Doctors are too trusting of alternative medicine

A recent paper in PLOS ONE (a journal published by the Public Library of Science) raises some interesting questions about the public's use of complementary and alternative medicine (CAM). Paul Stoneman and his colleagues found that about one third of the UK public appears to espouse conventional medicine while rejecting CAM in general and the efficacy of homeopathy in particular.

However, they found that a much larger group expressed a high degree of confidence and trust in mainstream medicine while at the same time using CAM and expressing belief in the efficacy of homeopathy. They point out that this challenges the rather simplistic view that CAM supporters are necessarily anti-science and rejecting of modern medicine.

They found that this second group had lower levels of understanding of science and were less likely to have a scientific qualification. They speculate that this may result in this group being more easily persuaded by the anecdotal and selective evidence put forward in support of CAM.

Paul Posadzki and his colleagues, in the journal Clinical Medicine, published two systematic reviews of surveys looking at the prevalence of CAM use among patients/consumers and among physicians in the UK.

With regard to the patient/consumer data they point out that while many surveys had been conducted, the methodological quality of most was very poor.

Across studies in general, average one-year prevalence of CAM was 41 per cent while average lifetime prevalence was 52 per cent. In the better designed surveys these figures were 26 per cent and 44 per cent respectively.

For the review relating to physicians, use of CAM was defined as provision of any type of access to CAM, including recommendations, referrals, provision of treatment or self-administration. The estimates of this kind of use from the studies considered are surprisingly high.

On average, CAM was recommended by 46 per cent of physicians (range 38-55 per cent). Worryingly, a high number of adverse effects were reported, particularly with spinal manipulation. In one study 38 per cent of physicians reported such consequences. Again there were problems with quality in many of the surveys.

Posadzki and his colleagues point out the ethical concerns that arise with doctors prescribing CAM therapies for which the evidence of efficacy is “far from strong”, when the duty of care implies that patients should be treated with the optimal treatment for their particular condition. They also note that only 10 per cent of doctors had any training in CAM.

Training doctors
This latter point raises another issue: CAM courses in third-level colleges. Given the lack of supportive evidence for the majority of CAM therapies, such "training" should point out these evidential limitations along with the often esoteric and questionable theoretical bases for systems included in CAM. The primary function of courses in CAM should be to enable the doctor to engage meaningfully with patients who use CAM and to caution them where necessary.

Unfortunately, in cases where CAM methods are taught in some third-level colleges it seems they are taken seriously and professionals are being equipped to practise or promote them. A brochure for the NUI Galway School of Medicine lists Understanding Complementary Medicine as a special study module. It may be that this is of the critical kind that I suggest, but a quote included from a student makes me wonder: “You get to choose modules such as Sports Psychology, Alternative Medicine, teaching CPR to school kids . . .”

A brochure from the School of Pharmacy at Queen’s University Belfast is far clearer and thus of greater concern. Their module on Complementary and Alternative Medicine “will develop the student’s ability to prescribe complementary and alternative medicines appropriately”.

How does one appropriately prescribe “medicines” that have not been shown to work, or have been shown not to work? Does this constitute an education in science?

This whole area is in need of major re-evaluation and clarification. While it is clear there is minimal evidence to support any common CAM therapies beyond placebo, we do not fully understand the complex range of variables involved in the use of CAM by a large proportion of the population. The messages coming from the medical and pharmaceutical professions are contradictory and add to the confusion.

Paul O'Donoghue is a clinical psychologist and founder member of the Irish Skeptics Society. contact@irishskeptics.org