How To Change Someon's Opinion About Conventional Medicine
BMJ. 2000 Nov 4; 321(7269): 1133–1135.
The role of complementary and alternative medicine
Complementary and alternative medicine is defined every bit "diagnosis, treatment and/or prevention which complements mainstream medicine past contributing to a common whole, by satisfying a demand not met by orthodoxy or past diversifying the conceptual frameworks of medicine."i It comprises a confusingly large and heterogeneous assortment of techniques, with both therapeutic and diagnostic approaches (tabular array 1).
Table 1
Examples of techniques used in complementary and culling medicine
| Technique | Method | Indication (examples) | Serious risks (examples) | Benefits* | Take chances benefit analysis |
|---|---|---|---|---|---|
| Acupunctureii | Therapeutic /diagnostic | Chronic pain | Tissue trauma, infections (rare)† | No disarming evidence | Uncertain |
| Acupuncture3 | Therapeutic /diagnostic | Nausea | Tissue trauma, infections (rare)† | Disarming evidence | Positive |
| Aromatherapy4 | Therapeutic | Diverse | Allergic reaction, carcinogenic potential in some oils | Good evidence for relaxing effects | Uncertain |
| Chelation therapy5 | Therapeutic | Intermittent claudication | Kidney damage, electrolyte imbalances† | No convincing prove | Negative |
| Chiropractic6 | Therapeutic /diagnostic | Back pain | Vertebral or carotid artery dissection† | Promising but not convincing evidence for acute or chronic back hurting | Uncertain |
| Herbalism7 eight | Therapeutic | (St John's wort for depression‡) | Increased run a risk of bleeding, interaction with numerous drugs | Clear show that it is superior to placebo | Positive |
| (Ginkgo biloba for intermittent claudication‡) | Increased risk of bleeding, interaction with anticoagulants | Clear testify that it is superior to placebo | Positive | ||
| Homoeopathy9 | Therapeutic /diagnostic | Various | No serious straight risks of highly dilute remedies | No articulate show for clinical effectiveness for whatever condition | Uncertain |
| Iridologyx | Diagnostic | NA (diagnostic method) | Faux positive or fake negative diagnosis | No convincing show | Negative |
| Massageeleven | Therapeutic /diagnostic | Back pain | No serious direct risks | No convincing evidence | Uncertain |
| Reflexology12 | Therapeutic /diagnostic | Various | No serious direct risks | No convincing evidence for clinical effectiveness for any status | Uncertain |
| Spiritual healing13 | Therapeutic /diagnostic | Various | No serious directly risks | No convincing evidence for clinical effectiveness for any condition | Uncertain |
Complementary and culling medicine is popular
A recent telephone survey on the utilize of complementary and alternative medicine in the United Kingdom yielded a 1 yr prevalence of 20%.14 Herbalism, aromatherapy, homoeopathy, acupuncture, massage, and reflexology were among the most popular. This level of use may seem impressive but, compared with other countries, it is low (effigy). National differences are difficult to translate. To some they point that in the United Kingdom complementary and alternative medicine will grow to match its popularity in Federal republic of germany or French republic, where, reverse to the Uk, it is more often than not practised by medically trained doctors.
Complex reasons for popularity
The verbal reasons for the popularity of complementary and alternative medicine are complex; they change with time and space, they may vary from therapy to therapy, and they are unlike from ane individual to another—for example, a patient with AIDS will have other motives than someone who is "worried well." Reporting on complementary and alternative medicine in the British daily press is considerably more enthusiastic than that for conventional medicine.15 Too complementary and alternative medicine is largely practised privately. In that location is an intriguing, positive correlation between signs of abundance and the sales figures of commercial complementary and alternative medicine products.16
In essence, therefore, no single determinant of the nowadays popularity of complementary and alternative medicine exists, merely at that place is a broad range of interacting positive and negative motivations. Some of these amount to a biting criticism of our mod healthcare system. Regardless of whether this criticism is valid or non, it is often deeply felt past those who plow towards complementary and alternative medicine, and mainstream medicine would be well advised to consider it seriously.
