Skip to main content

Advertisement

SpringerLink
Log in

Two into One Won’t Go: Conceptual, Clinical, Ethical and Legal Impedimenta to the Convergence of CAM and Orthodox Medicine

  • Published:
Journal of Bioethical Inquiry Aims and scope Submit manuscript

Abstract

The convergence of complementary and alternative medicine (CAM) and evidence-based medicine (EBM) is a prominent feature of healthcare in western countries, but it is currently undertheorised, and its implications have been insufficiently considered. Two models of convergence are described – the totally integrated evidence-based model (TI) and the multicultural-pluralistic model (MP). Both models are being incorporated into general medical practice. Against the background of the reasons for the increasing utilisation of CAM by the public and by general practitioners, TI-convergence is supported and MP-convergence is rejected. MP-convergence is epistemologically and clinically incoherent, and it cannot be regulated. It is also inconsistent with developments in the legal determination of the standard of care for both diagnosis/treatment and disclosure. These claims concerning MP-convergence are justified by the fact that science is not a member of the group of perspectives or world-views which postmodernism treats as equally valid, and this is especially important for healthcare.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Lewith, G. T., & Bensoussan, A. (2004). Complementary and alternative medicine – With a difference. Medical Journal of Australia, 180, 585–586.

    PubMed  Google Scholar 

  2. Coulter, I. D., & Willis, E. M. (2004). The rise and rise of complementary and alternative medicine: A sociological perspective. Medical Journal of Australia, 180, 587–589.

    PubMed  Google Scholar 

  3. National Centre for Complementary and Alternative Medicine. What is complementary and alternative medicine? [On-line] [cited 11 November 2005]. Available from: http://nccam.nih.gov/health/whatiscam/#1.

  4. Kotsirilos, V. (2005). Complementary and alternative medicine. Part 1 – What does it all mean? Australian Family Physician, 34, 595–597.

    PubMed  Google Scholar 

  5. Kaptchuk, T. J., & Eisenberg, D. M. (2001). Varieties of healing. II: A taxonomy of unconventional healing practices. Ann Int Med, 135, 196–204.

    PubMed  CAS  Google Scholar 

  6. NSW Health. Regulation of complementary health practitioners. Discussion paper. [On-line] 2002 [cited 13 November 2005]. Available from: http://www.health.nsw.gov.au/quality/files/compmed_paper.pdf.

  7. Expert Committee on Complementary Medicines in the Health System. Complementary medicines in the Australian health system. [On-line] September 2003 [cited 11 November 2005]. Available from: http://www.tga.gov.au/docs/pdf/cmreport.pdf.

  8. House of Lords. Science and Technology – Sixth Report. [On-line] 2000 [cited 11 November 2005]. Available from: http://www.parliament.the-stationery-office.co.uk/pa/ld199900/ldselect/ldsctech/123/12301.htm.

  9. Ernst, E., Cohen, M. H., & Stone, J. (2004). Ethical problems arising in evidence-based complementary and alternative medicine. Journal of Medical Ethics, 30, 156–159.

    Article  PubMed  CAS  Google Scholar 

  10. Kaptchuk, T. J., & Miller, F. G. (2005). What is the best and most ethical model for the relationship between mainstream and alternative medicine: Opposition, integration or pluralism? Academic Medicine, 80, 286–290.

    Article  PubMed  Google Scholar 

  11. Guinn, D. E. (2001). Ethics and integrative medicine: Moving beyond the biomedical model. Alt Ther in Healthcare and Medicine, 7, 668–672.

    Google Scholar 

  12. Mizrachi, N., Shuval, J. T., & Gross, S. (2005). Boundary at work: Alternative medicine in biomedical settings. Sociology of Health & Illness, 27, 20–43.

    Article  Google Scholar 

  13. Bensoussan, A. (2000). Complementary medicine: Searching for the evidence. Australian Family Physician, 29, 1129.

    PubMed  CAS  Google Scholar 

  14. Haigh, R. A. (2000). Alternative medicine and the doctrine of patient disclosure. Journal of Law and Medicine, 8, 197–206.

    Google Scholar 

  15. Parker, M. (2003). Chinese dragon or toothless tiger? Regulating the professional competence of traditional Chinese medicine practitioners. Journal of Law and Medicine, 10(3), 285–295.

