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Is CAM-use a risk factor for patient non-compliance?

GPs may find CAM-enthusiast patients highly sceptical of mainstream medicine, warns Professor Edzard Ernst

GPs may find CAM-enthusiast patients highly sceptical of mainstream medicine, warns Professor Edzard Ernst

Complementary and alternative medicine (CAM) users tend to be critical about science and the 'medical establishment'. This general attitude also seems to prevent such patients from complying with mainstream prescriptions1. Practitioners of CAM, as well as books, websites and newspaper articles on CAM, have all been implicated in influencing CAM users such that they tend to distrust conventional medicine2.

These issues are difficult to investigate and systematic evidence is therefore scarce. The best researched example by far is the issue of compliance with immunisation programmes.

Some CAM practitioners (eg homeopaths, chiropractors, naturopaths and doctors of anthroposophical medicine) advise parents against immunising their children3. In this situation, non-compliance represents a risk, not just for the child who might remain unprotected, but for the population as a whole. If non-vaccination happens on a sufficiently large scale, a population will lose its herd immunity. In this case, epidemics would return, which we had long thought to be a thing of the past.

In the UK, anti-immunisation advice by CAM practitioners seems to be one of the main reasons for children to remain unvaccinated4. Recent evidence from Germany suggests that failure to immunize children attending anthroposophical schools or doctors has led to outbreaks of measles5.

The lesson for GPs is, I think, simple. They should be aware that some CAM enthusiasts amongst their patients may be highly sceptical about mainstream medicine and thus be non-compliant with their prescriptions. In these cases, an open discussion of the issues might be the best way forward.

Professor Edzard Ernst is professor of complementary medicine at the Peninsula Medical School, University of Exeter.

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