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“Edzard Ernst…is concerned that the enthusiasm for alternative
medicine may lead to its acceptance within mainstream medicine without
evidence from trials that it is effective…integration should be after
evaluation and not the other way round.” [1]
We should measure this single sentiment against some from others in
this field, as follows:.
“But do the elderly Australians who use acupuncture under Medicare
largely hold postmodern values? Is there a greater proportion of
postmodern thinkers among sufferers of rheumatic or musculoskeletal
disorders or those afflicted with cancer? This would hardly seem the case.
The reasons for selecting CM are inevitably more pragmatic. Too often the
popularity of CM has been dismissed as a sign of rejection of scientific
authority, an expression of new values of natural medicine, or of
increased time and personal attention given by CM practitioners. Too often
these reasons are given to eclipse the more central purpose consumers shop
around for healthcare services.” [2]
“To the scientist, the evidence in support of CM may be weak, but to
the patient the instinctive search for a remedy that brings relief knows
no such intellectual boundaries. This is a search ruled by pragmatism.”
[2]
Readers should also note that the self-citation rate in the
Bensoussan article is 5.5%.
“Cancer patients use alternative therapies despite arguments such as
lack of scientific validity, proven ineffectiveness of some treatments and
reliance on the placebo effect. It may be helpful for Australian doctors
to know the range of alternative therapies used by cancer patients, and to
have an understanding of the reasons why they use such therapies, as this
may cast some light on deficiencies in the current standard of
conventional care.” [3]
Self-citation rate for the Begbie et al article is zero.
“On the one hand, GPs are reacting to social change as "economic
pragmatists", responding to consumers' increasing demand for CAM. On the
other hand, GPs themselves are acting as agents of social change by
acknowledging the limitations of orthodox biomedical treatments and
promoting CAM as part of their service delivery.” [4]
“Lack of scientific validation of CAM has not prevented GPs' use of
such therapies. The phrase "clinical legitimacy" can be seen as a trump
card that overrides "scientific legitimacy". It is the shibboleth of a
postmodern movement among GPs towards healing and the "art" of medicine,
as opposed to the "science" of medicine per se.” [4]
“GPs are using, these therapies because of factors beyond clinical
success -- factors related to globalisation and the characteristics of the
global market.” [4]
“…the elderly, and the chronically ill are not likely to embrace the
naivety of "new age" thought or the jargonistic obscurity of
postmodernism…” [4]
“CAM is effective, particularly in the treatment of chronic
conditions, regardless of the lack of scientific explanation or
validation. [4]
“Data from my research show that GPs acknowledge that, regardless of
the deficit of scientific evidence for how or why, CAM does achieve
clinical results.” [4]
“Market forces aside, a surprising number of the GPs interviewed were
openly critical of their biomedical training and their perceived role in
general practice as "technocrats" rather than "healers".” [4]
“The lack of scientific evidence for CAM does not appear to have
constrained these developments. In fact, my research revealed that GPs
often legitimise their use of CAM -- in addition to citing clinical
legitimacy -- by citing the history and tradition underlying these
treatments.” [4]
“It is of considerable interest that the Australian Therapeutic Goods
Administration has specified two major categories of evidence for
complementary therapies: (1) scientific evidence, and (2) evidence based
on traditional use of a substance or product.” [4]
The self-citation rate for the Eastwood article is 8.7%. The average
self-citation rate for Ernst is in the region of 38%.
Sources
[1] BMJ 1997;315:1111-1116 (1 November), News, Complementary medicine
should be integrated into the NHS, Zosia Kmietowicz,
CAn anyone provide me with information about legislation of the exercise of the
acupuncture (and other alternative medicines) in countries of the European
Community. At the moment, I have references for legislation in Belgium
and England, but I don't know the arrangements for countries like
Germany or France. The legisfrance's website doesn't help.
I would be very grateful if anyone could direct me to websites that provide this information.
Scientific Association of Medical Acupuncturists from
Seville.Website:http://www.acmas.com/
Conflicting views on integration of CAM into the NHS
Sir,
“Edzard Ernst…is concerned that the enthusiasm for alternative
medicine may lead to its acceptance within mainstream medicine without
evidence from trials that it is effective…integration should be after
evaluation and not the other way round.” [1]
We should measure this single sentiment against some from others in
this field, as follows:.
