Consider Alternative Medicine
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We read the article by Lederer et al. with great interest (1). The systematic review is quite meritorious. Indeed, the use of complementary and alternative medicine is an important and frequent phenomenon, and in particular, in oncology (2).
We do, however, have two additional comments to help deepen the discussion:
First, we consider the term “naturopathic treatment” to be an unfortunate nomenclature, as it does not conform to international usage. Internationally, the term “complementary and alternative medicine” has been adopted, which is broader and includes non-material measures (2). In contrast, “naturopathic treatment” is a very narrow German terminology, which is reflected in the fact that the main treatment measures of the review are not from this field.
Second, we cannot quite understand the uncritical recommendation of acupuncture. Many of the studies included in the reviews and meta-analyses have no or only inadequate blinding, and even numerous sham procedures insufficiently control for non-specific effects (3). In addition, the indicated rate of treatment-related adverse effects (0.8%) in a complementary measure with uncertain effects is not very low. This makes acupuncture one of the complementary measures with the most complications, after phytotherapy (3, 4).
In the final report of the German Federal Joint Committee (Gemeinsamer Bundesausschuss, G-BA), this is quite well differentiated (3): “Acupuncture is associated with a multitude of possible adverse effects that can be expected with varying incidence. Serious adverse events, such as pneumothorax or infections, are rare and potentially preventable. The type and severity of the adverse effects depend in particular on the style of acupuncture, the acupuncturist, and the acupuncture point localization. Patients receiving acupuncture treatment must be given accurate information about the potential for adverse effects.”
Prof. Dr. med. Oliver Micke
Klinik für Strahlentherapie und Radioonkologie,
Franziskus Hospital Bielefeld, Germany, firstname.lastname@example.org
Prof. Dr. med. Jens Büntzel
Klinik für Hals-Nasen-Ohren-Heilkunde,
Südharzklinikum Nordhausen, Germany
PD Dr. med. Ralph Mücke
Strahlentherapie RheinMainNahe, Bad Kreuznach, Germany
Prof. Dr. med. Jutta Hübner
Universitätsklinikum Jena, Klinik für Innere Medizin II
Abteilung Hämatologie und Internistische Onkologie, Germany
Conflict of interest statement
Prof. Dr. Micke, Prof. Dr. Büntzel, and PD Dr. Mücke are members of the Working Group of Prevention and Integrative Oncology of the Germany Cancer Society. PD Dr. Mücke has received reimbursement for conference registration fees and travel expenses, as well as speaking honoraria, from biosyn-Arzneimittel GmbH, Lilly, and Roche. Prof. Dr. Hübner declares that no conflict of interest exists.
|1.||Lederer AK, Schmucker C, Kousoulas L, Fichtner-Feigl S, Huber R: Naturopathic treatment and complementary medicine in surgical practice—a systematic review. Dtsch Arztebl Int 2018; 115: 815–21 VOLLTEXT|
|2.||Loquai C, Dechent D, Garzarolli M, et al.: Use of complementary and alternative medicine: a multicenter cross-sectional study in 1089 melanoma patients. Eur J Cancer 2017; 71: 70–9 CrossRef MEDLINE|
|3.||Ernst E: Acupuncture: what does the most reliable evidence tell us? J Pain Symptom Manage 2009; 37: 709–14 CrossRef MEDLINE|
|4.||Gemeinsamer Bundesausschuss Akupunktur: Zusammenfassender Bericht des Unterausschusses „Ärztliche Behandlung“ des Gemeinsamen Bundesausschusses über die Bewertung gemäß §135 Abs.1 SGB V der Körperakupunktur mit Nadeln ohne elektrische Stimulation bei chronischen Kopfschmerzen chronischen LWS-Schmerzen chronischen Schmerzen bei Osteoarthritis. 2007 www.g-ba.de/downloads/40–268–487/2007–09–27-Abschluss-Akupunktur.pdf (last accessed on 21 February 2019).|