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Alternative treatment modalities: The need for a rational response by the nursing profession
Commentary ALTERNATIVE TREATMENT MODALITIES: THE NEED FOR A RATIONAL RESPONSE BY THE NURSING PROFESSION Lois Biggin Moylan, RN, PhD During the last 2 decades, interest in and use of alternative modalities of health care has proliferated. As the public demand for such therapies increased, nursing has been among a few of the health professions to fill this need. Some of these therapies may prove to be valuable, others may be shown to be ineffective, and others may be harmful. Presently, many alternative methods have not been tested by using rigorous scientific methods. In addition, standardization in education and credentialing of practitioners of these modalities is lacking. As health care professionals, nurses have a responsibility to their patients and to their profession to validate the safety and efficacy of their practice. It is incumbent on the recognized bodies of the nursing profession to address these serious issues. The safety of patients and the reputation of the profession of nursing may depend on it.
D
uring the last 2 decades, interest in and use of alternative modalities of health care has proliferated. As the public demand for such therapies increased, nursing has been among a few of the health professions to fill this need. Historically, nursing has always provided a far more holistic approach to care than other health care providers. Treatments such as diet, hygiene, and ventilation1,2 were incorporated into nursing regimes long before physicians recognized these treatments as having significance in the curative process. Herbs containing digitalis, ergotamine, and belladonna were used by nurses before their acceptance into mainstream medicine.3 The way these therapies made their way into accepted practice and were legitimated as effective treatments was through careful empirical study. Such methods included meticulous medical record keeping relating to outcomes and case studies until the middle of the twentieth century. The latter half of the century saw nursing research expand dramatically in quantity, complexity, and sophistication, thereby generating new knowledge and evaluating the effectiveness of current methods of treatment.4 Nursing has fought long and hard to establish its reputation as a legitimate health profession having credibility within the health care community and among the population at large. The gains made in this area in the last half of the century have been evidenced by significant increases in salary, inclusion of nurses in institutional review boards, funding of nursing Nurs Outlook 2000;48:259-61. Copyright © 2000 by Mosby, Inc. 0029-6554/2000/$12.00 + 0 35/1/108598 doi:10.1067/mno.2000.108598
NURSING OUTLOOK
NOVEMBER/DECEMBER 2000
research by National Institutes of Health and other reputable organizations, and dual authorship of scholarly articles with physicians, pharmacists, and other respected professional disciplines. These strides have resulted from the nursing profession’s ability to validate its worth through rigorous scientific documentation of the benefits of professional nursing care. At this time in the history of nursing, I believe it is vital that we continue this proud heritage. As the myriad of new alternative modalities of care appear on the horizon, nursing must look at them closely and assess their appropriateness for incorporation into the armamentaria of nursing care approaches. Unfortunately, more and more frequently we are hearing of nurses who are using techniques in practice that are untested, unproven, and whose use may actually prove to be detrimental. Schrock5 identified a professional obligation for health care workers to implement new treatment modalities in their practice only after rigorous scientific testing has been done. Members of our profession are concerned about nurses who are rushing in to fill the vacuum created by the escalating demand for alternative practitioners, yet many of these nurses hesitate to publicly voice their concerns as they think it may be divisive to nursing. Although some recognized nursing bodies and organizations have official statements relating to the use of alternative treatments, I have not noted any recognition by our profession of the extensiveness of the problem of questionable practice or of any concerted effort to stem these activities. In the interest of protecting the public and maintaining the integrity of the nursing profession, I believe a public stand must be taken by nurses relating to this trend. This article will examine some major issues related to this phenomenon. Alternative therapies include modalities such as meditation, imagery, acupuncture, prayer, Reiki, biofeedback, crystals, magnets, herbs, therapeutic touch,6 and iridology.7 When subjected to valid scientific testing, some of these modalities have shown some degree of significance for effectiveness in treating specific disorders. Research at the National Institutes of Health8 found acupuncture to be effective in relief of pain and relief of nausea. Although there is no scientific evidence that the original theory basis used to explain acupuncture (that there is a flow of Qi, an energy force in the body which acupuncture corrects when it becomes distorted) is valid, the result is important. As hand washing was an effective measure in prevention of infection before our knowledge of germ theory, a therapy need only to be empirically shown to be beneficial to legitimate its inclusion into practice. Studies of a wide variety of herbs have shown some to have a degree of effectiveness, depending on active ingredients. Examples are St Johns Wort, used to treat depression, and estrogen-containing Moylan
