The Ethics of Complementary, Alternative and Integrated Medicine

In my recent item about ethics I mentioned that Paul Root Wolpe from the University of Pennsylvania is interested in the ethics of Complementary and Alternative Medicine (CAM), and, by extension, its offspring, Integrated Medicine. This caused some raised eyebrows, but it shouldn’t.

Using unorthodox therapies carries a number of ethical and moral responsibilities.

When I was still on faculty at the University of Pennsylvania, on one occasion I caused outrage amongst many friends using natural medicine, when I pointed out on a TV show that just because something’s natural doesn’t mean it’s safe. Think arsenic, deadly nightshade and hurricanes! But there is more to the ethics of CAM than just the safety of the treatments involved.

Just a few months ago I was asked to look at a study by someone claiming to debunk one of the tapping therapies. Neither the investigator nor the practitioners and patients inveigled into the “research,” understood the principles of informed consent. This is important: one of the many consequences of the Holocaust was a re-consideration of what to do with medical “data” collected by Nazi doctors in the most unprincipled ways imaginable. Should the data be kept, so that people would not have died in vain? Or should it be destroyed, because information from unethical experiments was tainted. After a great deal of heart searching, it was decided that any information obtained under those circumstances was likely to be junk. This is one of the reasons for the absolute insistence on informed consent. I shall say something else about consent in just a moment.

Let’s have a look at the ethical issues involved in CAM, because much of the criticism of the emerging models of healthcare has come from people genuinely concerned about patient welfare.

1. If we do anything with or for an individual, there has to be informed consent. Informed consent includes full disclosure not just of the chances of efficacy, but also of the possible toxicity of a treatment and an agreement of what we hope to achieve. A therapist may want to balance your Qi and stop you getting sick in the future. You may just want to be rid of your headaches. When we ask about the chances of efficacy, we all run into the problem of positive bias. I was once planning some research with a very well known practitioner in the UK, who told me that he cured every single person he saw, whether they had cancer, schizophrenia, heart disease or anything else. I was astonished, and asked him for something to backup what he said. He flew into a rage! “How dare I question him?” he said.It soon turned out that although he probably was a genuine healer who got a lot of people better, he had no evidence at all. It was like a study in the medical arena in which the investigators decided that anyone who did not come back for treatment was cured! Not a common reaction if someone fails to turn up for an appointment!
2. People often say to me that there can be no harm in giving someone a homeopathic remedy. And of course, from a purely physical and psychological perspective, that’s probably true. Though I once participated in an experiment in which I took the homeopathic remedy Pulsatilla, that is prepared from the Passion Flower. I had what is known as an exacerbation, and was unable to function for several hours. But we also need to think about some of the other things that can follow from using treatments that work at the level of the subtle systems. One of our biggest objections to people who believe that they can do acupuncture after a weekend course, is that acupuncture, homeopathy and the rest are powerful medicines. Putting a needle into the wrong part of a person’s anatomy may not just cause physical harm, but can do extraordinary things to a person’s subtle systems. A fact that is exploited in some martial arts. In the Jet Li movie Kiss of the Dragon, Jet uses acupuncture needles to do some extraordinary things. The filmmakers used little artistic license: with one exception I have personally seen all of the things demonstrated in the movie.
3. I mentioned that informed consent includes full disclosure about the chances of efficacy and toxicity of a treatment and agreement on therapeutic goals. We can find ourselves in a real ethical dilemma when patients have unrealistic expectations for an untested remedy. Sometimes people don’t inform their patients realistically, and they rationalize it as either choosing not to remove hope or as providing support. But we have to be sure that we are not supporting potentially dangerous or harmful decisions. The problem is not necessarily the treatment itself. Using an untested treatment in place of something that we know can be effective can also lead us into difficult ethical waters. Regular readers will remember a sad case that I highlighted a few months ago.

I’m all for holistic therapy: the less invasive the better. I’ve spent the last 35 years helping develop new and better ways of integrating treatments.

But it’s really important to be realistic, to use what we know works and if we don’t know if a thing works, then to be totally honest with the individual, and keep meticulous records of why we want to use an untested remedy in combination with the conventional.

In the 1980s, the Research Council for Complementary Medicine began to train complementary practitioners in the basics of research, so that they could be better at obtaining informed consent and monitoring the effectiveness of treatments that they were using. We had some success, and it is high time that we helped practitioners in other parts of the world do the same thing.