In the press, Book Chapter.

Alternative medical therapies should be considered part of New Age spirituality - it is inappropriate to evaluate them using scientific research methods such as randomized trials

Bruce G Charlton MD

Bruce G Charlton MD
Editor-in-Chief - Medical Hypotheses
Newcastle University

I am broadly supportive of alternative and complementary therapies because I think that overall they do a great deal of good for a large number of people. But the kind of good they do is psychological and spiritual; not medical. They are about making people feel better (‘healing’) not mending their dysfunctional brains and bodies (‘curing’). Alternative therapies certainly are not a part of medical science. So, on the one hand, I would like to see alternative therapies thrive and spread, and on the other hand they should drop all their pretensions to ‘scientific’ validity. In future, alternative medicine should explicitly become part of New Age spirituality, and thereby clearly be differentiated from orthodox medicine and biological science.

What is an alternative therapy?

I would define alternative therapies in terms of them having non-scientific explanations. In so far as a therapy does have a biological explanation, I would regard that therapy as simply part of orthodox medicine. The crucial difference between orthodox and alternative therapies is therefore that alternative medical systems have non-scientific explanations based on spiritual, mystical, legendary or otherwise intuitively-appealing insights.

This difference between orthodox and alternative medicine can be illustrated with an example. In orthodox medicine, the illness of ‘hypertension’ or high blood pressure is explained in terms of a mass of inter-linked biological knowledge concerning the structure and function of the human body including heart and arteries and the functional relationship between blood pressure and diseases such as stroke. Drug treatment of hypertension is based on a detailed scientific understanding of how the heart and arteries are regulated by the nervous system, and how this can be modified using drugs. The fact that orthodox therapies are embedded in standard biological science is what makes them scientifically testable.

By contrast, acupuncture is based around the existence of meridians, which are structures described in historic medical and religious literature but not detectable using scientific equipment. In homoeopathy, the mechanism of action is based on a ‘magical’ form of reasoning – the ‘law of similars’, or like-cures-like - which has no basis in modern therapeutics. Another homoeopathic principle, that of increasing potency of a medicine with increasing dilution (so long as dilution is done in a particular way called succussion) is in contradiction with modern chemistry. And in chiropractic medicine, the presumed spinal vertebral subluxations which are supposed to cause disease are not visible using imaging technologies such as X-rays or MRI scans. Yet acupuncture, homoeopathy and chiropractic are among the most professionalized of alternative therapies – the explanatory theories for crystal healing or aromatherapy are even more imaginative and less scientific. This means that Alternative medical systems are unconstrained by existing scientific knowledge even where they do not actually contradict current science.

Why randomised controlled trials cannot be applied to Alternative medicine

Despite many decades or centuries of experience, there is no clear-cut instance in which any alternative therapy is unequivocally effective and indicated for any particular disease or symptom. There are no cures of the otherwise incurable - nobody dragged-back from certain death in the way that has happened many millions of times with antibiotics and steroids. Severed limbs are not re-attached to bodies, nor diseased internal organs extracted, nor (despite the misleading political propaganda for acupuncture) can reliable anaesthesia be induced.

The only positive indicators for effective alternative therapies comprise some randomised trials, and this has led to calls that more such randomized trials be performed. But this will only serve to perpetuate uncertainty because, while clinical trials of Alternative therapies may be randomized, they cannot be ‘controlled’. Control requires that all the relevant scientific factors be firstly understood then held constant in the experiment. But alternative therapies do not have scientific explanations, so the concept of 'control' has no relevance.

A randomized trial of an alternative therapy merely amounts to comparing two groups which differ by random assignment of treatment. When a difference is found then it cannot be understood in a scientific context. Therefore such findings cannot be generalized to other situations. This is why clinical trials for alternative therapies never settle anything, but merely lead to further inconclusive trials.

It is noticeable that the only positive trials in alternative therapies have been reported for conditions characterized by very unpredictable and reversible symptoms such as hay fever, rhinitis, asthma, eczema, back pain, arthritic pain, migraine, chronic fatigue, post-operative ileus, and multiple sclerosis. These are conditions where it is hard to prove that anything works, and where factors such as the placebo effect play a large role.

