Pluralism of conventional medicine and alternative medicine
Commenting on the recent published Kaptchuk editorial http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrievedb=pubmeddopt=Abstractlist_uids=15734812query_hl=1
Kaptchuk has a long history of open and sincere efforts to achieve a standard of care in medicine that involves both EBM and treatment that is subjective and essentially unprovable.
According to the summary, "pluralism" versus opposition or integration of CAM recognizes "the value of freedom of choice in medical options" and supposedly sets the stage for the physician and patient to agree to disagree on the importance of a CAM treatment in the plan of care. In adopting pluralism, Kaptchuk doesn't advocate a relativistic stance toward CAM, but insists the practitioner not ignore the fact that their patients will continue to believe what they want to believe about a CAM treatment, regardless of what they are told.
First of all, pleasant or not, someone must be upfront with the patient that he/she may be being hoodwinked into adopting one form of CAM or another. To ignore the huge amount of blatant fraud associated with the marketing and advocacy of CAM is irresponsible practice of medicine. The predators in CAM are expert at playing off the emotions and psychological conditions of desperate and sick people and their families. Even the most pluralistic practitioner must make sure the patient understands the red flags and warning signs of charlatanism.
Second, pleasant or not, someone should help the patient understand the difference between physics and faith, science and pseudoscience, EBM and CAM. It is unethical to infer that that our empiric understanding of physiology and disease and the vitalistic approaches of CAM are each accepted if not equally valid approaches for practicing medicine. In the least, there must be understanding that both are not working off the same principles of action.
The dangerous social consequence of adopting pluralism is the same as for adopting integrative medicine: increased costs for healthcare. As individuals are willing, and as third-party payors are forced to pay for any (even whimsical) understanding and/or treatment of disease, more and more will apply for payment. As the market grows, so will the power to influence it. Worst case scenario: a totalitarian society with citizens solely dependent upon the State for every need, for every human need is ultimately associated with health, and the individual can't be expected to pay for all the (perceived) individual health needs.
dras
Kaptchuk has a long history of open and sincere efforts to achieve a standard of care in medicine that involves both EBM and treatment that is subjective and essentially unprovable.
According to the summary, "pluralism" versus opposition or integration of CAM recognizes "the value of freedom of choice in medical options" and supposedly sets the stage for the physician and patient to agree to disagree on the importance of a CAM treatment in the plan of care. In adopting pluralism, Kaptchuk doesn't advocate a relativistic stance toward CAM, but insists the practitioner not ignore the fact that their patients will continue to believe what they want to believe about a CAM treatment, regardless of what they are told.
First of all, pleasant or not, someone must be upfront with the patient that he/she may be being hoodwinked into adopting one form of CAM or another. To ignore the huge amount of blatant fraud associated with the marketing and advocacy of CAM is irresponsible practice of medicine. The predators in CAM are expert at playing off the emotions and psychological conditions of desperate and sick people and their families. Even the most pluralistic practitioner must make sure the patient understands the red flags and warning signs of charlatanism.
Second, pleasant or not, someone should help the patient understand the difference between physics and faith, science and pseudoscience, EBM and CAM. It is unethical to infer that that our empiric understanding of physiology and disease and the vitalistic approaches of CAM are each accepted if not equally valid approaches for practicing medicine. In the least, there must be understanding that both are not working off the same principles of action.
The dangerous social consequence of adopting pluralism is the same as for adopting integrative medicine: increased costs for healthcare. As individuals are willing, and as third-party payors are forced to pay for any (even whimsical) understanding and/or treatment of disease, more and more will apply for payment. As the market grows, so will the power to influence it. Worst case scenario: a totalitarian society with citizens solely dependent upon the State for every need, for every human need is ultimately associated with health, and the individual can't be expected to pay for all the (perceived) individual health needs.
dras
posted by nawledge at
9:45 PM
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