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Advice to die for

How much harm is caused by incompetent advice in complementary and alternative medicine, asks Professor Edzard Ernst

Not so long ago, an undercover journalist visited five London-based CAM practitioners to ask for advice regarding the treatment of his non-Hodgkin lymphoma. He was told to use a myriad of unproven treatments. The cost of these interventions amounted to £26,0001.

One wonders how many cancer patients would have followed such advice. I often ask myself how much harm is being done by incompetent advice in CAM. Unfortunately there is little research into this tricky but important area.

A more systematic study concluded that ‘the use of alternative medicine was associated with a significant delay in cancer treatment’2. The phenomenon is, of course not confined to the UK, nor to cancer, nor to CAM practitioners; in fact, several of the clinicians the journalist consulted1 were doctors. Here are two other examples: UK non-medically trained acupuncturists advise 3% of their patients about prescription medicine3 without adequate competence to do so; only 23% of UK chiropractors regularly discuss with their patients the serious risks of their treatment4.

Misleading advice can, of course, also come from books or the internet or other sources. The recommendations of some CAM books for the lay public are quite clearly such that many patients could suffer serious harm if they adhered to it5. Several studies have demonstrated that information about CAM from websites can be equally dangerous6. Advice from health food stores is also often found wanting7. One study concluded that ‘the willingness of personnel in health food stores to make any recommendations should foster concern by patients and healthcare providers alike’7.

The lesson from all this, I think, is that GPs need to know the facts about CAM, provide reliable advice to their patients and warn them of sources which are likely to issue potentially harmful recommendations.

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

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