OPINION: The rhetoric around what constitutes 'good' evidence has become increasingly polarising
While some think that there is no difference between the research that needs to be done to ‘prove’ that a complementary medicine and a conventional drug is effective, others argue that because complementary medicines are considered to be low risk and are often come from traditional forms of health and healing, different evaluation models need to be developed.
Irrespective of who is correct, the rhetoric around what constitutes ‘good’ evidence has become increasingly polarizing.
A central part of this question may not be the evidence itself but how it is used.
It is now time to reframe the question of evidence from one of scientific evidence being good versus traditional evidence being bad and move to a respectful discourse that focuses on how best to support consumers in making informed decisions about including complementary medicines in their health care options.
Dr. Margaret Chan, Director General at the WHO said: “The two systems of traditional and Western medicine need not clash. Within the context of primary health care, they can blend together in a beneficial harmony, using the best features of each system, and compensating for certain weaknesses in each. This is not something that will happen all by itself. Deliberate policy decisions have to be made. But it can be done successfully.”
As stated by the World Health Organisation, this can only be done through deliberate policy decisions and not by applying a rule of one size fits all. Establishing the role of traditional evidence in supporting claims by complementary medicines is not easy.
One reason this is so challenging is that these products have traditionally been taken on the recommendation of a practitioner and now are available for consumers to self-select. For example, how can this form of evidence can be translated from a practitioner driven setting to a self-care model in a way that supports informed choice? This provides an opportunity for continued research and development of approaches into how this can be done.
Framing the debate
Compared to most countries, Australia is an enviable situation in helping answer these questions. It has a regulatory framework that is the envy of the world, focused on product quality that can exquisitely balance the need for the rigorous western science with a respect for traditional forms of health and healing such as traditional Chinese medicine and Ayurveda.
Australia has the added advantages of a mature complementary medicine practitioner community, a well regarded research academic community committed to high quality complementary medicine research and a robust industry with the resources and desire to support research and innovation. There are also vocal groups critical of what is being done and as long as the comments are constructive and objective rather than simply being based on ideology, they too also play an important role in the conversation
One of the greatest challenges in empowering consumers to make informed choices is the lack of consumer’s knowledge of the regulatory framework. Additional focus on supporting initiatives that increase Australians’ awareness and understanding of the Australian regulatory framework are needed. Rather than negative disclaimers, an approach shown in many overseas jurisdictions not to be effective, a multicultural country like Australia, could develop positive, informative and respectful ways to educate consumers so they can make good choices.
The original concept of evidence-based medicine acknowledged that good decisions incorporated three types of information: clinical expertise, best research evidence as well as patients’ values and expectations. In this spirit, it is time to move the discussion from the confrontational to the collaborative. This means ensuring that consumers are supported in effectively using the range of evidence available in making informed choices about including or, maybe as important, not including a complementary medicine in their health care options. After all, in the end it is their decision.
Michael Smith’s career in complementary medicines spans over 25 years and includes roles as a regulator, policy maker, educator, academic and now consultant. He is a speaker at the Complementary Medicines Australia Conference 2018 “Think Big” at Dockside, Sydney, September 19th 2018.
