the EAV system (eleo tro-acupuncture according to Dr med Reinhold Voll) and provides published references in support.

1. In diverse books examined, an apparently identi- cal acupuncture point can be shown at different anatomical loci, depending on which manual is consulted.

2. de Vemejoul’s published evidence for meridians and acupuncture points, in which he used radio- active markers, has turned out to be unrepeatable under controlled conditions, despite several at- tempts.

3. For many years the Viennese histologist Kellner had vainly tried to find histological evidence for acupuncture points: he has since publicly ad-

4. Acupuncture has been lifted from its Toaist cultu- ral bedrock in the Orient and grafted onto au in- imical medical structure in the West, which cannot but grossly misunderstand and, therefore, badly practise it (is EAV an example?).

5. Gloerfeld’s own investigations on 32 ‘clinically healthy’ VOhIWXS Under COnlI’Okd COnditiOrIS

showed that both the contact medium used be- tween skin and electrode (water versus electrode paste), as well as the force of application of the electrode (the probe pressure), do both signifi- cantly affect electrical resistivity readings, which, perforce, would have to alter the EAV-di- agnosis - though no allowance is made for this very common anomalous situation. Such EAV readings diverged as widely as 33 points on a scale of 100. Momover, the so-called ‘indicator drop’, a diagnostically significant phenomenon in EAV interpretations, all but disappears with the use of the electrode paste.

6. EAV textbooks state that the skin beyond an area immediately around an acupuncture point dis- plays a markedly reduced electrical resistivity (the intrinsic property of the skin as a conductor, measured in Ohm-me&es). Yet investigations have established that other points exist with elec- trical properties like those of the recognised points. Gloerfeld suggests that it is nothing more outlandish than the various sweat glands at these points that may be responsible for the en- tire electrical EAV phenomenon, labile as they are also known to be by their response to a pa- tient’s emotional state at any given time.

7. Voll himseli apparently said to Gloerfeld, when he was Voll’s student, that he (Voll) could not provide any objective evidence to support his choice of acupuncture points as used in EAV.

8. By capturing energetic processes EAV claims to recognize disease developments long before con- ventional clinical tests could ever do so. He in- terjects, cynically, that hereby EAV evades verification, and adds that to hope to capture the energy flow set in motion by the 30 000 odd chemical reactions taking place in the body every minute, and simultaneously to examine the internal organs, by what is, after all, no more than a simple d.c. Ohm measurement, must be seen as nothing short of Utopian.

9. To maintain that EAV is not amenable to investi-

mitted failure to judicial medical examiner Pro- kop of Vienna.

114 Complementaty Therapies in Medicine : Review section

10.

gation by the methods of physical science, Gloer- feld feels is disingenuous, when all EAV meas- urements am themselves done on the basis of physical science alone.

Gloerfeld also dismisses as spurious the slogan ‘He who cures is right !‘, that is so often brand- ished by the practitioners of alternative me- dicine; for he who cures may well be a good physician but it would not necessarily also make his every assertion infallibly correct.

Gloerfeld says that though EAV has been around for a quarter of a century, the absence of methodics for the provision of proof of effectiveness and compatibility in all this time has left the door wide open for medical ‘charla- tans’. He explains the increasing public demand for EAV in Western society as part of a growing aversion to any- thing technological (including what is perceived as tech- nological medicine) which is blamed for all the catastrophic environmental degradation and mounting so- cial dilemmas. He sees a reverse trend, away from reason and enlightenment towards a new religiousness, in the growth of alternative medicine.

Here Gloerfeld makes a quantum leap and dismisses all of alternativemedicine because, allegedly, EAV could not pass muster. I wonder how many of the 30 000 or so full-time practitioners of alternative medicine in the UK use EAV? My guess is that they number about a dozen, and half of these only use it occasionally. This can hardly be said to be representative of alternative medicine as a whole, even if his thesis that EAV is a failure were to be accepted.

This non-sequitur emasculates the principal thrust of his paper; but some of Goerfeld’s peripheral observations deserve attention. For instance, he maintains that altema- tive medicine offers nothing new: he feels that orthodoxy already covers the ‘essentials’ of alternative medicine in psychology, psychosomatic medicine, behavioural ther- apy, physiotherapy, psychoneuro-immunology, hy- drotherapy, and placebo-therapy.

He bemoans the fact that these are used less and less. while a pervasive reliance on uncritical ‘maximal-dose’ pharmaco-therapy remains orthodoxy’s mono-thera- peutic riposte. Why, for instance, he asks, am information and guidance, physical therapies, life-style correction, nutritional therapy, imaging, hypnotherapy, etc, so very rarely a part of what the average medical practitioner will offer to a patient?

Why indeed? And what of many alternative practition- ers, who only offer a very narrow therapeutic range: can they rightfully claim to be holistic?

Harnld C. Gaier

ND, DO, DHomM, FSAHA, DipAc Registered Naturopath

Osteopath & Homoeopath

Current literature

GENERAL

Lynoe N, Svensson T. Physicians and alternative medicine - an investigation of attitudes and practice. Stand J Sot Med 1992; 20( 1): 55-60 (29 refs).

Renewed interest in natural medicines. Pharm J 1992; 249(24 0%): 540-541.

Sketchley J, Fielding S. Approach to the education of health care professionals within the European Community. J Interprof Care 1992; 6(3): 273-279 we EC has refused to issue regulations for complementary therapists in line with other professional bodies].

Stevenson C. Holistic power. Nurs Tunes 1992,88(38) 16 Sept: 68.70 me use of various complementary therapies in nursing; author rnns Zday introductory courses at the Bloomsbury De partment of Continuing Education].

ACUPUNCTURE

Baldry P. Fibromyalgia: a review of current knowledge. Acup Med 1992, 10(l): 13-17 (28 refs).

Brown S. North D. Marvel MK, Fons R. Acupmssure wrist bands to relieve nausea and vomiting in hospice patients: do they work? Am J Hosp Palliat Care 1992, g(4): 26-29.

Chatfield K. Successfully treating chronic fatigue syndrome with acupuncture and Chinese herbs. Townsend Lett 1992; 11 l(Oct): 838-842.

Dundee J, McMillan C. Some problems encountered in the scientific evaluation of acupuncture antiemesis. Acup Med 1992; IO(l): 2-8 (51 refs).

Halevi S. Can cancer be defeated by acupuncture? A case history analysis. J Chin Med 1992; 40 (Sept): 405-407.

Hu S, Stem RM, Koch KL. Electrical acustimulation relieves vection-induced motion sickness. Gastroenterology 1992; 102(6): 18541858.

Huang MZ, Huo LQ. The effect of acupuncture needle stimula- tion of the phrenic nerve in resuscitation during respiratory arrest. Am J Acup 1992; 20(3): 223-227.

Ji Y. Auricular acupuncture: its mechanism and application. Br J Acup 1992; 15(2): 3-9.

Jiao X, Chsng X. Yii K, Gao Y. Clinical and experimental studies on acupuncture therapy of strokerelated blood stasis. Int J Clin Acup 1992,3(3): 229-241.

Joshi YM. Acupuncture: a critical evaluation. J Ass Phys Jndia 1992; 40(3): 184189.