MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

In 2017, Medline listed just over 1800 articles on ‘complementary alternative medicine’. If you find this number impressively high, consider that, for ‘surgery’ (a subject that has often been branded as less that active in conducting research), there were almost 18 000 Medline-listed papers.

So, the research activity in CAM is relatively small. Vis a vis the plethora of open questions, this inactivity is perhaps lamentable. What I find much more regrettable, however, is the near total lack of investigations into the ethical issues in CAM. In 2017, there were just 11 articles on Medline on ‘ethics and CAM’ (24393 articles on ‘ethics and surgery’).

One of the 11 papers that tackled the ethics directly and that was (in my opinion) one of the best is this article. Here is its concluding paragraph:

When we encounter patients who use or consider the use of complementary and/or alternative medicine, we should respect their autonomy while also fulfilling our obligations of beneficence and nonmaleficence. Physicians should become more knowledgeable about research on CAM therapies and approach discussions in an open, nonjudgmental manner to enhance patient trust. In situations where there is little risk of harm and the possibility of benefit, supporting a patient in their interest in complementary therapies can strengthen the patient-physician relationship. However, when a patient’s desire to utilize alternative therapies poses a health risk, physicians have the ethical obligation to skillfully counsel the patient toward those therapies that are medically appropriate.

I have had a long-lasting and keen interest in the ethics of CAM which resulted in the publication of many papers. Here is a selection:

Problems with ethical approval and how to fix them: lessons from three trials in rheumatoid arthritis.

‘Complementary & Alternative Medicine’ (CAM): Ethical And Policy Issues.

Pharmacists and homeopathic remedies.

No obligation to report adverse effects in British complementary and alternative medicine: evidence for double standards.

Homeopathy, a “helpful placebo” or an unethical intervention?

Advice offered by practitioners of complementary/ alternative medicine: an important ethical issue.

The ethics of British professional homoeopaths.

Evidence-based practice in British complementary and alternative medicine: double standards?

Ethics of complementary medicine: practical issues.

The ethics of chiropractic.

Reporting of ethical standards: differences between complementary and orthodox medicine journals?

Informed consent: a potential dilemma for complementary medicine.

Ethical problems arising in evidence based complementary and alternative medicine.

Complementary medicine: implications for informed consent in general practice.

Ethics and complementary and alternative medicine.

Research ethics questioned in Qigong study.

Informed consent in complementary and alternative medicine.

The ethics of complementary medicine.

For most of the time conducting this research, I felt that I was almost alone in realising the importance of this topic. And all this time, I was convinced that the subject needed more attention and recognition. Therefore, I teamed up with with the excellent ethicist Kevin Smith from the University of Dundee, and together we spent the best part of 2017 writing about it.

Our book is entitled ‘MORE HARM THAN GOOD? THE MORAL MAZE OF COMPLEMENTARY AND ALTERNATIVE MEDICINE’ and will be published shortly by Springer.

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It is an attempt to highlight some of the most important topics in this broad and under-researched area. While working on it, I was continually struck by the fact that most of the issues we have been struggling with on this blog are, in the final analysis, ethical by nature.

My hope is that, in 2018, we will see many more high quality papers filling the almost total void of ethical perspectives on CAM. In my view, it is unquestionably an area that needs to be addressed with some urgency.

12 Responses to Ethical issues in alternative medicine [we neglect them at our peril]

  • The problem is that this area is largely ignored by the regulators. The GMC fails to enforce the obligation to obtain fully informed consent. The Professional Standards Authority never even asks any registrant for evidence of efficacy. There is simply little incentive to do research into the ethics of CAM.

    • right, that is one of the many ethical problems.

      • Yes, the regulation of of any of these so-called alternative medicines is in the hands of those who practice them so no real regulation at all. Certainly, mainstream doctors and vets should be barred from using any of them until they are shown peer-reviewed evidence confirm efficacy.

  • Dr Kevin Smith who according to the university website has published his recent 4 papers in:
    Bioethics impact 1.75 and the Journal Medical Ethics impact 1.78
    The Lancet impact factor is for comparison 44
    Meanwhile the impact factor for the Journal of Alternative and Complementary Medicine is 1.4- not too far emoved from 1.7!

    Looks like his work is about as accepted as the therapies that he so dislikes.

    • what an idiotic comment!

    • A truly uninformed comment indeed. Whoever JK may be, it* clearly has no blinking idea what it is talking about.

      For those in the audience who might not be familiar with the term “impact factor”, there is a reliable article about it on wikipedia. In the context of JK’s imbecile remark, suffice it to say that

      “…impact factor is a journal metric and should not be used to assess individual researchers or institutions”.

      (Quoted from Wp)

      If JK wants to take part in the discussion it would help if it tried not to use terms without finding out first if it really knows what they mean.

      *I try to avoid guessing at the sex/gender of someone who writes anonymously unless it has been declared or is obvious as in the case of our fizzled out friend “Greg”. In particular when dealing with an incognito idiot, referring to it as “it”, either sex will hopefully not be offended by the allegation that said idiot is a man or a woman as the case might be.
      Also, many of these incognito posters are so called internet trolls and trolls are of course referred to using the pronoun “it” 🙂

      • Hmmm…
        I missed adding an important clarification. In my footnote I am of course not declaring “JK” to be an idiot. This cannot be determined yet. Its ignorant comments may just as well be the result of poor education or other environmental or social factors and not necessarily a sign of inferior intellect.

      • When such pearls make their way into a journal, a higher impact factor would make me more worried, not more confident. And let’s restate that the impact factor is about, well…journal impact!

  • Now remind me what you lot say about CAM articles in low impact CAM journals?

    Björn: That is very kind of you to make that clarification. I was going to call you a complete buffoon but I won’t now. Of course ideally we should always embrace the Golden Rule of Humanism at all times of treating each other with tolerance, kindness and compassion. I am still establishing this fine rule in my life. Therefore at present I am not completely following the Golden Rule at the supreme level of typified by the likes of Alan Henness. So meanwhile you can all continue to go up your arses and bugger off.

    • “… you can all continue to go up your arses and bugger off.”
      I know that our foreign secretary just legitimised such obscenity by calling it ‘caustic wit’, but i still think it’s simply brainless stupidity.

    • @JK

      “Now remind me what you lot say about CAM articles in low impact CAM journals?” From your original comment I figured that’s what you had in mind. The point is that articles which claim to show something truly amazing, as many CAM efforts do, ought to merit publication in high-impact-factor journals. The fact that they all seem to appear in low-impact-factor, specialist CAM journals tells us something about the articles. (How many time have commenters on this blog pointed out that many CAM claims should be worthy of Nobel prizes, yet they curiously don’t even get published in top-rank journals?)

      That situation doesn’t relate to judging people where, as Bjorn Geir already explained, journal impact factors should not be used to judge individuals or institutions. Most scientists publish the bulk of their research in journals specialized to their fields. These tend to have single-digit impact factors, depending on the speciality.

      Your final sentence is really unworthy. You thought you were making a point that put critics of CAM research to shame, but for the reasons above and in other comments on this thread, you’re misunderstanding things. To quote Spencer W. Kimball (a Christian Scientist): “Profanity is the effort of a feeble brain to express itself forcibly.” Or from Kurt Vonnegut: “Profanity and obscenity entitle people who don’t want unpleasant information to close their ears and eyes to you.” On the other hand, maybe your inspiration was more akin to Mark Twain’s: “Under certain circumstances, profanity provides a relief denied even to prayer.”

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