259
Alternative Treatment Modalities: The Need for a Rational Response by the Nursing Profession
plant sources used to decrease symptoms related to menopause.9 Many other modalities report significant research findings, but a review of the related literature shows these findings to be invalid by scientific standards (ie, no use, or improper use, of controls to account for placebo effect, too few subjects, lack of randomization of subjects, failure to use blind or double-blind methodology as appropriate to the experimental design).10,11 Examples of this flawed research are contained in a discussion of iridology studies reported by Holl7 and a report of her own study, which was seriously flawed in its own methodology. Studies of therapeutic touch were found to be seriously flawed,10,12 and documentation exists of practitioners refusing to be tested on their practice.10,13 Evidence of efficacy cited by proponents of alternative therapies is often anecdotal or taken from unscientific reports in nonprofessional publications, newsletters, bulletins, and family magazines.14 An alarming trend that has developed is the proliferation of information on the Internet, which offers incomplete, erroneous, or undocumented material concerning alternative modalities of health care. Literally hundreds of these sites can be located via the search engines Alta Vista, Excite, Lycos, etc, by using the search term “alternative medicine.” For example, I counted more than 12 sites in a search of less than 30 minutes in which ginkgo biloba is recommended for memory loss or memory enhancement, and no mention is made of the risk of taking this herb along with anticoagulant medication. Yet the population most affected by memory loss is often taking these prescribed drugs. Of specific concern to the nursing profession are the sites where persons identify themselves as registered nurses and promote specific alternative modalities and herbal remedies without identifying potential risks or the untested nature of these treatments. Ethical concerns are involved in the use of untested alternative therapies. Many consequences can arise that are well documented in the literature. Use of herbal remedies has often resulted in serious deleterious effects. Even when the active ingredient present in the herb may be effective for prescribed symptoms, lack of dosage consistency and other quality control measures can cause serious or even deadly effects.15,16 Senior16 reports that imported herbs have been found to be contaminated and, in one case, heavy metal contamination caused toxicity. Digitalis toxicity and central nervous system depression related to use of herbal remedies were also reported by Senior. It has recently been reported that gingko biloba, commonly used to treat memory loss in the elderly, has caused cerebral bleeding.17 As a result of the lack of regulation and the often informal structure of many alternative care practitioner settings, information related to the prevalence of adverse events are not systematically collected or reported. Because herbal use is not regulated by law, nurses are currently able to recommend them in their practice, which can be an extremely dangerous situation of which we, as professionals, must remain acutely aware. Recommendation of therapies by nurses that result in harmful effects violates the ethical responsibility of nonmaleficence.18 Even in cases in which the treatment itself is innocuous, patient care may suffer. A placebo effect is often achieved by any 260
Moylan
intervention, which can result in marked positive effects. Although a treatment may have no specific action, the healing environment created by the treatment restores a sense of control and provides a powerful antidote to illness.19 Yet the underlying pathology may continue to progress. If a patient believes the alternative treatment is effective, he or she may not seek out or not continue with a scientifically documented treatment regime. A delay in seeking effective treatment or a discontinuation of effective treatment can result in harm to the patient, which violates the ethical responsibilities of beneficence.18 Issues of practitioner expertise and qualifications are of great concern in the practice of alternative treatments.20 Keegan and Cerra21 report that in a survey of nurses attending a healing workshop, 85% of the participants used alternative therapies including acupressure, herbs, meditation, and therapeutic touch. Yet, many of these modalities have no recognized standardized preparation, testing, certification, scope of practice, regulatory body, or statutory authorization. Nurses with varying degrees, levels of education, and levels of preparation are currently using alternative therapies. Wolfe22 identified the need to “Demand state licensing and regulatory standards, accrediting agencies, federally recognized schools, nationally standardized exams and malpractice insurance for all providers of health care.” The argument has been offered by many practitioners of alternative therapies that these modalities do not lend themselves to empirical research methodologies.23 Yet, if a registered nurse is recommending a treatment and implying that a treatment is effective, it stands to reason that results of the treatment must be reproducible. Although nursing is both an art and a science, these aspects of practice are complementary; they can not be mutually exclusive. The New York State