Revisited: Snake oil

In Dr James Miles’ unreflective volley against complementary and alternative medicine (CAM), entitled “Snake oil revisited: For doctors’ eyes only” (BCMJ 2006;48[1]:20-21), he suggests that the entire world outside pharmaceutical and surgical therapies is “unscientific.” We believe this is not so.

The world has changed since the glory days of reckless pharmaceutical hegemony. Nowadays there is a growing realization that drugs and surgery, while valuable, constitute only one approach to restoring well-being and health. Our patients are undertaking a host of preventive practices as well as using CAM modalities; we need to have a rational grasp of what they are doing. We also need to have a balanced and open mind toward their initiative or they will disclose little; our patients quickly detect a negative ideological or emotional bias on our part.

The world has changed in other ways. Any physician who is up-to-date with the literature will see that there is a considerable volume of high-quality research devoted to CAM supporting its efficacy, safety, and cost-effectiveness. This research has been carried out despite the fact that most CAM treatments are not patentable, leaving, consequently, only modest funding available for such work.

The peer-reviewed Journal of Alternative Medicine even publishes negative trial results—something the orthodox literature, to its shame, has been avoiding like the plague for decades.

Furthermore, there is often a sound therapeutic reason why certain treatments have persisted for 200 (homeopathy) or 2000 (acupuncture) years. The empirical test of time can be a useful yardstick. Almost certainly we will be laughing (and perhaps a bit embarrassed) at many of our current orthodox therapies 10 or 20 years from now.

Whatever Dr Miles may feel, the public—frequently its best-educated members—are choosing CAM in droves; their choices are in fact changing the health system. They seek physicians who support a truly patient-centred approach and who therefore have an understanding of and sympathy toward a wide range of approaches to healing, prevention, and wellness. Many conventionally trained physicians understand this and are taking steps to familiarize themselves with this citizen-driven reality. Exposing our medical students to CAM (and nutrition, exercise physiology, and a host of other preventive matters) provides them with adequate practical knowledge of these practices. Without such knowledge, they will be inadequately prepared for the integrated medicine of the future. Unfortunately, such exposure is increasingly seen as unethical.

Toward its close, Dr Miles’s commentary contains one particular statement that is more striking for what it does not say than for what it does. He writes, “The medical schools should acquaint their students with alternative medicine, but certainly never get into business with them.”

In every major newspaper in the country and in the entire Western world, there are repeated articles and exposés about the unsavory financial interconnections between the pharmaceutical industry and the medical profession. Continuing medical education is almost completely driven by money from the drug industry, which indeed exercises an unseemly influence over physicians’ behavior in almost all spheres of clinical activity, especially in terms of our choices of therapeutic agents.

Perhaps Dr Miles might consider reading former New England Journal of Medicine editor Dr Marcia Angell’s The Truth about the Drug Companies[1] or respected clinician, Dr John Abramson’s Overdosed America.[2] Or he might consider rereading the classic book, The Real Pushers[3] by York University professor and ER physician, Dr Joel Lexchin, published in 1984 but still entirely relevant today.

He might be concerned that the latest National Report Card on Antibiotic Resistance,4 distributed by the Canadian government last month (and, I might add, supported by “an educational grant from Pfizer”), notes sadly that despite a “five-year target to reduce community antibiotic prescriptions by 25%…prescriptions have decreased by only 9%.”4 Moreover, there has been an “increase in the overall rate of antibiotic prescriptions…of almost 3%.”[4]

We suggest that Dr Miles spend some of his well-earned leisure time in critiquing the currently lamentable economic symbiosis between orthodox medicine and the pharmaceutical industry, which far too often results not in the occasional frivolities such as those over which Dr Miles so gleefully expatiates but in serious morbidity and even death (viz, the recent report in The Observer from London of six young men nearly killed in a drug trial at the Northwick Park Hospital). Indeed, critiquing this state of affairs would be a valuable pursuit for any practitioner who uncritically embraces a comfortable inter-relationship with any commercial interests, whether orthodox or complementary, and is unwilling to recognize that such inter-relationships compromise his or her professional judgment in ways that are not always subtle.

The College of Physicians and Surgeons of BC chose Dr Angell as the keynote speaker at its Ethics Conference in March 2006. We think Dr Miles would have found her comments bracing.

If Dr Miles does not wish to represent a very large and rather tarnished pot calling a modest and unpretentious kettle black, then less rhetoric and more balance and calm reason would be a good way to proceed.

—Warren Bell, MD, CM, CCFP
President, Association of Complementary and Integrative Physicians of BC (ACIPBC)
—Carol Douglas MD, FRCP
Vice-President, ACIPBC 
—Steven Kleinman, MD
Secretary-Treasurer, ACIPBC
—Ron Puhky, MD
Past President, ACIPBC 
—Stephen Malthouse, MD
Past President, Canadian Complementary Medical Association

References

1. Angell M. The Truth About the Drug Companies: How They Deceive Us and What to Do About It. New York: Random House; 2004. 
2. Abramson J. Overdosed America: The Broken Promise of American Medicine. New York: Harper-Collins, 2004. 
3. Lexchin J. The Real Pushers: A Critical Analysis of the Canadian Drug Industry. Toronto: New Star Books, 1984. 
4. National Information Program on Antibiotics (NIPA). 2006 National Report Card on Antibiotic Resistance. March 2006 (1).