Practitioners of complementary and alternative medicine (CAM) are not doing enough to protect their patients, according to an expert in the field.

A survey of 95 British CAM organizations revealed that few practitioners monitor the side effects of their therapies. And many of the organizations questioned said that they don't even consider the possibility that adverse reactions might occur.

Edzard Ernst, professor of complementary medicine at the Peninsula Medical School of the Universities of Exeter and Plymouth, wrote to the CAM organizations in May, asking whether they advise their members to report adverse events. He also asked for details of such events. The organizations he approached covered some 20 healing arts, from herbal medicines and homeopathy to crystal therapy and hypnotherapy.

Little is known about possible side effects of complementary treatments. Credit: S. STAPLETON/REUTERS/CORBIS

Fewer than a third replied. Of those who did, just nine said that they advised members to report side effects. And only one, an acupuncture association, gave details of adverse reactions reported in 2004.

Ernst says that he was surprised by the general lack of familiarity with the concept of adverse reactions. “Some respondents said they didn't really understand what was meant by the term,” he says. Others denied its relevance to them. “Several organizations said that adverse events were only connected with mainstream medicine, but were inconceivable in their own practice,” Ernst says.

Side effects do occur with CAM and can sometimes be serious — stroke can occur after chiropractic treatments and some deaths have been recorded. “Yet no one is looking,” says Ernst. “In the interest of patient safety, that has to change.” He wants studies to be carried out in different parts of the world to research adverse events associated with each therapy.

“We have been calling for more regulation for a long time,” says a spokesperson for the British Medical Association. “Doctors know that patients like these sorts of therapies, and they would like to be confident before they refer a patient to a CAM practitioner that the therapy in question works and is safe.”

Terry Cullen, chairman of the British Complementary Medicine Association, says that his organization does not believe the therapies it represents could be harmful. For example, he says that even if a client receiving reflexology, which involves applying pressure to the hands and feet, doesn't end up more relaxed, they are unlikely to have any reaction serious enough to need monitoring or regulating.

But the Scottish Institute of Reflexology says that Ernst's enquiry has prompted it to establish a system for monitoring adverse effects.

“We are going to introduce a sort of ‘yellow-card’ system like the medical profession has — a form that members can fill in and return to us if they observe any adverse effects,” says Margaret Smillie, the institute's president. Smillie adds that complementary medicine should adopt the same standards as the mainstream. “We feel a responsibility to protect the public and our members,” she says.