In Australia, the Friends of Science in Medicine have issued a challenge to Australian tertiary institutions to stop “offering courses in the health care sciences tat are not underpinned by sound scientific evidence“. This challenge, aimed specifically at tertiary organisations teaching what are commonly referred to as complementary and alternative medicine (CAM), has drawn strong reaction from those who support and teach it.
One of the challenges of discussing CAM is that not everyone has the same definition of what it means. Indeed in Darcy’s post earlier in the week on Why Do People Use Alternative Medicine? the fact that several commenters had slightly different definitions on what “alternative medicine” actually means lead to unnecessary disagreements. A good starting point for any intelligent debate is to make sure that you are talking about the same subject so I have had a look around on line.
The free online dictionary describes CAM as:
“a large and diverse set of systems of diagnosis, treatment, and prevention based on philosophies and techniques other than those used in conventional Western medicine, often derived from traditions of medical practice used in other (non-Western) cultures. Such practices may be described as alternative, that is, existing as a body separate from and as a replacement for conventional Western medicine, or complementary, that is, used in addition to conventional Western practice. CAM is characterized by its focus on the whole person as a unique individual, on the energy of the body and its influence on health and disease, on the healing power of nature and the mobilization of the body’s own resources to heal itself, and on the treatment of the underlying causes, rather than symptoms, of disease. Many of the techniques used are the subject of controversy and have not been validated by controlled studies.”
This is quite a broad definition, and as such provides some challenges – with some people potentially agreeing with parts of it and disagreeing with others. Consequently, perhaps in debates about CAM, there will be more value if proponents and opponents of CAM were to discuss specific “therapies” covered by the CAM banner on an individual basis in order to consider each ones merit, based on the available evidence?
For example, I see no merit in tertiary institutions teaching courses involving homeopathy, reiki, dowsing or colour therapy. There is no reliable evidence which supports these therapies (and a reasonable amount of evidence against them).
Herbal medicine, may first appear to have some merit, after all many modern pharmaceuticals are derived or inspired by natural compounds. However, given that the active components in herbal medicines vary from batch to batch, it seems to me this is an unreliable therapy. Also, given that many of the claims for its benefits focus on vitalism, a concept which has no evidence to support, I personally would be wary of it.
Chiropractic manipulation for muscular complaints and acupuncture for back pain, appears to have some evidence to support it, however, the application of these therapies to a wider range of problems (with no reliable evidence to support it), should, in my opinion, be challenged.
Dietary supplements is a quagmire of an issue. There is strong evidence that some supplements can be used to treat specific diseases (e.g. folic acid to reduce neural tube defects in the unborn; iron supplements for anaemia etc). However, for other claims the evidence is less convincing or even no existent.
The same applies to dietary advice. While gluten-free diets are helpful for those suffering coeliac disease, there is no evidence that they have benefits for everyone. Likewise, while fresh fruit and vegetables provide valuable nutrients, this does not necessarily mean that excessive or exclusive consumption of them will enhance ones health.
CAM is used to cover a wide range of therapies and treatments, a few of which are supported by evidence. However, those with no reliable evidence to support their use, need to be either assessed carefully (if this has not been done) or discarded (if there is evidence to show they do not work). Let each therapy stand on its own merit, or fall by the wayside.