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Role of Complementary Medicines according to the French Academy of Medicine

Role of Complementary Medicines according to the French Academy of Medicine

 

The French Academy of Medicine published a report in 2013 on the usefulness of acupuncture, osteopathy, chiropractic, hypnosis and Tai Chi.

The report by Bontoux and colleagues, published by the National Academy of Medicine in 2013, analyzes the clinical value of four techniques: acupuncture, manual medicine (osteopathy and chiropractic), hypnosis and Tai Chi. The French Academy calls such practices “complementary therapies”. This report takes stock of their benefits by following the approach of Evidence Based Medicine. The authors conclude that these four practices can be effective for certain health problems. However, they recommend establishing good practice to harmonize the activity between Health Professionals.


The Study Rationale

The public is ambivalent on the progress of medicine. On one hand, they admire for its scientific and technological prowess. But, on the other hand, they openly criticize when innovations do not heal, cause side effects or create irreversible damage. Nearly 4 in 10 French then turn to complementary medicines. These non-pharmacological interventions are very frequently used in cancers, especially under the name supportive care.

The report of French Medicine Academy identifies links between conventional medicine and complementary therapies for mutual benefits in terms of public health. To do this, it relies on scientific knowledge from evidence-based medicine to highlight the efficacy of complementary therapies.

400 complementary medicines are listed in the world. Some are based on medical and scientific evidence indisputable. But why?

The Question

What are the effects of complementary therapies? What are their indications? What are their rules of good practice?

The Method

A working group of the French National Academy of Medicine completed a report on the effectiveness of complementary therapies and their role in care. The report conducted by Daniel Bontoux synthesizes knowledge on these practices according to the principles of Evidence Based Medicine. Of the 400 inventoried practices, only acupuncture, osteopathy, hypnosis and Tai Chi have been retained. The authors explain that these four therapies are most fed in clinical studies and they are already used by some hospitals.

The Non-Pharmacological Intervention (NPI) assessed

Acupuncture:

Its purpose is to regulate the yin and yang of the body or parts of it by manipulating specific areas called “acupuncture points”. The acupuncturist uses sterile disposable needles. 5 to 15 needles are inserted at the acupuncture points then left in place for a few seconds at 20-30 minutes. The usefulness of acupuncture can be seen in the following directions: back pain, neck pain, lower limb osteoarthritis, tennis elbow, fibromyalgia, headache, pain in pregnancy and childbirth, pain of dysmenorrhea, nausea and vomiting of cancer chemotherapy. The practice of acupuncture is reserved for doctors and trained midwives.

Osteopathy and Chiropractic:

The objective of osteopathy is to manipulate and mobilize various musculoskeletal areas and myo-facial of unforced manner and not instrumental. Chiropractic aims to treat disorders of the musculoskeletal system by manipulating vertebrae. Both techniques are part of the manual medicine which only the doctors and health workers already trained and graduates have the right to practice. This practice follows the rule of non pain and requires a medical diagnosis before handling.

Hypnosis:

Its goal is to induce a “disconnect” mental and physical by the suggestion causing relative isolation of the organism from its environment. Hypnosis creates a focused state of attention considered endowed with restorative powers that may assist in a better homeostasis and better management of the relations of the organization with its environment. Hypnosis is accompanied by clinical and neurophysiological events that guarantee the authenticity and legitimize its therapeutic use. Hypnosis is a technique used by psychotherapists, physicians and other caregivers.

Tai Chi:

The aim of the Chinese gymnastics method is better well-being, a harmony between body and mind for a better opening to the outside. Tai Chi is a combination of relaxation techniques and deep breathing in a controlled, defined postures and chained to each other by slow and harmonious movements. The number of positions is between 24 and 108. It is practiced by healthy individuals, especially the elderly, in order to maintain good physical and mental health. It is also recommended in certain pathologies.

Main Results

Acupuncture can bring benefit to patients suffering from low back pain or chronic neck pain, migraine or tension headache, osteoarthritis of the lower limbs, epicondylitis and pregnant women experiencing pain or lower back and pelvis during labor pains. This technique prevents nausea and vomiting induced by cancer chemotherapy. Its usefulness in fibromyalgia is uncertain. Its effect in other diseases such as stroke, asthma, autism, depression, schizophrenia is not excluded, but is not shown.

Manual medicine can show moderately effective on acute or chronic low back pain, the acute or chronic neck pain, headache and on vertiginous states of cervical origin, and to a lesser degree on migraines. Most Results from clinical trials manual medicine irrelevance due to low enrollment.

Hypnosis is most often used in cases of pain associated with medical procedures (surgeries, vaccinations) and side effects of anticancer chemotherapy. This technique of psychotherapy is effective in post-traumatic stress disorder. Some items show the superiority or equality of the effects of hypnosis compared to standard treatment or no treatment. By cons, other items are faced with too low numbers and too many methodological bias to really conclude.

Tai Chi improves balance and significantly reduced the risk of falls in the elderly. It increases the confidence in the ability of equilibration. For many geriatricians and professionals on aging, Tai Chi is considered a great way to prevent falls, with the advantage of group practice and act on cognitive function. Tai Chi would reduce blood pressure. The use of Tai Chi and Qigong especially improves the respiratory condition of patients with asthma, COPD or bronchiectasis.

Complementary therapies should be used in health facilities. However, this requires better identify their roles, to achieve strict control of personnel who provide, develop guides to good practice and to encourage clinical research in the field.


What it means for Patients

Acupuncture, osteopathy, chiropractic, hypnosis and Tai Chi are offered as complementary therapies by some hospitals. These practices must be encouraged according to the National Academy of Medicine when the supervisors are well trained. However, they should never be chosen by the patient as a first resort solution, nor as an alternative therapeutic solution to expose errors or delays in diagnosis and the occurrence of new diseases.

What it means for Healthcare Professionals

Acupuncture, osteopathy, chiropractic, hypnosis and Tai Chi are complementary therapies that must gradually integrate into hospital care. They must be carried out by qualified and trained personnel. The opening of the public hospital in this type of non-drug interventions should be encouraged particularly in order to improve the quality of practices and encourage research. Guides of good practice should be well prepared for the benefit of all health professionals.

What it means for Researchers

The recent opening of French hospitals, including university, to the practice of acupuncture, osteopathy, chiropractic, hypnosis and Tai Chi becomes an opportunity to conduct robust clinical studies. Work is desirable to clarify the modalities of practice, indications and levels of evidence, which remain quite low according to the National Academy of Medicine. For example, doubts persist about the role of the placebo effect as the main mechanism of action in acupuncture. It is the same, at least partially, for manual medicine. The special importance of hope, the patient’s expectation of a favorable outcome is accepted and proven by numerous experiments. It is the same for certain psychological engines such as packaging, confidence, motivation, anxiety reduction.

What it means for Policymakers

The effectiveness of acupuncture, osteopathy, chiropractic, hypnosis and Tai Chi is often mentioned in the press. Yet it remains limited to certain health problems with insufficient level of evidence. But the public’s interest in these practices now require to consider with the utmost seriousness and encourage clinical research.


The Reference

Académie Nationale de Médecine (2013). Thérapies complémentaires (acupuncture, hypnose, ostéopathie, tai-chi): Leur place parmi les ressources de soins. Paris: Académie Nationale de Médecine.


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To reference this Blog en Sante © article.

Ninot G (2015). Role of Complementary Medicines according to the French Academy of Medicine. Blog en Sante, A41.

© Copyright 2015 Gregory Ninot. All rights reserved.

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