The 1991 formation of the Office of Alternative Medicine (OAM) as a department the National Institutes of Health (NIH) marked the beginning of the systematic use of unestablished medical practices by physicians. At the time, ‘alternative’ referred to practices outside of established western medical practice, including the use of natural(herbal) products, chiropractic manipulation, special diets, homeopathy, and massage. In 1998, the office was renamed NCCAM (National Center for Complementary and Alternative Medicine), and by the year 2010 it had a budget of $128.8 million1. The addition of the word ‘Complementary’ highlighted the movement towards combining allopathic practices with alternative methods.
While CAM therapies may appear to many as the a pure and natural form of medicine, these methods instead have many inherent ethical and practical dilemmas. Since the origin of western medical practices, physicians have been bound by the Hippocratic oath, which states that no harm must be done to the patient and that the most efficient therapies must be provided. The increased accessibility of evidence-based treatment provides physicians with insight into new, novel therapies. However, in evaluating the risk of these procedures, the quality and amount of research must be taken into account. It is here that ethical issues with complementary and alternative (CAM) medicine begin. Given the scarcity of literature on CAM therapies, clinicians must use their best judgment on determining which therapies are unlikely to be of harm and which ones may be beneficial2. A CAM therapy that is neither harmful nor effective can be detrimental if it precludes the patient receiving effective, conventional treatment.
Additionally, simply conducting further research on CAM therapies poses intrinsic ethical issues. Informed consent documents require patients be accurately informed as to the potential risks and benefits of any treatment. However, CAM therapies frequently lack any tests on systematic safety and are instead verified by personal accounts3. As a result, the patient often lacks the full perspective of the potential risks with the treatment. Furthermore, CAM therapies often have a misconception that, because they are natural, they are inherently safe. This misconception encourages participation in the study without having a clear understanding of the dangers associated with involvement4.
A 2008 report by the US Department of Health and Human Services found that 40% of adult Americans and 12% of children use CAM therapies. With all these apparent complications in CAM therapies, why is there such a high usage of these procedures? A study conducted by JA Astin found the primary reason for its high usage is because these health care alternatives tend to be more congruent with the patient’s own values, beliefs, and philosophical orientations toward health and life5. At the end of the day, it is the patient’s decision what treatment they would like to receive. For this reason, completely curtailing the use of alternative medicine is unrealistic and would result in a negative public reaction.
However, unless rigorous research has supported the use of unconventional, alternative practices, physicians should only resort to these unconventional procedures when it is either complementary to conventional practices or mandated by the patients. While many may conflict with this approach, it is important to understand the practical and ethical dilemmas that alternative medical treatments incur. Practically, the use of botanical extracts contradicts the pharmaceutical paradigm of a single molecule derived in its pure form. Additionally, studies of these treatments are frequently very difficult to conduct as they rarely can be applied to different groups of people.
Ethically, utilizing practices that have not been consistently tested in research literature can be detrimental to the patient. Often times, patients are unaware of the realities of CAM therapies and assume the best because of their natural roots. This causes increased participation in medical studies that can have extremely adverse impacts.
The use of CAM therapies is rising in the United States, for both positive and negative reasons. What often gets misconstrued about these procedures is how limited the understanding is of their actual effects on the body. If used in place of conventional medical practices, the patient may be receiving treatment that poses a lesser benefit than conventional methods, essentially reducing the desired effect of medicine.
References:
1 “Complementary, Alternative, or Integrative Health: What’s in a Name?” June 28, 2016. Accessed October 23, 2016. https://nccih.nih.gov/health/integrative-health#types.
2 Adams, Lizbeth A, CIP Director, Office of Research Integrity, Bastyr, Cases contributed, and Kelly A Edwards. “Complementary Medicine: Ethical Topic in Medicine.” October 2, 2014. Accessed October 23, 2016. https://depts.washington.edu/bioethx/topics/compl.html
3 Sugarman, Jeremy. “Informed Consent, Shared Decision-Making, and Complementary and Alternative Medicine.” The Journal of Law, Medicine & Ethics 31, no. 2 (June 2003): 247–50. doi:10.1111/j.1748-720x.2003.tb00085.x.
4 Complementary and Alternative Medicine in the United States. Washington, DC: National Academies Press, 2005.
5 Astin, John A. “Why Patients Use Alternative Medicine.” JAMA 279, no. 19 (May 20, 1998): 1548–53. doi:10.1001/jama.279.19.1548.