Teaching complementary and alternative medicine

Dear Sir

While the use of complementary and alternative medicines (CAM) is prevalent throughout many parts of the world, it is estimated that only about 7.4% of CAM is evidence-based (Ernst 2011). For healthcare professionals, the lack of well-designed randomised controlled trials adds difficulty to decision-making. Although it is essential to base clinical decisions on the best available evidence, if the best available evidence is weak, it introduces the risk of recommending useless or even harmful interventions. Furthermore, a recent study conducted by academics in our School found that pharmacy graduates had inadequate knowledge of CAM and placed considerable value on the placebo effect (Hanna & Hughes 2012). While there is little doubt that the placebo effect can have therapeutic benefits, pharmacists are ethically required to avoid making claims that cannot be substantiated. Hence, in an era of evidence-based practice, it is not easy to justify a recommendation which has the primary aim of promoting a placebo response.

Given the global acceptance of CAM and the significance of evidence-based medicine, it is important that training in this area is available at both undergraduate and postgraduate levels to ensure that patients receive unbiased and accurate advice. The General Pharmaceutical Council provides educational standards for schools of pharmacy in the United Kingdom (UK) and outlines that undergraduate pharmacy students should learn about CAM. However, there is no specific guidance as to what exactly must be taught and the depth of knowledge required. This is similar to the General Medical Council standards set for undergraduate medical education.

We believe that it would be beneficial to introduce a syllabus covering core components of CAM and consider this to be an ideal subject to teach in an inter-professional environment. This approach would also ensure that patient care was standardised across the range of healthcare providers. Key challenges for educators include how to teach healthcare professionals to be evidence-based practitioners in all aspects of practice (while respecting patient autonomy) and how to make clinical decisions and effectively communicate to patients in the absence of robust evidence. With the demand for CAM, and our professional obligations, we must address these issues in students’ formative years to adequately prepare them for their future practice.