New Zealand Ministerial Advisory Committee on Complementary and Alternative Health (MACCAH) |
Questions
|
Evidence of efficacy and safety is often regarded as a prerequisite for the integration of CAM into mainstream medicine, or for increased public funding of CAM (House of Lords Select Committee 2000; Australian Medical Association 2002). The Select Committee recommends that CAM practitioners who make specific claims about efficacy should be able to back these up with evidence 'above and beyond the placebo effect' (para 4.18), and that this is particularly important where CAM treatments are to receive public funding. [This is absolutely correct, but the devil is in the details -- such as who decides what the evidence means.] It has also been argued that integration should focus on chronic conditions and those for which biomedicine has been unable to fully meet patients' needs (Foundation for Integrated Medicine 1997). [That's a very poor argument because the fact that science-based medicine can't supply all the answers does not mean that "CAM" methods has anything better to offer.]
Evidence of cost-effectiveness is also desirable, but little is currently available. However, some argue that it is occasionally appropriate to develop services in response to need and without conclusive evidence of cost-effectiveness (Peters and Gillam 2001). Examples are counselling and hospice care. [Whether methods are effective is a scientific decision. Whether they are cost-effective is a political decision.]
Question
|
[Evidence of safety and effectiveness should be required before methods can be marketed. Those labeled "CAM" should be required to meet the same standards. How much evidence is required depends on the circumstances. In the United States, for example, the substantiation standard is higher for prescription drugs than for nonprescription drugs.]
The House of Lords Select Committee suggests that there are several approaches to, and models of, successful integration, rather than a single route to be followed in all circumstances (para 9.8). It does, however, identify a basic six-stage pathway for integrating CAM into mainstream general practice, with key questions to be asked at each stage (see Section 1.4, Table 3, page 21). This could be used as a framework for integrating other types of health services.
For examples of different approaches to integration, the Foundation for Integrated Medicine has published a book on good practice in setting up and running integrated health services (Russo 2000). It presents case studies from both primary and secondary care in the UK.
[It is not possible to "integrate" methods that work and methods that don't work.]
Question
|
[No. It falsely assumes that many "CAM" methods are effective and need special promotion. Methods that are effective don't need special promotion.]
It is sometimes suggested there should be common elements in the core undergraduate curriculum of all health practitioners, whether biomedical or CAM (eg, Foundation for Integrated Medicine 1997). Medical schools in New Zealand currently offer no formal study options on complementary medicine, but CAM may be covered to some extent within other modules. Most nursing courses do at least touch on CAM, and more formal education is available at some polytechnics and to nurses training for certain specialties (eg, palliative care). [Methods should receive no special academic consideration simply because they are labeled "CAM."
Many CAM training courses include 'conventional' biomedical subjects such as anatomy and physiology. [Whether this information influences how they eventually practice is another matter. Some "CAM" disciplines advocate concepts that clash with basic scientific knowledge.] However, the depth of coverage varies between modalities and even from course to course within modalities. Chiropractic and osteopathy courses tend to have a particularly strong biomedical component. For example, the double degree in chiropractic currently based at the University of Auckland requires students to complete a bachelor's degree in physiology as part of their studies for a master's degree in chiropractic. [The majority of chiropractors worldwide base their practice on a theory that clashes with basic anatomic and physiologic knowledge.]
Questions
|
[The first part of this question cannot be answered without knowing the quality of what would be taught. The second part would depend on how the information would be used. If used to improve practice, that might be good. In many cases, however, the information would not improve the practice but would merely enable practitioners to market themselves more effectively by stating that they have some medical training.
Integrated services are more likely to succeed in a culture that values both CAM and mainstream practitioners, and encourages tolerance and mutual respect. [I have neither tolerance nor respect for quack practices. The tolerance plea is a pernicious ploy which implies that criticism of quack practices is based on bigotry rather than lack of evidence.] Even when services are not formally integrated, an integrated culture has several advantages. For example, it enables patients who use CAM to be open with their doctor and share important information about any CAM medicines they are taking. [Whether more openness would be good or bad has not been scientifically studied. Openness would be good in situations where a science-based practitioner can warn a patient about adverse effects. However, many situations exist where telling one's doctor would waste everyone's time.]
The Foundation for Integrated Medicine has identified a number of factors that promote an integrated culture (Foundation for Integrated Medicine 1997). These include:
[This falsely assumes that "CAM" practices have a lot to offer.]
Developments overseas suggest that biomedical tolerance and acceptance of CAM is growing. For example, the Australian Medical Association's recent position statement acknowledges the growing popularity of CAM in Australia and recognises that 'evidence based aspects of complementary medicine are part of the repertoire of patient care and may have a role in mainstream medical practice' (Australian Medical Association 2002). [This is a typical example of "politically correct" blather. Popularity is not a measure of effectiveness. In fact, if popularity is measured by sales figures, it is possible that high sales figures reflect promotion rather than satisfaction.]
Question
|
[This falsely assume that it is beneficial for quack methods to be tolerated. Why doesn't the MACCAH ask how a culture could be created where people who engage in false advertising or deceptive health practices can be stopped?]
The New Zealand Health Strategy identifies 13 priority objectives for improving the health of the population (Minister of Health 2000). These are:
It may be appropriate to determine whether greater integration of CAM into mainstream medicine would help to achieve these objectives, and to examine how this could be done. For example, evidence-based CAM treatments could be incorporated into the toolkits developed for some of the 13 priority areas.
[Good nutrition, appropriate physical activity, and weight control are part of mainstream health promotion activities. "CAM" theorists have contributed nothing of value in these areas. Of the remaining ten, I know of no special value of "CAM methods. Worse yet, many "CAM" practitioners oppose fluoridation and vaccination.]
Questions
|
[I don't believe that "integration" will help achieve the New Zealand Health Strategy. Regarding the document, I find it puzzling that the MACCAH asked only about "integration" and did not consider whether consumers need more protection from quackery.]