Why there's a need for Complementary and Alternative Medicines and the medical profession to learn from each other

Complementary and Alternative Medicines (CAM) have regularly pioneered healthcare innovation

Complementary and Alternative Medicines (CAM) are often at the leading edge of advances in healthcare.

It's not uncommon for key concepts which were initially found outside mainstream medical paradigms to be gradually integrated over time into mainstream practice, perhaps after they have been sifted, filtered, stripped bare of any excess or loss of perspective, and then evaluated so that a scientific foundation or evidence-base is laid down. Other CAM concepts never make it into the mainstream and fall away.

The same sifting process happens with many accepted medical treatments, too, which are popularised in mainstream clinical guidelines, then found over time to not work, or to lack any pathophysiological rationale, or to even do harm.

Here are some important things to know about Complementary and Alternative Medicines.

• CAM is more attuned to the ancient traditions across different cultures which understand and ritually celebrate the interconnectedness of our human mind, body and soul with all other living things. Many CAM practices are deeply rooted in traditional cultures, operating outside Western philosophical frames. At the very least, these CAM approaches draw on the neurobiological power of expectation, which is not 'make believe' the way our Western culture likes to say, but a deeply healing power in its own right, since healing is a psychobiospiritual event which unfolds at the interface between the human immune and nervous systems, and other biological systems within our body.

• CAM therapies are often much more attuned to the healing powers of imagination than the medical profession. CAM may be much more attuned to the vast and mysterious universal powers which play up through our human minds and bodies.

• CAM understands that the built environment and our sensory experience affect our bodily and mental wellbeing, that music, scent, sounds, lighting and touch are integral to healing. Modern medicine has much to learn from this.

Improved nutrition is one example of a fundamentally important area of health pioneered by CAM practitioners in my life-time

An example of a concept that has become mainstreamed in my lifetime is the importance of a wholesome diet, which contains a predominance of unprocessed, plant-based foods. Preoccupation with a wholesome diet in the late 1970s was still viewed as an alternative medicine pursuit, the purview of naturopaths.

As a medical student, the doctor who taught me physiology announced to the two hundred medical students in his lecture theatre that "diet doesn't matter, because it's all broken down into constituent parts in the digestive tract anyway." He had a pasty complexion and looked rather unhealthy to me, though he was an excellent teacher. I rather judgementally attributed his complexion to his dietary beliefs, because I'd been influenced by what were at the time viewed as alternative perspectives on the body's evolutionary need for a low-sugar, plant-based, high-fiber diet.

But by the 2000s, an appreciation of the importance of a wholesome diet was mainstreamed within my own profession.

Treatment for movement and musculoskeletal pain and dysfunction is another example of a fundamentally important area of health pioneered by CAM practitioners in my life-time

Another vital example of how CAM practitioners have pioneered in healthcare is in the area of movement and musculoskeletal pain and dysfunction. You can find out about my experiences of this here.

Prescribing anti-thrush diets for diagnosis of candidiasis in patients with chronic fatigue, myalgias, and other complaints is one example of how some CAM practitioners have lacked perspective-taking and scientific integrity in my life-time

It could be that unwholesome diets very high in sugars predispose to mucosal candida infections in some cases, presumably because of the impact upon microbiomes. But systemic candida - in body tissues and bloodstream - only occurs in genuinely immunocompromised patients, and is very serious.

Yet for the first decade of my practice as a young GP, the diagnosis of candidiasis was a favourite amongst CAM practitioners here in Australia, who even told my frightened patients they could see the yeast in samples of their blood (which the local naturopaths examined under a microscope, claiming to have been trained by various institutes to do so). Whole CAM conferences were devoted to diagnosing systemic candidiasis, during which the medical profession was roundly condemned for our ignorance in failing to identify blood-born yeast infection. CAM therapists diagnosed systemic candidiasis for symptoms ranging from fatigue, mood swings, gut problems, recurrent vaginal thrush, and recurrent viral infections. The kinds of diets that were prescribed by naturopaths for this condition tended to be burdensome and obsessive, wrapped in a detailed pseudo-science. There was, of course, no yeast visible in the blood samples - unless that patient was seriously ill with life-threatening invasive infection.

Yet despite this dangerous lack of perspective, this absence of scientific credibility, there remained something important and pioneering about the core concept of the importance of a wholesome diet low in refined foods and sugars, and high in vegetables.

Breastfeeding support professionals and their organisations and guidelines have regularly drawn on CAM treatments for breastfeeding women and their babies throughout my life-time

In the world of breastfeeding, at this time in my career, including from when I was first qualified as an International Board Certified Lactation Consultant from 1994, women with nipple pain were treated with aggressive courses of antifungal medications, even though it was increasingly clear to me that repetitive nipple microtrauma was the culprit. Old CAM beliefs about the dangers of systemic candidiasis still persist in the unfounded belief that nappy rash thrush in the baby or a mother's vaginal thrush predispose to nipple and breast thrush.

Because mainstream medical practice has seriously failed breastfeeding women in recent generations in Western societies, breastfeeding advocacy has in my experience always tended to be strongly influenced by CAM beliefs and practices. Dietary manipulations (for instance, to treat allergies in babies who were unsettled) and diagnoses of thrush are just two examples. But there are many more. I have aimed to address these unhelpful practices in my research publications and the NDC programs over the past 20 years.

