Positive Health Online

Complementary Cults

In your editorial in Positive Health 58 you bemoan the polarizations and conflicts within complementary health and between complementary and conventional medicine. I too find this saddening but not surprising. I will confine my comments to complementary medicine but I believe what I have to say applies in the conventional field too.

Quite simply, much of the acrimony between various training and teaching organisations stems from some of the leaders of these organisations putting their own egos and self-interest ahead of the interests of the profession. I have seen this so many times I begin to wonder if being a training organisation head goes hand in hand with an inflated ego. Many could do with spending some time in psychotherapy to work on this. The problem is not helped by many leaders encouraging a transference situation with their students who therefore often become dependent on them. So the students themselves perpetuate the situation-instead of being open-minded about other forms of therapy they believe their way is best, the only true path, and the trainer/leader becomes a guru-like figure. When this happens the situation verges on cultism. One of the hallmarks of cults is that they don't listen to anyone else.

So the organisation isolates itself. It actively condemns or at best ignores other approaches. Graduates of the organisation who set out to broaden their horizons by maybe studying with a 'rival' organisation are effectively 'excommunicated'. Other ideas, points of view, new developments are ignored by the organisation – new and different ideas are seen as threatening unless they arise within the organisation. It becomes a 'closed system', dogmatic, cultish, paranoid when threatened with new ideas. The leader has a clique of 'yes-men' or women surrounding them. They may delude themselves that they're doing the right thing because no-one is going to contradict them for fear of losing their favoured position within the clique.

Sad isn't it? I can only ask that prospective students be on their guard. Above all, training organisations must be able to demonstrate links with other similar organisations and host multidisciplinary conferences etc. In other words an open approach must be demonstrated.
Keep up the good work

Will Wilson

Light Therapy for PMS

Jo George's article on Treatment Approaches to Premenstrual Syndrome (Issue 58) provided an excellent review of the available options, backed up by an extensive list of published references. As the supplier of one of the treatment options, light therapy, may I be permitted to offer a small correction and add a few additional ideas.

Trials of light therapy for PMS have involved both bright light treatment, similar to that used for winter depression (SAD), and flickering light treatment. The 'promising preliminary study' of light therapy1 mentioned by Jo George actually involved flickering light, not bright light as she reported. It showed a much stronger result than a bright light trial.[2]

In fact the light used in the flickering light treatment is not particularly bright and it is viewed with closed eyes. Thus its effect is probably quite different from the bright light SAD treatment and probably involves some form of neuronal stimulation rather than melatonin production (though there is much to be learned yet about the mechanisms of both forms of light therapy).

Jo George's table of perceived effectiveness of PMS treatments is interesting. When lifestyle changes are excluded, the three treatments perceived to be most effective by the women surveyed are mood altering drugs (SSRIs and anxiolytics), progesterone, and light therapy. SSRIs have been widely trialed for PMS and shown to be very effective,[3] though with some substantial side-effects. Light therapy showed effectiveness comparable to the SSRIs, but in only one trial[1] (which was open). On the other hand, progesterone has usually failed to show effectiveness in controlled trials, yet it continues to be a popular treatment and seems to have considerable anecdotal support amongst actual women with PMS. Could there be such a thing as 'a better placebo'?

References
1. Anderson DJ, Legg NJ, Ridout DA. Preliminary trial of photic stimulation for premenstrual syndrome. J. of Obstetrics and Gynaecology 17(1):76-79. 1997.
2. Lam RW, Carter D, Misri S, Kuan AJ, Yatham LN, Zis AP. A controlled study of light therapy in women with late luteal phase dysphoric disorder. Psychiatry Res 86(3):185-92. 1999.
3. Dimmock PW, Wyatt KM, Jones PW, O'Brien PMS. Efficacy of selective serotonin-reuptake inhibitors in premenstrual syndrome: a systematic review. Lancet 356: 1131-1136, 2000.

David Noton, PhD
Light Mask Ltd; Light Therapy Centre
www.light-therapy.com

Response from Jo George

I would like to thank David Noton for pointing out an incorrect reference to bright light therapy in my article Treatment Approaches to Premenstrual Syndrome – Issue 58. It was unfortunate that the 6 women in my study who reported using 'light therapy' were not given the option to distinguish between the two forms; flickering and bright. It may have been interesting to find out their perceptions of the two forms, and whether they correspond to current research. However, the sample number is too small to answer this question, although such a distinction would be useful in future research.

I would also like to offer a correction to David Noton's analysis to my table of effective PMS Treatments. When one excludes lifestyle changes from the table it was Massage, not Light Therapy that was perceived to be the most effective complementary treatment by 80% of the 25 subjects who tried it.

This issue aside, with regards to progesterone being a 'better placebo', if something is considered to be better than something else, surely it is seen as having some kind of an effect. However the extent of its significance is another matter.

Not all Progesterone trials had negative results, and many used different routes of administrations, low doses, and many failed to recognise the existence of subtypes in PMS, (Wyatt 1999). For example if a comparison was made in a trial, the 'better placebo' may be of greater therapeutic value in some women with a particular subtype of PMS than in others. These factors may offer some rationale for incongruous reporting between women's anecdotal experience of Progesterone and its effectiveness in some trials.

References
Wyatt KM, Dimmock PW, O'Brien PMS. Premenstrual Syndrome. Clinical Evidence 1: 286-297. 1999.

Jo George. BSc (Hons) Acupuncture, Dip. Clin. Acu. (China), ICHT, Dip TTM (Thailand) jogeorge.chinesemedicine.fsmail.net
Her research was carried out as part of her BSc(Hons) in Acupuncture at the University of Westminster.

Progesterone and PMS

Re David Noton's comments re progesterone.

There is a rational explanation for the benefit of progesterone to women whose premenstrual symptoms include anxiety, irritability and aggressive behaviour. Progesterone metabolites enhance transcription of the gene coding for part of the GABA receptor. These receptors are inhibitory neurones in the brain which have a calming effect. Hence falling progesterone levels in the luteal phase may give rise to these symptoms.[1,2]

If one presumed placebo is more beneficial than another presumed placebo there is a case for a well designed trial to compare them. The 'better placebo' may turn out to be a useful treatment.

References
1. Britton KT, Koob GF. Neuropharmacology. Premenstrual steroids? Nature 392 (6679): 869-70. 1998.
2. Smith SS, Gong QH, Hsu FC, Markowitz RS, Ffrench MJM, Li X. GABA(A) receptor alpha4 subunit suppression prevents withdrawal properties of an endogenous steroid (see comments). Nature NSC. 392(6679): 926-30. 1998.

Olive Ford

Internet Site Helpful

My name is Nora Pope. I am a third year student at the Canadian College of Naturopathic Medicine in Toronto. I enjoyed reading your site: "Nutrition and Cancer", in particular Chapter 10 on Mind/Body Medicine.

I am completing a four-year program in Complementary Medicine which encompasses Nutrition, Homeopathy, Botanical Medicine, Acupuncture and Counselling. I have participated in Meditation sessions with cancer patients which were led by Alastair Cunningham, at the Princess Margaret Hospital in Toronto. I am so glad that sites such as yours are available to inform people of all the research behind alternative treatments to cancer.

Sincerely, Nora Pope

Comments re Dr Pheby's ME article

Best reviews of ME I've read for a long time

Compared to the recent article by Professor Pinching, Dr Pheby's article makes far better reading.

I found the Pheby article excellent generally.