Tag Archives: health care

‘Holistic’ dentistry: more poppycock than panacea?

The Conversation

Michael Foley, The University of Queensland

Many Australian dentists’ websites proudly advertise that they practise holistic dentistry, a philosophy that promotes health and wellness rather than simply treating disease, and considers the whole body and mind, not just teeth.

It sounds exciting. The implication is that this practice is very different – and superior – to the type of dentistry being practised by mainstream dental professionals. But different doesn’t actually mean superior.

Most holistic dental surgeries embrace and encourage alternative therapies. A quick internet search finds Australian dentists practising or endorsing homeopathy, naturopathy, Bach flower essences, acupuncture, traditional Chinese medicine, chiropractic, ayurvedic medicine, osteopathy, kinesiology, crystals, aromatherapy, reiki, vibrational healing, Buteyko and esoteric chakra-puncture.

Since all dentists are registered by the Australian Health Practitioner Regulation Agency, the public tends to assume they must be reputable and their treatments, even if out of the ordinary, must be effective. And, surely, we have to respect the centuries of ancient wisdom from whence many of these therapies came, right? Well, yes and no.

Not quite right

Many ancient remedies have given us modern medical treatments. Hippocrates recognised that powdered willow bark (containing aspirin) alleviated headaches. South Americans used cinchona bark (containing quinine) to treat malaria. Traditional Chinese medicine gave us ephedrine, a commonly used stimulant and decongestant, and the anti-malarial drug artemisinin. Both are now effective pharmaceuticals.

But doing something for centuries doesn’t automatically make it right. From the time of the ancient Greeks and Mesopotamians up to the late 19th century, misguided medicos bled patients, sometimes to death, in vain attempts to treat a multitude of ills. Bloodletting is still a core belief in some traditional health systems.

Doing something for centuries doesn’t automatically make it right.

Marcel Douwe Dekker/Flickr, CC BY-SA

And traditional Chinese medicine also uses rhino horns, tiger penises, shark fins and bear bile. Even ignoring the appallingly cruel way these “medicines” are obtained, none has any proven health benefits. Rhino horns are more expensive by weight than gold. As they consist largely of the protein keratin, purchasers could have saved a fortune by chewing their toenails.

Former Victorian dentist and self-styled “professor” Noel Campbell was practising (very) alternative dentistry in the late 1990s when charged with administering ozone to a patient’s rectum to relieve her facial pain. Not surprisingly, it didn’t work.

Campbell avoided disciplinary action by allowing his dental registration to lapse but continues to provide unproven alternative therapies to patients with cancer and other conditions through his website. And he’s not alone.

The recent cases of Wellness Warrior Jessica Ainscough and The Whole Pantry’s Belle Gibson show the importance of safe and effective health-care recommendations being based on more than a pretty smile and social media presence.

Importance of evidence

But aren’t some alternative therapies safe and effective? And how can we tell the difference? Thankfully, we have very good ways of determining if health treatments are effective.

The concept of evidence-based health care has arisen over the past few decades and is now almost universally accepted as the required standard for professional health practice.

Evidence-based dentistry accepts patients’ needs and preferences, while insisting treatments be based on the highest-quality scientific evidence and regular systematic reviews of published research.

Currently, most alternative therapies have a very limited evidence base to support their practice, and research methodologies are often poor. If a beneficial effect is shown, it’s often no greater than that achieved by placebo treatment, and less than that achieved by mainstream health care.

Most “natural” medications have never been placed on the Australian Register of Therapeutic Goods simply because they’ve never shown effectiveness. And alternative therapies found to be safe and effective become part of the mainstream health-care arsenal.

Does that really matter though, as long as patients receive the treatment they want and feel better as a result? Yes, it does matter.

A patient-dentist relationship must be based on trust and professionalism.

The Guy With The Yellow Bike/Flickr, CC BY-NC

Most holistic dental practices will provide a wonderfully caring and nurturing environment for patients, but a patient-dentist relationship must also be based on trust and professionalism. A dentist who provides or endorses treatment options based on centuries of “eye of newt and toe of frog” without finding out if any beneficial effect is real or merely a placebo is not acting in the patient’s best interests, even if their belief is genuine.

