In this paper I argue that evidence based medicine (EBM) offers a more transparent system of knowledge and medical care than complementary medicine (CM). While an individual’s choice to use CM should be respected, users of this form of medicine, nevertheless, risk loss of autonomy. This loss of autonomy is an outcome of CM’s offering fewer transparent possibilities for informed patient consent In both EBM and CM patients risk physical harm(s) but science gives EBM patients the (...) benefit of being able to factor known side effects into their health care decisions. (shrink)

This article discusses some aspects of the practice of complementary and traditional medicine in urban Mexico through a transcultural paradigm, hence it focuses on how medical knowledge are commodified as well as how a `travelling' medical knowledge acquires agency in a transculturation process. This study, while analysing different practices of Chinese and Japanese medicine, argues that oriental medicine is translated in at least two ways - a popular and a cosmopolitan form - that shape particular expressions (...) of citizenship. The popular form is carried out in low-income neighbourhoods and it focuses around a `Mexicanization' of oriental medicine and the reaffirmation of the popular as part of the national. Cosmopolitan medicine, on the other hand, is particularly practised in exclusive health spas and seeks to purge the popular out of the national and to incorporate `traditional' medicine as one of the multiple components of cosmopolitan consumption. The article argues that both popular and cosmopolitan expressions are important to understanding how complementary and oriental medicine have become not only part of a global market, but also part of a particular history of national and popular medical systems. (shrink)

This book provides a systematic analysis of the ethical implications of traditional and complementary medicine, focusing on pragmatic solutions. The author uses a bioethical methodology called the “Ethical Matrix,” to consider the impact of T&CM use for animals and the environment as well as for humans. A systematic search of the literature reveals that most published ethical concerns are related to the safety of T&CM use for humans. However, application of the Ethical Matrix demonstrates that the ethical implications (...) for T&CM use are much broader. In this book, the author analyses the most serious implications, including adverse events related to homeopathy, the use of animals in T&CM products, and the impact of herbal medicine on the environment. Comparisons with the ethical implications of conventional biomedicine help readers to contextualise debate, and highlight aspects that may be unique to T&CM. Globally, many high-level health policy makers promote T&CM as an accessible and affordable healthcare option. However, their use is considered by some to be a waste of resources, unscientific, and unethical. Offering a frank analysis of this largely ignored field of healthcare ethics, this book is both timely and essential. It helps patients, policy makers, practitioners, researchers, and students gain the knowledge they need to make more informed decisions. (shrink)

Medication reconciliation for pediatric oncology patientparticipants enrolled in clinical trials often reveals the use of chemical complementary medicine alongside protocol therapeutic agents. Considering the blurry delineation between clinical ethics and research ethics, this paper demonstrates how complementary medicine-related protocol violations introduce ethical questions of who should be included and excluded from clinical trials and offers recommendations on how to manage physician-patient-family interactions around these challenging issues.

Complementary and alternative medicine research presents unique problems for research ethics committees which must be considered in some detail. Applying conventional research techniques to CAM raises a number of issues which ethics committees may find challenging. CAM is widely available and this will have a substantial effect on any proposed research strategy as so many individuals will have pre-existing opinions about these treatments. Whilst many complementary therapies may eventually be ‘validated’ by appropriate clinical trial methodologies other research (...) methods could be more appropriate in the early stages of a research strategy, particularly in view of the widespread availability in both the public and private sectors. Safety, efficacy, cost-effectiveness and patient preference also need evaluation; and these cannot be adequately assessed through double blind randomised placebo controlled trials. If the research question is clear, then thoughtful and often innovative evaluative processes can be designed to answer the socially and clinically relevant issues posed by this area of medicine. There are a number of agencies and organizations available to offer advice to ethics committees in this newly emerging field of CAM research including CAM Strategy Research and Development, the Foundation for Integrated Health and the Research Council for Complementary Medicine. (shrink)

