Box 4

Safety of complementary therapies

AcupunctureHomoeopathyManipulation
*Yes in case of infection.
†Fracture rates might be minimised by excluding high risk patients (for example, menopausal women).
Evidence presented in this table is based on Ernst et al,32 Assendelft et al,35 and Ernst et al.37
Examples of serious adverse effectsTrauma, infectionsAllergiesFractures, stroke
Fatalities reported?YesNoYes
Frequency of adverse effects known?NoNoNo
Complication avoidable?No*NoNo†
Indirect safety issues• Potentially applicable to all complementary therapies:
• Missed diagnoses
• Misdiagnoses
• Disregarding contraindications
• Discontinuation, prevention/delay of effective therapy
• Potentially hazardous diagnostic procedures