Let’s not overdo it. I’ve noticed over the decades in this field that a wide range of approaches appear to enhance recovery for different individuals. I don’t like to dismiss them simply because we lack good scientific evidence to support them.
Take acupuncture: that’s not backed up by conventional science, and yet I happen to live in a hotbed of the practice. There are close to a hundred qualified practitioners in our small city of 85,000. At our treatment center, we kept a list for patients who were interested. They had to pay the fees themselves, and I figured not many would take us up on it. Needles were involved, after all.
I was wrong. It became one of our more popular therapies.
Does it work? Depends who you ask. I read the research, which suggests that the needles themselves have little or nothing to do with the effect. So what is making patients feel it’s worth the trouble? Who knows?
But if they do feel better, and appear to suffer no harm, I didn’t think it was my place to interfere.
A year after my experience at that treatment center, I happened to visit a premier medical school where I mentioned this experience to several of the faculty. They frowned. What was I doing, one insisted, foisting pseudoscience on vulnerable patients? I didn’t see myself as “foisting” anything on anyone, just recognizing an apparent benefit. The professor stopped short of open scorn, but managed to make it clear that on some level, he felt I had betrayed science.
I disagree. Research admittedly takes a long time, including the need for replication, and patients in clinical programs aren’t necessarily willing to wait. With the opioid epidemic uppermost in everyone’s mind, the current emphasis is on enrolling as many as possible in MAT. That’s sound strategy from a public health standpoint. But it’s also true that a significant percent will drop out within a year. In healthcare we politely refer to this a retention problem. To call it common would be an understatement. Is it OK for me to encourage patients to try different things, to see if they help? Assist them in making an informed choice? Assuming the practice isn’t harmful.
By the way, I did notice that some acupuncturists were far more highly rated by patients than others, though all had the same credential. That’s usually a sign that the practitioner is more important than the practice, in terms of outcome. There’s good research to support the notion that the ability to create a strong bond with the patient is in fact more critical than the specific type of approach used. If that turns out to be true, then I don’t see a problem with encouraging people to cast their net around for things that help — whether or not science has gotten around to providing evidence to confirm it.