A PROUD debate has ignited over the ethics of prescribing alternative therapies that may lack an evidence base.
Writing in the “Opposing Opinions” section of MJAProfessor John Dwyer, emeritus professor of medicine at the University of New South Wales, said many alternative therapies are not based in science and it is unethical for doctors to prescribe them in most situations. (1)
Consumers are increasingly exposed to “a plethora of absurd (unscientific) claims that waste their money, distract them from effective care strategies, and often cause harm,” he writes.
Presenting the opposing view, Dr Marie Pirotta, from the University of Melbourne’s department of general medicine, said patients wanted to receive information about complementary or alternative therapies from their GP. (2)
“…it is important that GPs discuss complementary and alternative medicine (CAM) options with patients in order to ethically fulfill their role as trusted primary care providers,” she said.
Professor Dwyer criticized doctors who practiced “integrative medicine”, an approach which combines conventional medicine with complementary and alternative therapies.
“To do so…is to abandon scientific medicine…in favor of an approach that does not believe in testing, is content to exploit the placebo effect, and rejects any psychological influence on health,” he wrote .
Professor Dwyer’s comments sparked a strong response from the Australasian Integrative Medicine Association (AIMA), the peak body for doctors practicing integrative medicine.
Professor Kerryn Phelps, president of AIMA, said Professor Dwyer’s comments “make my blood boil because they are so ignorant and so offensive”.
“This is a professional insult to the highly intelligent and scientific doctors who practice integrative medicine. This is also a very narrow and parochial view. In the United States, more than 60% of medical schools have an integrative philosophy,” she said.
Professor Phelps described integrative medicine as “the emerging mainstream”.
Previous MJA Research has shown that more than half of the Australian population uses complementary or alternative therapies each year, at a cost of more than $2 billion. (3)
Professor Phelps said that given the number of people using these therapies, it was unethical for doctors not to practice in an integrative way.
“Physicians who do not educate themselves in this area, which impacts their practice, whether they know it or not, are not practicing optimally and may expose themselves to (legal) risks.”
Dr Pirotta said it was ethical to recommend that any treatment be carried out with a careful history, examination and diagnosis.
“Discussions about complementary medicine options (including recommending or discouraging their use, where appropriate) can be ethically integrated into this framework. »
Professor Dwyer said the scientific study of alternative medicine was important and any treatment with supporting evidence should be adopted by orthodox medicine.
However, Dr Pirotta said a lack of evidence did not mean a treatment was ineffective or harmful.
“It is estimated that barely a quarter of conventional medicine is based on level 1 evidence,” she writes.
Dr Pirotta said the evidence base for complementary treatments was slowly growing, despite obstacles such as lack of financial reward for research investments.
Professor Phelps said the evidence was a “moveable feast” and cited changing evidence in favor of orthodox treatments such as cyclooxygenase-2 (COX-2) inhibitors and hormone replacement therapy.
“Many pharmaceutical treatments that are supposed to be evidence-based have been discredited, negative studies are not published, etc. I think the evidence itself is flawed.
In a comment published in this issue of MJA OverviewDr. Sue Ieraci wonders why a sophisticated consumer market believes so much in alternative medicine.
– Sophie McNamara
1. MJA 2011; July 11 (online)
2. MJA 2011; July 11 (online)
3. MJA 2004 ; 180; 587-589
Published on July 11, 2011
