If your doctor sent you off to try reiki, coffee enemas, or (my personal favourite) vaginal blowing, you should go straight to the registration board.
But what if they’re recommending St John’s Wort, or acupuncture? Where does medicine end and dodgy science begin?
The latest Medical Journal of Australia delves into these quackery-tainted waters with two pieces on whether doctors should be prescribing complementary and alternative ‘medicines’ (CAM).
My gut reaction to the idea of taxpayers funding doctors to recommend anything like homeopathy or reiki or machines that go ‘ping’ is, shall we say, negative. The idea of endorsing the sort of bullshit that gets peddled by the snake oil merchants looking to make a quick buck by exploiting the poor and vulnerable is one that should be shut down immediately.
But let’s move past the immediate emotive reaction, shall we?
The complicating factors are:
1) Millions of Australians use CAM so for doctors to adopt a hands-off approach is head-in-the-sand avoidance; doctors need to know if patients are using other therapies in case there are reactions with existing medications, and they need to be able to talk patients through the evidence and the choices. So, consultations need to allow for full and frank discussions. Which, by the way, is nigh impossible at the moment with the have-an-antibiotic-and-a-liedown state of affairs.
2) Some CAM work.
3) The placebo effect works.
In the MJA, University of NSW Emeritus Professor of Medicine John Dwyer is scathing of doctors being involved at all in CAM. He says people are increasingly exposed to a “plethora of nonsense (non-science) claims that waste their money, distance them from effective care strategies and, not infrequently, cause harm”.
He says many people are sold on the pleasures of CAM, of long appointments with massages and conversation, false promises and placebos, and that doctors who sign up for ‘integrative medicine’ are blurring the boundaries possibly for commercial gain – and along with private health insurance funds that cover therapies like iridology and reflexology, give them a “totally undeserved imprimatur”.
He also rightly points out the corruption of pharmacies’ shelves, where homeopathic preparations sit alongside Panadol.
Taking the other side, Dr Marie Pirotta from the University of Melbourne says Medicare – ie taxpayers – should pay for consultations to discuss complementary and alternative procedures.
She makes the point that CAM covers bizarre treatments, but also some sensible ones. She also refers to a study that found “as little as a quarter of conventional medicine is based on level-1 evidence”.
She says doctors can alienate patients if they do not talk about CAM, and that they should be able to advise of alternative, evidence-based options.
While the MJA debate has been set up as two opposed positions, it’s not hard to see that there’s common ground.
It’s clear doctors need to engage in the conversation about different therapies – even the wacky, useless ones – because their patients are already using them. It’s clear doctors need to help everyone become more health literate, because people are absorbing false beliefs from a range of sources, not least the internet. It’s clear people need to learn that ‘natural’ does not mean ‘harmless’.
It’s clear somehow doctors need to get enough wriggle room in their hectic days to have these sorts of discussions with patients – a vain hope, perhaps.
But what would help them along would be a more thorough grounding in science for all Australians so they are better equipped to sort good medicine from bad, and an independently produced, trustworthy list based on evidence and an evaluation of benefits and risks that sets therapies out in black and white – and all shades of grey.
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