Nurses Association6 is clear in its policy concerning complementary therapies that full disclosure is necessary regarding the lack of validating information, the need for further research, and the need for concomitant conventional nursing and medical therapy. The ability to predict outcomes is exactly what is tested in a quantitative clinical study. Only through obtaining reproducible results to a quantifiable level of certainty can a nurse ethically claim that a therapy is effective and safe. Qualitative methodologies are valuable in generating new knowledge and in developing theory, but only quantitative methodologies can identify with a predictable degree of certainty a cause and effect relationship.4 Currently, the National Institutes of Health is in the process of carrying out rigorous scientific studies specifically focused on the effectiveness of alternative medical modalities. The findings engendered by this research may prove helpful in the direction nursing takes in the acceptance of specific alternative modalities. All professional health care providers should be concerned about the incorporation of alternative methodologies into their practice. History has shown that many new innovations, which proved to be highly beneficial, were initially resisted. Others were accepted without empirical validation and later proved to be fallacious. Some of the new modalities may prove to be highly effective. Others may be ineffective. At worst, some may be found to be deleterious. When assessing new VOLUME 48 • NUMBER 6
NURSING OUTLOOK
Alternative Treatment Modalities: The Need for a Rational Response by the Nursing Profession
techniques and therapies, Harris14 identifies signs that are often present in questionable modalities and indicate a lack of credibility. These are that the treatment is purported to be effective in a broad range of diagnoses, a broad range of body systems are affected by the one treatment, the theory basis is incongruent with current knowledge in the fields of anatomy and physiology, and no controlled studies are reported in a reputable peer-reviewed journal. Nurses want to incorporate new modalities into their practice for many reasons. As professional health care practitioners, nurses are aware of the many limitations and shortcomings of mainstream medicine. Medical science is an inexact science. In spite of the tremendous strides that have been made during the last century, many chronic and acute illnesses remain incurable. In addition, many of the commonly accepted therapies for these illnesses are devastating to the person in their effect on quality of life, bringing into question the risk/benefit ratio. Some medical interventions ignore the holistic nature of caring and healing in the human experience—an area that has always been a strength of nursing—and focus solely on a biomechanistic model. Mainstream medicine does not always encourage significant patient participation in health care decision making or offer a wide selection of options. A variety of the new therapies are purported to be more effective in treating the pathology and more holistic in their approach, to provide the patient with a better quality of life and treatment experience, and to offer an increase in availability of treatment options. Unfortunately, some nurses embrace new modalities before appropriate validation has been achieved, thinking that no harm can result and that a benefit may occur. This acceptance may be true in some cases, but as discussed previously, illness and injury may result from the therapy itself or from the deferral of traditional medical intervention, which patients may do if they believe an alternative therapy is effective alone as a result of a potential placebo effect. Other nurses may be unduly influenced by a phenomenon that is occurring in our culture in which pseudo science is being purported to be as valid as science.24 This concept is often incorporated into new age philosophies. Some nurse authors are speaking out against the lack of credibility of some alternative therapies.10,13 In addition, several journals are focusing on scientific assessment of alternative treatments, either in full or in part. The Scientific Review of Alternative Medicine is a journal that was established specifically for the purpose of evaluating articles previously published that discuss alternative therapies through the use of standard rational analysis of the claims made in these articles. Yet many other publications continue to report findings that are unsubstantiated by legitimate research. In his book “The Demon Haunted World,” the noted scientist Carl Sagan24 discusses the dangers of accepting pseudo science as fact and proceeding to act on this information. According to this author, these dangers exceed the poten-
NURSING OUTLOOK
NOVEMBER/DECEMBER 2000
Moylan
