The controversies that have arisen between complementary and alternative medicines (CAMs) and conventional medical practice may come from a difference in their origins.
Conventional medicine is based on evidence, often derived from randomised clinical trials, resulting in detailed knowledge about the likely benefits and side effects. This information can help a patient decide on a treatment recommendation. Moreover, how the medicine works is often known.
CAMs are not supported by the same type of evidence. Their proposed mechanisms of action do not accord with the way modern science believes the body works. “Evidence” is commonly from testimonials or generations of use, with little information that would allow a patient to judge their chance of responding. Although the evidence produced for conventional medicine can create uncertainty, CAMs are often promoted without that uncertainty.
Worse, from the conventional medical standpoint, is the frustration of the doctor when a patient chooses CAMs instead of a conventional therapy despite scientific evidence showing the therapy is highly effective. Often the patient eventually regrets that choice.
However, CAMs are widely used by the community. It is estimated that up to 80 per cent of patients with cancer use some form of CAMs. However, there is a difference between using CAMs to complement conventional therapy and being led to believe that one must make a choice between the two. Many patients have reported improvement in symptoms with the use of a complementary medicine and would want to continue to use it in addition to other therapies. There can be little harm in that as long as it is not toxic and the price is reasonable.
Given the widespread use of CAMs, it is vital that conventional practitioners are familiar with what is being used. It is most important to know what CAMs interact with other medicines to avoid harm. It is also important that patients are encouraged to reveal their use of CAMs. They will only do this if they feel that they can do so in a supportive environment.
It is in such a setting that doctors may in turn be able to better advise patients about CAMs.
CAMs are not only biologicals, but the term includes physical therapies, meditation and practices to improve spiritual wellbeing. It may be very difficult to collect evidence in the form of randomised trials on such practices or to investigate the mechanisms if benefit is reported, but documenting their use and outcomes may still be a useful exercise. After all, many of our anticancer therapies were used before their mechanisms of action were discovered.
Knowing how widely CAMs are used it would be helpful to step back from controversy and suggest a way forward. Teaching medical students about CAMs would better equip them to understand their patients’ choices.
Subjecting selected CAMs to rigorous research evaluation will allow more widespread acceptance of those CAMs with greatest benefit. Finally, moves toward integrative clinics where a range of both therapies are provided to patients in the same medical setting are worth evaluating to demonstrate whether this will improve overall patient care which is the ultimate goal.
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