Not only is any placebo effect unlikely to be maintained in the long term, patients may have wasted considerable amounts of money and been deprived of legitimate treatments that could have provided much greater benefits.

Still the same

More than 2,000 years ago, Hippocrates wrote:

There are in fact two things, science and opinion; the former begets knowledge, the latter ignorance.

The public expects all health professionals to practise competently, ethically and professionally. Would you prefer a dentist who provides treatment and advice based on evidence from the most recent and highest-quality research studies, or based on clouds of dubious and scientifically unsupported mysticism?

In 1948, the preamble to the constitution of the World Health Organisation defined health as “a complete state of physical, mental and social well-being, and not merely the absence of disease or infirmity”. This description still holds up today, and sits very well with the concept of holistic dentistry. So holistic dentistry is really nothing new.

All dentists should be practising holistic dentistry. And they should all be practising evidence-based dentistry, too.

The ConversationMichael Foley is Senior Lecturer, Public health dentistry at The University of Queensland.

This article was originally published on The Conversation. (Reblogged by permission). Read the original article.


Filed under Reblogs

Are pharmacists are trustworthy as they’d like us to believe?

The Conversation

By Michael Vagg, Barwon Health, 12 September 2014

Pharmacists are consistently held up as among the most respected and trusted of professionals. They fulfil an important role within the health professions of being the gatekeepers of medication dispensing and the link between the community and their medication use. For more than one hundred years, there has been a very clear and ethical distinction between doctors (who prescribe medications) and pharmacists (who sell them). That way, the argument goes, doctors have no direct financial interest in drugs they prescribe, and pharmacists have no direct financial interest in recommending any of the drugs on their shelves directly to patients. So far, so good.

There has been a bit of role creep over the years, with calls from some doctors to be allowed to sell their own concoctions directly to their patients, as well as a much more concerted push by pharmacists to play a bigger role in health care, including providing immunisations and health checks direct to consumers. Naturally this is of concern to GPs as such proposals have the potential to fragment primary care even further. Not to mention taking the critical role of diagnosis and putting it into the hands of those who are underqualified, underinsured and undersupported to handle it.

What concerns me particularly is not so much that these health checks will take work away from GPs. If anything I suspect they will increase GPs workloads, sorting out the advice already given to patients by wannabe GP enthusiasts like pharmacists and their associated naturopaths. This month’s Skeptic magazine from Australian Skeptics highlights the problem quite well.

I think it’s time for pharmacists to decide if they want to keep the trust placed in them by the community to give sound advice. If they want to remain a trusted source of advice they need to lift their game and get all the ear candles, homeopathy, magnets, herbs and supplements out of their shops, along with the iridologists and other fairground ‘health professionals’. In short, they need to start acting like they deserve the trust and respect that is accorded them. We have heard nothing of the training and CPD requirements for pharmacists who want to diagnose and treat patients, let alone how they will be insured. I would want to see all this detail before I let my croupy baby or breathless grandmother within a bull’s roar of a pharmacist’s diagnostic skills.

The protectionism involved in the business of running pharmacies is breathtaking. Like dentists, only pharmacists are legally allowed to profit from running pharmacies, and they have defended this with all the bitterness and vitriol you might expect from a group who know they are onto a good thing. Health Minister Peter Dutton seems all for the pharmacists’ ambitions and has been on the media trail vowing not to wind back their protected status.

So it seems the pharmacists will have all they want. I wonder if they deserve it? I hope they take the opportunity to lift their game as a profession and use their protected status to raise standards, not profits. A good place to start would be to stop advertising and selling shonky devices and products that would be considered fraudulent in any other context. Too hard? Then get out of the expanded responsibility game for good.

The ConversationMichael Vagg does not work for, consult to, own shares in or receive funding from any company or organisation that would benefit from this article, and has no relevant affiliations.

This article was originally published on The Conversation. (Republished with permission). Read the original article.

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