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

Given the high prevalence of burdensome symptoms in palliative care (PC) and the increasing use of so-called alternative medicine (SCAM) therapies, research is needed to determine how often and what types of SCAM therapies providers recommend to manage symptoms in PC.

This survey documented recommendation rates of SCAM for target symptoms and assessed if, SCAM use varies by provider characteristics. The investigators conducted US nationwide surveys of MDs, DOs, physician assistants, and nurse practitioners working in PC.

Participants (N = 404) were mostly female (71.3%), MDs/DOs (74.9%), and cared for adults (90.4%). Providers recommended SCAM an average of 6.8 times per month (95% CI: 6.0-7.6) and used an average of 5.1 (95% CI: 4.9-5.3) out of 10 listed SCAM modalities. Respondents recommended mostly:

  • mind-body medicines (e.g., meditation, biofeedback),
  • massage,
  • acupuncture/acupressure.

The most targeted symptoms included:

  • pain,
  • anxiety,
  • mood disturbances,
  • distress.

Recommendation frequencies for specific modality-for-symptom combinations ranged from little use (e.g. aromatherapy for constipation) to occasional use (e.g. mind-body interventions for psychiatric symptoms). Finally, recommendation rates increased as a function of pediatric practice, noninpatient practice setting, provider age, and proportion of effort spent delivering palliative care.

The authors concluded that to the best of our knowledge, this is the first national survey to characterize PC providers’ SCAM recommendation behaviors and assess specific therapies and common target symptoms. Providers recommended a broad range of SCAM but do so less frequently than patients report using SCAM. These findings should be of interest to any provider caring for patients with serious illness.

Initially, one might feel encouraged by these data. Mind-body therapies are indeed supported by reasonably sound evidence for the symptoms listed. The evidence is, however, not convincing for many other forms of SCAM, in particular massage or acupuncture/acupressure. So encouragement is quickly followed by disappointment.

Some people might say that in PC one must not insist on good evidence: if the patient wants it, why not? But the point is that there are several forms of SCAMs that are backed by good evidence for use in PC. So, why not follow the evidence and use those? It seems to me that it is not in the patients’ best interest to disregard the evidence in medicine – and this, of course, includes PC.

6 Responses to Use of so-called alternative medicine (SCAM) in US palliative care. Is it based on sound evidence?

  • to the best of our knowledge, this is the first national survey to characterize PC providers’ SCAM recommendation behaviors and assess specific therapies and common target symptoms. Providers recommended a broad range of SCAM but do so less frequently than patients report using SCAM. These findings should be of interest to any provider caring for patients with serious illness.

    That’s a misquote. They actually used the acronym CIM, not SCAM, and their usage should be respected when quoting them.
    By the same token, people when quoting you should quote you correctly as calling it SCAM, and not calling it “alternative medicine” or another complimentary label.

    • you are right, but I refuse to use silly words like ‘complementary and integrative medicine (CIM)’ and I expect my readers to understand this.

      • People can understand that you are quoting someone and it doesn’t represent your own views.
        Also, it sounds like some of it actually is helpful, like the mind-body therapies that you say actually have good evidence. Those could be fairly described as complementary, not scams.
        And the excessive deference towards alt-med involved in using those polite acronyms is something notable in itself.

      • If you’re paraphrasing, you use your own words, but if you’re quoting you have to use the exact words of the person you are quoting. If they’re using incorrect terminology, put [sic] after it. For example, “this is the first national survey to characterize PC providers’ CIM [sic, referring to SCAM] recommendation behaviors.”
        Since Dr Ernst used italics rather than quotation marks, perhaps it was intended to be a paraphrase?
        http://www.differencebetween.net/language/words-language/difference-between-quoting-and-paraphrasing/

  • This

    to the best of our knowledge, this is the first national survey to characterize PC providers’ CIM recommendation behaviors and assess specific therapies and common target symptoms. Providers recommended a broad range of [so-called] CIM but do so less frequently than patients report using [so-called] CIM. These findings should be of interest to any provider caring for patients with serious illness.

    would get the point across, that the authors are being untruthfully complimentary.

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