The proper role of randomised trials

One way to think of the role of randomized trials is to recognize that the most useful randomised trials come at the end of a long process of scientific development of a therapy. This is because a randomised trial cannot be well-designed until it is known what needs to be controlled. Knowledge must be accumulated to answer such questions as: what dose of a drug should be given, what are the side effects of treatment, does the treatment affect men and women differently, what is the effect of age, how specific does the diagnosis need to be, what severity of disease should be studied, do other drugs or diseases interfere with the outcome, what outcomes should be measured, and so on. But alternative therapies have not been through this process.

Randomisation is in fact one of the least important aspects of a useful clinical trial, in the sense that for a well-controlled experiment randomisation is merely a prelude to averaging-out the uncontrolled elements in the trial. The better the experimental control: the less need for randomization. Conversely when a trial is scientifically uncontrolled (as for alternative therapies) then the experimenter is relying purely on randomization to take account of an unknown number of uncontrolled interfering variables of unknown power.

So, when randomised trials are used in alternative medicine, the usual process of therapeutic development is turned on-its-head. Instead of coming at the end of a long process of scientific evaluation, randomized trials are placed at the beginning of evaluation, and are indeed expected to be the only form of scientific evaluation – with randomization used in isolation with no possibility for cross-checking using other scientific methods.

The problem is not so much that alternative therapy systems are scientifically primitive; it is that alternative systems are not scientific at all. By definition they do not have scientifically-grounded explanations. When the constraints of randomised trials are properly understood, it becomes clear that 'positive' trials in alternative medicine are irrelevant.

Incorporating alternative treatments into orthodox medicine

Before they can be clinically deployed, therapies need to be embedded in a scientific theory. Even orthodox treatments of proven effectiveness which lack an accepted scientific explanation tend to be regarded as disreputable. For example the unpopularity of electro-convulsive or 'shock' therapy (ECT) in psychiatry (despite may clinical trials demonstrating its effectiveness and safety) is largely due to the fact that there has never been a widely accepted scientific explanation for why this therapy is effective. Because doctors cannot agree on how ECT works, it is hard to know whether it really is working, or even whether it might be doing more harm than good.

When a truly effective intervention emerges within an alternative medical system, its benefits therefore need to be re-explained using ‘orthodox’ theories in order that it can be evaluated. St John's Wort (Hypericum) is an effective antidepressant herbal medication as confirmed by a wide range of research methods including clinical trials, animal experiments and laboratory techniques. But the herb has been slotted-into orthodox medicine by treating it as essentially interchangeable with conventional antidepressants and anti-anxiety drugs and using the same research theories and methods developed for these orthodox medical therapies. This links St John’s Wort into standard scientific modes of explanation for drugs and, in principle, enables the herb to be examined using a wide range of scientific methods.

In other words, the effectiveness of an alternative intervention can only formally be established by incorporating that specific intervention into the scientific explanatory framework of orthodox medicine, and then evaluating it scientifically using a range of methods. Without such possibilities of testing and confirmation, randomized trials do not mean much.

New Age spirituality

I have said that alternative therapies are not a part of science, but should instead be considered part of New Age spirituality – however, the meaning of 'New Age' may require further explanation.

New Age spirituality tends to be used to refer to people who overtly adopt an ‘alternative’ or 'green' lifestyle, which evolved from the hippies of the late 1960s. And surveys have shown that alternative therapies are indeed very popular among this group. But the typical New Age style of spirituality is, in fact, much broader than this minority counter-culture fringe, indeed New Age practices - broadly conceived - characterize the majority of the population in modernizing societies.

The New Age movement probably constitutes the largest and most rapidly-growing spiritual practice in the contemporary Western world, having evolved from traditional religion to become well-adapted to the conditions of modern societies. The New Age focuses on subjective psychological states such as integration, authenticity and self-expression.

