Medical Ethics of Complementary and Alternative Medicine (4)

My view of complementary and alternative medicine is that the practice should be more complementary than alternative. What I mean is that I think that the very best treatment for the patient, if alternative treatment is considered, should be a carefully orchestrated combination of both alternative and conventional standard medicine with practitioners of both disciplines working together. There is no doubt that alternative medicine has something to offer patients. For one example is the attention that the alternative practitioner provides to the patient. There is something important provided to the patient with the “listening to the patient” by the chiropractor and others in alternative medicine or the “laying on of hands” by the chiropractor or those practicing “therapeutic touch.” Medical doctors are often criticized for such deficiencies in terms of their brief history taking and their perfunctory physical examinations.

With regard to the therapeutic benefits of the techniques or substances administered, there is certainly the possibility that they provide a benefit through the so-called “placebo” effect. This effect would not involve a direct physical or pharmacologic action but produce benefit indirectly through unknown or psychologic or behavioral mechanisms. Direct benefits must be proven by research studies.

What are the ethical implications of alternative medicine as integrated into conventional medicine? I agree with much of the concerns and conclusions written in the articles of the previous two postings. With regard to establishing a benefit beyond a placebo effect, many of the techniques or substances could be subjected to controlled studies with care taken to provide the same informed consent and protection to the subjects as research studies done in conventional medicine. When alternative medicine is used with conventional medical treatment, the orchestration mentioned above should include care that the patient is not harmed or burdened by either method, that the interference of the methods be minimized and that the patient should be informed about the all the risks and known benefits. There will be cases where conventional medicine has reached a dead end in terms of specific therapy for the illness. This is where conventional medicine must reach out with comfort care to the patient and not simply abandon the patient to alternative medicine. The medical doctor should not extinguish the little flame of “hope” which the patient holds but still be realistic in talking to the patient and support the patient if the patient wishes to try alternative medicine as long as this is part of a program of comfort care for which the medical doctor is managing.

As you see,in this posting,I am supporting the view of the patient always engaging in complementary medicine rather than going out and obtaining alternative medicine on their own. My rationale is that diseases are based on anatomical,physiologic,psychologic,biologic,pharmacologic,biochemical and physical principles and the practitioners who have the best education for treating diseases are the medical doctors (or modern osteopaths)and therefore they should never remain outside the care of the patient.You may hold a different view and I certainly would like to hear from you. Please write your comments on this subject. ..Maurice.