{"id":35539,"date":"2015-10-26T15:56:16","date_gmt":"2015-10-26T14:56:16","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=35539"},"modified":"2015-10-26T15:56:16","modified_gmt":"2015-10-26T14:56:16","slug":"william-cayley-neither-complementary-nor-conventional","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2015\/10\/26\/william-cayley-neither-complementary-nor-conventional\/","title":{"rendered":"William Cayley: Neither complementary nor conventional"},"content":{"rendered":"

\"bill_cayley_2\"<\/a>I appreciate Timothy Caulfield\u2019s exploration of<\/a> the \u201cstraw men\u201d set up in many a discussion over integrative, complementary, or alternative medicines (CAM for short). However, I think we need to take the argument one step further. As he makes clear, many of the arguments proposed by \u201cCAM-ers\u201d against \u201cconventional\u201d medicine also apply to and undercut the claims to validity of CAM. This comes through most clearly anytime one hears in conversation the question: \u201cDo you believe in . . . oils, herbs, meditation, etc.?\u201d<\/p>\n

If the question is one of \u201cbelief\u201d\u2014whether in CAM, or the (dubious) wonders of what \u201cBig Pharma\u201d has to offer, or the necessity of a \u201cmedical approach\u201d (for example, the opinion that a test tells us more than history taking or examination)\u2014then one truly is talking in religious terms and not the terms that should be used to define inquiry and healing in modern healthcare.<\/p>\n

When I teach learners about evidence based medicine (EBM), I start first with some epistemological categorization of the approaches to making decisions (this is from my very brief online intro to EBM<\/a>:
\n\u2022 Some decisions are guided by dogma or an \u201ca priori\u201d set of beliefs (for example, \u201cnatural is best\u201d).
\n\u2022 Some decisions are guided by tradition (for example, \u201cwe\u2019ve always done it that way\u201d), relying on the collective wisdom of the ages.
\n\u2022 Some decisions are guided by convention (for example, \u201ceveryone else does it that way\u201d), relying on the collective wisdom of colleagues.
\n\u2022 An evidence based approach makes decisions based on critical evaluation and reflection (for example, \u201cthe evidence supports doing it this way\u201d).<\/p>\n

In fact, the advocacy for \u201cbelief\u201d in CAM and<\/em> the arguments for \u201cstandard\u201d or \u201cscientific\u201d (what is usually implied here is \u201ctechnology or drug based\u201d) medicine are instances of \u201cdogma based\u201d medicine.<\/p>\n

While I think there is certainly a place for \u201ctradition\u201d (the wisdom of the ages can at least be informative) and for \u201cconvention\u201d (after all, there is some measure of reassurance from sticking with the crowd to a point), in the 21st century we need to shift the conversation to focus on the evidence.<\/p>\n

Granted, there are technical, methodological, and (unfortunately, as shown by recurrent stories of data fabrication) ethical issues in producing the best evidence. Nevertheless, we need to focus our inquiry and discussion on what the best evidence is for how we may help our patients live longer and better.<\/p>\n

For example:
\n\u2022 Does tea tree oil work for nail fungus? Rather than argue about whether or not to \u201cbelieve\u201d in it, a quick search of TRIP shows there have been a grand total of two controlled trials<\/a> addressing the question, one showing it may work comparably well to clotrimazole<\/a>, and the other showing butenafine hydrochloride plus tea tree oil may work better than placebo<\/a> (and what I find disappointing here is the lack of more recent research to explore the question further).
\n\u2022 What is better for a cold:\u00a0conventional medicine or honey? It turns out there is evidence that for children with night time cough and difficulties sleeping<\/a> due to an upper respiratory infection (URI), honey may be the preferred treatment rather than dextromethorphan.
\n\u2022 Do all hand lacerations need sutures? Not necessarily, and in some cases avoiding suturing may be better<\/a>!<\/p>\n

Granted,\u00a0these may be rather simple clinical situations (and admittedly, I picked three of my favorite illustrations). Nonetheless, they are situations that demonstrate evidence of better effectiveness with what could be considered a \u201cCAM\u201d approach, but the point is not \u201cCAM\u201d or \u201cconventional,\u201d rather the point is about what the evidence says.<\/p>\n

Do I \u201cbelieve\u201d in \u201cCAM?\u201d No. Do I \u201cbelieve\u201d in \u201cconventional medicine\u201d\u2014not necessarily that either. What I \u201cbelieve\u201d (my dogma) is that as physicians in the 21st century, it is our collective ethical obligation as healers to seek for, to understand, and to implement the best evidence for what helps our patients live longer and better lives.<\/p>\n

William E Cayley Jr<\/strong>\u00a0practices\u00a0at the Augusta Family Medicine Clinic; teaches at the Eau Claire Family Medicine Residency; and is a professor at the University of Wisconsin, Department of Family Medicine.<\/em><\/p>\n

Competing interests:<\/strong>\u00a0I declare that I have read and understood BMJ policy on declaration of interests. I am the author of the open access web resources \u201cLess is More<\/a>\u201d (an index of medical literature documenting when \u201cless is more\u201d) and \u201cEvidence for the point of care<\/a>,\u201d but otherwise I have no relevant interests to declare.<\/p>\n","protected":false},"excerpt":{"rendered":"

I appreciate Timothy Caulfield\u2019s exploration of the \u201cstraw men\u201d set up in many a discussion over integrative, complementary, or alternative medicines (CAM for short). However, I think we need to […]<\/p>\n

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