If traditional religion can be seen as a combination of spirituality and church (i.e. a formal institutional structure) then New Age can be conceptualized as individual spirituality separate from churches. In the past, spirituality was controlled by churches, and the forms and practices of spirituality were restricted. New Age really is something new, a product of modern individuals and was not possible in earlier and less complex stages of society.

Essentially, New Age consists of individuals pursuing their own spiritual goals in their own way. They make evaluations based upon what kinds of spiritual benefit they want, and what is effective in achieving these benefits. A New Age 'seeker' needs to be free to choose (liberal democracy), have a sufficiently large range of choices (market economy), requires access to these choices (mass media) and can then express the resulting behaviours in terms of their individual and possibly unique ‘lifestyle’ such as their conversation or writings, style of dress, purchases, hobbies and social activities (which requires a modern society that is tolerant of counter-cultural behaviours).

So the New Age approach does not rule-out participation in churches or other forms of traditional religion when these contribute to the individual’s self-evaluated well-being. Also, members of traditional religions can and do frequently express their individual spiritualities by means of participating in New Age activities outside the specific scope of their religion – for instance reading self-help books, attending personal growth groups, meditating, or decorating their houses (or bodies) in a spiritually-satisfying style.

Now even regular church-goers in modernizing societies may find much of their spiritual sustenance outside the institutional context of their own specific denomination, selecting what they find most personally valuable from the vast choice of material on offer in books, magazines, television, the internet and other mass media. The advantage of a New Age approach is that individuals whose spiritual needs are not fully catered-for within their church are now able to fill the gaps by seeking elsewhere. And they can – if they prefer – engage in many of these spiritual activities in privacy, beyond the knowledge of their church. Characteristic New Age activities like reading a book on higher levels of consciousness, browsing the internet to contemplate pictures of prehistoric standing-stones, listening to ambient music, wearing a distinctive amulet, performing divinatory or magical rituals, solitary meditation or shamanic trances – can all be done solo, without the knowledge of others.

The specific content of New Age spirituality is almost infinite. The term is usually associated with a somewhat stereotypical interest in esoteric or mystical things such as Zen or Transcendental Medication, occult and paranormal phenomena, or divination techniques such as astrology, Tarot cards and the I Ching. And, of course, alternative medicine is very much a part of this social stereotype grouping. For example, acupuncture may go along with Far Eastern interests, or the use of herbs or flowers in healing may mesh with ecological concerns.

But though alternative medicine fits a stereotype of counter cultural New Age, the specific content of New Age spiritual practice is almost irrelevant. What matters is the meaning to the individual. Specific places and landscapes may have spiritual meanings of a personal nature. Individual spirituality may be associated with complex high culture – such as poetry and literature, classical music, sculpture and the fine arts. In principle, almost anything might become a stimulus for individual spirituality, according to a person’s unique heredity and experience – ‘whatever turns you on…’

Healing versus curing – myth versus science

Alternative therapies are often advertised as ‘healing’, and this word can be interpreted as referring to their personal, subjective and psychological benefits. Any specific alternative therapy may or may not benefit any particular individual in this psychological sense. But the range of alternative therapies is very large, and continually growing. Among this vast choice of therapies it is likely that an individual can find some which harmonize with his or her own spiritual goals.

Perhaps the commonest theme in alternative therapies concerns 'energy'. But this is 'energy' as a positive subjective sense of vitality and harmony – it has nothing to do with the scientific concept of energy as measured by scientific technologies. Indeed, in Alternative medicine, the term 'energy' has a multi-faceted, metaphorical quality which stands in stark contrast to the equations of physics.

I regard the explanations of alternative medicine as mythic. Myths are stories which function as poetic symbols, and not as literal signs. Myths are meant to imply many things (not just one thing), and have a personal meaning (rather than be an objective description). Scientific theories are not myths – they are intended to be precise and literal signs or descriptions with narrowly-defined meanings.

