Maurice Cauchi

Before scientific medicine appeared on the scene less than 200 years ago, alternative medicine existed side by side with what was considered to be college-certified medical practice. Surgery took a bit longer to become an academic discipline, looked down on by medical doctors and was, for a long time restricted to unqualified barbers.

Since then, with the application of the scientific method, medicine has made, and is still making enormous strides. We do not accept anymore anecdotal evidence. We do not think highly of articles which are not peer reviewed. We are ready to accept criticism and modification of long-held dogma: a typical example of this is the ready acceptance of H. pylori as a cause of gastric ulcer rather than the long-held theory of hyperacidity due to vagal stimulation.

No wonder therefore that western medicine looks down on alternative medical methods which many believe relies heavily on the placebo effect, and at worst is seen as pure charlatanism.

Natural therapies have grown and now cover practically every aspect, ranging from the time-hallowed Chinese medicine to more recent modalities, such as Nutritional Medicine, Western Herbal Medicine, Musculo-skeletal Therapy, Massage, Homeopathy, Mindbody medicine, etc.

The degree to which any of these has managed to infiltrate into Western Medicine varies enormously. Acupuncture has become an established technique in a number of hospitals including Mater Dei Hospital and is used by an increasing number of clinicians. Referrals to other practitioners such as chiropractors and osteopaths is becoming more frequent, a process which acknowledges and provides legitimacy to these practitioners.

But the real question is why in recent years the number of patients resorting to natural therapy and other modalities of treatment is on the increase. What makes patients prefer these therapies instead of, or in addition to medical practice provided by the average general practitioner?

In a liberal society of course, anyone is free to choose one line of treatment rather than another. It is still the case, however, that medical practitioners and medical practice in Malta in particular is held in high esteem. So what are the perceived needs which are not being covered currently by our medical system?

There is no doubt that the degree of success of treatment of medical conditions varies considerably. In particular, the success of treatment of chronic diseases like arthritis, migraine, psychological disorders etc, by their very nature are long-standing and often intractable and resistant to treatment.

There is also, particularly in Malta, a well-known penchant for patients to seek a second opinion, in case the first one was inadequate or even wrong. All these factors may play their part in allowing other disciplines to make headway as an alternative method of treatment.

It is also possible that the long waiting queues in hospital outpatients’ departments and clinics tend to be a deterrent. In addition to this, the wellrecognized overloading of our doctors may result in less than adequate time spent with the patient. This is something which alternative medicine practitioners are well aware of, in fact they allow plenty of time to ensure that the patient is fully satisfied that their queries have been fully answered.

There is no doubt that the placebo effect has a great degree of significance in all aspects of medicine, whether classical western or alternative medicine. This is not to be ignored, because in many cases involving relatively minor or longstanding disorders, how the patient feels is an important part of dealing with the patient in a holistic manner.

There are, however, certain aspects which one must be on the look-out for. The author believes that it is the duty of healthcare professionals to correct misconceptions wherever they come from. 

One important misconception is that alternative medical treatment can do no harm. This is a fallacy. We all know that many important medicines that we use even today were originally derived from plants, and whether we take these in the form of tablets or as an infusion of the original leaf makes no difference to the potential sideeffect profile.

Secondly, vitamins and other products may actually counteract the effects of medication. A typical example is the ingestion of folate tablets by cancer patients on antifolate regimens.

Perhaps one misconception with potential tragic results to whole populations rather than merely to the individual is the increasing tendency for several alternate medicine practitioners to undermine the value of vaccinations, quoting anecdotal evidence for complications following such procedures. It is particularly important to emphasize that, while parents have every right to object to their child being vaccinated, the result of following such an advice by the general public would lead to reduction in ‘herd immunity’ with disastrous epidemics by diseases which have been under control for several generations.

The author believes that healthcare professionals need to be on constant watch for new trends evolving in alternative medicines. At the very least we should be aware what alternative medications are being used, to ensure that there is no danger of drug interactions or significant side-effects.

Perhaps it is also important to ask ourselves why patients are voting with their feet and requesting services which are not being provided by medical practitioners. It may not be within our powers to satisfy everybody, but it is in our interest to keep up-todate with developments in the medical field, however peripheral we may think they happen to be.