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The Forum > Article Comments > Integration or bust > Comments

Integration or bust : Comments

By Susan McDonald, published 21/3/2006

If a therapy is effective does it matter if it is unorthodox?

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"CAM therapies by their nature can be difficult to test with random clinical trials."

Why? If something works and has a chemical effect on the body (not just a placebo), there should be empirical evidence for it, which is what random clinical trials are for. Proponents of CAM often seem to want us to believe their therapies work because they say so, and any questioning of that makes you spiritually shallow and narrow minded. I am extremely open minded, all I need to believe you is credible evidence. Anecdotes about bad GPs don't count. Complaining about funding is a furphy too, medical research money is stretched thin across the board and yet testing still manages to be done and results reached. "Natural" remedies are a billion dollar business too, its not just big pharma making alot of money. The fact is, most of the treatments which come under the alternative label have been tested, repeatedly. And they repeatedly fail. Not because of some mystical element that makes them unsuitable for proper testing but because they just don't work, except perhaps as a placebo.

The defintition of "alternative therapy" is so broad in this article. Walking is an "alternative therapy" now? Despite the author's father's bad experience I really can't imagine most doctors advising against exercise. If they do, you really need a new doctor.

Dr Cohen's AIMA represents not only reasonably well established or borderline therapies like yoga, various massage techniques or acupuncture but practitioners of undoubted quackery -- and yes the word is completely appropriate in these cases -- of chelation, homeopathy, reflexology etc Proponents of CAM should be more discrimintaing, fight for the good stuff by all means but be honest about the junk. This is one way the industry can improve its credibility.

I agree though that we should do whatever works, and that includes investigating all treatments. See the story of Nobel Prize winners Barry Marshall and Robin Warren, yes the medical establishment resists change (as do we all) but actually come up with real evidence and even the nasty old medical establishment will follow.
Posted by AmandaR, Tuesday, 21 March 2006 10:14:08 AM
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I have no problem with trying "alternative" remedies, however I believe that it is a long road to achieving an official endorsement of such from the medical profession. Utilisation of nursing staff seems a useful, less costly and less time consuming solution in the interim (and indeed in the long term).

I'm reminded of my experience during my two pregnancies. I went the public hospital route for both. During my check ups, I would attend the obstetric clinic and would be speedily dealt with by the nurses/midwives on duty. They would weigh me, take my blood pressure, listen to my baby's heartbeat, talk to me about any problems I was having, advise on diet, etc. I would then have to go back to a waiting room where I could be sitting tapping my foot for up to two hours before I was again invited into another examination room. A hospital obstetrician would race into the room, go over the nurse's notes and tell me all was well in two minutes. As long as a doctor saw me, the hospital could claim a larger fee.

What a shame the medical profession continues to undervalue the role of our nurses in the community for the sake of money.
Posted by bell, Tuesday, 21 March 2006 10:30:39 AM
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Susan,

Thanks for your article. I agree that "alternative therapies" as they are outlined in this article have proven effective for thousands of people in this country.

It is, however, not universally true that alternative therapies are cheaper than medical care, at least to the consumer. While I don't think it's better for anyone's health, there's no denying that seeing a doctor for a pain-killer prescription is going to remain the preferred alternative for some one who simply can't afford ongoing remedial massage to fix an aching back. It's not my preferred path, but it is the choice (considered or not) of many people. Whatever work we can do to change this would be greatly appreciated, and some of that is about raising awareness.

Likewise, access to a range of treatments will always be an issue for anyone who lives outside a metropolitan area unless governments require those working in the regional/rural health system to reskill in complementary therapies, because private providers cannot yet feasibly operate in all areas. While lack of access remains true of some conventional therapies (e.g. chemotherapy) it is doubly so for alternative therapies.

Lack of aged care, respite care and access to bulk-billing GPs are an enormous problem putting huge strain on the hospital system and, as you point out, this will only increase with an ageing population. There are many potential low-cost solutions to the health-care crisis, but they require an integrated response from all sectors which intersect with health care provision.

Additionally, our responsibility is to take ownership of our health as your father did - to question the treatments being suggested and (as was the buzz of the 70's and 80's) seek a second opinion from another therapy provider - whether "traditional" or "alternative".
Posted by seether, Tuesday, 21 March 2006 10:57:21 AM
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I agree with the concerns in the article - however it is also broader that the perspective expressed. I have a specific interest in the Mental Health field which claims to work within the framework of the bio-psychosocial model. However the psychosocial components are rarely included in the package of service delivery (and funding) - with practitioners emphasising medical (i.e. pharmacutical)treatment. Often psychosocial interevention comes too late, as 'life-skills' training or 'occupational therapy' for individuals who are chronically unwell. While this has merit, the demand on services would decrease if the bigger picture was considered and responded to. e.g. Clinical studies have identified a corelation between poverty and depression - as if we didn't already know that from lived experience.Not just the psychological (and biochemical) impact of continuous financial stress, inadequate / unstable housing, unemployment but also related factor e.g. poor diet, inactive lifestyles etc. - can all contribute to vulnerable people developing depression - and it often becomes a self-perpetuating cycle. So social conditions that create poverty need to be addressed as a measure to prevent the increased prevelance of depression in our population. Nutrition, exercise, personal and community empowerment, clean / non-toxic environments, provision of basic primary health care and many other factors need to be included in the equation - as measures of prevention and early intervention - both for physical and mental health.
Posted by WOMAN4LEE, Tuesday, 21 March 2006 11:11:37 AM
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Hello Susan

As someone who spends a lot of time in general practice may I advise your father to seek another GP if, indeed, his current one genuinely advised him against exercise. Unless there is some serious other condition you haven't mentioned that makes that advice intelligible.

Most GPs are open to alternative therapies and medicine - it just depends what it is. All those I know are happy to hand over treatment to others - nurses or alternative therapists - provided they can believe it will be beneficial to their patient. So, most will refer to nurses, dieticians, OTs, physios etc etc.

What most GPs won't do is refer a patient to a person who thinks that their grand passion for alternative medicine, coupled with 6 months Mickey Mouse study, entitles them to stick a hose up people's bums and flush 'em out. Not only is there no evidence for such alternative medicine but, in that case particularly, the number of perforated bowels is a good argument for regarding some practitioners as dangerous charlatans.

So, while I agree with quite a bit of your article, it's far too undifferentiated. Some alternative therapy is good, some is dubious, some is horrendous and even potentially dangerous. Could we try a debate on what goes under which category and then we can talk to GPs about why they and hospitals don't use alternative practitioners more.

Regards

Kevin
Posted by Kevin, Tuesday, 21 March 2006 11:18:08 AM
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Good post Bell that the real answer a reorg of our health care people. It's time to acknowledge that a good Nurse of a number of years on the job has a lot to offer and can be used to great effect in our hospitals. It strikes me that out here in the bush were there are no doctors a Nurse it just fine but in the city she/he suddenly is not capable. As for the article if someone thinks that putting a crystal on their forehead will do something for them then let them pay for it. After they have found that crystals donít stop bleeding from a severed limb they can come to a real health care worker.
Posted by Kenny, Tuesday, 21 March 2006 12:46:50 PM
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