For example, the meridians of acupuncture have no literal scientific signification. But meridians are suggestive poetic symbols of the way that life can be experienced as a flow of energies, the fact that these energies may come into conflict (yin and yang) and the need for these energies to be balanced. The oriental basis of acupuncture may also appeal, and the precision (and frisson of fear, which must be overcome) of the needle insertion technique may also be intuitively pleasing. If so, then acupuncture might be chosen as one part of a lifestyle.

But another individual may dislike or fail to be engaged by oriental themes, or may find needles too scary, and may instead find a spiritual benefit from contemplating stone age rock carvings or cave paintings. This person might find that healing rituals involving beautiful crystals produce the psychological effects they seek. Healing crystals come with poetic descriptions of the expected effect of each type of crystal, and ways in which they might be deployed to generate these effects.

A person either finds an intuitive plausibility to these descriptions of crystal healing, or they do not. Someone who likes the idea of crystals can try out the rituals, and if this has the desired effect they might continue to do them; but if the rituals don’t make the person feel any better, or make them feel worse, then they will presumably give-up crystal healing and might try something else instead – such as aromatherapy, colours, runes, flowers or herbs.

Alternative therapy is separate from science

Because New Age healing is based upon individual feelings it is inappropriate (indeed potentially dangerous) when applied to such matters of public policy as science, technology, law or economics. But so long as New Age reasoning stays away from these objective areas, its subjective evaluations may have great personal value.

Also, this subjective evaluation system makes New Age healing immune to challenge by science or medicine. New Age validity is a matter of what ‘works for me’; contradiction from other people is re-defined as ‘your truth’. Individual experience is the ultimate authority, and if an individual claims that they find an alternative therapy to be effective in achieving subjective spiritual goals such as personal harmony and growth, then there can be no argument from medicine or biology. If someone feels energized by an alternative Therapy and gains a more positive attitude towards life, then this subjective perception is just as valid as artistic appreciation, preferences among foods or selection of fashions. And the wide range of choice, competition and continual innovation in New Age systems of healing ensures that there is little chance of the public becoming habituated or fatigued by the stimuli on offer – there is always something novel to experience.

New Age spiritualities – including alternative systems of healing – constitute a vast resource of ideas and stimuli, and fulfil a range of useful functions. People are free to ‘opt-in’ to the extent that they find ideas helpful, and are free to ignore anything they do not. New Age ideas are published and disseminated widely, for instance in the ‘mind, body and spirit’ sections of bookshops, in the broadcast mass media and on the Internet.

Avoiding conflict between orthodox and alternative therapies

The parallel growth of modern medicine and the New Age implies that consumers of alternative healing nearly-always use these therapies broadly appropriately: i.e., for the attainment of subjective personal and spiritual goals, and not for the treatment of diseases. The relationship between orthodox and alternative therapies is therefore potentially a harmonious one.

But clashes are inevitable when both sides claim interpretative authority over the same situation. The major source of conflict is when alternative healing practitioners make claims which purport to be factual but are scientifically incredible. The dilemma is that in the short-term a modicum of science (or pseudo-science) may serve to increase the status of New Age practitioners and validate their activities. Yet, in the longer term, the attempt to subordinate science to spirituality will lead to a conflict which science will win. Scientists and orthodox physicians who are rightly dismissive of bogus claims to objective effectiveness may in turn deny the subjective benefits of alternative therapies.

Contemporary alternative healing is an unstable mixture of science and spirituality. It would be better if these incompatible elements would separate-out. For example, alternative medical professionals in well-established systems – such as homeopathy, chiropractic, osteopathy and acupuncture – may undergo some biological and orthodox medical training. However, attempts to explain and justify these therapies in biological terms are unconvincing at best, and more often absurd.

Alternative medicine will survive and grow most effectively by dropping its scientific pretensions; and becoming candidly mythic, poetic, fictive, symbolic, metaphorical and fantasy-based. This process is already well advanced in other aspects of New Age spirituality where an explicit appeal to subjective intuition is made.

