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Complementary and Alternative Medicine (CAM), Regulation and Appraisal, but what about CAM familiarisation for doctors?
- Anona L Blackwell, Natalie Taylor (9 May 2007)
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Re: Complementary and Alternative Medicine (CAM), Regulation and Appraisal, but what about CAM familiarisation for doctors?
- Raymond G Holder (12 May 2007)
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What is art?
- Hugh Mann (20 April 2008)
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Familiarisation by whom?
- David Colquhoun (4 July 2008)
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Anona L Blackwell, Consultant in Genito-Urinary Medicine Singleton Hospital ,Sketty Lane, Swansea,SA2 8QA, Natalie Taylor
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Day elegantly discusses problems concerning the regulation of complementary practitioners and we note also that recently the British Medical Journal has published a debate about the pros and cons of appraisal of Complementary and Alternative medicines (CAMs) by the National Institute for Health and Clinical Excellence (NICE).1-3 However, the general public are using non-orthodox therapy in ever increasing numbers and whether CAM practitioners are regulated or not, and NICE or no NICE appraisal , healthcare staff need to be familiarised with CAMs so that they are aware of possible benefits and risks, in particular, of potential interactions with orthodox therapy. This was the view held by the authors of the House of Lords Science and Technology Committee’s sixth report on CAMs published in 2000 which also noted that Cardiff medical school offered little specific CAM familiarisation. 4 We decided to see what, if any, CAM teaching improvements had been made in Medical schools in Wales since this report was published. Senior academic staff from Cardiff University School of Medicine and Swansea University School of Medicine were asked about CAM teaching provision for their students. We were told little formal CAM familiarisation is offered to either UGES or GES in Wales. This is some six years after the Select Committees recommendations and despite endorsement of CAM familiarisation by the General Medical Council.5 In addition, in October/ November 2006 we distributed voluntary questionnaires to 74 first year undergraduate entry medical students (UGES) attending Cardiff University and 62 first year graduate entry medical students (GES), 60 of whom were attending Swansea University. They were asked if they should receive CAM familiarisation, what previous knowledge /experience they had of CAMs and if they believed CAMs had a role in the NHS. Responses to the questionnaires showed that 58/62 (94%) of GES and 46/74 (62%) of UGES in Wales wanted CAM teaching but only 32/62(51%) of GES and 24/74(32%) of UGES had knowledge or previous experience of CAMs. Thirty one of 62 (50%) GES students felt CAMs had a role in the NHS but only 23/74(31%) of UGES agreed. Given continuing CAM usage by the public we feel that more emphasis should be given to CAM familiarisation for medical students since they have little personal experience or knowledge of CAMs and most want some teaching. Unless this is happens we will continue to train doctors who are unable to give their patients informed advice about CAMs whether or not CAM practitioners are regulated or individual CAMs are NICE appraised. References 1. Day M. Mapping the Alternative. BMJ 2007;334:929-31. 2. Freanck L, Chantler C, Dixon M. Should NICE evaluate complementary and alternative medicine? YES. BMJ 2007:334;506. 3. Colquhoun D. Should NICE evaluate complementary and alternative medicine? NO. BMJ 2007:334;507. 4. House of Lords Select Committee on Science and Technology. Sixth report: complementary and alternative medicine. London: Stationery Office, 2000. www.publications.parliament.uk/pa/ld199900/ldselect/ldsctech/123/12302.htm 5. General Medical Council. Tomorrow’s doctors. Recommendations on undergraduate medical education. London: GMC, 2003. Competing interests: None declared |
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Raymond G Holder, Retired engineer BH9 3NF
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The terms Complementary and Alternative medicine are not fully defined. Is a medication alternative because, although having impeccable scientific and safety properties, it does not appear in the BNF, or has not been approved by NICE or MHRA ? Does the fact that a substance has not been submitted to MHRA, for example, because it is not patentable and thus the expenditure involved would give advantage to other possible suppliers of the same substance without cost to themselves, make it alternative? Is there no official body looking out for discoveries and such things as essential supplements which have real benefits to offer to patients without a drug company piling money behind an application. The regulations state that such a substance must not be said to cure any particular problem, and that supplementary nutrients must not be said to offer any advantage over a balanced diet. How much can regulations distort the truth, when one has a deficiency, the obvious answer is to try to satisfy the requirement, but the necessary amount of dietary food to make up that deficiency can run into pounds of meat, or pounds of peanuts, etc,etc, per day. One who has read my postings before will realise that among other things, I refer to Coenzyme Q10, depleted dangerously by statin use, and known in this respect since 1990, but here only very tentative research has been made into this effect. Carnitine is another substance which is affected probably as a result of CoQ10 depletion, this deficiency is in mainstream literature (although not recognised by statin protagonists as a result of statin use) and is actually in the BNF, but at a prohibitive price. What is holding this research back, could it be fear of upsetting the major suppliers of research funding, i.e. the drug manufacturers? Heads are being buried in the sand over statin damage, I wonder who are the members of the NICE Statin Safety Committee, and whether they are equipped witth the knowledge of the dangers involved in inhibiting the flow rate within the mevalonate pathway, and not just the cholesterol portion of that process, or whether the statistical evidence from less than convincing trials, ignoring subsequent real life evidence, will form the basis of the patient's only defence against permanent damage in the new guidelines. It is only to be expected that a mainstream medical service, which virtually ignores the damage done by its most often prescribed "protective "drug, should find that those damaged patients take advantage of the necessary supplements from non-health service sources, what alternative have they?. The costs to them can be considerable, I spend £2000 a year on CoQ10 and Carnitine, resulting from statin damage, I only do this because my heart will fail without Q10 and my muscle wastage (CK) rises in a few days without carnitine, also needed regularly to maintain what little strength I still have. I would direct you to a new website which has appeared, not yet complete,------talkingstatins.com-------it may open your eyes to things not revealed in the official literature on statins. Competing interests: Badly statin damaged patient |
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Hugh Mann, Physician Eagle Rock, MO 65641 USA
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Art is the translation of common pain into uncommon beauty.
Competing interests: None declared |
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David Colquhoun, Research professor UCL WC1E 6BT
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If the Health Professions Council took seriously its own edict about "practice based on evidence of efficacy", it would refuse to take on things like herbal medicine and acupuncture. I expect it will come under pressure to ignore evidence, but if it gives in to that pressure it will not be an organisation that can be taken seriously. Blackwell and Taylor emphasise 'familiarisation with CAM', but that is totally meaningless until you say who does the familiarisation. I do some of it myself at UCL and have recently been asked to do it at another London medical school. I assess the evidence as honestly as I can. But some such familiarisation is so stifled by political correctness that it is rather worse than useless. And the worst option of all would be to allow CAM advocates themselves to do the familiarisation. That is obvious since they are either incapable or unwilling to be honest about the evidence. They simply say the usual rules don't apply to our sort of magic. That, in my view, is not so much 'familiarisation' as advertising. Notice the direct contradiction between Ernst and McIntyre about the evidence for the efficacy of herbal medicines. Note too, that McIntyre is a herbalist who makes his living from it, and that Ernst is a academic without vested interests and who is devoted to honest assessment of evidence, wherever that leads.As Day says, the Pittilo report raises more problems than it solves. Let's hope a more sensible solution prevails. Competing interests: None declared |
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