Monday, February 6, 2012

Complementary Medicine in Australia - an ethical analysis

400 scientists and doctors have attacked the 19 Australian universities that teach, or give degrees in, complementary and alternative medicine (CAM):
 Such courses involve so-called ‘complementary or alternative medicine’ masquerading as, and sitting side-by-side with, evidence-based health-related science courses. We take the view that those universities involved in teaching pseudoscience give such ideologies undeserved credibility, damage their academic standing and put the public at risk.
The controversy is half scientific, half ethical.

We health educators should be honest. A lot of medical and nursing care is based on evidence. That evidence, and the sciences that allow the evidence to be developed, should, and do, form the center of the curriculum.

But much of what we physicians and nurses do is based on belief and tradition. That doesn't mean we shouldn't do and teach these things. But we should be honest with ourselves and our students about when our practices aren't evidence based. Non-evidence based practice isn't limited to CAM!

Controversy over CAM isn't new. In the early 20th century organized medicine was horrified by the growth of Christian Science. Wise physicians recognized that the emergence of Christian Science reflected a sense that something was missing in "conventional" medicine. That hunger is still present. More than 1/3 of U.S. adults use "alternative" medicine techniques. I'm sure the same is true in Australia.

Gerald Caplan, my mentor in community psychiatry, taught me a valuable lesson about CAM. He experienced intermittent low back spasm, for which he had treatment with a chiropracter. Dr. Caplan told me:
The chiropracter takes low back pain seriously and lays on hands. The orthopedist is bored by it unless he can operate. I think chiropractic theory is nonsense, but chiropractic treatment gives me relief. Bringing relief is our goal in medicine.
There are three primary reasons why physicians should learn about CAM. (1) Many of our patients use CAM, and we should understand what they're doing in order to be able to advise. (2) We need to understand, from their perspectives, what felt needs CAM is addressing and what they hope to get from it. (3) Even if - like Gerald Caplan - we don't believe CAM practice is based on hard evidence and sound theory, we can sometimes learn from the way CAM practitioners carry out their practice.

Unfortunately, one of the Australian Universities manifested the same kind of arrogance that disturbs me when I see it in medicine. (I've interlaced my comments in bold italics.):
Students are taught the science-practitioner model and our aim is to produce graduates who are critical thinkers. [so far so good!] This enables them to distinguish between fad and genuine innovation in the discipline as practitioners, intelligent consumers of research and promoters of the scientific method. [even better!] A clear distinction is made in all of our courses between areas for which the evidence is clear and those in which the science has not caught up with accepted practice and where sufficient evidence has yet to be accumulated. [This is way off base. The speaker is assuming that "accepted practice" is based on science, and the science just hasn't "caught up" yet. That's religious faith, not critical thinking.]
(For previous posts about CAM, see here, here, and here. For the New York Times article from which I learned about Australia, see here.)

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