    PubMed  Google Scholar 

  16. Saks, M. (2003). Bringing together the orthodox and the alternative in health care. Comp Ther in Med, 11, 142–145.

    Article  CAS  Google Scholar 

  17. Kaptchuk, T., & Eisenberg, D. M. (2001). Varieties of healing. I: Medical pluralism in the United States. Ann Int Med, 135, 189–195.

    PubMed  CAS  Google Scholar 

  18. MacLennan, A. H., Wilson, D. H., & Taylor, A. W. (1996). Prevalence and cost of alternative medicine in Australia. Lancet, 347, 569–573.

    Article  PubMed  CAS  Google Scholar 

  19. MacLennan, A. H., Wilson, D. H., & Taylor, A. W. (2002). The escalating cost and prevalence of alternative medicine. Preventive Medicine, 35, 166–173.

    Article  PubMed  Google Scholar 

  20. MacLennan, A. H., Myers, S. P., & Taylor, A. W. (2005). The continuing use of complementary and alternative medicine in South Australia: Costs and beliefs in 2004. Medical Journal of Australia, 184, 27–31.

    Google Scholar 

  21. Cohen, M. M. (2004). CAM practitioners and “regular” doctors: Is integration possible? Medical Journal of Australia, 180, 645–646.

    PubMed  Google Scholar 

  22. Chinese Medicine Registration Board of Victoria. [On-line] [cited 16 November 2005]. Available from: http://www.cmrb.vic.gov.au/.

  23. Chinese Medicine Registration Act 2000 (Vic). [On-line] [cited 16 November 2005]. Available from: http://www.cmrb.vic.gov.au/registration/ChineseMedicineRegistrationAct2000.mht.

  24. Australian Centre for Complementary Medicine. Education page. [On-line] [cited 17 November 2005]. Available from: http://www.accmer.edu.au/education/index.html.

  25. Australian Integrative Medicine Association. [On-line] [cited 17 November 2005]. Available from: http://www.aima.net.au.

  26. AIMA-RACGP Joint Position Statement. [On-line] [cited 20 November 2005]. Available from: http://www.aima.net.au/documents/media/RACGP-AIMA%20Position%20Statement%20on%20CM%20May%202005.pdf.

  27. Owen, D., & Lewith, G. T. (2004). Teaching integrated care: CAM familiarisation courses. Medical Journal of Australia, 181, 276–278.

    PubMed  Google Scholar 

  28. Australian Medical Council. Assessment and accreditation of medical schools: Standards and procedures. [On-line] 2002 [cited 10 December 2005]. Available from: http://www.amc.org.au/accredit.asp.

  29. Australian Medical Association. Complementary medicine position statement. [On-line] 2002 [cited 10 December 2005]. Available from: http://www.ama.com.au/web.nsf/doc/SHED-5FK4YN.

  30. Health World Ltd. [On-line] [cited 15 December 2005] Available from: http://www.healthworld.com.au/index.htm.

  31. Goldner, M. (2004). The dynamic interplay between western medicine and the complementary and alternative medicine movement: How activists perceive a range of responses from physicians and hospitals. Sociology of Health & Illness, 26, 710–736.

    Article  Google Scholar 

  32. Pelletier, K. R., & Austin, J. A. (2002). Integration and reimbursement of complementary and alternative medicine by managed care and insurance providers: 2000 update and cohort analysis. Alt Ther in Health and Med, 8(1), 38–48.

    Google Scholar 

  33. Willison, K. D., Mitmaker, L., & Andrews, G. J. (2005). Integrating complementary and alternative medicine with primary health care through public health to improve chronic disease management. J Comp & Int Med, 2(1) Abstract available at http://www.bepress.com/jcim/vol2/iss1/2/ (accessed 11 January 2006).

  34. Department of Health and Ageing. Medicare items for allied health services for people with chronic conditions and complex care needs. [On-line] [cited 20 December 2005] Available from: http://www.health.gov.au/internet/wcms/publishing.nsf/Content/health-medicare-health_pro-gp-pdf-allied-cnt.htm.

  35. Astin, J. A., Marie, A., Pelletier, K. R., Hansen, E., & Haskell, W. L. (1998). A review of the incorporation of complementary and alternative medicine by mainstream physicians. Arch Int Med, 158, 2303–2310.

