Volume 181 - Issue 10
Ethical and legal issues at the interface of complementary and conventional medicine
Med J Aust 2004; 181 (10): 581-582.
Published online: 15 November 2004
Published online: 15 November 2004
In reply: We agree with Kotsirilos and Hassed that there are many examples of successful integration of “proven” CAM into conventional medical practice. Our question, however, is whether it is possible to integrate CAM where its theoretical maxims and practices are incommensurate with allopathic medicine (eg, homoeopathy) and whether “integrative medicine” will ulti-mately fragment and diminish CAM, further isolate “non-evidence-based” CAM practi-tioners and make less visible those views of health and disease that are not consistent with modern medicine.1
It is misleading for Arnold to imply that there may be no evidence base for complementary and alternative medicines (CAMs). We suggest that medical practitioners should ask themselves not whether an “evidence base” exists, but what the existing evidence shows. The picture that emerges from a review of the literature is one of variable clinical efficacy. Thus, there is no evidence to support the use of chiropractic for childhood asthma,2 but there is good evidence that phytomedicines may reduce crises in sickle-cell disease,3 that cranberry juice may reduce the frequency of symptomatic urinary tract infections in women,4 and that horse chestnut seed extract is an efficacious treatment for chronic venous insufficiency.5 There is also clinically important evidence about harmful interactions, for example that St John’s Wort, garlic and ginseng may lower blood levels of warfarin.6
Medical practitioners should be critical and sceptical of all untested claims of therapeutic benefit. We suggest they acquaint themselves with evidence about risks and benefits of CAMs, particularly in their own area of practice. This is not pandering to anything. It is evidence-based practice. By the same token, use of CAM may reflect evidence-based decision-making by doctors and patients. It is simply divisive to dismiss it as “unscientific consumerism about unproven theories”, and it is foolish in any case to dismiss the latter. Medicine and science must compete with non-scientific perspectives in the public sphere, for the contest of ideas is never over in human history.
Ideological positions are black and white. Science prefers shades of grey. We have indeed learnt much from Galileo’s experience.
References
- Faass N. Integrating complementary medicine into health systems. Gaithersburg: Aspen Publications, 2001.
- Balon J, Aker PD, Crowther ER, et al. A comparison of active and simulated chiropractic manipulation as adjunctive treatment for childhood asthma. N Engl J Med 1998; 339: 1013-1020. CHDFEDBG
- Cordeiro N, Oniyangi O. Phytomedicines (medicines derived from plants) for sickle cell disease. Cochrane Database Systematic Rev 2004; 3: CD004448. i1085621
- Jepson RG, Milhaljevic L, Craig J. Cranberries for preventing urinary tract infections. Cochrane Database Systematic Rev 2004; 1: CD001321. CHDGEJBB
- Pittler MH, Ernst E. Horse chestnut seed extract for chronic venous insufficiency. Cochrane Database Systematic Rev 2004; 2: CD003230. CHDFIAGC
- Izzo AA, Ernst E. Interactions between herbal medicines and prescribed drugs. A systematic review. Drugs 2002; 61: 2163-2175. i1085627