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The writing on the wall

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    The heyday of unfettered alternative medicine is coming to an end. All right I can hear you saying: “What a ridiculous claim. Doesn’t he know that many, if not most, general practices have taken it on board and the public will brook no gainsaying of it?” I say it again, the end is in sight. Just you wait, ’enry ’iggins; just you wait and see.

    I said unfettered—unrestrained, uninhibited, unregulated—that will stop. The good bits (of course there must be good bits) will become separated from the mire of therapeutic magic that has threatened to drag us back to an age of unreason. Why? The answer is obvious. Money—the American marketplace; the real thing for my dollar, and for the government’s dollar. The practitioners of unconventional medicine can be no more immune to these demands than are those of the medicine we call conventional. Evidence-based alternative medicine; why not? But then, of course it will be conventional medicine.

    Quite recently, there has been a discernible change in attitude to alternative medicine, especially in the American medical journals, and it’s getting tougher. Over the years the pendulum has swung from “what a load of rubbish”, to “well, perhaps there’s something in it”, and now “prove it”. The often stated claim that alternative medicine cannot be subjected to scientific scrutiny no longer washes.

    Listen to some of the opinion formers in US medicine in the second half of 1998: “It is time for the scientific community to stop giving alternative medicine a free ride.” “There cannot be two kinds of medicine—conventional and alternative. There is only medicine that has been adequately tested and medicine that has not” (New England Journal of Medicine September 17), “ . . .there appears to be little evidence to support the value of spinal manipulation for nonmusculoskeletal conditions” (Ibid October 8), “To adopt alternative medicine without developing quality standards for its practices, products, and research is to return to a time in medicine when quackery and therapeutic confusion prevailed. . . .The challenge is to move forward carefully . . .as we attempt to separate the pearls from the mud,” (Journal of the American Medical AssociationNovember 11), “ . . .until solid evidence is available . . .uncritical acceptance of untested and unproven alternative medicine therapies must stop,” (Ibid November 11) , “ . . .insurers in the United States are only now beginning gingerly to tread the alternative waters. Some are already beating a hasty retreat,” (Ibid November 11). And a professor of complementary medicine at a British university, “ . . .it seems uncertain whether chiropractic does more good than harm” (British Medical Journal July 18).

    The US National Center for Complementary and Alternative Medicine at the National Institutes of Health has a US$50 million budget and funds a core of 13 research centres, the one for paediatrics being at the University of Arizona in Tucson. Things are moving on the alternative medicine front and the demand for evidence can no longer be ignored.

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