Complementary and Alternative Medicine
By Guest Blogger Rachel McNamara
This is a topic I’ve wanted to write about for a very long time now. But it is such a delicate topic that I have been too afraid to attempt it until now. It’s not politics, it’s not religion and it’s not even football.
Everyone does it these days. Everyone talks about it. No, it’s not sex and most of you will now be very disappointed; some of you relieved. It is Complementary and Alternative Medicine (CAM). Well, that was an anti-climax and it can hardly even be called ‘alternative’ anymore now because it is so common it seems to have become therapeutic norm.
What is CAM?
CAM includes: naturopathy, chiropractic, aromatherapy, homeopathy, reflexology and Chinese herbal medicine among many others.
The National Center for Complementary and Alternative Medicine (NCCAM) defines CAM as a group of diverse medical and health care interventions, practices, products, or disciplines that are not generally considered part of conventional medicine.
When I was young I was fascinated about the story of travelling ‘snake oil’ salesman. Apparently, in the 19th century there existed a popular product based on snake oil that fraudulent salesmen promoted and sold as a ‘cure all’ to vulnerable audiences. They moved from one township to another quickly enough to avoid any unsatisfied customers. I wondered how anyone could become so easily convinced to buy such products and naïvely assumed that people would be too aware to be fooled by that sort of thing now. I was wrong. The snake oil salesman has evolved with us and adapted his products, terminology and his sales techniques. He is alive and well in the guise of some CAM practitioners.
Many years ago, I completed a Bachelor of Science at the University of Melbourne and a Masters of Nutrition and Dietetics at Deakin University, so not surprisingly what concerns me most about CAM practitioners is their nutrition advice. We don’t just have fad diets now but we also have food prejudice.
Certain food groups and nutrients have become the number one enemy. I don’t know what it is about humans but we have an intense desire to pit ourselves against enemies and the person we are most likely to trust is the person who points out our enemies, the snake oil salesman has exploited that. Milk and wheat are two of the most hated foods at the moment. Perhaps ‘gluten’ should have been called ‘slimmen’ and ‘casein and whey’ should have been called ‘healin and lite’.
Do you know how perplexing it is to me that after having completed my five years of tertiary education to become a Dietitian, even my own sisters have made appointments with naturopaths and followed their diet advice to varying degrees?
Friends, family and strangers alike have often recommended certain diets to me or told me the evils of a specific food group, food or nutrient even after or especially after I have disclosed my dietetic background (something I don’t enjoy doing because it only encourages people to promote their own beliefs about food). Beliefs; not facts.
I am not denying that people can have allergies or intolerances to specific foods or nutrients but unfortunately many people who have been told by CAM practitioners they have allergies to certain foods are not allergic to them at all. It is not uncommon for false diagnoses of allergies to be given by CAM practitioners who use unproven allergy tests. High-allergen foods are not intrinsically unhealthy (if you are not allergic or intolerant to them) so restricting their consumption is of no benefit and in some cases may pose nutritional risk.
This is about the point where people feel compelled to write about how their CAM practitioner changed their life, which will only make me feel like banging my head against a brick wall. Why do I feel that way? Because as wonderful as you might feel right now, I can’t help thinking that you have been hoodwinked like so many others and in being hoodwinked an injustice has been done. It’s like the story about the emperor’s new clothes, only I don’t think anyone deserves to be deceived with regard to their health.
Over half of all Australians report using CAM treatments1 and less than half of those who use CAM treatments tell their General Practitioner (GP) about their use of CAM1. Concerns regarding CAM based strategies relate to the fact that they are usually not evidence based even if they claim to have scientific proof and can be used to replace known effective treatments, provide harmful side effects or financial burden for no real positive end result2.
Did you know that if someone gives you a pill, which you believe may be capable of relieving symptoms you are experiencing, it may actually work even if it is made entirely of sugar? It’s true; it’s called the placebo effect.
