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Recent changes in policies allowing practitioners of Ayurveda, Yoga, Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) to integrate into the mainstream of healthcare and also allowing practitioners of Ayurveda and Homoeopathy to perform medical termination of pregnancy (MTP) under the proposed amendment to the MTP bill have brought crosssystem practice into the limelight. We evaluate cross-system practice from its legal and ethical perspectives. Across judgments, the judiciary has held that cross-system practice is a form of medical negligence; however, it is permitted only in those states where the concerned governments have authorized it by a general or special order. Further, though a state government may authorize an alternative medicine doctor to prescribe allopathic medicines (or vice versa), it does not condone the prescription of wrong medicines or wrong diagnosis. Courts have also stated that prescribing allopathic medicines and misrepresenting these as traditional medicines is an unfair trade practice and not explaining the side-effects of a prescribed allopathic medicine amounts to medical negligence. Finally, the Supreme Court has cautioned that employing traditional medical practitioners who do not possess the required skill and competence to give allopathic treatment in hospitals and to let an emergency patient be treated by them is gross negligence. In the event of an unwanted outcome, the responsibility is completely on the hospital authorities. Therefore, there is an urgent need to abolish cross-system practice, invest in healthcare, and bring radical changes in health legislations to make right to healthcare a reality.

In recent years, the term integrative medicine has gained acceptance in medical academia. The Consortium of Academic Health Centers for Integrative Medicine defines this term as "the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals, and disciplines to achieve optimal health and healing."1 Integrative oncology has been specifically described as both a science and a philosophy that focuses on the complex health of people with cancer and proposes an array of approaches to accompany the conventional therapies of surgery, chemotherapy, molecular therapeutics, and radiotherapy to facilitate health.2 The SIO and its Medline-indexed journal ( Journal of the Society of Integrative Oncology ), founded by leading oncologists and oncology professionals from major cancer centers and organizations, promote quality research and appropriate application of useful, adjunctive complementary modalities (〈http://www.IntegrativeOnc. org〉). The SIO assembled a panel of experts in oncology and integrative medicine to evaluate the current level of evidence regarding complementary therapies in the care of cancer patients. To help health care professionals make evidence-based treatment decisions in integrative oncology, the panel made specific recommendations based on the strength of the evidence and the risks/ benefits ratio. These practice guidelines, developed by the authors and endorsed by the Executive Committee of the SIO, address principles for clinical encounters, followed by individual classes of treatment modalities. There is an essential difference between "complementary" and " alternative" therapies. "Alternative" therapies are typically promoted as a substitute for mainstream care. By definition, alternative therapies have not been scientifically proven, often have no scientific foundation, and have sometimes even been disproved. However, complementary medicine makes use of unconventional treatment modalities and approaches that are nonsurgical and nonpharmaceutical but that have known efficacy. When combined with mainstream care, these modalities can enhance effectiveness and reduce adverse symptoms. The use of complementary and alternative therapies by cancer patients is common, and given that complementary therapies can be helpful in symptom control, but the substitution of therapies with no evidence of safety and/or efficacy can delay or impede treatment, we strongly recommend that medical professionals routinely inquire as to the use of such therapies during the initial evaluation of cancer patients. The extensive use of complementary and alternative therapies can also challenge and frustrate both health care professionals and patients, leading to a gap in communication that negatively affects the patient-provider relationship. This communication gap may also arise from the patient's perception that health care professionals are indifferent to or object to the use of unconventional therapies, a perception that can lead to a loss of trust within the therapeutic bond. Health care professionals, who remain open to inquiries and aware of subtle, nonverbal messages from patients, can create an environment where patients feel free to openly discuss all choices in their care. Evidence suggests that patients supported in this manner are less likely to pursue potentially dangerous alternative therapies and are more likely to adhere to conventional, evidence-based treatment programs. We strongly recommend that qualified professionals provide guidance in an open, evidence-based, and patient-centric manner with those who use or are interested in pursuing complementary or alternative medicine so that they can approach these therapies appropriately. Patients should be informed of the conventional treatment approach, the nature of specific alternative therapies, the realistic expectations, and the potential risks and benefits. © 2009 BC Decker Inc.