Doctors in for a dose of alternative medicine
- From: rpautrey2 <rpautrey2@xxxxxxxxx>
- Date: Sat, 5 Jul 2008 04:14:18 -0700 (PDT)
Doctors in for a dose of alternative medicine
Nick Miller
July 5, 2008
Is a move by the college of GPs to set up a faculty examining natural
therapies enlightened or opening the door to quackery?
IT'S IMPORTANT to keep an open mind. But, when it comes to healing the
sick, is there such a thing as being too open? The Royal Australian
College of General Practitioners, the body that sets standards for
GPs, last week called on its members to help set up an integrative
medicine faculty to accredit and educate doctors. "Areas of interest
will include mind-body medicine such as hypnosis and meditation,
evidence-based nutritional and environmental medicine and evidence-
based herbal medicine," the email said.
A curriculum statement from the college also includes "prayer (and)
mental healing", "natural but as yet scientifically unproven therapies
eg using shark cartilage to treat cancer", and "energy therapies
(that) manipulate biofields, (such as) qi gong, Reiki and therapeutic
touch".
The field of integrative medicine was pioneered and popularised by Dr
Andrew Weil, a media-friendly American familiar to Oprah viewers and
also well known for taking illicit drugs and writing about it. In the
past he has professed belief in shared consciousness, ESP and "stoned
thinking" — which is exactly what it sounds like. He even has a
mushroom named in his honour.
But he has grown to respectability: in 1997 Time magazine named him
one of the 25 most influential Americans. Weil has developed the field
of integrative medicine over 30 years. He says it "combines both
alternative and conventional approaches to maximise the body's natural
healing powers. It gives me a sense that I'm in the right place,
somewhere between alternative medicine and Western," he told an
interviewer. "I call it the future of medicine."
Some experts worry this "future" comes with a lower standard of
medical care, a waste of public money on unproven treatments and even
a risk to patients.
Others welcome it as a timely recognition there's more to health and
wellbeing than old-fashioned and dictatorial prescription of
pharmaceuticals. GP Vicki Kotsirilos is one of the driving forces
behind the GP college's embracing of integrative medicine. In 1992 she
became so frustrated with colleagues she considered closed-minded that
she founded the Australasian Integrative Medicine Association (AIMA).
The new faculty is the brainchild of a working party she chairs that
involves the association and the college. In her Whole Health Medical
Clinic in Clayton, she practises acupuncture, hypnosis, herbal
medicine, counselling and nutritional medicine. But she is careful to
draw a line between her own work and the college.
"We know that up to 60% of the community is using complementary
medicine," she says with her college hat on. "The college has
recognised that GPs need to know more about it, they need to know what
evidence there is, what therapies are safe or unsafe, which therapies
might interact with (conventional) medicine and what the risks are."
She says it is about broadening the knowledge of GPs rather than
changing their approach. "Community use has grown, and the level of
scientific evidence for some of these therapies has grown."
As an example, with her private GP hat on, she cites the herb St
John's wort. "There is some scientific evidence as a treatment for
depression, but also a large potential for harm if taken with anti-
depressants."
Kotsirilos says she knows Weil but had not heard him use the term
'integrative medicine' when she founded AIMA. "We thought it was a
good term because it implies we are not rejecting orthodox medicine
but rather integrating what is best for the patient," she says.
Dr Weil also believes in expanding, rather than replacing, existing
medical practice. "By integrative medicine, I mean medicine that works
from the premise that the body can heal itself if you give it a
chance," he said in an interview. "It emphasises prevention. It looks
at people as more than just physical bodies and makes sensible use of
other modalities of treatment."
But some fear the field is part of a trend away from evidence-based
medicine. In 2006, a group of leading doctors wrote to the British
health service saying it should stop paying for alternative medicine
and use the money for conventional treatments. Renowned skeptic
Richard Dawkins last year claimed in a TV documentary that "health has
become a battleground between reason and superstition".
