Volume 195 - Issue 8
Is it ethical for medical practitioners to prescribe alternative and complementary treatments that may lack an evidence base?
Author: Vicki Kotsirilos
Med J Aust 2011; 195 (8): 450-451. || doi: 10.5694/mja11.10877
Published online: 17 October 2011
Published online: 17 October 2011
To the Editor: I am concerned that the viewpoints by Dwyer1 and Pirotta2 were published without establishing a clear definition of “complementary and alternative medicine” (CAM).
The term CAM is not ideal as it groups many non-evidence-based therapies that have little in common, such as iridology and homoeopathy, with more evidence-based complementary therapies such as acupuncture, nutritional medicine, meditation and some herbal medicines that have demonstrated efficacy. To date there is a growing body of research, including Cochrane reviews, to support the use of some complementary therapies (Box).
The fact that many complementary therapies have not been tested and subjected to high-quality research does not necessarily mean they do not work.3 For other complementary therapies, there are mixed findings (negative trials balanced by positive trials, as seen in Cochrane reviews), so one needs to ask why the differences in results? Were there differences in dosage, the quality of the substance or method of the therapy tested? Would you argue with patients who find symptomatic relief for troublesome symptoms of menopause from herbs when they are intolerant to hormone replacement therapy, or relief from osteoarthritic pain from complementary medicines and acupuncture if non-steroidal anti-inflammatory medications are contraindicated because of a peptic ulcer? Demand for complementary therapies in Australia is actually coming from consumers. If they found the therapies unhelpful, why would they continue with them?
A better term for complementary and alternative medicine is integrative medicine (IM), defined as:
the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing.4
The aim of IM is to find common ground and respect for the patients who choose to use complementary therapies and to understand their use. General practitioners have been shown to be very interested in learning about complementary therapies, with one study finding that about 30% of Australian GPs identified themselves as practising IM and most (more than 80%) requesting more education and research in complementary therapies.5 It is important that doctors balance clinical decisions between the risks associated with any therapy, the evidence and the therapeutic clinical outcome (effectiveness) to inform patients appropriately.
Competing interests
I was the Founder and Founding President of the Australasian Integrative Medicine Association.
References
- 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_CHDDJJDD
- 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_i1142918
- Altman DG, Bland JM. Absence of evidence is not evidence of absence. BMJ 1995; 311: 485. 0_i1142921
- Consortium of Academic Centers for Integrative Medicine. Definition of integrative medicine (adopted May 2004). http://www.imconsortium.org/about/home.html (accessed Aug 2011).
- Brown J, Morgan T, Adams J, et al. Complementary medicines information use and needs of health professionals: general practitioners and pharmacists. Sydney: National Prescribing Service, 2008. http://www.nps.org.au/__data/assets/pdf_ file/0020/66620/CMs_Report_-_HP_-_Apr_09.pdf (accessed Sep 2011).