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Doctors should focus on providing the best care, alternative or otherwise

The lack of a strong evidence base is not unique to complementary medicines. Jenny O'Donnell/Wikimedia Commons

Read the argument against the use of complementary medicines.

Over half of Australians use complementary therapies, at a cost of about $AUD1.8 billion a year, to either prevent or treat health problems.

The Australian Bureau of Statistics (ABS) estimates that three-quarters of million people see complementary therapists each year.

Most of these people don’t reject orthodox medicine – they are looking for answers for health problems that orthodox medicines don’t relieve or adequately address.

In fact, orthodox and complementary medicines are often used at the same time to treatment the same health issue.

What are complementary medicines?

Some people talk about complementary therapies as if they were a singular thing: a creed to be either adhered to or not.

But complementary therapies can include anything from medicines made from plants through to crystals and other exotic practices.

Detractors of complementary therapies generally focus on the more unusual types of therapies. In particular, they highlight the downright scandalous schemes that pedal ineffective and expensive therapies to vulnerable people.

And they generally tend to overlook the many complementary therapies that share the same origins as our early pharmaceuticals. Or therapies from well outside our medical paradigm for which there’s a growing body of good scientific evidence.

Think about medicines that come from plants. Many important orthodox medicines derive from plants, such as aspirin for pain, quinine for malaria and digitalis for heart failure.

Growing body of evidence

It’s not surprising that evidence is now building for other herbal medicines, such as St John’s wort for depression.

Perhaps less expected is that acupuncture, a traditional Chinese therapy with thousands of years of history, now has scientific evidence to support its use in certain health problems, for example in migraines and for tension headaches.

What’s more, a lack of evidence doesn’t necessarily mean that some complementary therapies don’t have a genuine therapeutic effect.

Many complementary therapies currently lack evidence because of a perceived lack of need for research (as these therapies are already marketed freely in Australia); lack of capacity in the sector to undertake good independent research; and lack of dedicated funding.

Rigorous trials can cost millions of dollars. Developers of pharmaceuticals undertake these risky, expensive trials and derive potential profits from patents.

The same degree of pecuniary benefit doesn’t exist for complementary products.

Fortunately, the National Health and Medical Research Council (NHMRC) has recently recognised the importance of developing evidence for complementary therapies.

And while every health professional’s goal should be the practice of evidence-based, ethical and safe medicine, the Cochrane Collaboration’s website notes that as little as one quarter of what we practise in orthodox medicine may be firmly based on evidence.

Ethical medical practice

In every medical consultation, after making a diagnosis (or at least a list of possibilities, or excluding serious illness), there is a balancing of risks and benefits in the treatment options.

Evidence is, of course, an extremely important factor in this balancing act, as is the potential for harm.

Doctors and patients together balance priorities, urgency, costs (to the individual and the community), patients’ values and preferences, other illnesses and other treatments being used.

Where an evidence-based orthodox therapy is an option, it will be discussed. But when no such option exists or when it has been used without benefit (or resulted in harm), then complementary medicine options may reasonably enter the discussion.

In fact, some have suggested that it may be unethical to not offer complementary therapy options where there’s evidence that they’re useful and safe.

Fortunately, on the knowledge we have so far, complementary therapies are generally safer than pharmaceuticals, although side effects and interactions with other treatments do occur.

So like all therapies used in the practice of medicine and the management of health, the use of complementary therapies needs to be done with knowledge of the risks and alongside monitoring of side effects over time.

What then are doctors to do while waiting for evidence about the complementary therapies so many of their patients are already using?

I think we need to develop an ethical way of practising the best medicine we can. This includes good two-way communication and respecting patients’ autonomy and preferences. It is up to us to help them make the best and safest choices for their health.

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

Do you think its unethical for GPs to not offer safe and effective alternative therapies when conventional medicine cannot help their patient?

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