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What amuses, annoys, concerns or otherwise interests me – Noodlemaz

Complementary Responsibilities

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I’ve just stumbled upon this article via the Twitters. It’s a blogpost by the Leukaemia and Blood Foundation about some complementary therapy workshops (by @drshaunholt) in New Zealand.

I just want to take some bits from their post and add my own comments as it’s raised an issue in my mind that maybe isn’t condsidered too often in the various ‘communities’ of relevance; medical, skeptical, patient-centred and so on.

Who has responsibility for complementary therapy education?

That’s the question I’ve been pondering, admittedly since about 10 minutes ago so apologies if this isn’t very well-formed.

The therapists?

An obvious candidate would be the provider of said ‘therapy’. However, since we have the unknown quantity of deliberately misleading, fraudulent individuals who are simply out to make money, it would be unwise to rely on this group.

This by no means includes everyone working in the ‘field’ but I think we can safely assume that asking a chiropractor if you should pay them to crack your spine because it hurts will result in a resounding “Yes!” in most (but not all) cases.

The patients?

This is the group that most skeptical activities seem to focus on. Sense About Science, for example, aims to arm the public with the tools to ask the right questions and protect themselves against potentially damaging offers of hope, sometimes where none really exists.

We often talk about the people who read the papers and believe poorly-worded articles. People who forsake validated medical treatments in favour of something their mum’s friend’s brother’s daughter recommended and DEFINITELY WORKED. This is another goal of SAS, to address poor science reporting in the media – also mentioned by Dr. Holt.

We’re keen that fewer people allow themselves to be misled and taken advantage of – and I continue to believe this is an important mission, if one that usually feels somewhat futile. If you know your stuff and can be assertive, you can stand up to a barrage of nonsense and come out of difficult situations largely unscathed, and without lining the pockets of charlatans.

What about healthcare professionals?

Here is a group of people oft ignored in this complementary confusion. Regarding the aforementioned Dr. Holt, the blog states:

Shaun is not afraid to tell it like it is. He has had well-publicised battles with both the chiropractic and homeopathic communities due to the lack of evidence that these treatments are effective in helping cancer patients.

Excellent. We need more of these. The diagnosis of a serious illness has to be one of the most traumatic experiences anyone can go through. Healthcare professionals are the ones to break this news and to offer advice and support as people take it in and make their choices about what to do next.

Having clued-up doctors has to be a priority if we’re to help people make sensible decisions for themselves and their families, that will avoid needless suffering and false-hope chasing.

This doesn’t just apply to cancer but to all manner of debilitating and/or potentially life-threatening illnesses:

It is completely understandable that cancer patients will do anything possible to maximise their quality of life and chances of recovery but it does appear that at times certain complementary therapies can interfere with medical treatment.

One of the most famous cases is probably St John’s Wort, a plant and its derived herbal products well-known for supposed anti-depressant properties. However, its active ingredient is also known to interfere with prescription drugs and if people are taken in by those purporting the benefits of ‘all-natural’ treatment approaches, it can lead to disaster.

Something that pro-CAM people will often argue is that there is a place for complementary therapies and patients should be informed of these and given access to them. This may be true to an extent,

Shaun’s research indicates that around five per cent of complementary therapies have real merit in helping address the symptoms and quality of life of cancer sufferers. These therapies include acupuncture, aromatherapy, meditation, art therapy, yoga, certain herbs and vitamins.

However, it should be made abundantly clear that these things are not alternatives, they are not treatments and they will not cure. As Shaun and the blog report lays out,

What must be stressed however, is that complementary therapies can not cure cancer, and it’s really important that patients do not delay seeking conventional medical treatment which may save their lives!

I would like to see a nomenclature change here; therapy can be be somewhat of a misnomer, since we would also apply this term to effective interventions – chemotherapy for example.

These are therapies in the sense that a cup of tea is therapy. Yes, there can be real, measurable benefits but it’s in a more general sense than the treatment of a specific problem in a known, targeted manner.

No one is suggesting we deny people access to lovely things like massages, foot rubs, mugs of tea, candles and fluffy pillows. God, I love candles – my university peers can attest to this (I filled my gigantic room with them and frequently pissed off my housemates with incense. But they let the kitchen descend into a hazardous-to-health state so much it’s not really possible for me to feel bad about it!).

The point is, while it’s good to support ourselves emotionally in difficult times with these little things that can make a big difference in day-to-day life, medical professionals should be clued-up on the associated dangers of fields that make claims bigger than what they can deliver. They should not be shepherding patients in the direction of ‘therapists’ without full explanations of the reality.

Homeopathy will not fix your RSI. Aromatherapy will not sort out your cataracts. Sure, doctors are largely intelligent individuals who won’t fall for any of this stuff, but an alarming number do not know what homeopathy is (or more importantly, isn’t), let alone be able to explain it clearly to someone who’s under considerable emotional stress and may well know nothing at all except hyped-up anecdotes from concerned friends and relatives.

As pointed out by Simon Singh and Edzard Ernst in Trick or Treatment, healthcare professionals hold a lot of responsibility in the drive to educate people about CAM and perhaps it’s time we teamed up with those who are already doing a fantastic job to spread their knowledge so that more doctors can help their patients with these  decisions more effectively.

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Author: noodlemaz

I prefer to think of myself as a realist rather than a pessimist, but perhaps that's just optimistic. Honest, atheist, scientist, feminist.

2 thoughts on “Complementary Responsibilities

  1. Excellent post!

    We need GPs/PCPs, etc to stop being “shruggies” (as Dr. Steven Novella calls them) and step up to the plate. They have, IMO, a positive duty to be aware of the pitfalls and dangers of the common ‘alternative’ treatments for their patients’ sake. Even something as simple as asking routinely if the patient uses them with a generic warning about possible interactions would be a start!

  2. Another very good post Noodlemaz.

    I particularly liked this comment of yours:

    “I would like to see a nomenclature change here; therapy can be be somewhat of a misnomer, since we would also apply this term to effective interventions – chemotherapy for example.”

    Sellers of ‘alternative’ medical treatments can gain implied legitimacy for their products and services by using terms quasi-medical terms such as “therapy”. I think to get round this misinformation, we need to come back to the “health warning” type of notice that has been used for cigarettes. ‘Complimentary’ medicines, treatments and interventions should be licensed or registered, and all bottles/ notices/ signs should include a phrase clearly stating that:
    “There is currently no reliable, independent evidence indicating that this therapy is effective, other than as a placebo. Consult your GP before your CAM seller.”

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