Background There is a need for clearer guidance for pharmacists regarding their responsibilities when selling complementary medicines. A recently published ethical framework provides guidance regarding the specific responsibilities that pharmacists need to meet in order to fulfil their professional obligations and make a positive contribution to health outcomes when selling complementary medicines. Objective Evaluate the acceptability and feasibility of a new ethical framework for the sale of complementary medicines in community pharmacy. Methods Australian community pharmacists were invited (...) to participate in online focus groups and interviews. Participants were recruited via multiple methods, including social media and the professional networks of pharmacy groups. Participants were provided the ethical framework prior to the discussion. Discussions were transcribed verbatim and analysed using thematic analysis. Results Seventeen community pharmacists participated in the study. There was good representation among participants in terms of gender, years of practice, pharmacy location and script volume. Participants differed in how proactive they were in relation to selling and providing advice on complementary medicines, how they interpreted evidence in relation to complementary medicines, and how they navigated their practice within the retail environment of community pharmacy. The majority of participants found the framework was acceptable for practice and was feasible for implementation with targeted support. Participants identified two important areas for targeted support in implementing the framework: improved access to evidence-based information resources on complementary medicines and independent evidence-based education and training on complementary medicine for pharmacists and pharmacy support staff. Conclusion The ethical framework addresses an important gap in providing specific professional guidance to pharmacists when selling complementary medicines. The results of the study suggest that the framework may be acceptable to community pharmacists and be feasible to implement with targeted support. (shrink)

The extensive community use of complementary medicine can no longer be overlooked in the practice of hospital medicine. Protocols need to be developed and implemented so that health professionals can deal with the issues surrounding the use of CM. Policy development has generally focussed on the supply of CM in hospital but another approach, which is based on consideration of the ethical and legal context, is presented here. Such an approach demands clarification of institutional policy for individuals (...) who are competent and those who are incapable of self-administration or non-competent. (shrink)

In classical physics, the world is considered as a matter-based reality, the arrangement of whose parts in time is uniquely determined by certain dynamic laws. By contrast, modern quantum physics reveals that matter is not composed of matter, but reality is merely potentiality. The world has a holistic structure, which is based on fundamental relations and not material objects, admitting more open, indeterministic developments. In this more flexible causal framework, inanimate and animate matter are not to be considered as fundamentally (...) different but as different order structures of the same immaterial entity. In a stable configuration, effectively all the uncertainties are statistically averaged out, thus the unique and deterministic behavior of ordinary inanimate matter is exhibited; whereas in the case of statically unstable but dynamically stable configurations, the “lively” features of the underlying quantum structure have a chance to surface to the mesocopic level and to be connected with what we observe as the phenomenon of life. This supposition can be more explicitly treated and clarified by identifying the electric dipole moment of biomolecules as the ordering parameter of the corresponding macroquantum system. This has important consequences for biology and medicine. In particular, it suggests the existence of a quantum-based “software,” essential perhaps for the logistics of biological processes, which are hidden behind the matter/energy-based “hardware” that alone is considered in the conventional approach. In medicine it opens an opportunity to build bridges between conventional medicine based essentially on the classical paradigm, and the various forms of complementary medicine, which have strong affinities with the new features of the modern holistic worldview. (shrink)

Analysis of the debate concerning the appropriate way of researching the effects of complementary and alternative medicine (CAM) treatments highlights the controversial issue of the mind–body bond in medical research. The article examines a range of approaches, extending from outright opposition to CAM research, through the demand to employ only rigorous trials, to suggestions to use a hierarchy of evidence, up to practice‐based research proposals. These diverse approaches are analysed using theoretical concepts from the field of sociology of (...) science and knowledge. The article uses the concept of “hybrid knowledge” to denote the knowledge being constructed in late modern CAM discourse—knowledge that hybridises differentiated and even contradictory modern categories of knowledge. The article suggests that the different approaches taken by sociologists of science and knowledge, such as strong anti‐dualism and the assertion that there are differences in our understanding of the natural and the cultural–social terrain, are all useful and are not necessarily mutually exclusive. The article seeks to clarify the debate concerning the appropriate way of researching CAM and to contribute to the ongoing development and application of sociology of knowledge. (shrink)

Science provides the most important set of tools for the evaluation of complementary and alternative medicine. Nonetheless, there are important limits in science that constrain its ability to evaluate CAM effectively. Some are the limits encountered by science in conventional medical research. Others are peculiar to this controversial topic. The most important limits are not those inherent within the basic methods of science, but rather within the culture of science — the particular ways that scientific knowledge, theory, and (...) method are configured and arrayed rhetorically, and in the social context in which science operates. It is the limitations of scientists as a group of human beings more than science as a set of methods that hamper scientific evaluation of CAM. (shrink)

