Les universités sont l’endroit tout indique pour l’étude des médecines alternatives et complémentaires, qui gagnent chaque jour en popularité.
In “Integrating Nonsense,” his May-June column for Policy Options, Timothy Caulfield argues that universities should not engage in the study of complementary and alternative medicines (CAM), because these forms of integrative medicine are not based on proven science. But research to expand our knowledge of how things work and how to better humankind is the raison d’être of universities. The very high use of CAM products and practices makes it imperative for researchers to investigate what works — and what is harmful — in which patients and why.
Such work should not (and cannot) be left solely to companies trying to sell these products or practitioners who make a living from providing these therapies. Universities are a home for scholarship and excellence in research and education. These public institutions promote education and the creation of new knowledge for the public good, which is why they are the best places to engage in research and debate relevant to society. It is in the public interest that universities ask and answer relevant questions to inform the public good, including health care and public policy.
According to the 2010 Natural Health Product Tracking Survey conducted for Health Canada, almost three-quarters of Canadians report having used some form of CAM treatment, usually defined as a natural product, mind-body therapy or manual therapy (see http://nccam.nih.gov/health/whatiscam). Studies across the Western world show similar levels. Universities have a vital role to play in investigating such a widespread social phenomenon.
We live in an era when evidence-based medicine, patient-centred research and patient-centred care are valued.A patient’s values, beliefs and priorities determine which therapies they will or won’t take and help to identify priorities for health care research. Good health care decisions — at the patient and the health care system levels — should be founded on scientific evidence. It is the role of universities and university-based researchers to generate, synthesize and disseminate this evidence.
Unfortunately, CAM attracts a polarization of opinion, which poses a major threat to reasoned discussion. Paradoxically, those opposing views are often united in their lack of need for evidence to support their positions. Advocates do not need evidence because they already believe, and detractors do not need evidence because they are already convinced all CAM is quackery. Neither position is evidence-based and neither invites thoughtful discourse and dialogue.
We prefer a position in the middle: open-minded, yet skeptical; willing to listen and to investigate further. To dismiss CAM without considering its merits and limitations, without acknowledging the thousands of randomized controlled trials that have been conducted to evaluate it, does not seem evidence-based or even evidence-informed. To presume that all CAM research is conducted poorly and that all well-done CAM research shows negative findings, and to attribute any or all positive results to bias or placebo, does not reflect the open mind demanded by good science. Theories must be re-evaluated in light of available data, not vice versa.
Like universities around the world, many North American universities have embraced the challenge of researching CAM. It is false to think that there is no evidence for CAM products or therapies, just as it is false to think that all products and therapies recommended by physicians are supported by randomized controlled trials, the gold standard in health care research.
We are very concerned at suggestions that it is inappropriate for conventional health care providers to discuss CAM with patients or for universities to research CAM. Such an approach will not dissuade patients from seeking CAM. It will only drive their use of CAM underground, where they feel they can ask questions without scorn. Worse, this approach alienates patients by disrespecting their values and preferences.
There is a growing call for “integrative medicine” — the evidence-informed blending of products and therapies from conventional medicine and CAM, such as by using both acupuncture and medication to manage the side effects of chemotherapy in the treatment of cancer. This approach requires research to help us understand what can be safely blended to benefit patients, as well as research on how different types of practitioners can share care and communicate.
Furthermore, once we understand what works and what doesn’t, we will need to explore costs. Proponents argue that many CAM therapies are less costly than conventional treatments and will thus save the health care system money. This is a key question that university-based researchers need to investigate.
So much use. So many questions. Only if scholarship is vigorously pursued will we realize our goal of patient-centred, evidence-based health care.