Volume 195 - Issue 8
Is it ethical for medical practitioners to prescribe alternative and complementary treatments that may lack an evidence base?
Authors: Luis Vitetta, Shoshannah L Beck, Samantha Coulson and Avni Sali
Med J Aust 2011; 195 (8): 450-451. || doi: 10.5694/mja11.10916
Published online: 17 October 2011
Published online: 17 October 2011
To the Editor: We read with interest the commentaries by Pirotta and Dwyer on complementary and alternative medicines (CAMs).1,2 This debate has a long history, spanning more than two decades,3 and the pessimism continues to ignore good science.2
Firstly, integrative medicine (IM), which combines alternative and conventional medical practices, is not and never has been synonymous with CAMs. IM is a global paradigm shift that expands the conventional model of medical care with evidence-based laboratory and clinical research. IM embraces the foundations of medicine, such as (i) the critical role of the doctor–patient relationship, (ii) the importance of lifestyle, and (iii) improving the wellbeing and promoting the natural healing potential of people afflicted with disease.4
Secondly, a thinly disguised commentary on the ineffectiveness of CAMs,2 while dismissing a large body of scientific clinical evidence, is broadly misleading. This is significantly remiss, failing to cite the value of prebiotics and probiotics in digestive diseases,5 the effect of omega-3 essential fatty acids on endothelial function,6 the efficacy of acupuncture for some forms of pain,4 mindfulness-based stress reduction and mindfulness-based cognitive therapy for mental health,7 and emerging modalities such as yoga for menopausal symptoms4 and tai chi for fibromyalgia,4 and many more.4 Moreover, such deliberate carelessness serves only to confuse researchers and clinicians, as well as the public.
Evidence-based medicine is critical in expanding the medical model of care; of this there can be no doubt. Adhering to biologically plausible mechanisms of action is the key foundation that will always guide scientific evidence, including that for CAMs. As an example, we have recently scientifically challenged the validity of the antioxidant effect to abrogate free radicals that are purported to contribute to the development of chronic diseases.8
Therapies that deviate from the conventional medical model still elicit an unhealthy cynical response2 that hinders the progress of scientific and medical investigations. If Florey and Fleming had adopted such cynicism and dismissed the biologically far-fetched notion of an antimicrobial mould in a Petri dish (Penicillium notatum), they most probably would not have pursued and contributed to the discovery of the antibiotic penicillin. Thus there is no place in science and medicine for the imprimatur of distrust and scepticism that is levelled without respite at novel concepts, even those with scientific plausibility.
Competing interests
Luis Vitetta and Avni Sali have research collaborations with nutraceutical companies in Australia.
References
- Pirotta MV. Is it ethical for medical practitioners to prescribe alternative and complementary treatments that may lack an evidence base? — Yes. Med J Aust 2011; 195: 78. 0_i1142901
- Dwyer JM. Is it ethical for medical practitioners to prescribe alternative and complementary treatments that may lack an evidence base? — No. Med J Aust 2011; 195: 79. 0_i1142909
- Eisenberg DM, Davis RB, Ettner SL, et al. Trends in alternative medicine use in the United States, 1990–1997: results of a follow-up national survey. JAMA 1998; 280: 1569-1575. 0_i1142911
- Kotsirilos V, Vitetta L, Sali A. A guide to evidence-based integrative and complementary medicine. Sydney: Churchill Livingstone Australia, 2011. 0_i1142913
- Yan Y, Polk DB. Probiotics: progress toward novel therapies for intestinal diseases. Curr Opin Gastroenterol 2010; 26: 95-101. 0_i1142915
- Egert S, Stehle P. Impact of n-3 fatty acids on endothelial function: results from human interventions studies. Curr Opin Clin Nutr Metab Care 2011; 14: 121-131. 0_i1142917
- Fjorback LO, Arendt M, Ornbøl E, et al. Mindfulness-based stress reduction and mindfulness-based cognitive therapy — a systematic review of randomized controlled trials. Acta Psychiatr Scand 2011; 124: 102-119. 0_i1142919
- Linnane AW, Kios M, Vitetta L. Healthy aging: regulation of the metabolome by cellular redox modulation and prooxidant signaling systems: the essential roles of superoxide anion and hydrogen peroxide. Biogerontology 2007; 8: 445-467. 0_i1142923