My presentation was set as a counterpoint to the presentation by Lawrence Schneiderman, M.D., “Alternative Medicine or Alternatives to Medicine.”’ In this talk, Dr. Schneiderman vigorously critiqued CAM on the basis of evidence-based science as opposed to what he called “the collective romantic fantasy” of CAM. will challenge this science-versus-CAM view on the basis of several limits to science. My thesis here is: (1) the basic methods of science are as appropriate to the study of CAM as they (...) are to the study of conventional medicine (that is, there are some limits in both cases, but they are not special exemptions for CAM); however, (2) the human actors who practice science are cultural and emotional beings and the enterprise of science is therefore limited by human capacities. This is not a controversial claim, because human limitations in science are well-recognized. (shrink)

It is doubtful that any feature of the American health care system in the last several decades has had as profound an effect on the way Americans pursue their perceived health needs as complementary and alternative medicine. Almost half of all Americans take care of some of their health care needs outside of contemporary scientific medicine. The number of visits to CAM practitioners was estimated 6 years ago to be 629 million a year, with expenditures of $27 (...) billion a year. The use of CAM has been expanding rapidly despite little objective evidence of its safety or effectiveness. Little more than a decade ago CAM was viewed by the traditional medical community as a nuisance that offered unproven treatments at best and as outright quackery at worst. In any case, alternative medicine, as it was known at that time, seemed unworthy of serious attention. (shrink)

It is doubtful that any feature of the American health care system in the last several decades has had as profound an effect on the way Americans pursue their perceived health needs as complementary and alternative medicine. Almost half of all Americans take care of some of their health care needs outside of contemporary scientific medicine. The number of visits to CAM practitioners was estimated 6 years ago to be 629 million a year, with expenditures of $27 (...) billion a year. The use of CAM has been expanding rapidly despite little objective evidence of its safety or effectiveness. Little more than a decade ago CAM was viewed by the traditional medical community as a nuisance that offered unproven treatments at best and as outright quackery at worst. In any case, alternative medicine, as it was known at that time, seemed unworthy of serious attention. (shrink)

With the prevalence of complementary and alternative medicine (CAM) increasing in western societies, questions of the ethical justification of these alternative health care approaches and practices have to be addressed. In order to evaluate philosophical reasoning on this subject, it is of paramount importance to identify and analyse possible arguments for the ethical justification of CAM considering contemporary biomedical ethics as well as more fundamental philosophical aspects. Moreover, it is vital to provide adequate analytical instruments for this task, (...) such as separating ‘CAM as belief system’, and ‘CAM as practice’, Findings show that beneficence and non-maleficence are central issues for an ethical justification of CAM as practice, while freedom of thought and religion are central to CAM as belief system. Many justification strategies have limitations and qualifications that have to be taken into account. Singularly descriptive premises in an argument often prove to be more problematic than universal ethical principles. Thus, non-ethical issues related to a general philosophical underpinning - e.g. epistemology, semantics, and ontology - are highly relevant for determining a justification strategy, especially when strong metaphysical assumptions are involved. Even if some values are shared with traditional biomedicine, axiological differences have to be considered as well. Further research should be done about specific CAM positions. These could be combined with applied qualitative social research methods. (shrink)

Subjective probabilities play a significant role in the assessment of evidence: in other words, our background knowledge, or pre-trial beliefs, cannot be set aside when new evidence is being evaluated. Focusing on homeopathy, this paper investigates the nature of pre-trial beliefs in clinical trials. It asks whether pre-trial beliefs of the sort normally held only by those who are sympathetic to homeopathy can legitimately be disregarded in those trials. The paper addresses several surprisingly unsuccessful attempts to provide a satisfactory justification (...) for ignoring the pre-trial beliefs of the homeopathic community. The ensuing diagnosis of the difficulties here emphasizes that the reason the arguments for choosing the pre-trial beliefs of the conventional community seem insufficient is not the arguments per se. It is rather that there is no cogent argument for choosing the conventional stance which would at the same time rationally persuade a member of the homeopathic community. The paper concludes that, once we understand that this is the predicament, there is no genuine reason to doubt the reasoning that leads us to reject the pre-trial beliefs of the homeopathic community. (shrink)

