"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.

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.

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".

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.

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

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 don’t stop bleeding from a severed limb they can come to a real health care worker.

As published in the academic magazine "Dissent some time ago, the problem under discussion here, could relate to Mr Costello stacking too much government cash into the Future Fund, hoping to pile up some sort of creditable political fortune, when both Adam Smith and Maynard Keynes gave warning that a government's first two responsibilities are health and education. Furthermore, both should be mainly financed from government.



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McDonald gives no reference for the alleged "recent, large, randomised controlled trial". She may be referring to http://www.aafp.org/afp/20030115/339.pdf , although that is a survey, not report of a "large" trial. There is more at http://www.hopkins-arthritis.som.jhmi.edu/mngmnt/cam.html The fact that glucosamine is "natural" is irrelevant. Arsenic in their well water that is slowly poisoning many Bangladeshis is also "natural".

Complementary and alternative medicine (CAM) is best defined as treatments that cannot be patented by drug companies and so sold at outrageous markups. The classical definition of CAM, therapies outside scientific mainstream medicine, fails to apply to substances like glucosamine, once properly conducted clinical trials have produced evidence of efficacy.

Most CAM treatments are worthless and sometimes dangerous, but this can also be true of some mainstream treatment. Some medical practitioners for example still think that gastric ulcers are caused by stress.

Inability by drug companies to find lucrative markets has worse results than to hamper marginally improved arthritis treatments. From http://seattlepi.nwsource.com/globalhealth/151859_markets10.html on 10/12/03:

QUOTE
One of the leading causes of death and disease in the developing world, according to Bill Gates, is "market failure."

The drug industry has paid scant attention to Third World diseases, largely because preventing them is not as profitable as pills for Western heartburn, stress and erectile dysfunction.

Gates, however, has helped change that market equation by throwing cash at neglected diseases.

Drug makers became a lot more interested in developing a malaria vaccine, for instance, after the Bill & Melinda Gates Foundation donated hundreds of millions to the cause.

Now the foundation is taking aim at another big killer: rotavirus.

"It's the leading cause of life-threatening diarrhea in the world," said Al Kapikian, the National Institutes of Health scientist who discovered the virus in the 1970s and led efforts to find a cure...
END QUOTE

When the market fails, governments should step in. To a limited extent, they do. The [US] National Center for Complementary and Alternative Medicine is one of the National Institutes of Health and is funded in 2006 for $US122.7 million. More about it at http://nccam.nih.gov/about/

The reason things are getting bad is very simple, but sadly glossed over by those that can't see past the chemist. The cause is the problem, nothing else. Until the causes are recognised, things will just get worse and general health will deteriorate for everyone addicted to the current lifestyle and dietary regime.

99% of health problems are related to the types of foods and how we combine and eat them. Until thats accepted, your all in for a bad time health wise with deteriorating bone structures, collapsing organs and obese smelly bodies. Does anyone ever consider what the chemical deodorants and other rubbish that people put on their bodies does to their metabolism, other than clog up the pores of their skin. Shaving all your body hair also contribute by stopping the natural regulation of body temp, cleansing and skin being able to breath

No amount of doctors nurses or facilities can cope with the growing health crisis caused by consuming so many chemicals and rotten dairy laden foods. Why is it that we are told to eat more dairies to make our bones stronger, yet osteoporosis is on the increase as is asthma, heart disease, arthritis, macular degeneration and obesity.

CAM's works if used properly,but like all therapies they effect people differently. All forms of health practitioners make the same mistake and treat everyone the same, whilst everyone is different and what works for one won't work for another. And we must remember that they are all in it for the money, very few do it to help people without payment.

Hen we have the medical and food industries controlled by pharmaceutical companies, what hope is there when these companies provide both the chemicals hat cause e the problems and the chemicals that mask the symptoms. Then they provide the drugs to depress the symptoms and that you have t take for the rest of your life. Considering the majority of people take some form of pharmaceutical everyday, can give you and idea of why physical and mental health is deteriorating at such a rapid rate.

McDonald quotes a common complaint: "There are too many patients, not enough beds..."

There is no evidence that there are insufficient hospital beds to accommodate patients who require them. Due to the dysfunctional split between federal and state funding of health systems, large numbers of hospital beds are occupied by people who would be better off and would cost far less somewhere else.

Because of a shortage of (federally funded) nursing home beds, elderly infirm people are clogging up (state funded) hospital beds.

Furthermore, many patients currently treated in hospital could be as well, or better, treated at home. A small trial as long as seven years ago found that, "Home treatment appears to provide a safe alternative to hospitalisation for selected patients, and may be preferable for some older patients. We found high levels of both patient and carer satisfaction with home treatment", http://www.mja.com.au/public/issues/feb15/caplan/caplan.html

But of course much of the cost of home treatment would be born by (federally funded) Medicare, rather than by the (state funded) hospital system. Furthermore the medical benefit funds are unable to apply hospital insurance cover to expenses incurred outside hospitals.

The present system is structured so as to encourage the most costly and inconvenient possible treatment. Yet all our politicians do is to point fingers at each other. We should be spending less on health, not more, but spending it more intelligently.