Difficulties in research
Many providers of complementary and alternative medicine are convinced that their therapy defies the "straightjacket" of reductionist research. They argue that information technology is individualised, holistic, intuitive, etc, and call for a "image shift" in enquiry. Normally these arguments are based on a series of misunderstandings, and frequently the problems can be resolved by clearly defining the research question and subsequently finding the research tool that optimally matches it. If the aim is to test the effectiveness of complementary and alternative medicine, randomised controlled trials commonly provide the least biased method for finding a reliable answer.17
While few obstacles to research exist in principle, there are many in practice. Complementary and alternative medicine lacks both a research tradition and a research infrastructure and therefore fails to attract experienced researchers. Most chiefly perhaps, the orthodox attitude remains highly (some would say destructively) sceptical, and as a consequence the funding of inquiry is dismal.18
Opinion based medicine
Numerous indicators suggest that complementary and alternative medicine is largely stance based. In the grade of writing a strictly evidence based reference book of complementary and alternative medicine, I extracted all complementary therapies recommended for defined medical conditions in seven contempo and seemingly authoritative books on the subject. Later, I contrasted the results with the hard evidence from systematic reviews. More than 100 dissimilar complementary therapies were recommended for asthma, while systematic reviews failed to back up a unmarried treatment for this indication.19 There was little agreement between the seven books. For instance, rarely was i treatment for asthma recommended by more than than two authors. The exceptions were acupuncture, which was backed past four authors, and homoeopathy, which was backed by 6 authors. Even so neither of these treatments was supported by acceptable bear witness.20 ,21 Even more surprisingly, less than half of these authors recommended St John's wort for depression, which happens to be of proved effectiveness.7 Opinions that frequently contradict the existing evidence seem to dominate complementary and alternative medicine, and this highlights the necessity of bringing opinion into line with evidence. The best mode to achieve this is through rigorous inquiry and the broad dissemination of its findings.
Hard evidence is scarce
If there are no funds there will be no research. If at that place is no research, nosotros will be unable to find out whether complementary and alternative medicine does more good than harm. All the same this is the central question destined to determine its role in futurity health care. Simple answers or broad generalisations are non possible. Each of the numerous techniques has to be evaluated separately and on its own merits. Some forms of complementary and alternative medicine are safety but others aren't; some are effective while others may exist pure placebos (run into table 1).
It seems blatantly obvious that only well designed clinical investigations can establish the truth. Those who would prefer to bypass rigorous inquiry—for example, by shifting the discussion towards patients' preference—and promise to integrate unproved treatments into routine health care are unlikely to succeed in the long run. Those who believe that regulation is a substitute for evidence will find that fifty-fifty the nigh meticulous regulation of nonsense must still result in nonsense. And those who insist that the evidence to support complementary and alternative medicine can legitimately exist softer than in mainstream medicine will have to reconsider their position. Double standards in medicine existed for many years; undoubtedly they however exist today, but hopefully their days are numbered.
The lack of show plagues large sections of complementary and culling medicine. For a few treatments, however, our knowledge is sufficiently advanced to allow preliminary hazard benefit analyses (see table 1). In some cases (for instance, ginkgo biloba for intermittent claudication) the balance is positiveviii; in other instances (for example, chelation therapy for intermittent claudication) it is negative.5 This underscores the indicate made earlier: generalisations are not possible, and those who offer them must be listened to with scepticism.
The principle of "cyberspace benefit" should besides include costs. Complementary and alternative medicine is not cheap. Extrapolation from the results of the phone survey,fourteen suggests that Britain's annual expenditure is around £1.6 billion, and providers' fees are considerable (tabular array 2).22 Only costs must not exist viewed in isolation; the existent question is whether the use of complementary and alternative medicine increases or decreases overall expenditure in our healthcare arrangement. To answer it, one would require reliable toll evaluation studies. Few such investigations are bachelor to date, the about rigorous of which negate the hypothesis that utilize of complementary and culling medicine reduces overall expenditure.23
Table 2
Average fees (£) charged past providers of complementary and alternative medicine in south w London (1995)*
| Type of handling | Fee for 1st visit | Fee for follow upwardly visits |
|---|---|---|
| Acupuncture | 35.0 | twenty.0 |
| Chiropractic | 37.0 | xvi.5 |
| Homoeopathy | 40.0 | 20.0 |
| Osteopathy | 19.5 | 18.0 |
Association with powerful non-specific furnishings
It has been pointed out repeatedly that complementary and alternative medicine can be "ineffective" (in the sense of non beingness amend than a placebo) and still do a globe of good to the wellbeing of our patients.24 Some fence that complementary and alternative medicine should be used regardless of the results of placebo controlled clinical trials, particularly when its employ is non associated with serious risks (see table ane). In such cases, rigorous inquiry could even be seen as counterproductive. Nosotros might, for instance, find trivial "hard" prove in favour of aromatherapy; if its "ineffectiveness" became known its availability would decrease, and yet aromatherapy could considerably assistance patients through its not-specific effects.24
Such arguments cannot be used confronting the rigorous investigation of complementary and alternative medicine. If research really showed that aromatherapy has no adverse effects and helps people through powerful non-specific (placebo) effects, the medical customs should start seriously considering the ability of placebos. The research question and then shifts to how not-specific effects might be optimised so that more patients (non just those seeing an aromatherapist) can turn a profit from them. Fifty-fifty in this (worst case) scenario, inquiry would yield clinically valuable data.
Determination
We should listen less to the opinions of those who either overtly promote or stubbornly refuse complementary and alternative medicine without acceptable testify. The many patients who utilize complementary and alternative medicine deserve meliorate. Patients and healthcare providers demand to know which forms are condom and effective. Its future should (and hopefully volition) be determined past unbiased scientific evaluation.
