Thursday, October 11, 2007

Evidence based medicine - how does alternative medicine contribute?

A couple of weeks ago I met a gentleman at a training event I attended and we got to talking about the businesses we were each in. This gentleman was a naturopath and became quite animated when I discussed my interest in clinical research. As can often be the case when you mention a background of working in the drug industry, I quickly found myself trying to defend the industry I've been a part of. This gentleman was very anti-drug/company, with lots of conspiracy theories about why drug companies do what they do, and how messed up the health system is.

For me personally, I fell into the industry as part of my journey as a scientist. All I wanted to do as a scientist was research that would help people, and clinical research seemed one pathway I could follow to do that. Many of the colleagues I meet in the industry have the same vision. However, it seems that because we work for commercial organisations that make money, our intentions are to be questioned.

One of the arguments presented to me was that drug companies do unnecessary clinical trials that cost lots of money, and then use those costs to justify the price we need to pay for medications. From the naturopath's perspective, these trials are unnecessary, as are the drugs, as he claims to be able to heal many people for whom conventional medicine has not worked.

I have no reason to doubt the naturopath's claimed success rate, but also don't have enough evidence to believe him. As a scientist, you will often come up with ideas about how good something is or how it works, only to find when you test those ideas, they don't always stand up to formal review. This can be a heartbreaking moment, but at least the due diligence has been done and the evidence speaks for itself.

I don't think there is anyone in the health profession that would NOT embrace alternative medicine if there was adequate proof that the alternatives worked. Granted, there is alot of anecdotal evidence that some alternatives do work very well for some people. However, as a scientist, I am always looking for evidence. In fact, our conventional health system is increasingly based on the premise of evidence-based medicine. Without evidence, how can a government hope to be selective about the treatments the limited health budget is able to afford? Equally, how can doctors make decisions on the best treatment if there are not comparative studies to help them draw conclusions.

I challenged the naturopath to perform studies to help build the knowledge based around his treatments of choice, so as to improve their reputation and build the body of evidence around alternative therapies. However, he was not personally willing to put his treatments to the test through formalised research - especially since he knows it works. After all, trials are expensive and time consuming, and there is so much paperwork. He'd prefer to leave that to others to do. From an article I recently came across, it would appear however there isn't necessarily much good quality research going on to help his cause... (A systematic review of randomised clinical trials of individualised herbal medicine in any indication

If then, drug companies choose to spend their money on trials in order to provide evidence to help prove either way the safety, tolerability and ability of their drugs to work, and then to share that information with doctors proactively, is it any surprise that this then forms the foundations of the health system that doctors dish out and governments help fund?

And it is not only drug companies doing clinical research, so money, while less readily available, can be sought from other more independent sources. Governments, consumer organisations, charities, philanthropic organisations, all fund medical research, including that on humans. To attract the funding, researchers increasingly need to collaborate, produce good scientific questions, and quality output, making it in theory just as within the reach of alternate medicine practicitioners as those in conventional medical research to attract funds to conduct that research.

One argument I've heard for not conducting research in alternative medicine is the individual nature many of those treatments take on, such that it would be hard to compare groups of individuals such as happens in randomised clinical trials. My counter to that however is that is can be just as difficult for drug companies to test their drugs in large populations of people. I think it would be recognised, particularly as scientists understand our genes and diseases better, no two individuals are perfectly alike, nor are the effects they will have from a drug alike. People experience different side effects, they have different success rates with different drugs. It may take doctors some time to define the right dose, or right drug, if it exists for a particular individual for a particular condition. The journey with alternative medicine can be just as much trial and error.

Yes, alternative medicine can work for some people, but it does fail others. I've had personal experience of such a failed journey with someone close. Whether alternative medicine techniques are any more successful on a population basis than conventional medicine, I don't know. I don't believe that conventional medicine has all the answers for everyone, just as alternative medicine does not, so an integrated approach is of value.

I say provide the evidence through formalised clinical research, and whatever the treatment, whether conventional or alternative, and it will lead to health practitioners being more comfortable to offer it as a treatment option for their patients.

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