Ethical problems arising in evidence based complementary and alternative medicine

Complementary and alternative medicine has become an important section of healthcare. Its high level of acceptance among the general population represents a challenge to healthcare professionals of all disciplines and raises a host of ethical issues. This article is an attempt to explore some of the more obvious or practical ethical aspects of complementary and alternative medicine.     

Ethical and legal issues at the interface of complementary and conventional medicine

Doctors should: Honestly answer patients' direct questions about CAM and elicit information about their use of it. Establish patients' understanding of the conventional and complementary therapies, both those available to them, and those that they may already be using. Establish why the patient uses CAM, and their goals for both complementary and conventional therapies. Reflect on whether information about CAM would be material for that patient at that time, taking into account the patient's burden of illness, his or her expressed preferences and the risks and benefits of both conventional and complementary therapy. Take steps to become adequately informed about available CAM that has consistently been shown to be safe and effective; has consistently been shown to be ineffective and/or harmful; or is consistently enquired about by patients. Become familiar with qualified and competent CAM practitioners (medical and non-medical) to whom referrals can be made when necessary. Continue a relationship with the patient, while continuing to monitor the patient conventionally and staying open to further discussions about CAM.     

Ethical issues in transfusion medicine

The practice of transfusion medicine involves a number of ethical issues because blood comes from human beings and is a precious resource with a limited shelf life. In 1980 the International Society of Blood Transfusion endorsed its first formal code of ethics, which was adopted by the World Health Organisation and the League of Red Crescent Societies. A revised code of ethics for donation and transfusion was endorsed in 2000. Blood donation as a gift, donor confidentiality, donor notification and donor consent, consent for transfusion, the right to refuse blood transfusion, the right to be informed if harmed, and ethical principles for establishments, are discussed in the international and Indian contexts.     

Cancer complementary and alternative medicine research at the US national cancer institute

The United States National Cancer Institute(NCI) supports complementary and alternative medicine(CAM) research which includes different methods and practices (such as nutrition therapies) and other medical systems(such as Chinese medicine). In recent years,NCI has spent around $120 million each year on various CAM-related research projects on cancer prevention,treatment,symptom/side effect management and epidemiology.The categories of CAM research involved include nutritional therapeutics, pharmacological and biological treatments,mind-body interventions,manipulative and body based methods,alternative medical systems,exercise therapies,spiritual therapies and energy therapies on a range of types of cancer.The NCI Office of Cancer Complementary and Alternative Medicine(OCCAM) supports various intramural and extramural cancer CAM research projects.Examples of these cancer CAM projects are presented and discussed.In addition,OCCAM also supports international research projects.     

Ethical issues concerning New Zealand sports doctors

Success in sport can provide a source of national pride for a society, and vast financial and personal rewards for an individual athlete. It is therefore not surprising that many athletes will go to great lengths in pursuit of success. The provision of healthcare for elite sports people has the potential to create many ethical issues for sports doctors; however there has been little discussion of them to date. This study highlights these issues. Respondents to a questionnaire identified many ethical matters, common to other areas of medicine. However they also raised problems unique to sports medicine. Some of these ethical difficulties arise out of the place of the sports doctor within the hierarchy of sport. Yet others arise out of the special relationship between sports doctors and individual players/athletes. This study raises some important questions regarding the governance of healthcare in sport, and what support and guidance is available to sports doctors. As medical and scientific intervention in sport escalates, there is a risk that demands for enhanced performance may compromise the health of the athlete, and the role the sports doctor plays remains a critical question.     

A survey of complementary and alternative medicine in Iran

Objective:To survey the use,capability and satisfaction of complementary and alternative medicine(CAM)in comparison with conventional medicine in Iran.Methods:In this national survey,a cross-sectional study was designed,5,000 people were surveyed to identify predictors of Iranian traditional medicine(ITM)use compared with conventional medicine.Data were collected through a questionnaire that covered three different predictor categories: demographic information,patient’s viewpoint,and patients’ experiences.Results: Most of the participants preferred government owned hospitals rather than other places.Praying for one’s own health was the most frequent and favorable ITM domain(P=0.017)based on patients’ interests,both in low-(P=0.08)and highlevel (P=0.011)educated subjects.Among the participants,97.8%had previous conventional medicine history due to their chronic diseases Conclusions:Iranian patients resort to ITM as a choice at the late stage of the disease.Current deficiency in integration of CAM and conventional medicine is in contrast to the increasing demand on patients’ side.Health care organizers should be facilitating the CAM services by tuition of CAM practitioners and supporting eligible CAM centers for diagnosis and treatment of patients.     

Use of complementary and alternative medicine in Hawaii cancer patients

This research investigated complementary and alternative medicine (CAM) use by Hawai'i cancer patients. Thirty-six percent of patients used CAM, most commonly religious/spiritual therapy and herbal treatments. CAM use was linked with younger age, female gender, Catholic religion, and more education. More research is needed to inform decision-making.     

补充替代医学国际使用情况分析

中医药属于世界补充替代医学的重要组成部分，把握补充替代医学的国际形势以及中医药在其中的地位是中医药国际化的基础。本文通过分析国际社会补充替代医学的使用率、应用病种、使用者的社会人口学特征以及医学经济学情况等，探索提升中医药在海外的声誉和使用率的可行途径。     

Review on efficacy and health services research studies of complementary and alternative medicine in inflammatory bowel disease

Objective:To assess the evidence of the use and efficacy for complementary and alternative medicine(CAM) in inflammatory bowel disease(IBD). Methods:A systematic literature search in MEDLINE was performed for randomized controlled trials(RCTs) in Crohn’s disease and ulcerative colitis.Moreover,a selective literature search for health services research studies on the use of CAM in patients with IBD was performed.Results:Health services research studies showed a high use of CAM in adult and pediatric patients with IBD worldwide.In contrast to the high use among IBD patients,there was a lack of high-quality data for many of the used CAM methods.Although most of the studies showed positive results,the methodological quality of most studies was rather low;therefore,the results had to be interpreted with caution.While there were many studies for probiotics and fish oil,RCTs for the highly used method homeopathy, for most herbal products,and for traditional Chinese medicine methods apart from acupuncture RCTs were completely lacking.Conclusions:The lack of high-quality studies might be the consequence of the problems associated with the funding of clinical trials involving CAM.However,having the high user rates in mind,high-quality studies assessing efficacy and safety of those methods are urgently needed.Furthermore,there is a need for better representation of CAM in undergraduate and postgraduate medical education.