Thanks to Dr*T on the Bad Science forum, I was pointed to an article on complimentary and alternative medicine (CAM) in the Nursing Times.
CAM is news, no doubt, so there’s no problem with the NT publishing an article about it per se. However I would expect it to be rigorous in its examination of the evidence base for the treatments discussed, and generally sceptical of unsupported claims. Is that the case? Let’s find out.
It starts with some background; how much is spent on CAM in the UK, how it is projected to increase, and some definitions.
Then we get into the nitty gritty.
Alternative medicine is understood to mean therapies that are presented as an option to conventional or Western medical treatments. For example, when cancer patients choose not to have chemotherapy or radiotherapy and instead follow special dietary regimes
No discussion as to whether this is an effective treatment for cancer or not, no criticism of a treatment that has no evidence of efficacy, nothing about whether it’s advisable to discontinue the recomended medical treatment.
complementary medicine or therapy describes treatments that can be used alongside conventional treatment, for example, osteopathy, Reiki healing, chiropractic and massage therapy.
Again, no examination of the evidence for any of these treatments. Is that because the evidence is either non-existant or extremely poor?
Where complementary therapies are used within a conventional medical setting as part of a prescribed treatment, this is known as integrated medicine. Integrated health may be seen as a response to the changing patterns of disease in the early 21st century
Or it may be seen as the result of a successful marketing campaign by quacks and charlatans, combined with a credulous media.
Most therapies have a holistic approach which believes that health flows from the harmonious balance of our physical, psychological and spiritual states. A disruption in any of these spheres can impact on one or both of the others.
I have no idea what a “spiritual state” means in this context. Are they saying that if you don’t go to church you’re more likely to feel ill? I’m pretty sure most doctors would agree that your physical health and psychological health are linked. How this fits in with CAM, I’m not sure.
In order to uncover the root cause of a symptom, a CAM practitioner will ask questions not only about your medical history but also about your diet, lifestyle habits, sleeping patterns, relationships etc. While this helps the therapist build up a picture, patients also find it helpful to have the opportunity to talk at length about themselves, something they are unable to do in an orthodox medical setting.
Ah, the old “CAM treats the whole patient, while conventional medicine only treats the symptom” angle. Well, I don’t think that position can be sustained while Boots sells homeopathic medicine. Besides, conventional (or evidence-based, as I like to call it) medicine does treat the root cause of the problem where it can, and also treats the symptoms.
Credit where it’s due though, CAM practitioners are generally very good at spending plenty of time with their patients, talking to them about anything and everything, and generally putting them at their ease. That’s part of the reason why CAM is so popular. It would be nice if patients had longer appointments with GPs, but they’re just too busy, with the tight NHS budgets. Also, GPs are not counsellors, but I’m sure they can refer you to one.
In terms of finding a fit within conventional medicine, complementary medicine or therapy is an adjunct or complementary to conventional medicine. For example, osteopathy can often relieve back pain more effectively than medication.
Yes, it can. However medication is not generally what conventional medicine would prescribe for back pain; rather physiotherapeutic exercise has been shown to be effective. Osteopathy is one of the few CAM therapies that actually has some positive supporting evidence (it’s generally considered to be as, but not more, effective than physio for musculoskeletal problems), but consider that:
- it’s more expensive than physio
- it cannot be shown to be more effective than physio
- it comes bundled with a whole world of woo, where it is claimed to be able to treat asthma, ear infection and colic with no evidence for this whatsoever
It can also enhance conventional treatment. Massage therapy or Reiki healing may help relieve anxiety in cancer patients allowing insertion of a cannula more easily.
This is rather a bizarre argument for the inclusion of unproven therapies; that it will relax the patient. I would imagine that an sympathetic and professional manner by the medical professionals, along with an explanation of the benefits of the treatment under discussion (and maybe a mild sedative if appropriate) would have a similar effect, and without having to resort to quackery.
Increasingly, health professionals regard integrated medicine as the healthcare of the future.
Any references to support that? No, thought not.
The idea being that when you consult your GP, he or she might prescribe medication or send you to a specialist and may also refer you to a complementary therapist attached to the practice.
I would hope that most GPs would balk at the idea of having alternative practitioners associated with their practices. I would certainly hope that the tightly stretched NHS budgets would not be spent on promoting and supporting unproven treatments.
The CAM sector conducts itself within a weak regulatory regime. The UK Government does not require CAM practitioners to be licensed to operate a business, enabling almost anyone to set up a practice.
A “weak regulatory regime”? That’s the understatement of the century.
However acupuncture, homeopathy, herbalism, massage, naturopathy and nutritional therapy do have well-established training standards and professional protocols.
But with no legal requirement to be a member of such a body before practising (with the exception of oseto and chiro), and the knowledge that the body will most likely not enforce its own rules anyway.
Due to the increased popularity of complementary medicine in this country, the House of Lords Select Committee on Science and Technology undertook a 15-month study of CAM and their report was published in November 2000.
The report concluded that most therapies are relatively safe, with the exception of acupuncture, chiropractic and herbal medicine which could cause harm in the wrong hands.
They can frequently cause harm in the right hands too. Even if a treatment can be shown to be safe in that it does not directly cause harm, there’s also the problem of CAM causing people to discontinue conventional treaments.
Following that there’s a brief discussion on the House of Lords Select Comittee on Science and Technology report on CAM, published in 2000.
It is widely accepted that CAM is still under-researched
True. So why are we expected to use the treatments? If a drugs company produced a treatment that had no supporting evidence of efficacy, but suggested we use it anyway, do you think doctors would be justified in prescribing it? And while CAM may be under researched as a whole, areas of it like homeopathy have had a lot of research. The result in most cases? No evidence to support the claims of the treatment.
Commercial interests in CAM are scarce, so support has to rely heavily on government and charitable funding.
What? Find out how much homeopathic pills cost, which considering they don’t actually contain any active ingredient is almost pure profit. The business of CAM is huge.
Many feel that all good medicine is evidence-based and, therefore the CAM community needs to embrace the need for evidence-based work in order raise its acceptance, not only amongst clients but also medical practitioners.
Yes, all good medicine is (or at least should be) evidence-based. Until CAM can actually show evidence to support their claims, it’s not good medicine, and shouldn’t be getting NHS support.
This article was provided by the Institute for Complementary and Natural Medicine
Ah, the penny drops. So it’s not an article by the Nursing Times at all, but a long winded advert for CAM by the ICNM. I wonder how much they paid NT for this article to be published? Who decided that it was appropriate in a medical publication? I think we should be told.
