Volume 186 - Issue 4
The "therapeutic footprint" of medical, complementary and alternative therapies and a doctor's duty of care
Authors: Craig S Hassed, Vicki Kotsirilos, Marie Pirotta and Avni Sali
Med J Aust 2007; 186 (4): 214-215. || doi: 10.5694/j.1326-5377.2007.tb00868.x
Published online: 19 February 2007
Published online: 19 February 2007
To the Editor: Sanderson et al provide an interesting viewpoint about how the community, including medical practitioners, have embraced complementary and alternative medicine (CAM).1
However, if we were reviewing this article for publication, we would ask the authors to:
make a valid distinction between those complementary and alternative therapies promoted as curative versus those considered palliative;
define how they decided which therapies belong to one or other side of the arbitrary CAM boundary;
review and justify the boundaries for the “therapeutic footprint” in a more evidence-based and rigorous way;
locate specific therapies inside the footprint;
locate where chemotherapy lies within the footprint, in light of the recent review showing, for the vast majority of adult malignancies, its marginal survival benefits considering its high costs, both monetary and healthwise;2
emphasise that there are relatively few recorded adverse events for CAM compared with conventional cancer care (Therapeutic Goods Administration Medicine Summary reports 2003, 2004, 2005 — Dr K Mackay, Acting Director, Adverse Drug Reactions Unit, TGA, personal communication); and
vigorously question the marketing of conventional medicines, such as trastuzumab (Herceptin, Roche), to vulnerable patients and an uncritical public when the evidence suggests huge expense and little, if any, survival benefit.3
Perhaps a distinction also needs to be made between CAM therapies, many of which provide proven symptomatic relief, and those lifestyle interventions, such as exercise,4 dietary change,5 and social support, which provide symptomatic relief and may also confer a survival benefit. It does not serve the profession well when many cancer patients and their carers have to go outside the medical system to access information, advice and therapies which they should have easy access to within the system. In fact, we might even question how helpful these arbitrary boundaries are when all that patients and doctors want is to use what works and what is safe.
References
- Sanderson CR, Koczwara B, Currow DC. The "therapeutic footprint" of medical, complementary and alternative therapies and a doctor's duty of care. Med J Aust 2006; 185: 373-376. CBBCGJEF
- Morgan G, Ward R, Barton M. The contribution of cytotoxic chemotherapy to 5-year survival in adult malignancies. Clin Oncol (R Coll Radiol) 2004; 16: 549-560. CBBJHBCI
- Murray S. Trastuzumab (Herceptin) and HER2-positive breast cancer. CMAJ 2006; 174: 36-37. i1091801
- Holmes MD, Chen WY, Feskanich D, et al. Physical activity and survival after breast cancer diagnosis. JAMA 2005; 293: 2479-2486. CBBHFABB
- Rock CL, Flatt SW, Natarajan L, et al. Plasma carot-enoids and recurrence-free survival in women with a history of breast cancer. J Clin Oncol 2005; 23: 6631-6638. i1091806