One year prevalence of complementary and alternative medicine in various countries. Data based on surveys of random or representative samples of population
Acknowledgments
This is an edited version of a presentation at the the Millennium Festival of Medicine in London, 6-10 Nov 2000.
Notes
Based on a presentation from the Millennium Festival of Medicine
Footnotes
Competing interests: None alleged.
References
ane. Ernst Eastward, Resch KL, Mills S, Hill R, Mitchell A, Willoughby M, et al. Complementary medicine—a definition. Br J Gen Pract. 1995;45:506. [Google Scholar]
two. Ezzo J, Berman B, Hadhazy VA, Jadad JR, Lao L, Singh BB. Is acupuncture effective for the handling of chronic pain? A systematic review. Pain. 2000;86:217–225. [PubMed] [Google Scholar]
3. Lee A, Done ML. The use of non-pharmacologic techniques to prevent postoperative nausea and vomiting: a meta-analysis. Anesth Analg. 1999;88:1362–1369. [PubMed] [Google Scholar]
5. Ernst E. Chelation therapy for peripheral arterial occlusive disease. Circulation. 1997;96:1031–1033. [PubMed] [Google Scholar]
six. Bronford G. Spinal manipulation. Current state of research and its indications. Neurol Clin N Am. 1999;17:91–111. [PubMed] [Google Scholar]
7. Williams JW, Mulrow CD, Chiquette E, Noël PH, Aguilar C, Cornell J. A systematic review of newer pharmacotherapies for low in adults: evidence study summary. Ann Intern Med. 2000;132:743–756. [PubMed] [Google Scholar]
8. Pittler MH, Ernst Due east. Ginkgo biloba excerpt for the handling of intermittent claudication: a meta-analysis of randomized trials. Am J Med. 2000;108:226–281. [PubMed] [Google Scholar]
9. Linde K, Claudius N, Ramirez G, Melchart D, Eitel F, Hedges LV, et al. Are the clinical effects of homoeopathy placebo effects? A meta-assay of placebo controlled trials. Lancet. 1997;350:834–843. [PubMed] [Google Scholar]
10. Ernst East. Iridology—non useful and potentially harmful. Arch Opthalmol. 2000;118:120–121. [PubMed] [Google Scholar]
11. Ernst E. Massage therapy for low pack hurting: a systematic review. J Pain Symptom Manage. 1999;17:65–69. [PubMed] [Google Scholar]
12. Astin JA, Harkness E, Ernst Eastward. The efficacy of "distant healing": a systematic review of randomized trials. Ann Intern Med. 2000;132:903–910. [PubMed] [Google Scholar]
xiii. Ernst E, Köder K. An overview of reflexology. Eur J Gen Pract. 1997;iii:52–57. [Google Scholar]
14. Ernst E, White A. The BBC survey of complementary medicine use in the UK. Complement Ther Med. 2000;8:32–36. [PubMed] [Google Scholar]
sixteen. Ernst Due east. Alternative views on alternative medicine. Ann Intern Med. 1999;131:229–230. [PubMed] [Google Scholar]
17. Vickers A, Cassileth B, Ernst East, Fisher P, Goldman P, Jonas W, et al. How should we research anarchistic therapies? A report from the briefing on complementary and culling medicine research methodology, National Establish of Health. Int J Technol Assess Health Care. 1997;13:111–121. [PubMed] [Google Scholar]
18. Ernst East. Funding research into complementary medicine: the state of affairs in Britain. Complement Ther Med. 1999;seven:250–253. [PubMed] [Google Scholar]
nineteen. Ernst E, ed. Complementary and alternative medicine. A desk top reference. London: Mosby (in press).
xx. Linde Grand, Jobst Yard, Panton J Cochrane Collaboration, editors. Cochrane Library. Event iii. Oxford: Update Software; 1997. Acupuncture for the treatment of bronchial asthma. [Google Scholar]
21. Linde Grand, Jobst KA Cochrane Collaboration, editors. Cochrane Library. Issue 2. Oxford: Update Software; 2000. Homeopathy for chronic asthma. [Google Scholar]
22. White AR, Resch KL, Ernst E. A survey of complementary practitioners' fees, practice, and attitudes to working within the National Health Service. Complement Ther Med. 1997;5:210–214. [Google Scholar]
23. White AR, Ernst E. Economic analysis of complementary medicine: a systematic review. Complement Ther Med. 2000;eight:111–118. [PubMed] [Google Scholar]
24. Vickers A. Why aromatherapy works (even if information technology doesn't) and why nosotros need less research. Br J Gen Pract. 2000;50:444–445. [PMC gratis commodity] [PubMed] [Google Scholar]
Articles from The BMJ are provided here courtesy of BMJ Publishing Group
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1118903/
Posted by: marinohaductincer.blogspot.com
0 Response to "How To Change Someon's Opinion About Conventional Medicine"
Post a Comment