DOI: https://doi.org/10.4414/smw.2014.13930
Reply to the Letter to the Editor "Provision of complementary and alternative medicine in Swiss hospitals: neither increasing nor evidence-based"
We thank Dr. Shaw for his comments on our article [1], thus giving us an opportunity to clarify our position regarding complementary and alternative medicine (so-called CAM). This is all the more important because, in our opinion, Dr. Shaw wrongly interprets our paper in suggesting that we unconditionally support the use of “superstitious” therapeutic approaches, which is clearly not our message. Dr. Shaw apparently ignores the fact that that there are many evidence-based publications pertaining to CAM [2, 3], which does not mean that any CAM should be used in any situation, but that some CAMs have proven to be effective in specific diseases or health problems.
We fully agree with the proposal that “action should be taken to ensure that any CAM offered in Swiss hospitals is evidence-based”, which would mean that hospitals should base the choice of implementing CAM interventions on scientific data. We also make the point that “if the safety and efficiency of the CAM is evidence-based, it should receive the same resources as a conventional therapy”.
In our conclusion, we state that “The number of hospitals offering CAM in the French-speaking part of Switzerland seemed to have risen since 2004.” Shaw suggests that, based on the available data, there has been no increase in the use of CAM in Swiss hospitals. As a matter of fact, our study focuses on hospitals within the French-speaking part of Switzerland. As outlined in the methods section of our paper, rather than using the 2004 all-Switzerland figure for comparison, we reanalysed the database used in the 2004 study [4], selecting data from the French-speaking part of the country as the denominator for comparison. In the 2004 database, in hospitals of the French-speaking region, only 43% of the hospital managers indicated that they offered at least one CAM in 2004. Moreover, the 64% figure for CAM provision quoted by Shaw is incorrectly used as it was obtained from a second questionnaire sent only to a selection of persons or departments referred to by respondents of the first questionnaire.
When Shaw writes that “’effective evidence-based alternative medicine’ is a contradiction in terms” (because, according to him, “if we have evidence that it works, it is no longer alternative”), he overlooks the large number of prestigious institutions which have used this term for several decades, including the US-based National Institutes of Health [3], the Mayo clinic, the Harvard medical school and La Charité in Berlin, for example.
As health professionals, we have to take into account the fact that patients use CAM very often: in the 2007 Swiss health survey, 30.5% of women and 15.2% of men had used at least one CAM method in the past 12 months [5]. It is thus extremely important, as stated by Bonvin, that medical students, physicians and hospital managers include in their vision the fact that, as CAM use is part of the lifestyles of many patients, the phenomenon should not be ignored, but rather adequately addressed.
In other words, and this is why the Faculty of Biology and Medicine of Lausanne has implemented a modest sensitisation teaching track on CAM, academic researchers and teachers have to train physicians on how to discuss CAM treatment with their patients, specifically to deliver informed and relevant counselling about complementary medicines, as they are used to doing for conventional treatments [6, 7].
1 Shaw D. Provision of complementary and alternative medicine in Swiss hospitals: neither increasing nor evidence-based. Swiss Med Wkly. 2014;144:w13926 http://www.smw.ch/content/smw-2014-13926 .
2 Ernst E, Pittler MH, Wider B, Boddy K. Oxford handbook of complementary medicine. Oxford: Oxford University Press; 2008. 424 p.
3 Briggs JP, Killen J. Perspectives on complementary and alternative medicine research. JAMA. 2013;21;310(7):691–2
4 Widmer M, Donges A, Wapf V, Busato A, Herren S. The supply of complementary and alternative medicine in Swiss hospitals. Forsch Komplementärmed. 2006;13(6):356–61.
5 Klein SD, Frei-Erb M. Wolf U. Usage of complementary medicine across Switzerland. Swiss Med Wkly. 2012;142:w13666 http://www.smw.ch/content/smw-2012-13666/ .
6 Graz B, Rodondi PY, Bonvin E. Gibt es wissenschaftliche Daten über die klinische Wirksamkeit komplementärmedizinischer Behandlungsmethoden? Forum Med Suisse. 2011;11(45):808–813. German.
7 Rodondi PY, Graz B, Bonvin E. Faut-il collaborer avec les médecines alternatives? Rev Med Suisse. 2012;8:224–5. French.