Dr Morton Rawlin, director of education at the GP college, says the
proposed faculty will only approve therapies that have a strict
scientific evidence base. It will then advise the college how to
integrate them into general practice.
"Some areas like evidence-based herbal medicine, hypnotherapy and
meditation all have a scientific basis," he says. "There's a
considerable body of knowledge being developed — in some areas it's
really well covered, in others there's variable evidence. One of the
aims of the group is to give proper advice about that grey zone."
He says the faculty will not be stacked with proponents of alternative
medicine and will use the same standards of scientific rigour used in
conventional medicine.
Professor Edzard Ernst from Britain's Exeter University is
spearheading scientific research into alternative therapies. The
world's first professor of complementary medicine, he was trained as a
physician in Germany in acupuncture, herbalism, homeopathy and spinal
manipulation. He says alternative medicine is useless and even
dangerous if it is not put to the test. His new book, Trick or
Treatment: Alternative Medicine on Trial, finds that rigorous tests of
common alternative therapies lead to some disappointing conclusions.
Acupuncture, chiropractic, and homeopathy are all dissected and found
to be of limited benefit.
The findings on acupuncture are the most surprising. It has already
entered Australian mainstream medical practice — Rawlin considers it
"science-based medicine". It can even be claimed on Medicare. But the
latest research leaves the beneficial claims of acupuncture "neither
consistent nor convincing", Ernst concludes.
Chiropractic and osteopathy also have Medicare benefit codes, and
treatments such as hypnotherapy can attract a rebate if they are
"clinically relevant".
Asked about the wisdom of bringing these treatments further into
general practice, Ernst takes a nuanced view. "Some of those
treatments work, some don't and most are under-researched," he says.
"There is no reason why the first category (those that work) should
not be considered for general practice. Usually, however, they would
not be an alternative to anything but an adjunct to mainstream care."
Bringing unproven treatments under the banner of conventional medicine
might give them undeserved respectability, he warns, or worse,
"accepting such treatments into routine health care might turn out to
jeopardise patients' safety …"
Says British journalist Rose Shapiro, author of the new book Suckers:
How Alternative Medicine Makes Fools of Us All: "Alternative medicine
is a collection of unproven and disproven therapies and diagnostic
procedures, none of which have been shown to be any more effective
than a placebo and some of which are positively dangerous. Uncritical
teaching of evidence-free alternative practices applies a veneer of
respectability to them (and) stimulates the public appetite for yet
more quack therapies. It is a scandal if scientific medicine is being
undermined in this way by doctors who should know better. It is a
waste of time and money. I hope there's someone at the (college) who
is prepared publicly to resist the introduction of irrational nonsense
into its academic courses."
That said, she agrees GPs should know about alternative medicine — on
a know-thine-enemy basis. She believes the appeal of alternative
medicine is due to a growing resentment of rushed, impersonal modern
medicine.
Dr Ken Harvey, from La Trobe University's school of public health,
recently called in the Medical Journal of Australia for tighter
regulation of complementary remedies. But he feels orthodox medicine
should keep an open mind. He points to aspirin — it began as a herbal
medicine and was later extracted as an analgesic. Later, a new use was
found as a blood-thinning agent. "Where there's good evidence that
things work, the medical profession should engage with them," Harvey
says
But, he asks, "What do they mean by evidence? Some complementary
medicine uses celebrity endorsement as evidence. Or it might be a
small, uncontrolled trial … Or there might be evidence of some limited
use, and then there is the temptation to extrapolate that to unproven
uses." In practice, GPs must listen to their patients, and patients
demand answers, he says. "Younger people . . come into the clinic with
printouts from the internet. We (GPs) must not be pontificating
wisdom. The new style of doctor is more about helping people through
this maze of information, to tell them what is good medicine."
Nick Miller is health editor.
Copyright © 2008. Fairfax Digital
URL: http://www.theage.com.au/national/doctors-in-for-a-dose-of-alternative-medicine-20080704-31xh.html?page=-1
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