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Journal of Postgraduate Medicine, Vol. 53, No. 2, April-June, 2007, pp. 85 Expert's Comments Noncompliance with conventional medicine and use of complementary/alternative medicine Ernst E Complementary Medicine, Peninsula Medical School, Universities of Exeter and Plymouth, 25 Victoria Park Road, Exeter EX2 4NT Code Number: jp07033 Complementary/alternative medicine (CAM) stands out from all other areas of medicine in one characteristic: more surveys (about one every 1½ days) are being published than in any other field. Many tell us very little new or worth knowing,[1] but every now and then a grain of wheat emerges from the chaff. In this issue, Jose et al report a survey from India which essentially suggests that noncompliance with conventional medicine could be related to the use of CAM.[2] Noncompliance is a widespread, costly and life-threatening phenomenon.[3] For decades, researchers have, by and large unsuccessfully, tried to determine what causes noncompliance. Jose et al[2] show that CAM use could be an important factor. How could we explain this finding? We know that CAM users tend to be critical about science and the establishment.[4] So this general attitude could also prevent patients from complying with mainstream prescriptions. But there could be more. Practitioners of CAM, as well as books, websites and newspaper articles on CAM have all been implicated in influencing patients such that they distrust conventional medicine.[5] These issues are difficult to investigate and systematic evidence is therefore scarce. The best-researched example by far is immunization. There is good and plenty of evidence to show that some CAM practitioners (e.g., homeopaths, chiropractors, naturopaths and doctors of anthroposophical medicine) advise parents against immunization programs for their children.[6] In this situation, noncompliance represents a risk, not just for the child that might not get vaccinated but to the population as a whole. If non-vaccination happens on a sufficiently large scale, we as a population will lose our herd immunity. In this case, epidemics would return which we had long thought a thing of the past. We know that, in the UK, anti-immunization advice by CAM practitioners is one of the main reasons for children to remain unvaccinated.[7] So, the initially somewhat amazing finding of Jose et al[2] does after all tie in with previous research. Nevertheless, I do think we need independent replication of their data and information from countries other than India. If such studies confirm the original result, we may have an important stone in the puzzle to better understand noncompliance. In any case, we should be vigilant and proactive about CAM use. We should ask our patients whether they consult CAM practitioners and, if so, we should make sure they are properly informed about the risk they may expose themselves to, if they listen to wrong advice. References
Copyright 2007 - Journal of Postgraduate Medicine |
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