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Mike Price is a freelance industrial pharmacist
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Hardly a year passes when there is not a cluster of letters in this
journal attacking the practice of complementary and alternative medicine
(CAM),
and the usual modality that pharmacists enjoy exercising their spleen
on is homoeopathy. Indeed, I have been among colleagues at branch and
continuing professional development meetings when conversation has drifted
to remembering absent friends: not those who have died, but those who
have drifted into practising CAM. Had we been alive a century ago, the
tone of conversation may be compared with that of an official in the
Empire who may have gone “native”. All very sad, and probably
the heat, malaria and not enough tonic with the gin.
It was against this perception of the feelings of my fellow members that
I found myself taking numerous precautions against being recognised slipping
into the 11th Symposium on Complementary Health Care in Exeter last month.
Not only did I check that no member had seen me entering the venue, but
I donned one of Peter Sellars’ cast-off disguises to avoid being
recognised if photographs were to be taken and published. I felt slightly
grubby, that I was letting the side down and that if I had a role there
it would be to heckle the presenters.
This symposium has grown in stature as one of the most important for
the presentation of new research in CAM. It was attended by researchers
from many different countries, and representing both academia and practice-based
research. All sorts of data were presented in the oral and poster presentations — ranging
from some basic research, through pre-clinical to, mainly, clinical.
The pace was rapid and the quality generally high, although some of the
presenters were young and still sporting their “L” plates.
I must admit, I had my preconceptions before attending. I had expected
to be witness to poor quality science: poorly designed trials, doubtful
results, highly questionable conclusions. I expected to meet a well-meaning
bunch of parascientists: rose tinted spectacles, pony tails, sandals
and body piercings. To the contrary, I found good science and
a bunch of sober scientists committed to examining CAM with the rigor
modern health care practitioners may reasonably expect. I felt happier,
I felt that this was a group of scientists we could trust and, where
outcomes were positive, we could start to shed some of our entrenched
scepticism that may be a product of our education.
The Journal reported recently that a market survey had discovered that
patients needed more
information on complementary medicines (PJ, 6 November,
p672). In the same report, Edzard Ernst, director, complementary medicine,
Peninsular Medical School, Exeter, and chairman of the above mentioned
symposium commented: “Pharmacists should put themselves in a position
where they can meet this need.” He is right; whatever opinion pharmacists
may have of CAM, we are happy to promote ourselves as the experts in
medicines, and in the broader context of care, are an accessible profession
given no general requirement for appointments and widespread distribution.
In this respect pharmacists should ask themselves whether their knowledge
is sufficient to provide their clients with the information they claim
to need, and if it is not, to recognise the training gap and address
it through their preferred CPD channel.
A potential advantage of developing a greater knowledge of CAM is that
pharmacists may benefit in other ways, some not so immediately obvious.
In particular, something that is, I think, part skill and to a greater
extent, philosophy. I am referring to the so-called “holistic” approach — unfortunately
a frequently misused and, I guess, widely misunderstood word. It is hard
to put simply, but illness can be regarded in the context that the parts
of any whole cannot exist and cannot be understood except in their relation
to the whole. More simply, to understand that pain in the tummy presented
by the patient, you need to consider a broader picture than the anatomical
diagram you remember from college. This is fundamental to most CAM practice,
and developing this approach may help pharmacists to better understand
their patients’ complete needs.
The availability of good quality information on CAM, especially for the
areas that may be of greatest relevance to pharmacists, has improved
in recent years. A good starting place may be Steven Kayne’s book1 and Professor Ernst and colleagues’ more critical appraisal of
the CAM evidence.2 The latter book is soon to be extensively updated
given the large amount of published data accrued in the three years since
the last edition.
Last month’s experience at the symposium was reassuring. I was
happier witnessing the existence of committed scientists, many of whom
were generating quality data that continued to answer the questions of
safety and efficacy in relation to CAM. And in my view these questions
are more important than those of the mechanisms of CAM. What was apparent
to me was that, in many conversations with the participants, there appeared
to be no zeal to disprove CAM as mumbo jumbo, or the contrary — they
were simply seeking the truth. Yes, there are still many unanswered questions,
many common CAM interventions are not supported by the outcome of rigorous
scientific investigation (but this is also the case, some of the time,
in orthodox medicine). However, and within the restrictions of limited
research funds, progress is slowly being made, and quality data generated
allowing more informed advice to be dispensed by pharmacists and other
health care advisers.
And finally, homoeopathy, the thorn in the side of those wedded to the
pharmacology paradigm. I am sure the revision of the latter, above-mentioned,
book will review some recent positive outcomes in randomised clinical
trials of homoeopathy (which are published)3. Further, readers familiar
with the now infamous Benveniste research (published in Nature in the
late 1980s) may also be aware that there has been some recent success
in developing similar sensitive immunological assays. Using a basophil
degranulation model,4 Philipe Belon and co-workers have demonstrated
activity for high dilutions of histamine. They were unable to explain
their findings, but the basic science may now be demonstrating the unthinkable!
What do I think? I remain sceptical, but also open-minded. I have experience
of a positive effect, which may have been a so-called placebo response.
The slowly mounting evidence is slowly moving me along the line that
separates disbelief and belief. I may be a fool, but it was once a self-evident
truth that the world was flat. I have travelled extensively, I am yet
to find the edge.
References
1. Kayne SB. Complementary therapies for pharmacists. London: Pharmaceutical
Press; 2002.
2. Ernst E, editor. The desktop guide to complementary and alternative
medicine: an evidence-based approach. London: Elsevier; 2001.
3. Weatherley-Jones E, Nicholl JP, Thomas KJ, Parry GJ, McKendrick MW,
Green ST et al. A randomised, controlled, triple-blind trial of the efficacy
of homeopathic treatment for chronic fatigue syndrome. Journal of Psychosomal
Research 2004;56:189–97.
4. Belon P et al. Histamine dilutions modulate basophil activation. Inflammation
Research 2004;5:181–8. |
The
Pharmaceutical Journal