Complementary and Alternative Medicine Education in Medical Schools

               It’s been more than six weeks since the urge to rant about all things complementary and alternative overcame me but I can’t hold it in anymore. I was trawling (knee deep in quackery) through some CAM journals the other day when I came across an article in the Journal of Evidence-Based Complementary & Alternative Medicine called “The Importance of Complementary and Alternative Medicine Education in Medical School”. Seeing as CAM and evidence are generally not compatible I was a bit sceptical but as the article was written by real doctors and not the expected bunch of chiropractors or naturopaths I gave it a chance.

                

              The article details the results of a survey carried out to assess CAM teaching and usage in medical students from the University of Aberdeen. As a medical student I was shocked initially by the authors claims that 66% of medical students has used CAM therapies but further reading showed that maybe we’re not as bad as I first thought. First of all, over a third of CAM users had used CAM therapies more than a year ago. These could have been administered by the participants’ parents during childhood or used before beginning a medical education that should really make them question the effectiveness of CAM. Also, in their list of CAM treatments, the authors include a number of therapies that could hardly be called complementary or alternative. Things like massage, which was used after exercise or just for relaxation, and protein supplements, whose benefit after exercise is fairly well-supported, should hardly be included in the same list as chiropractic and reflexology.  I can only hope that these factors give a false impression of the popularity of CAM use in medical students and that that actual rates of use are much lower.

Even still, the number of participants using therapies that could at best be described as useless is a bit worrying. 5.6% has used acupuncture, 5.4% has used Bach flower remedies and probably worst of all 5.1% had used homeopathic “medications”. These figures only serve to support the author’s claims that medical students need more formal education about complementary and alternative therapies and highlight a lack of critical appraisal when selecting therapies.  

The ability to source and evaluate information about treatments and interventions is essential if medical students are going to practice evidence-based medicine. However, sometimes it’s just assumed that we will pick it up along the way without any formal instruction. Unfortunately, this article highlights that may not be the case as most participants relied on anecdotal evidence from family members when selecting complementary and alternative therapies. If medical students are not capable of sourcing reliable information before selecting ineffective therapies for themselves, how can they be expected to determine what treatments are best-suited to treating illness in their future patients. Formal teaching of critical appraisal skills is unfortunately forgotten in some cases and I have experienced a number of lecturers and senior doctors complain that despite the current emphasis on evidence-based practice, students are allowed to get as far as their clinical years without these skills. They provide students with the ability to evaluate the safety and effectiveness of both conventional and alternative treatments and to provide their future patients with the best possible quality of care. Maybe if the participants of this study had properly developed these skills, rates of pointless complementary and alternative medicine use would have been lower.

Education about CAM therapies in medical school is a difficult subject. Medical students are already overloaded with information about medicine that actually works without being forced to learn about “medicine” that doesn’t work as well.  Some teaching is unfortunately required however due to the number of patients using these treatments with a 2010 study conducted in England finding that 26.3% of participants had used CAM therapies in the last 12 months. Education about the use of herbal and dietary supplements is especially important as there is growing evidence that their interaction with conventional medications is more common than previously thought and can have potentially serious side effects. This problem is further exacerbated by the fact that many patients do not inform their doctor about the alternative therapies they use with one study finding that only 33% of herbal and dietary supplement users had informed their regular care provider. An understanding of commonly used CAM therapies and their effects on real medicine must be included in medical education just like the effects of other factors such as social support, alcohol and nutrition. It is unfortunate but medical students must learn to consider the effects of ineffective and potentially dangerous alternative treatments when CAM practitioners can still practice without any regard for evidence or ethical standards.

The authors of this study advise that doctors must learn to make allowances for CAM use when recommending treatments. It would be wrong, however, for a doctor to simply accept a patient’s CAM use just as it would be wrong not to advise them about the risks of smoking or obesity. Doctors must also learn to address patient’s beliefs in alternative therapies and dispel the misinformation they may receive from CAM practitioners. While CAM use may be regarded as harmless by many, the financial losses and risks incurred when utilising these generally ineffective treatments far outweigh any benefits. It is in the interest of a patient’s health and safety for doctors to enquire about CAM use and to attempt to dispel any myths the patient may believe about these treatments. This may be counter-productive in devoted believers and should not be allowed to harm the doctor-patient relationship but may protect many patients from any potential harm to their health and avoid a waste of both time and money.

In an ideal world, complementary and alternative medicine would be of no concern to medical students as only safe and effective treatments supported by reliable evidence would be available to the general population. The current situation, however, is far from ideal and CAM therapies appear only to grow more numerous and more popular with each passing day. Greater education about complementary and alternative medicine is required in medical schools to reflect its growing popularity and mounting evidence of the risks it presents both alone and when combined with conventional medical treatments.

References:

• ·      Rao, A., Shakeel, M.S., Trinidade, A., Rao, G., Pearce, A., Ah-See, K.W. (2012). The Importance of Alternative Medicine Education in Medical School. [Electronic Version] Journal of Evidence-Based Complementary & Alternative Medicine. 17 (3) 191 – 198.
• ·      Mehta, D.H., Gardiner P.M., Phillips, R.S., McCarthy, E.P. (2010). Herbal and Dietary Supplement Disclosure to Health Care Providers by Individuals with Chronic Conditions. [Electronic Version] The Journal of Alternative and Complementary Medicine. 14 (10) 1263 – 1269.
• ·      Hunt, K.J., Coelho, H.F., Wilder, B., Perry, R., Hung, S.K., Terry, R., Ernst. E. Complementary and alternative medicine use in England: results from a national survey. [Electronic Version] International Journal of Clinical Practice. 64 (11) 1496 – 1502.