One of the concerns I have about complementary and alternative medicine (CAM) is that it tends to come packaged with a philosophy or point of view which is hostile to scientific medicine. Even if specific CAM interventions are themselves harmless or even beneficial, CAM use seems to go along with irrational and unfounded or exaggerated fears of conventional medicine so that on balance the patient is harmed by not being able to utilize established therapies. The case of Dr. Gloria Dodd I recently discussed is a textbook example of this.
While the “complementary” approach in CAM is supposed to avoid this by marketing CAM interventions as compatible with conventional medicine, the underlying vitalist philosophy and epistemology of many CAM approaches is fundamentally incompatible with a scientific understanding of the world, so I suspect there is still a tendency for those who are attracted to CAM to shun much of conventional medical science.
A small bit of evidence to support this suspicion is contained in a study recently released in the journal Vaccine:
Jessop LJ, Murrin C, Lotya J, Clarke AT, O’Mahony D, Fallon UB, Johnson H, Bury G, Kelleher CC, Murphy AW; Lifeways Cohort Study Steering Group. Socio-demographic and health-related predictors of uptake of first MMR immunisation in the Lifeways Cohort Study. Vaccine. 2010 Aug 31;28(38):6338-43.
I haven’t been able to access the complete study, so I can’t comment on the methodology or whether the definition of CAM is appropriate (though I would appreciate it if anyone who can could pass it along or comment). But the conclusions are at least consistent with other evidence on the subject. According to the authors, “These data confirm prospectively for the first time that in addition to factors associated with disadvantage, other health practices and beliefs, particularly mother’s complementary and alternative medicine use, are associated with decreased MMR uptake (adjusted OR 2.65 (1.76-3.98)).”
Lower socioeconomic status is well-established as a factor reducing compliance with recommended childhood vaccination regimes. And decreased compliance is clearly associated with increased occurrence of vaccine-preventable diseases. However, this study also appears to show that a mother’s use of CAM is also associated with decreased compliance with recommended vaccination. Such indirect risks of CAM must not be ignored in evaluating the balance of risks and benefits for such approaches since they do represent a real source of harm to CAM users.
Update: January 9, 2011
A kind reader sent me a complete copy of the study, which I have had a chance to review. It provides an interesting look at the factors that influence compliance with recommended immunizations in Ireland, a country which has seen measles outbreaks, predominantly among unvaccinated children, in the aftermath of the Wakefield MMR/Autism hoax. I am particularly interested in the issue of whether CAM use is predictive of non-compliance with vaccine recommendations. I suspect it would be, since I believe one of the forms of indirect harm attributable to CAM is the rejection of conventional medical interventions, due to certain attitudes and philosophical positions that likely underlie both. However, I’m not aware of extensive research to support this hypothesis, and it is unclear to what extent this study can be seen as providing supportive data.
One big challenge in surveys examining CAM use and associated attitudes or behaviors is defining CAM. The authors of this study used the definition of the National Center for Complementary and Alternative Medicine (NCCAM) at the NIH:
a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine
This is a pretty loose definition, and of course begs the question of what “conventional medicine” is and how it differs from CAM. But the more salient issue is how exactly the survey participants were asked about their CAM use. A general question involving language such as that in the definition above is likely to generate different responses than, for example, a series of questions asking about specific CAM practices (acupuncture, chiropractic, TCM, etc). The latter would probably be more useful, but of course is harder to accommodate within the logistics of a survey.
This issue has been discussed with respect to previous surveys looking at the popularity of CAM. The significance of the results obtained depends on the definitions used. If respondents are asked about massage, prayer, diet, or other common practices, they may report high rates of CAM usage. But these practices do not necessarily share common philosophical underpinnings with more specific CAM modalities such as acupuncture or homeopathy, so these reports can be misleading if one’s goal is to assess underling attitudes or predict responsiveness to public health education.
I have not yet been able to ascertain how the CAM use data was collected in this study, but I have contacted the lead author to see if that information is available.
Januray 15, 2011
The lead author was kind enough to respond to my query. The original questionnaire apparently had only one question that essentially asked if the respondent had ever used complementary and alternative medicine, with no definition or examples provided. The authors also found that those who self-reported they had seen an alternative practitioner were less likely to have had primary imunizations given to their children, as well as the boosters discussed in the paper referenced above.
Obviously, more specific, detailed information regarding the relationship between specific CAM practices as well as CAM generally and use or avoidance of conventional medicine is needed. But the results of these studies certainly bolsters the impression, found also in much CAM advertising, that the ideology behind CAM use is often hostile to scientific medicine.