Most readers would know of the current debate about universities teaching complementary and alternative medicine (CAM). A core question not being addressed in this debate is what other institution is better placed to deliver evidence-based knowledge of CAM.
The latest controversy started when a group called Friends of Science in Medicine (FSM) wrote to vice chancellors across the country asking them to review their health science courses. FSM rightly says that rigorous academic standards and evidence for scientific conclusions and health-care practices are of the essence and should be the basis of all university teaching.
I’m sure that any university lecturer would agree with these principles; most would consider themselves as friends of science in medicine. But it’s a matter of concern when the debate and terminology become simplistic, generalised and uninformed.
CAM is a term for many different practices and medicines and there’s scientific evidence for a number of them. Some of the modalities are derived from ancient sciences, for instance, and have a very long history of successful traditional use. FSM mentions acupuncture as a therapy it considers pseudo-scientific and argues that it shouldn’t be taught at university. But this isn’t entirely true.
There’s clinical evidence for acupuncture as effective treatment for various conditions, including migraines, tension-type headaches and chronic low-back pain. What’s more, there’s a Medicare rebate available for acupuncture if it’s part of a doctor’s examination. Why shouldn’t medical practitioners learn about the evidence for this treatment option at universities to increase consumer choices and improve patient outcomes?
The National Prescribing Service’s “Review of the Quality of Complementary Medicines Information Resources” can be used to identify which CAM information resources are of high quality, evidence-based, unbiased and well structured. The use of such high-quality resources is available and encouraged at universities.
In Australia, complementary medicines are regulated as medicines by the Therapeutic Goods Administration (TGA). The TGA’s ambit includes homeopathic and traditional medicines, such as Traditional Chinese Medicines. According to the TGA’s guidelines general and medium-level claims (such as the temporary relief of minor self-limiting conditions) for complementary medicine’s efficacy can be based on certain traditional use evidence. The guidelines allow the use of such medicines until high-level evidence, that would allow for high-level claims, is available.
A balanced view in this debate is particularly important because about 70% of Australians already use CAM, mostly alongside conventional medicines and treatments.
So the community expects health professionals to be able to provide information and guidance about the quality use of all medicines, which, according to Australian’s National Medicines Policy, includes complementary medicines. To be able to do that, health professionals need to be knowledgeable, at least, about the principle, paradigm and available evidence for all complementary medicines, including homeopathic and traditional medicines.
And where else would health professionals gain this knowledge if not at university, during their degree? One of the advantages universities have is the close relationship between research and teaching – students are more engaged and inspired by research-led teaching, and research is informed by queries from students while teaching. Many universities research CAM to generate an evidence base or prove their lack of efficacy.
So why support research but exclude teaching of CAM from universities? Aren’t we obliged to translate our research results into practice – starting by teaching new practitioners?
At Griffith University, evidence-based CAM education is integrated throughout the whole pharmacy curriculum. Our teaching research has shown that pharmacy students perceive education about CAM as a core part of their professional degree. We found that CAM research and education had a moderating effect on students' attitudes towards CAM. The training also encouraged students to look at and evaluate evidence and make informed decisions in the best interests of their patients.
We also offer a specifically designed “Short Course in Integrative Medicine for Pharmacists,” which has been accredited for continuous professional development. The course addresses the shortage of CAM knowledge among practicing Australian pharmacists as identified in a recent Pharmacy Guild-funded project, which surveyed Australian pharmacists nationally.
The survey found most pharmacists supported undergraduate CAM education (76%), and the majority (85%) were interested in additional CAM education themselves.
Research also suggests that CAM education may also teach practitioners greater self-awareness, improved core competencies (such as evidence-based practice), enhanced cultural competency and patient-centred care.
So should we turn our back on the consumer-driven trend toward holistic and integrative healthcare, or should we work together to understand, research and teach different principles, practices and evidence to improve health outcomes for customers and patients? I, for one, would prefer the latter.