Maintaining perspective remains a challenge for some Complementary and Alternative Medicines

In my view, the danger for complementary and alternative medicines, which may be an inevitable consequence of training traditions, limited exposure and responsibility for the devastating breadth of human illness, high numbers of specific kinds of patients and conditions, and being located on the margins in health, is a loss of perspective. There is usually very little grounding in the benefits of conventional scientific inquiry. This loss of perspective tends to go hand-in-hand with a mistrust of mainstream medicine.

The failings of mainstream medicine are obvious to CAM therapists (and also to many of my younger medical colleagues coming through, especially in general practice), but CAM therapists are often unable or not trained to hold in perspective the historically unprecedented privilege of our healthcare systems within advanced economies, for all their flaws.

This critical loss of perspective in CAM, culminating in a mistrust of mainstream medicine and science, has been amplified by social media in recent years. Social media tends to emphasise a group belonging which coalesces around opposition to mainstream organisations, focusing on a mainstream institution's flaws and blind spots (which of course are plentiful.)

Pseudo-sciences flourish as a result, with shared scientific and medicalized languages quite different to mainstream medicine. An apparently scientific discourse (which is, however, not evidence-based or consistent with medical science) and reductionist methods which offer quick fixes impresses patients, who relocate their trust from the doctor to the CAM practitioner - ironically just at a time when many doctors (especially in family medicine or general practice) are moving away from medicalized and pathologizing language, and developing scientific models based in evolutionary biology and complexity science (not reductionism).

To my mind this lack of perspective was amplified in the anti-vax movement of the Covid pandemic, as folks who lacked an understanding about how to analyse data and research, or how to hold data and research in perspective, developed a frightening and paranoid pseudo-scientific discourse - even though there were good reasons to critically engage our public health responses.

The widespread embrace of pseudo-scientific language by CAM therapists, and the split between the medical profession and CAM therapists, is dangerous. People are drawn to CAM because it offers something that my own profession doesn't. Doctors have traditionally been dismissive and even contemptuous of alternative therapies, although I believe that has changed over the course of my professional life. CAM therapists can be dismissive and also contemptuous of the medical profession. I wish I could say I think that is changing but in the world of breastfeeding I believe it is getting worse - no doubt in reaction to my own profession's disgraceful lack of knowledge about clinical breastfeeding support.

CAM therapists often provide a kind of attentive, time-intensive, empathic care that patients don't easy find in the medical system. Female GPs, who (from experience and also documented in the research) spend longer time with patients and are more avaiable to listen to the complexities of both mental health challenges and multiple interrelated medical conditions, are paid significantly less than those who practice quicker patient throughput, and have higher rates of burnout as a result.

How can we bridge the gap between Complementary and Alternative Medicines and mainstream medical practice?

One solution I believe lies is a careful listening to each other. As doctors and registered health professionals, we need to be aware that our patients are attracted to CAM for important reasons. They find something in CAM that our own profession is not offering, and which we would do well to identify.

For the CAM therapists, it is to aim for perspective-taking, to avoid simplistic interpretations, accepting both the strengths and the limitations of one's own scope of practice. It's been alarming for me to see over the past decade that as CAM therapists aim to move into the mainstream of breastfeeding support, they promote reductionist approaches, detailing anatomic dysfunctions and diagnosing pathologies, using scientific terms and anatomic labels in the absence of supporting scientific evidence, copying the worst of the reductionist medical traditions with its trend to overdiagnosis and overtreatment.

For example, the widespread belief that complex breastfeeding problems result from restricted infant fascia or poor neuromuscular integration or overactive and underactive reflexes, which can be treated by repeated hands-on intervention or teaching parents to do exercises on the baby, is reductionist and unscientific, without evidence of benefit. This is not to deny the power of this kind of bodywork in older children and in adults. You can find out about this here. But when applied to the pristine tissues of a small baby who is having difficulties breastfeeding from his mother, it lacks perspective.

I often think that the way forward in a hyperpolarized world, in which groupthink sweeps us up in social media and the news so that no-one is quite certain what is true or not anymore, is for an individual to become highly ethically attuned and to find the courage to live both privately and publicly according to one's own values. You can find out about groupthink here. To tune into reliable sources which are either evidence-based or honest about the limitations of the evidence, which align with one's own values, which decline to exaggerate or dehumanise other perspectives is, I believe, the way forward in a world that often puts money before the best interests of patients.

I have always been interested in the way the lives we lead write into our human bodies. This is what drew me into the practice of medicine. I have always known that our stories - our family-life, our psychological and spiritual lives, the events in our physical and social environments - inscribe into our vulnerable human flesh, into the integrity of our cells and organs, into patterns of movement and muscle tone and neural pathways, into our very bones.

Our life experiences and choices are not the only factors that impact upon our health, since the body speaks intergenerational genetic languages and there is always the mystery, affliction beyond our control or comprehension struck into the body by fate.

But I want to let you know that I've always known that the mind, body, and soul, including our patterns of movement, are integrally interrelated. This understanding has been fundamental to the development of the Possums programs, including Possums Breastfeeding & Lactation.