In recent years so-called Complementary and Alternative Medicine practices have made significant political and professional advances particularly in the United Kingdom : osteopathy and chiropractic were granted statutory self-regulation in the 1990s effectively giving them more professional autonomy and independence than health care professions supplementary to medicine ; the practice of acupuncture is widespread within the National Health Service for pain control; and homoeopathy is offered to patients by a few General Practitioners alongside conventional treatments. These developments (...) have had a number of consequences: one is that both CAM and Conventional and Orthodox Medical professions have had to reappraise their professional identity. In manual therapy for example, questions have been asked about the differences between physiotherapy, osteopathy and chiropractic, and what the justification is for having separate professions. A wider question concerns the relationship between CAM and COM; are CAM distinct professions or should they, as has happened to a limited extent in the UK, be absorbed into the broader field of ‘ Medicine ’ or ‘Health Care’ as adjunctive therapies. CAM professions have also had to develop, implement and enforce codes of practice for practitioners and clarify the scope of practice within a profession. At the heart of these issues lies the need to identify and clarify professional values. A key claim of CAM professions is that their practice is distinct and the outcome of treatment at least as effective and in many cases more effective than with conventional therapies. In addition, what counts as effective outcome is often different from conventional medical understanding, involving more subtle humanitarian considerations, for example. Three values are identified as being commonly held across CAM professions. These are: offering ‘natural’ treatment; being patient rather than disease focussed; and being holistic. However, these may not be as distinctive of CAM as is claimed either because the meaning is unclear or because COM professions claim similar values. The paper argues that the values that inform ‘good practice’ and ‘effective outcome’ should be seen as distinct components of professional competence. This has implications for establishing professional identity and codes of practice. (shrink)

This article considers various approaches used in complementary and alternative medicine research, and discusses the challenges that reviewing such research poses for Human Research Ethics Committees. Drawing on our experience with the University of Technology Sydney HREC, we offer some suggestions about how ethical principles governing conventional medical research can be applied in the context of research in complementary and alternative medicine. We argue that effective HREC review requires members to gain familiarity with such research, which (...) helps ensure that such research is conducted rigorously and ethically. (shrink)

This book reveals the numerous ways in which moral, ethical and legal principles are being violated by those who provide, recommend or sell ‘complementary and alternative medicine’. The book analyses both academic literature and internet sources that promote CAM. Additionally the book presents a number of brief scenarios, both hypothetical and real-life, about individuals who use CAM or who fall prey to ethically dubious CAM practitioners. The events and conundrums described in these scenarios could happen to almost anyone. (...) Professor emeritus of complementary medicine Edzard Ernst together with bioethicist Kevin Smith provide a thorough and authoritative ethical analysis of a range of CAM modalities, including acupuncture, chiropractic, herbalism, and homeopathy. This book could and should interest all medical professionals who have contact to complementary medicine and will be an invaluable reference for patients deliberating which course of treatment to adopt. (shrink)

Complementary and alternative medicine has become an important section of healthcare. Its high level of acceptance among the general population represents a challenge to healthcare professionals of all disciplines and raises a host of ethical issues. This article is an attempt to explore some of the more obvious or practical ethical aspects of complementary and alternative medicine.

Complementary and alternative medicine is used by many in hopes of achieving important health-related goals. Survey data indicate that 42 percent of the U.S. population uses CAM, accounting for 629 million “office” visits a year and expenditures of 27 billion dollars. This high prevalence of use calls for a careful evaluation of CAM so as to ensure the well-being of those using its modalities. Such an evaluation would obviously include assessments of the safety and efficacy of particular approaches, (...) the training and integrity of practitioners, and the appropriateness of modalities for different conditions or uses. Given the lack of published data concerning many of these aspects of CAM, the likely unfamiliarity of its practitioners to the approaches available to clinicians practicing modern scientific medcine, and the need to respect the unique preferences of persons seeking assistance with achieving health-related goals, it is also important to assess the potential roles of informed consent for the use of CAM. Examining such roles is the central task of this paper. (shrink)

Complementary and alternative medicine is used by many in hopes of achieving important health-related goals. Survey data indicate that 42 percent of the U.S. population uses CAM, accounting for 629 million “office” visits a year and expenditures of 27 billion dollars. This high prevalence of use calls for a careful evaluation of CAM so as to ensure the well-being of those using its modalities. Such an evaluation would obviously include assessments of the safety and efficacy of particular approaches, (...) the training and integrity of practitioners, and the appropriateness of modalities for different conditions or uses. Given the lack of published data concerning many of these aspects of CAM, the likely unfamiliarity of its practitioners to the approaches available to clinicians practicing modern scientific medcine, and the need to respect the unique preferences of persons seeking assistance with achieving health-related goals, it is also important to assess the potential roles of informed consent for the use of CAM. Examining such roles is the central task of this paper. (shrink)

