Integration or bust

When my father recently suggested to his doctor that he control his blood pressure himself by walking, the doctor said: “I’ll give you a prescription. You won’t have to walk.”

Only one fifth of GPs in Australia offer any form of CAM treatment and often only as a token gesture: so the public goes elsewhere. More than half of us visit a CAM practitioner each year.

Why is there a disconnection between doctors and their patients? Wouldn’t it be better if my father controlled his blood pressure with exercise, or at least with pills and exercise? Walking produces no adverse side effects - in fact it promises a myriad of other health benefits, not the least of which is prevention of other health problems.

The case for resistance is based largely on the perception that CAM is untested. (The irony of now-discredited pharmaceuticals having earlier undergone supposedly rigorous trials that allowed them onto the market is not lost on integration proponents.) But, in fact, there is a growing evidence base, one that has legitimised the use of many (previously dismissed) therapies. And it will only get bigger.

In 1998 the US Congress established the NCCAM (National Centre for Complementary and Alternative Medicine), which is dedicated to exploring CAM in the context of rigorous science.

Still, progress is slow. CAM therapies by their nature can be difficult to test with random clinical trials. And it’s still hard to get funding, particularly when there is a bias against many alternative therapies. In Australia, despite the announcement last year of a new federal government initiative on CAM research, funding is disproportionately small, considering the widespread public use of CAM.

But waiting for evidence may take too long, and there is a case to be made for looking for other ways of getting information, rather than dismissing something out of hand because it hasn’t met the gold standard of a random clinical trial. If there is little potential for a remedy to cause harm, perhaps the standard of evidence required should be less strict.

Many therapies (like my father’s walking) can’t hurt and holding out for proof can mean that we miss out on effective treatments. That recent endorsement of acupuncture wouldn’t have surprised the millions who have been using it “untested” for years.

Proponents of the integrative approach insist they’re not turning their backs on conventional medicine. They don’t want to be sent to a herbalist if they’ve broken their leg. And they admit that some therapies aren’t effective, or safe. But they think it’s myopic to brand CAM in toto as so much quackery. For Cohen, therapies are effective or ineffective, not “orthodox” or “unorthodox”.

Hippocrates said, “Extreme remedies are most appropriate for extreme diseases”. That the crisis facing our health system is serious is something on which everyone seems to agree. The solution may require nothing less than a radical makeover of the way medicine is practiced.