Guest column: Complementary and alternative medicine — what’s the alternative?
In end-of-life care, a large percentage of cancer patients use some form of complementary and alternative medicine. Studies also have shown that almost half of all hospice care centers in the country offer complementary and alternative therapies and have a provider on staff, under contract or both. Alternative medicine refers to treatment that is used instead of conventional medicine, while complementary therapies are used in addition to regular medical treatments. Many patients who choose alternative medicine over the care of a general practitioner are likely to do so because they have had bad experiences with traditional medical practitioners. Those who use complementary therapies in addition to what their doctors order often don’t tell their doctors about their supplementary treatments, which can cause complications in their treatment.
The idea of complementary and alternative medicine speaks more to the formation of a medical orthodoxy than it does the variety of medical philosophies that exist for the purpose of treating patients. While orthodoxy provides standards and guidance for proper practice and affords its adherents (as well as those they are meant to serve) reassurance that those standards are followed, the monopoly that orthodoxy demands prohibits other voices and beliefs from contributing to the free market of ideas. This, at times, is a good thing, such as when regulation of health and safety must take priority over a plethora of bad choices. It is not, however, beneficial when exclusion detracts from the goals of the orthodoxy itself.
The past two centuries of American medical-practice history have been marked by the redefining of what constitutes complementary and alternative medicine and what makes the cut as orthodox. In the early 19th century, there was no such thing as complementary and alternative medicine; similarly, allopathic medicine (and the American Medical Association) did not have the professional authority it has today. Allopathy was not even the dominant school of thought; it competed with many other philosophies of medicine and healing.
As the American Medical Association grew in dominance, it also incorporated some of its rivals. For example, the AMA labeled osteopathic medicine a cult, and osteopaths were seen as “cultist.” The AMA code of ethics declared it unethical for a medical physician to associate voluntarily with an osteopath. Yet, today, osteopathic physicians can join the AMA and have full practice rights as medical doctors in all 50 states. On the other hand, though it shares the belief with osteopathic medicine and with physical therapy that manual manipulation is in fact a form of treatment, chiropractic medicine is nevertheless still considered a form of alternative medicine.
Today, many patients who use complementary and alternative medicine do not care about the philosophy of treatment; they just want the treatment to work. In the era of patient autonomy, this is a positive development. The difficulty arises, however, when the patient’s choice and the definition of treatment — regardless of its efficacy — do not align. A 1996 U.S. District Court ruling defined “experimental treatment” as “those procedures and/or treatments which are not generally accepted by the medical community.” Disapproval, however, may not be based on evidence but rather on orthodox medicine’s interest in incorporating the treatment or not. If it doesn’t, for whatever motivation — whether ideological, financial or other — many health insurers will decline coverage simply because there is not enough evidence of success to warrant deeming the particular treatment as medically necessary. I am not advising that every alternative remedy be considered sound medicine, but what should be considered is that the development of medicine be for the sake of the patient and not the profession. Patients should be able to trust their doctors to give sound advice so that they do not feel the need to seek alternatives without the knowledge and/or encouragement of their physicians.
Ira Bedzow is the director of biomedical ethics and humanities at New York Medical College and senior scholar at the Aspen Center for Social Values. Join him and top scholars July 20 for “When Life Nears Death: A Conversation of Medical & Social Values” from 5:30 to 7 p.m. at 435 W. Main St. in Aspen. The event is open to the public.
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