    Article  CAS  Google Scholar 

  36. Cochrane CAM Field. [On-line] [cited 20 December 2005] Available from: http://www.compmed.umm.edu/Cochrane/index.html.

  37. Eastwood, H. L. (2000). Complementary therapies: The appeal to general practitioners. Medical Journal of Australia, 173, 95–98.

    PubMed  CAS  Google Scholar 

  38. Pirotta, M. V., Cohen, M. M., Kotsirilos, V., & Farish, S. J. (2000). Complementary therapies: Have they become accepted in general practice? Medical Journal of Australia, 172, 105–109.

    PubMed  CAS  Google Scholar 

  39. Little, M. (1998). Cartesian thinking in health and medicine. In P. Baume (Ed.), The tasks of medicine – An ideology of care (pp. 75–95). Roseberry, NSW: MacLennan & Petty.

    Google Scholar 

  40. Thorne, S., Best, A., Balon, J., Kelner, M., & Rickhi, B. (2002). Ethical dimensions in the borderland between conventional and complementary/alternative medicine. J Alt & Comp Med, 8, 907–915.

    Article  Google Scholar 

  41. Australian Competition and Consumer Commission. ACCC info kit for the medical profession. [On-line] [cited 28 December 2005] Available from: http://www.accc.gov.au/content/index.phtml/itemId/575092.

  42. Eastwood, H. (2000). Why are Australian GPs using alternative medicine? Postmodernism, consumerism and the shift towards holistic health. Jurnal de Sociologie, 36(2), 133–156.

    Google Scholar 

  43. Willis, E. (1994). Complementary healers. In Illness and social relations (pp. 54–74). Sydney: Allen.

  44. National Health and Medical Research Council. General guidelines for medical practitioners on providing information to patients. [On-line] 2004 [cited 28 December 2005] Available from: http://www.nhmrc.gov.au/publications/synopses/e57syn.htm.

  45. Parker, M. (2002). Whither our art? Clinical wisdom and evidence-based medicine. Medicine, Health Care and Philosophy, 5, 273–280.

    Article  Google Scholar 

  46. Parker, M. (2005). False dichotomies: EBM, clinical freedom and the art of medicine. Journal of Medical Ethics; Med Humanities, 31, 23–30.

    Google Scholar 

  47. Medical Practitioners’ Disciplinary Tribunal. Decision No 237/02/89D. [On-line] 5 August 2003 [cited 4 January 2006] Available from: http://www.mpdt.org.nz/decisionsorders/decisions/0289dfindings.pdf.

  48. Medical Board of South Australia. Unprofessional conduct. [On-line] [cited 4 January 2006] Available from: http://www.medicalboardsa.asn.au/page2.php?parentid=46&pageid=393.

  49. Health Practitioners (Professional Standards) Act 1999 (Qld). Schedule: Dictionary. [On-line] [cited 4 January 2006] Available from: http://www.medicalboard.qld.gov.au/Legislation/Legislation_files/Health%20Practitoners%20(Professional%20Standards)%20Act%2099..pdf.

  50. Eisenberg, D. M., Cohen, M. H., Hrbek, A., Grayzel, J., & van Rompay, M. I. (2002). Credentialling complementary and alternative medical providers. Ann Int Med, 137, 965–973.

    PubMed  Google Scholar 

  51. Welsh, S., Kelner, M., Wellman, B., & Boon, H. (2004). Moving forward? Complementaty and alternative practitioners seeking self-regulation. Sociology of Health & Illness, 26(2), 216–241.

    Article  Google Scholar 

  52. Del Mar, C. B., Glasziou, P. P., & Hayem, M. (1997). Are antibiotics indicated as initial treatment for children with acute otitis media? A meta-analysis. BMJ, 314, 1526.

    PubMed  Google Scholar 

  53. Myers, S. P. (2005). The challenge of intellectual innocence. J Comp Med, 5(1), 45.

    Google Scholar 

  54. Parker, M. (1999). Book review. P. Baume (Ed.), The tasks of medicine – An idelogy of care. Bioethics, 13(2), 178–180.

  55. Olafson, F. (2001). Naturalism and the human condition: Against scientism, chapter 1. London: Routledge.

    Google Scholar 

  56. Robertson, M. (2005). Power and knowledge in psychiatry and the troubling case of Dr Osheroff. Aust Psychiatry, 13(4), 343–350.