Orthodox medicine and alternative healing cannot and should not become integrated, for precisely the reason that they are totally different forms of activity with different rules and purposes. To integrate would be to damage what is valuable in each. Randomized trials of New Age therapies are as inappropriate as randomized trials of prayer or the enjoyment of Mozart – such investigations will inevitably be inconclusive, confusing and irrelevant.

When therapeutic ideas are not based on scientific theories, then science cannot legitimately be used to evaluate them, any more than randomized trials can be used to determine the validity of literary criticism or the appreciation of ballet.

The benefits of separation for alternative therapies

As well as there being strong reasons of intellectual principle for separating orthodox and alternative therapies, there are also some strong practical benefits to be gained.

Alternative therapies typically lack a professional apparatus of training, certification and regulation, and consequently are mostly client-controlled. Orthodox medicine is provider-dominated with a narrow range of choice; by contrast, Alternative medicine is a marketplace offering a vast and growing range of choices. Orthodox medicine resembles a highly restricted but nutritionally-balanced diet; alternative therapies are like an endless pick-and-mix banquet from which the consumer selects what they fancy, taste it, then decide whether to eat more or try something else.

New Age healing deploys the placebo effect and the personality of the therapist in a much freer and more powerful way than can be achieved in orthodox medicine. Alternative healers will be impaired if required to work within strict theoretical and organizational confines. When healing depends on therapeutic charisma, professional and standardized forms of education and accreditation will just tend to weed-out some of the most potentially-helpful personalities.

Alternative medicine fits very well with some of the dominant attributes of modern society because it is characterized by continual generation of choice and depends upon the mass media for dissemination of information. This means that, in practice, the explanatory theories for alternative medicine have little to do with professionally authoritative texts, and mostly to do with whatever information circulates in the mass media as a matter of 'common knowledge'. Clients hear-about alternative therapies from newspapers, magazines, television, the internet; and by advertising. Their knowledge of the explanations and theories of alternative healing comes from media stories, product labels, and whatever a therapist tells them in private. The bulk of alternative therapy is self-administered – people buy products, enjoy the explanations, read the instructions, and treat themselves.

In situations where clients consult with therapists, it is likely that the role of charisma has a vital part to play. A popular therapist will probably have a 'therapeutic personality' such that personal interaction makes most clients feel better. But personality clashes are inevitable, even for a highly charismatic healer, which is why wide-choice and client-control of the consultation is of such great importance in alternative therapy. Among all the types of therapy, and all the types of therapist, the client needs to search (with the help of recommendations) to find the therapy-therapist combination which best suits their personal needs.

In orthodox medicine, the physician will try to present the standard scientific explanation underlying therapy in an intuitively-appealing way – but even if this attempt fails, the treatment should still be effective since its effectiveness has typically been objectively evaluated. Surgery or chemotherapy may make the patient feel much worse in the short term, even when they succeed in curing cancer.

But there are no objective boundaries on the explanations offered by alternative therapists, or provided with New Age products, because clients vary so widely in what they find convincing. In alternative healing, the explanation must be intuitively-appealing to the client, here-and-now, or else the therapy will not succeed in making the client feel better.

Indeed, so long as the therapy does no significant harm, intuitive benefit is the beginning and end of evaluation in alternative medicine.


I envisage a future in which orthodox and alternative therapies thrive separately.

Orthodox medicine is based on scientific theories and is properly characterized by objective evaluation criteria and formal professional structures of education and certification. Alternative healing deploys a wide range of intuitively-appealing but non-scientific explanations, and constitutes a consumer-dominated marketplace of ideas and therapies which are personally-evaluated by the client.

Orthodox medicine focuses on curing disease and promoting health. But alternative therapies should be based on promoting well-being and personal fulfilment. To do this it needs to be able freely to deploy poetic explanations and charismatic healers as part of the wide and growing practice of New Age spirituality.



also by Bruce Charlton
Palliative psychopharmacology
The Malaise Theory of Depression
Public Health and Personal Freedom
Psychiatry and the Human Condition
Pharmacology and Personal Fulfillment
Awareness, Consciousness and Language
Injustice, Inequality and Evolutionary Psychology