Alternative medicine in rheumatology: threat or challenge?

In the current issue of the journal the p e rsistence of ancient medical pra c-tices in Mexico is described (1). This a rt i cle raises an important issue: t h e large and poorly controlled use of un-proven or complementary and alternative medicine (CAM) in the field of rheumatic diseases. We all know that among patients suffering from chronic illnesses, in addition to or instead of c o nve n t i o n a l , m a i n s t ream medicine, CAM are often ap p l i e d. The use of CAM even seems to be growing, despite the trend to use only ev i d e n c e-based and cost-effe c t ive conve n t i o n a l medicine (2). Public interest in non-traditional treatments led the NIH in the USA to open the Office of Alternative Medicine (OAM) in 1992, which was replaced by the National Centre fo r Complementary and Alternative Medicine (NCCAM) in 1998. The NCCAM e n c o u rages and fi n a n c i a l ly support s research on CAM. In the Netherlands, there is no such national centre. Although we know that CAM are being applied frequently, exact numbers on the extent of usage cannot be given. An i m p o rtant reason is the pro blem of defining CAM. On the one hand, CAM might not only comprise therapies but also methods of diagnosis and prevention as well as philosophical wo rl d v i ew s , beliefs and attitudes. On the other hand, a clear definition of 'alter-native' is not easy to establish either. The cri t e rion of being ' n o n-m a i n-stream'is not satisfactory: what is non-mainstream in Europe could be mainstream in another part of the world, e.g. acupuncture. The same holds true for the criterion of not being taught widely in medical schools or not being generally available as a treatment modality in hospitals (3). Nor does the criterion of not having proven efficacy apply, as this criterion also applies to some of the e s t ablished conventional tre at m e n t s. The definition of the 'Cochrane Field in Complementary Medicine' of CAM (being 'diagnosis, treatment and/or prevention wh i ch complements mainstream medicine by contributing to a common wh …