    Article  Google Scholar 

  57. Skene, L. (2004). Law and medical practice. Rights, duties, claims and cefences (p. 41). Sydney: LexisNexis Butterworths.

    Google Scholar 

  58. Rich, B. (2005). Medical ccustom and medical ethics: Rethinking the standard of care. Cambridge Quarterly of Healthcare Ethics, 14, 27–39.

    Article  PubMed  Google Scholar 

  59. Toth v Community Hospital at Glen Cove, 239 N.E. 2d 368, 373. (1968).

  60. Whitaker, R. V. (1992) 175 CLR 479.

  61. Bolitho v City and Hackney Health Authority (1998). AC 232 HL.

  62. Myers, S. P. (2003). On the verge of negligence. Comparative Medicine, 31, May–June.

  63. Brophy, E. (2003). Informed consent and CM. Comparative Medicine, 23–28, July–August.

  64. Weir, W. (2003). Obligation to advise of options for treatment – Medical doctors and complementary and alternative medicine practitioners. Journal of Law and Medicine, 10, 296–307.

    PubMed  Google Scholar 

  65. Brophy, E. (2003). Does a doctor have a duty to provide information and advice about complementary and alternative medicine? Journal of Law and Medicine, 10, 271–284.

    PubMed  Google Scholar 

  66. Kerridge, I. H., & McPhee, J. R. (2004). Ethical and legal issues at the interface of complementary and conventional medicine. Medical Journal of Australia, 181, 164–166.

    PubMed  Google Scholar 

  67. Shakoor v Situ. (2000). 4 All ER 181.

  68. Freckelton, I. (2003). Shakoor v Situ. Journal of Law and Medicine, 10, 268–270.

    Google Scholar 

  69. Weir, M. (2000). Complementary medicine: Ethics and law. Brisbane: Prometheus, 77, 82, 86–87.

  70. Commonwealth Government. Review of the law of negligence. [On-line] 2002 [cited 9 January 2006] Available from: http://revofneg.treasury.gov.au/content/home.asp.

  71. Hurwitz, B. (2005). How does evidence based guidance influence determinations of medical negligence? BMJ, 329, 1024–1028.

    Article  Google Scholar 

  72. Freckelton, I. (2002). Clinical practice guidelines: Legal repercussions. Journal of Law and Medicine, 10, 5–9.

    PubMed  Google Scholar 

  73. Parker, M. (2003). Reforming the law of medical negligence: Solutions in search of a problem. Torts Law Journal, 11, 136–164.

    Google Scholar 

  74. NSW Legislative Council. General Purpose Standing Committee No. 1. Inquiry into Personal injury compensation. Final Report. Ch 23. [On-line] December 2005 [cited 4 January 2006] Available from: http://www.parliament.nsw.gov.au/prod/parlment/committee.nsf/0/6DEB694C553E0DB8CA2570D100000C9A.

  75. Goodman, K. W. (2003). Ethics and evidence based medicine: Fallibility and responsibility in clinical science, vol. 97. Cambridge: Cambridge University Press.

    Google Scholar 

  76. Ashcroft, R. (2004). Current epistemological questions in evidence based medicine. Journal of Medical Ethics, 30, 131–135.

    Article  PubMed  CAS  Google Scholar 

  77. Sampson, W., & Atwood, K. IV. (2005). Propagation of the absurd: Demarcation of the absurd revisited. Medical Journal of Australia, 183, 580–581.

    PubMed  Google Scholar 

Download references

Acknowledgment

I am grateful to the two anonymous reviewers for helpful comments.

Competing interests

None declared

Author information

Authors and Affiliations

  1. Mayne Medical School, University of Queensland, Herston Rd., Herston, QLD, 4006, Australia

    Malcolm Parker

Authors
  1. Malcolm Parker
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Malcolm Parker.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Parker, M. Two into One Won’t Go: Conceptual, Clinical, Ethical and Legal Impedimenta to the Convergence of CAM and Orthodox Medicine. Bioethical Inquiry 4, 7–19 (2007). https://doi.org/10.1007/s11673-007-9031-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11673-007-9031-z

Keywords

Search

Navigation