Complementary and Alternative Medicine: Intro to Evidence-Based Guidelines

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November 21, 2007 - 9:06 pm email to a friend printer friendly view / write comments

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Dr. West

The American College of Chest Physicians (ACCP) recently published multiple papers of evidence-based guidelines for many aspects of lung cancer, and among these was a provocative one about complementary and alternative medicines (CAM)(abstract here). These guidelines are novel because they attempt to compile the evidence about CAM, a broad topic about which there is a great deal of interest but not nearly enough clinical trials or evidence. Among the first points is that complementary and alternative are two different things, with complementary really being defined, as the name implies, as an adjunct combined with the current standard “mainstream” treatments, primarily given to minimize side effects and integrate to enhance patient well-being. In contrast, alternative approaches tend to either be unproven or even disproved strategies that are often promoted instead of mainstream treatments for cancer. The latter are far more problematic for oncologists, because it is often detrimental to the health of patients to delay or refuse standard treatments for cancer altogether. Complementary treatments are often eventually tested, sometimes found to be beneficial, and then combined with chemo, radiation, and other standard anticancer approaches as part of an “integrated oncology program”. Alternative medical approaches are less commonly subjected to clinical trials and have not, as a rule, been demonstrated as beneficial if they have been tested. Alternative therapies are more commonly aggressively promoted as a biologically active easy cure in lieu of standard and better tested treatments.

One key principle is that CAM in one form or another is commonly used by patients, estimated at about 50%, and up to about 75% if prayer specifically for health reasons is included; moreover, much of the research suggests that use of CAM approaches has increasing (full text article here). Because of that, one of the recommendations is that physicians specifically ask patients about their use of CAM.

The guidelines include commentary on topics ranging from acupuncture, for which there are actually a number of studies on it as a treatment for pain or nausea, to massage therapy, vitamins and herbal supplements, massage therapy, bioenergy fields, and other work. I’ll cover these topics in my next several posts, and I’ll invite Dr. Labriola to provide his commentary in order to add further information that may support or refute my input.

Posted in: Naturopathic Medicine/CAM                     email to a friend printer friendly