no such thing as complementary or alternative medicine
There is no such thing as alternative, complementary or orthodox
medicine. The current divisions are arbitrary. There are treatments,
therapies and interventions that have an evidence base and those that do
not. Although I think the BMJ has been drawn into giving credence to
snake oil salesmen, the theme issue did illustrate several points [1].
Firstly, there are side effects for practitioners who claim to practise
alternative/complementary medicine. They are at high risk of suffering
from pomposity, self importance and delusions of grandeur. There was an
Orwellian ‘four legs good, two legs bad’ tone to much of the writing [2].
Traditional healing good, modern medicine bad; oriental medicine good,
western medicine bad; complimentary practitioners caring and holistic,
orthodox doctors (apart from those who had been enlightened [3]) uncaring
and not holistic. Essex’s first inverse law says that the more someone
talks about being holistic, the less they are likely to be so. I can’t
remember the last time one of my colleagues used the phrase ‘holistic’ but
I know from doing joint clinics with them and seeing them practise that
they are holistic, caring and conscientious. They don’t talk about it,
they just do it. Perhaps those who are so ready to criticise and claim
the moral high ground should arrange clinical attachments for themselves
or their students with my colleagues.
Secondly, why is there grievance by some authors that ‘orthodox’ medicine
uses things that they believe are the preserve of
‘alternative/complementary’ medicine? The latter groups do not have a
monopoly on viewing the person as a whole or on certain treatments. For
example, extracts of hypericum perforatum from St John’s wort – which by
the current artificial division is called a herbal remedy – has been found
to help in depression [4]. Ideally the active ingredient will be
elucidated (and toxic impurities removed); licensing trials will be done;
the dosage(s) established; side effects, interactions and long term
effects will be reported; and evidence based guidelines will be produced
for its use. Then the NHS should fund it. There must be accountability
and responsibility by those prescribing it. Currently there appears to be
very little of either by those advocating ‘alternative/complementary’
therapies.
Millions of pounds are wasted annually both within and without the NHS on
interventions which have no proven value and whose effectiveness,
interactions, long term effects, and side effects are not known. The
challenge for purchasers is to ignore the orthodox -
alternative/complementary division, and ask, “Where is the evidence? Show
us the evidence and we’ll fund it; no evidence, no funding.”
Rapid Response:
no such thing as complementary or alternative medicine
There is no such thing as alternative, complementary or orthodox
medicine. The current divisions are arbitrary. There are treatments,
therapies and interventions that have an evidence base and those that do
not. Although I think the BMJ has been drawn into giving credence to
snake oil salesmen, the theme issue did illustrate several points [1].
Firstly, there are side effects for practitioners who claim to practise
alternative/complementary medicine. They are at high risk of suffering
from pomposity, self importance and delusions of grandeur. There was an
Orwellian ‘four legs good, two legs bad’ tone to much of the writing [2].
Traditional healing good, modern medicine bad; oriental medicine good,
western medicine bad; complimentary practitioners caring and holistic,
orthodox doctors (apart from those who had been enlightened [3]) uncaring
and not holistic. Essex’s first inverse law says that the more someone
talks about being holistic, the less they are likely to be so. I can’t
remember the last time one of my colleagues used the phrase ‘holistic’ but
I know from doing joint clinics with them and seeing them practise that
they are holistic, caring and conscientious. They don’t talk about it,
they just do it. Perhaps those who are so ready to criticise and claim
the moral high ground should arrange clinical attachments for themselves
or their students with my colleagues.
Secondly, why is there grievance by some authors that ‘orthodox’ medicine
uses things that they believe are the preserve of
‘alternative/complementary’ medicine? The latter groups do not have a
monopoly on viewing the person as a whole or on certain treatments. For
example, extracts of hypericum perforatum from St John’s wort – which by
the current artificial division is called a herbal remedy – has been found
to help in depression [4]. Ideally the active ingredient will be
elucidated (and toxic impurities removed); licensing trials will be done;
the dosage(s) established; side effects, interactions and long term
effects will be reported; and evidence based guidelines will be produced
for its use. Then the NHS should fund it. There must be accountability
and responsibility by those prescribing it. Currently there appears to be
very little of either by those advocating ‘alternative/complementary’
therapies.
Millions of pounds are wasted annually both within and without the NHS on
interventions which have no proven value and whose effectiveness,
interactions, long term effects, and side effects are not known. The
challenge for purchasers is to ignore the orthodox -
alternative/complementary division, and ask, “Where is the evidence? Show
us the evidence and we’ll fund it; no evidence, no funding.”
Yours sincerely,
Dr Charles Essex
Consultant Neurodevelopmental Paediatrician
Child Development Unit,
Gulson Hospital,
Coventry CV1 2HR.
c.essex@ntlworld.com
no conflict of interest
References
1. Integrated medicine : orthodox meets alternative [theme issue]. BMJ
2000;322: [20 January]
2. Orwell G. Animal Farm. London : Penguin, 1964.
3. Essex C. Patch Adams. BMJ 1999;318:817.
4. Woelk H. Comparison of St John’s wort and imipramine for treating
depression : randomised controlled trial. BMJ 2000;321:536-9.
Competing interests: No competing interests