Panacea or placebo: doctors should only practise evidence-based medicine

Some alternative medicine practices, such as homeopathy, have been proven to lack efficacy but remain in demand. Photo_Robson/Flickr

Read the argument for the use of complementary medicine.

The question of whether doctors should provide “complementary or alternative” medicines and procedures for which there is no scientific proof of effectiveness to their patients was recently put to me by the Medical Journal of Australia.

My response - no, they should not - is published today alongside an alternative view, opening the subject up to professional and public debate.

I have good reason to be confident in my stance - consumers looking for tactics to help them avoid illness and enhance good health are often bombarded with fraudulent misinformation.

The most recent highly-publicised example of this is the SensaSlim affair. The company marketed a solution, which, when sprayed on the tongue, had purportedly helped thousands lose weight.

Even more sadly, patients battling illness, particularly one that is chronic or incurable, are easy prey for peddlers of false hope.

Extreme examples of this have ended with serious charges being brought against “alternative ” practitioners.

Since current regulations are inadequate for protecting health consumers, I think doctors - men and women trained in science - should be the bastions of evidence-based approaches to health care.

Over 80% of Australians visit a doctor a number of times every year. These visits provide the perfect opportunity to educate patients about the uselessness of most alternative approaches - some of which can be dangerous and many of which are expensive.

Parallel worlds

In this, the most scientific of ages, it is surely unnecessary to accept two parallel but different approaches to prevention and treatment.

We need to abandon the dichotomy of orthodox medicine versus alternative and complementary medicines: there are, in fact, only two types of medicine - good and bad.

Good medicine is based on evidence, strives to be rigorously tested, does not accept as legitimate the deliberate use of the placebo effect and understands the realities of psychological factors in producing physical symptoms.

Bad medicine ignores scientific methodology, relies on anecdotal and “traditional” evidence, exploits the placebo effect and does not accommodate psychosomatic illness.

In our community, bad medicine often equates to alternative medicine.

False legitimacy?

Many universities now study complementary and alternative modalities. Using the scientific method to examine these allows scientists to declare something to be ineffective or not.

Studying alternative medicines also allows those found to be effective, which fill a therapeutic vacuum, to move into the good medicine category.

There are, however, precious few of the latter.

Colloidal silver, for instance, may kill bacteria but you wouldn’t use it in preference to an antibiotic.

And there are also a number of alternative practices that aren’t worthy of careful study because they’re an affront to certain knowledge of how bodies work as well as the laws of physics and chemistry.

Homeopathy, which was subject to intense study (even though its underlying premise is ridiculous) and shown to be useless; iridology; reflexology; “healing touch” techniques and; a number of claims made for chiropractic, all fall into this category.

Chiropractic practices are under the spotlight at the moment as claims that defects in the spine are responsible for numerous illnesses has some chiropractors treating asthma, migraine headaches, attention deficit syndrome and a host of other diseases, with spinal manipulation.

It is particularly disturbing that chiropractors make up the largest professional group affiliated with the anti-vaccination group known as the Australian Vaccination Network.

Seeking comfort

Consumers are confused by competing assertions but are understandably drawn to the claims made for alternative medicines.

A reporter from the New Yorker magazine explained to me that people in this postmodern world long for simple, and somewhat, magical panaceas.

But it is surely unacceptable that taxpayer dollars supporting private health insurers end up paying for alternative, unproven or indeed discredited treatments.

In fact, such payments give them an imprimatur from insurers and provide them with undeserved credibility.

Doctors billing Medicare for complementary unscientific care are providing similar endorsement while misusing taxpayer dollars.

Pharmacists should protect consumers from much that is fraudulent and unscientific. But a majority of pharmacists, though trained in scientific method, have abandoned the need for evidence and stock their shelves with preparations known to be ineffective.

They’re almost always embarrassed when engaged in a conversation about this practice. Perhaps many have taken the advice I once heard Marcus Blackmore give at a pharmacy guild conference to “capitalise on consumer sentiment”.

Increasing numbers of doctors are advertising that they practice integrative medicine, offering patients “the best of both worlds”.

Some are no doubt exploiting “consumer sentiment”, some may believe they are offering better care but all have an ethical responsibility to concentrate on practising efficacious medicine.

This is expected of them by the majority of their peers, the Medical Board with which they are registered and the patients who trust them with their health.

Read the argument for the use of complementary medicines. Both contributions are based on articles published in the Medical Journal of Australia.