«CHAPTER 24 Doctors who use complementary and alternative medicine Shaun Holt holds pharmacy and medicine degrees and is an Adjunct Professor at ...»
Doctors who use
complementary and alternative
Shaun Holt holds pharmacy and medicine degrees and is an Adjunct Professor at Victoria University
of Wellington where he teaches courses on clinical trials and evidence based natural therapies.
Cite this as Holt S 2013. Doctors who use complementary and alternative medicine. Chapter
24 in St George IM (ed.). Cole’s medical practice in New Zealand, 12th edition. Medical
Council of New Zealand, Wellington.
What is complementary and alternative medicine (CAM)? 198 How CAM can harm 199 Evidence based CAM 200 Medicolegal guidance 201 Cole’s MediCal praCtiCe in new Zealand 2013 197 CHapter 24 doCtors wHo use CoMpleMentary and alternative MediCine What is complementary and alternative medicine (CAM)?
Treatments that are not commonly used in mainstream medical practice have been given a number of names over the years, from quackery to unproven to unorthodox to unconventional. The most widely used current description is “complementary and alternative therapies and medicines”, shortened to CAM. Complementary therapies are health care and medical practices that work alongside traditional medical treatments, but are not currently an integral part of conventional medicine, whereas alternative therapies are used instead of standard medical treatments.
There are hundreds of CAM therapies and The National Centre for Complementary and Alternative Medicine, a United States government agency that carries out scientific research
on complementary therapies, classifies them into five categories:
• Alternative medical systems have a completely different theory and practice to the conventional “Western” way of understanding and treating medical problems. Some of these systems were developed in the Western world, such as homeopathy, but most originate in other parts of the world, particularly in the East, such as acupuncture.
In addition to homeopathy and acupuncture, they include ayurvedic medicine from India and traditional Chinese medicine.
• Manipulative and body based systems are methods of treating a person by way of moving part(s) of the body, or by using substances on/in the body for their physical properties (for example water, heat or oxygen) rather than for their pharmacological properties.
Such systems include acupressure, Alexander technique, chiropractic, colonic irrigation, craniosacral massage, cupping, ear candling, Feldenkrais technique, hyperbaric oxygen, iridology, massage therapy, osteopathy and reflexology.
1. Placebo effect — this is a beneficial effect, an improvement in health or a reduction in symptoms, that occurs when a treatment is administered but is not due to the treatment itself, but instead, is a result of complex mind body interactions whereby the expectation of a benefit from a treatment actually results in real benefits. Depending on the condition, up to 90 percent of patients can have an improvement in their health when taking a placebo, which is usually an inert substance such as a sugar pill that looks like a real treatment. Up to 30—40 percent improvements are common in clinical trials in participants who are in the placebo group.
2. Natural history — the role of the natural history of the illness when looking at whether a treatment works is often overlooked. Natural history refers to the likely course of events of an illness if it is not treated. For example, symptoms of the common cold will generally last 3—4 days and a cold sore will generally last 5—6 days without specific treatments. In other words, many illnesses will simply get better by themselves over time as the body heals itself.
There cannot be two kinds of medicine — conventional and alternative. There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work. … But assertions, speculation and testimonials do not substitute for evidence.
Alternative treatments should be subjected to scientific testing no less rigorous than that required for conventional treatments.4 Some recommended sources of reliable information on CAM are listed in the resources section.
Previous decisions by the Medical Practitioners Disciplinary Tribunal also provide important
guidance as to what is expected of doctors in this regards. For example decision 02/89D stated:
Where a registered medical practitioner practises “alternative or complementary” medicine, there is an onus on that practitioner to inform the patient not only of the nature of the alternative treatment offered but also the extent to which it is consistent with conventional theories of medicine and has, or does not have, the support of the majority of practitioners. The Tribunal recognises that persons who suffer from chronic complaints or conditions for which no simple cure is available are often willing to undergo any treatment which is proffered as a cure. As such, they are more readily exploited.
The faith which such persons place in practitioners offering alternative remedies largely depends on the credibility with which such practitioners present themselves. Where such remedies are offered by a registered medical practitioner, it is difficult to escape the conclusion that the patient derives considerable assurance from the fact that the practitioner is so registered. It follows, therefore, that a registered medical practitioner cannot discharge his or her obligation to treat the patient to the acceptable and recognised standard simply by claiming the particular treatment was “alternative or complementary” medicine.7
In assessing the performance of a doctor practising CAM, the Council will not attempt to evaluate the alternative therapy itself, although the critical appraisal skills of doctors may be of concern.
The usual domains of competence are assessed, rather than the principles of CAM practice.
Complementary therapies in medicine — http://www.elsevier.com/wps/find/journaldescription.cws_home/623020/description
5. Medical Council of New Zealand. Statement on complementary and alternative medicine, March 2012. (http://www.mcnz.org.nz/assets/News-and-Publications/Statements/ Complementary-and-alternative-medicine.pdf).