“But do the elderly Australians who use acupuncture under Medicare
largely hold postmodern values? Is there a greater proportion of
postmodern thinkers among sufferers of rheumatic or musculoskeletal
disorders or those afflicted with cancer? This would hardly seem the case.
The reasons for selecting CM are inevitably more pragmatic. Too often the
popularity of CM has been dismissed as a sign of rejection of scientific
authority, an expression of new values of natural medicine, or of
increased time and personal attention given by CM practitioners. Too often
these reasons are given to eclipse the more central purpose consumers shop
around for healthcare services.” [2]
“To the scientist, the evidence in support of CM may be weak, but to
the patient the instinctive search for a remedy that brings relief knows
no such intellectual boundaries. This is a search ruled by pragmatism.”
[2]
Readers should also note that the self-citation rate in the
Bensoussan article is 5.5%.
“Cancer patients use alternative therapies despite arguments such as
lack of scientific validity, proven ineffectiveness of some treatments and
reliance on the placebo effect. It may be helpful for Australian doctors
to know the range of alternative therapies used by cancer patients, and to
have an understanding of the reasons why they use such therapies, as this
may cast some light on deficiencies in the current standard of
conventional care.” [3]
Self-citation rate for the Begbie et al article is zero.
“On the one hand, GPs are reacting to social change as "economic
pragmatists", responding to consumers' increasing demand for CAM. On the
other hand, GPs themselves are acting as agents of social change by
acknowledging the limitations of orthodox biomedical treatments and
promoting CAM as part of their service delivery.” [4]
“Lack of scientific validation of CAM has not prevented GPs' use of
such therapies. The phrase "clinical legitimacy" can be seen as a trump
card that overrides "scientific legitimacy". It is the shibboleth of a
postmodern movement among GPs towards healing and the "art" of medicine,
as opposed to the "science" of medicine per se.” [4]
“GPs are using, these therapies because of factors beyond clinical
success -- factors related to globalisation and the characteristics of the
global market.” [4]
“…the elderly, and the chronically ill are not likely to embrace the
naivety of "new age" thought or the jargonistic obscurity of
postmodernism…” [4]
“CAM is effective, particularly in the treatment of chronic
conditions, regardless of the lack of scientific explanation or
validation. [4]
“Data from my research show that GPs acknowledge that, regardless of
the deficit of scientific evidence for how or why, CAM does achieve
clinical results.” [4]
“Market forces aside, a surprising number of the GPs interviewed were
openly critical of their biomedical training and their perceived role in
general practice as "technocrats" rather than "healers".” [4]
“The lack of scientific evidence for CAM does not appear to have
constrained these developments. In fact, my research revealed that GPs
often legitimise their use of CAM -- in addition to citing clinical
legitimacy -- by citing the history and tradition underlying these
treatments.” [4]
“It is of considerable interest that the Australian Therapeutic Goods
Administration has specified two major categories of evidence for
complementary therapies: (1) scientific evidence, and (2) evidence based
on traditional use of a substance or product.” [4]
The self-citation rate for the Eastwood article is 8.7%. The average
self-citation rate for Ernst is in the region of 38%.
Sources
[1] BMJ 1997;315:1111-1116 (1 November), News, Complementary medicine
should be integrated into the NHS, Zosia Kmietowicz,
http://www.bmj.com/cgi/content/full/315/7116/1111/f
[2] Editorial, Complementary medicine -- where lies its appeal? Alan
Bensoussan, MJA 1999; 170: 247-248
http://www.mja.com.au/public/issues/mar15/bensoussan/bensoussan.html
[3] Patterns of alternative medicine use by cancer patients, Stephen
D Begbie, Zoltan L Kerestes and David R Bell, MJA 1996; 165: 540
http://www.mja.com.au/public/issues/nov18/begbie/begbie.html
[4] Changing Healthcare, Complementary therapies: the appeal to
general practitioners, Heather L Eastwood, MJA 2000; 173: 95-98
http://www.mja.com.au/public/issues/173_02_170700/eastwood/eastwood.html
Competing interests: No competing interests