Besides the placebo effect there are so many statistical and scientific factors that need to be taken into account when evaluating studies in order to be sure that something is in fact doing what it is claimed to do. Not to mention that there needs to be a plausible explanation for it to work.
I no longer practise as a dietitian because I realised pretty quickly that I don’t have good social or sales skills, something that perhaps works in favour of the evolved snake oil salesman. Many people with scientific and academic strengths that have enabled them to be accepted into mainstream health and medical studies and professions have their weaknesses in ‘bedside manner’ or social skills. Meanwhile, the snake oil salesman says all the right things, inspiring you, empowering you and reassuring you that you can escape the ills of western civilisation by following a few simple steps.
I’m sure that some CAM practitioners believe in what they are doing (practitioners can sometimes be fooled just as easily as the consumers) and perhaps some might even admit it is not based on established science but that it is a belief system based on a vitalism* but I doubt any of them says “The only scientific evidence for what I’m about to do is anecdotal evidence, which is probably a reflection of placebo effect, confounding factors and statistics and you should let your GP know about all the supplements I am about to sell you in case it interferes with any of the medications you have been prescribed” because they wouldn’t be practicing for long.
I really think that people need to be making smarter, more informed choices with regard to their health. You only have one body, and making health mistakes by trusting the wrong practitioner can be costly in a physical, psychological and financial sense.
Over a 12 month period in 2004/ 2005 Australian’s spent 1.86 billion dollars on CAM products, 1.73 billion dollars for CAM practitioner visits, and 0.54 billion dollars for other CAM-related items1. No doubt that figure has increased substantially in the past decade.
The best advice I can give is to recommend that you make sure you understand how any particular treatment is meant to work. If a treatment doesn’t make sense, sounds like a fad diet or sounds too good to be true, ask for clarification and evidence of it’s effectiveness and don’t be afraid to do some research on it yourself. Don’t sign up to or pay for anything until you have looked into it further. The following link provides valuable advice on how to be an informed consumer and how to find and evaluate online resources.
It is also important to tell your GP or medical specialist when you are undertaking a CAM treatment because they are not without risks; they may result in harmful or unwanted side effects. If you are interested in a particularly CAM treatment your GP should be able to access and assist you to evaluate information on it also2.
Don’t be afraid to ask your GP about recommendations they have given too, I do. I’ve actually found that most doctors enjoy talking about things in greater detail. Of course, there is always the exception to the rule and that is why getting a second opinion (seeing another doctor or medical specialist for the same issue) is commonly done.
A brief note on CAM and Autism
A very good review article that I came across recommended trying (with proper guidance and/or training) only three out of nineteen commonly used CAM treatments for people with autism after evaluating the scientific evidence available3. For interests sake they were melatonin (for sleep problems in children with autism), multivitamin/ mineral (for those with a limited diet and/or poor appetite) and massage therapy3. Feel free to do further research on these treatments if CAM is of interest to you. Otherwise, there other more conventional approaches to supporting people with autism, some of which are briefly covered on my post on communication and behaviour.
As mentioned previously, it is important to tell your GP or medical specialist when you are undertaking a CAM treatment because they are not without risks; they may result in harmful or unwanted side effects.
*Vitalism (Oxford dictionary): The theory that the origin and phenomena of life are dependent on a force or principle distinct from purely chemical or physical forces. Examples include Reiki and qi.
- Xue, CC. Zhang, AL. Lin, V. Da Costa, C. Story, DF. Complementary and alternative medicine use in Australia: A national population-based survey. The Journal of Alternative and Complementary Medicine 2007; 13(6): 643-650
- Myers, SM and Johnson, CP. Management of children with autism spectrum disorders. Pediatrics 2007; 120: 1162-1182
- Lofthouse, N. Hendren, R. Hurt, E. Arnold, LE. Butter, E. A review of complementary and alternative treatments for autism spectrum disorders. Autism Research and Treatment 2012; doi: 10.1155/2012/870391