Homeopathy, cleansing diets, acupuncture, healing touch, magnetic therapy, meditation and many other so-called alternate or complimentary therapies are often used by our patients. Increasingly, they have been prescribed by some doctors and nurses as an adjunct to conventional treatments.
But is there a place for them in the hospital setting? And should nurses and doctors be advising their patients to try them? The Medical Journal of Australia posed this very question to two senior doctors with polar opinions, and it makes very interesting reading.
Here are some quotes from the articles and a link to the full responses.
The YES case:
The use of complementary and alternative medicine (CAM) is hugely popular â€” each year, over half of the Australian population uses some form of CAM, at a total cost of $A1.8Â billion.
Importantly, most of this use of CAM is not a substitute for conventional therapy. Indeed, CAM is often used together with conventional therapies to treat particular conditions.
One apparent hurdle is that much CAM currently lacks high-quality evidence. However, this should not be taken as proof that a given CAM is ineffective or harmful. To place this in context, it is estimated that as little as a quarter of conventional medicine is based on level-1Â evidence.
CAM research is slowly gaining momentum. It is hampered by factors including lack of financial reward for research investment for products already in widespread use, and few trained independent researchers. With increasing interest and research capacity, no doubt, evidence will accumulate for some CAM, which may be adopted into our armamentarium and become â€œmainstreamâ€.
Doctors who do not engage in discussion about CAM may harm the doctorâ€“patient relationship in the longer term â€” use of potentially harmful CAM may remain undetected, and patients may seek information from less reliable sources. Further, it may be unethical not to inform patients in situations where evidence-based CAM options exist.
Ethical prescribing of CAM is possible within good general practice if [doctors]Â have an adequate knowledge of CAM and have their patientsâ€™ best interests at heart. Generally, [doctors] need to keep up-to-date as evidence grows about CAM, and maintain a respectful relationship with patients so they feel able to ask questions about CAM and thus maintain their enviable position as trusted primary care providers.
The NO case:
While the answer to the question in most situations is a definite â€œnoâ€, the issues associated with the need to ask the question are important and troublesome. In this most scientific of ages, when orthodox medicine is committed to embracing an ever more evidence-based approach to clinical practice (and still has a long way to go), consumers of health care are increasingly exposed to a plethora of nonsense (non-science) claims that waste their money, distance them from effective care strategies and, not infrequently, cause harm. More than half the population will partake of some form of alternative or complementary therapy each year, spending more than two billion dollars to do so!
Significant numbers of doctors are advertising their practice of â€œintegrative medicineâ€, a mixture of the best treatments available from the orthodox and alternative medical universes! I know of no scientific study exploring the motivation for such an approach, so some may believe they are offering superior care while others are, no doubt, responding to commercial opportunities to capitalise on the popularity of complementary approaches. To do so, however, is to abandon scientific medicine â€” which strives for evidence, rejects the â€œtherapeuticâ€ use of the placebo effect and addresses the psychological nature of many symptoms â€” for an approach that does not believe in testing, is happy to exploit the placebo effect and rejects a psychological influence on health.
The scientific study of many of alternative medicineâ€™s claims is taking place in many universities. This is important because, of course, there is really only â€œgoodâ€ medicine and â€œbadâ€ medicine. Scientific studies that determine that an approach, supported previously only by anecdote, has evidence-based merit, should be embraced by orthodox medicine if it fills a therapeutic gap. Claims about therapies that turn out to be inaccurate when studied, would, if they are still propagated, represent bad medicine, and prescribing such therapies would be unethical. Science is the key to converging the approaches we have been discussing. However, we donâ€™t need to wait to warn the public in the strongest terms that many alternative strategies are already known to be useless. Homoeopathy, iridology, reflexology, healing touch, and many of the claims made for acupuncture are some examples.
Finally, doctors need to avoid supporting the alternative â€œlast-resortâ€ approach that may be suggested by desperate patients, because the extraordinary expense, false hope and removal from skilled end-of-life care can add so much to suffering.
My own feelings are mixed on this topic and I can see much to agree and to disagree with in both responses. And as a longtime meditation practitioner, I am very happy to see that this particular practice is gaining an increasing acceptance in mainstream medicine as more rigorous studies build evidence on its efficacy.
And that is the rub….there is a need for good strong research and clinical trials to be undertaken in much of these therapies, as indeed, there is for much of our mainstream medical treatments.
Perhaps a wiseÂ doctor friend of mine summed it up best when he wrote: there is no such thing as complimentary or alternative medicine….there is just medicine.