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The BMJ Today: Debates about alternative medicine and cancer screening

31 Mar, 14 | by BMJ

People love complementary and alternative therapies, and vote with their wallets to spend close to £5 billion a year in the UK alone on treatments such as massage, relaxation, evening primrose oil, and reflexology. Doctors may be more or less comfortable with these therapeutic choices, but we should all be trained to deal with them argues Graeme Catto in a new Head to Head that asks “Should medical students be taught alternative medicine?

Medical students should be given the full picture, not a cropped snap shot of the minority of practice that is evidence based, he writes. Some complementary therapies work. Others are positively harmful. But millions of people use them. To ignore their choices when training doctors would be a mistake, and a serious risk to fully informed doctor patient relations.

Nick Cork and Gareth Williams disagree. Complementary therapies have crept into undergraduate curricula without proper oversight, they write. The General Medical Council, guardians of good training and practice in the UK, seem conflicted on the issue and send mixed messages to doctors, medical students, and educators.  These authors want the curriculum reviewed and if necessary overhauled to remove teaching on treatments that are “seductive yet utterly devoid of scientific merit.” What do you think? Add your voice to the debate with a rapid response here. David Colquhoun has already weighed in with an uncompromising (and popular) thumbs down to Graeme Catto’s arguments here.

Discussions about screening for prostate cancer can be equally polarized, and opposing sides will only converge when men and their doctors have more precise information about who is likely to benefit from a prostate specific antigen test, and who is likely to be harmed. A large study from Sweden takes us one step closer by considering what happens to men with different serum concentrations of PSA when screened at 60. Men with a PSA concentrations of at least 2ng/ml benefitted most from further testing, which was associated with a substantial drop in mortality from prostate cancer. Men with a concentration below 1 benefitted least and the authors recommend no further screening for this group. Men in between, they say, should discuss the balance of benefits and risks with their doctor before making a decision. Easier said than done, according to L Sam Lewis, a rapid responder, who asks for more information on harms data including unnecessary biopsies and surgery.

In other new rapid responses, Trevor Rogers, makes a similar point about screening for lung cancer with low dose computed tomography. Overdiagnosis and overtreatment is a possibility here too, and he suggests we shift our attention from population screening to smarter detection and treatment of symptomatic disease. He also warns of the dangers of extrapolating from the US (where screening smokers and ex smokers may cut deaths from lung cancer) to Europe (where it probably doesn’t).

In the news, the tide may finally be turning in favour of US health reforms. The proportion of people polling in favour rose for the first time last week and almost half of respondents (49%) now want the Affordable Care Act to stay in one form or another. Preferably another—just 10% were happy with the act as it stands.

Alison Tonks is an associate editor, BMJ.

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