In this article we explore the role evidence ought to play in complementary and alternative medicine. First, we consider the claim that evidence in the form of randomized controlled trials cannot be obtained for CAMs. Second, we consider various claims to the effect that there are ways of obtaining evidence that do not make use of RCTs. We argue that there is no good reason why CAM should be exempted from the general requirement that treatments undergo evaluation by (...) RCT. Third, we consider two implications for health care policy. First, many activities in conventional medicine have never been rigorously evaluated and are widely in use nonetheless. We argue that this fails to provide a reason for exempting CAM from a demand for evidence. Second, CAM use may be compared to a choice of lifestyle, and this has a significant impact on which requirements of evidence can reasonably be imposed. (shrink)

Complementary and alternative medicines (CAM) have become increasingly popular over recent decades. Within bioethics CAM has so far mostly stimulated discussions around their level of scientific evidence, or along the standard concerns of bioethics. To gain an understanding as to why CAM is so successful and what the CAM success means for health care ethics, this paper explores empirical research studies on users of CAM and the reasons for their choice. It emerges that there is a close connection to (...) fundamental principles of medical ethics. The studies also highlight that CAM’s holistic ontology of health and illness has an empowering effect on people in caring for their health, and on an even deeper level, safeguards against biomedicine’s reducing image of oneself as biological body-machine. The question is raised what lessons bioethics should draw from this emancipatory social movement for its own relationship with biomedicine. (shrink)

Growing interest in complementary and alternative veterinary medicine (CAVM) has sparked a debate among veterinarians, who claim such therapeutic modalities fall under the purview of veterinary medicine, and non-veterinarians, who argue that several modalities do not require the rigorous training of a veterinarian to be performed safely. The veterinary profession must proactively redefine its definition of the practice of veterinary medicine in the face of increasing challenges to state practice acts. By looking to human medicine (...) as a model for how to balance conventional and alternative modalities, the profession can develop a system that provides animal caregivers access to CAVM while still safeguarding animal health. (shrink)

This paper argues that it is morally irresponsible for modern medical providers or health care institutions to support and advocate the integration of CAM practices (i.e. homeopathy, acupuncture, energy healing, etc.) with conventional modern medicine. The results of such practices are not reliable beyond that of placebo. As a corollary, it is argued that prescribing placebos perceived to stand outside the norm of modern medicine is morally inappropriate. Even when such treatments do no direct physical harm, they create (...) unnecessary barriers to patients' informed understanding of their health. (shrink)

The more popular complementary and alternative medicine (CAM) has become, the more often it is demanded that the integration of CAM should be limited to those approaches that are scientifically proven to be effective. This paper argues that this demand is ethically and philosophically questionable. The clinical legitimacy being gained by CAM and its increasing informal integration should instead caution against upholding the biomedical framework and evidence-based medicine as conditions of acceptance. Patients’ positive experiences with CAM deserve (...) a truly scientific exploration of non-biomedical conceptualizations of health and illness. It is also problematic to request scientific evidence when there is proven resistance against CAM in research institutions, under-funding and a lack of suitable research methodologies. This is even more so, when much conventional medicine is not practiced with the same level of evidence as demanded from CAM. (shrink)

Concerns about the possibility of a sharp rise in the prevalence of Alzheimer’s disease in Western nations have led to both the significant deployment of resources and the development of national research and healthcare plans. Although often focused on treatment, substantial efforts have also been dedicated toward preventing or delaying AD onset. As a result, recent technological and biomedical advances have greatly improved the understanding of AD pathophysiology. While some new tests can assess only risk ), some tests for certain (...) biomarkers (e.g., amyloid beta accumulation in the brain detected via positron... (shrink)

A long-debated question in the philosophy of health, and contingent disciplines, is the extent to which wise clinical practice (“clinical wisdom”) is, or could be, compatible with empirically validated medicine (“evidence-based medicine”—EBM). Here we respond to Baum-Baicker and Sisti, who not only suggest that these two types of knowledge are divided due to their differing sources, but also that EBM can sometimes even hurt wise clinical practice. We argue that the distinction between EBM and clinical wisdom is poorly (...) defined, unsupported by the methodology employed, and ultimately incorrect; crucial differences exist, we argue, not in the source of a particular piece of clinical knowledge, but in its dependability. In light of this subtle but fundamental revision, we explain how clinical wisdom and EBM are—by necessity—complementary, rather than in conflict. We elaborate on how recognizing this relationship can have far-reaching implications for the domains of clinical practice, medical education, and health policy. (shrink)