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Doctors need to speak out against treatments that have no evidence of success

In a world awash with alternatives, patients deserve a better understanding of the science behind our modern medicines.

 Alternative medicine is big business. With a cost of more than $2 billion annually in Australia, you might think practices like vitamin and mineral supplementation, acupuncture, naturopathy, homeopathy or even chiropractic care were conventional. Yet the majority of these have little foundation in evidence. So why are so many of us signing up for treatments with no guarantee of success? At least some of the fault lies with doctors like me. 

Effective communication has long been considered a key component of medical care. Patients want to know how likely a treatment is to work and doctors should be able to tell them. This is the promise of evidenced-based care, yet in some regard doctors are failing to promote it.

Patients want to know how likely a treatment is to work and doctors should be able to tell them.
Patients want to know how likely a treatment is to work and doctors should be able to tell them. 

Generally, evidence-based practice has helped to increase both the safety and utility of many medicines. This comes at the cost of losing the "power of suggestion" that occurs when proof is absent. Alternative medicine does not suffer this dilemma. When a substance has not been tested in a well-designed trial it is impossible to say it doesn't have a benefit. When the purported effect is vague, such as wellness or immune defence, it is easy to convince yourself it is working. The mystery is maintained.

But explanations from doctors about why evidenced-based medicines are more effective than alternative medicine are not just poor at the patient level. Broader communication, which has a better chance to affect opinion and understanding, is frequently squandered by those on the soapbox.

Patients flock towards non-conventional care as it provides hope, optimism and a sense of control.
Patients flock towards non-conventional care as it provides hope, optimism and a sense of control. 

Take the Australian Medical Association, for example. Ostensibly the peak representative body of Australian medical professionals, its engagement with the public seems to occur only when changes to health funding are at stake. Cynically, this is when doctors' incomes are threatened. The public knows this, and loses attention.

By prioritising income protection as a point of discussion, the AMA misses the opportunity to instead provide a united voice on evidence-based practice.

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The same is true for specialist colleges. The vital and fundamental role of these organisations is to ensure a uniformly high level of care by Australian doctors. Few members of the public understand this, as colleges rarely engage with anyone other than medicos.

With a few notable exceptions, doctors in the media do not often discuss the role of evidence in quality medical practice. The importance of scientific trials is infrequently extolled. The focus of all practitioners is then left unclear. Without rational, unified explanations for the public, it is unsurprising that people feel let down by conventional medicine. Instead, patients flock towards non-conventional care as it provides hope, optimism and a sense of control. These critical factors are often missing from standard medical practice.

The problem is, the premise is false. The hope is fleeting, the optimism misguided and the control reversed. Patients seeking care will always be vulnerable. To provide treatments in the absence of evidence is exploitative and unethical.

So what's the solution? Patients deserve a better understanding of evidence-based practice. They deserve legitimate confidence in treatments with confirmed benefits. They deserve to be fully aware of the difference between evidence-based practice and alternative medicine in order to make informed decisions about their healthcare.

At a patient level, doctors need to improve explanations regarding the basis for their recommendations. Likely gains should be emphasised. Areas of uncertainty need to be acknowledged.

More broadly, an understanding of evidence and the role of clinical trials needs to be communicated frequently, clearly and without ulterior financial motives. Doctors in the media have an important role, as do professional organisations that would otherwise remain silent.

A well-informed public is one sceptical of all treatments on offer. The sales pitch of a large drug company is as open to question as that of a naturopath. Ineffective communication from practitioners is at least partly responsible for the rise in baseless treatments. In counteracting this, we all stand to benefit from better care.

Adrian Pokorny is a Sydney doctor.

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