tial of harm to the person. A greater negative effect is the destructive force such thinking can have on society. Sagan’s polemic should be a clarion call to those of us in the nursing profession. It is incumbent on us to speak out with a unified voice against the misuse of alternative therapies to protect our patients and the credibility of our practice. After years of building a solid foundation on which to base our practice, the imprudent practice of some nurses may act to undermine the reputation of a proud and valuable profession. ■ REFERENCES 1. Herbert RG. Florence Nightingale: saint, reformer or rebel? Malabar (FL): Robert E Krieger; 1981. 2. Nightingale F. Notes on nursing: what it is, and what it is not. Philadelphia (PA): Lippincott; 1859. 3. Ehrenreich B, English D. Witches, midwives and nurses: a history of women healers. New York: The Feminist Press at the City University of New York; 1973. 4. Burns N, Grove S. Understanding nursing research. Philadelphia (PA): WB Saunders; 1995. 5. Schrock R. Conscience and courage: a critical examination of professional conduct. Nurs Educ Today 1990;10:3-9. 6. New York State Nurses Association. Position statement on the use of complementary therapies in the practice of nursing. Latham (NY): Author; 1999 July. 7. Holl R. Iridology: another look. Altern Health Pract 1999;1:25-43. 8. National Institutes of Health. Acupuncture. NIH Consensus Statement November 3-5, 1997;15(5):1-34. 9. Glisson J, Crawford R, Street S. The clinical applications of ginkgo, biloba, St. John’s wort, saw palmetto, and soy. Nurse Pract Am J Primary Health Care 1999;24(6):28, 31, 35-6. 10. Glickman R, Gracely E. Therapeutic touch: investigation of a practitioner. Sci Rev Altern Med 1998;2:43-7. 11. Sampson W. Why a new alternative medicine journal? Sci Rev Altern Med 1997;1:4-6. 12. O’Mathúna D. Therapeutic touch: what could be the harm? Sci Rev Altern Med 1998;2:56-62. 13. Glickman R, Burns J. If therapeutic touch works, prove it. RN 1996;59(12):76. 14. Harris S. How should treatments be critiqued for scientific merit? Phys Ther 1996;76:175-82. 15. Hirsch IB. New therapies: proof or consequences. Clin Diabetes 1999;17:106. 16. Senior K. Herbal medicine under scrutiny [science and medicine news]. Lancet 1998;352:1040. 17. What’s hot [drug update]. RN 1999;62:84,70. 18. Schneiderman L. Medical ethics and alternative medicine. Sci Rev Altern Med 1998;2:63-6. 19. Brown W. The placebo effect. Sci Am 1998;Jan:90-6. 20. Jonas W. Alternative medicine: learning from the past, examining the present, advancing to the future. JAMA 1998;(280):1616-24. 21. Keegan L, Cerrato P. Nurses are embracing holistic healing. RN 1996;59(4):59-61. 22. Wolfe K. Integrating complementary health practices into managed care. Altern Health Pract 1999;5:9-16. 23. Hamilton D, Bechtel G. Research implications for alternative health therapies. Nurs Forum 1996;31:6-11. 24. Sagan C. The demon-haunted world: science as a candle in the dark. New York: Ballantine Books; 1996.
261
D
uring the last 2 decades, interest in and use of alternative modalities of health care has proliferated. As the public demand for such therapies increased, nursing has been among a few of the health professions to fill this need. Historically, nursing has always provided a far more holistic approach to care than other health care providers. Treatments such as diet, hygiene, and ventilation1,2 were incorporated into nursing regimes long before physicians recognized these treatments as having significance in the curative process. Herbs containing digitalis, ergotamine, and belladonna were used by nurses before their acceptance into mainstream medicine.3 The way these therapies made their way into accepted practice and were legitimated as effective treatments was through careful empirical study. Such methods included meticulous medical record keeping relating to outcomes and case studies until the middle of the twentieth century. The latter half of the century saw nursing research expand dramatically in quantity, complexity, and sophistication, thereby generating new knowledge and evaluating the effectiveness of current methods of treatment.4 Nursing has fought long and hard to establish its reputation as a legitimate health profession having credibility within the health care community and among the population at large. The gains made in this area in the last half of the century have been evidenced by significant increases in salary, inclusion of nurses in institutional review boards, funding of nursing Nurs Outlook 2000;48:259-61. Copyright © 2000 by Mosby, Inc. 0029-6554/2000/$12.00 + 0 35/1/108598 doi:10.1067/mno.2000.108598
NURSING OUTLOOK
NOVEMBER/DECEMBER 2000
research by National Institutes of Health and other reputable organizations, and dual authorship of scholarly articles with physicians, pharmacists, and other respected professional disciplines. These strides have resulted from the nursing profession’s ability to validate its worth through rigorous scientific documentation of the benefits of professional nursing care. At this time in the history of nursing, I believe it is vital that we continue this proud heritage. As the myriad of new alternative modalities of care appear on the horizon, nursing must look at them closely and assess their appropriateness for incorporation into the armamentaria of nursing care approaches. Unfortunately, more and more frequently we are hearing of nurses who are using techniques in practice that are untested, unproven, and whose use may actually prove to be detrimental. Schrock5 identified a professional obligation for health care workers to implement new treatment modalities in their practice only after rigorous scientific testing has been done. Members of our profession are concerned about nurses who are rushing in to fill the vacuum created by the escalating demand for alternative practitioners, yet many of these nurses hesitate to publicly voice their concerns as they think it may be divisive to nursing. Although some recognized nursing bodies and organizations have official statements relating to the use of alternative treatments, I have not noted any recognition by our profession of the extensiveness of the problem of questionable practice or of any concerted effort to stem these activities. In the interest of protecting the public and maintaining the integrity of the nursing profession, I believe a public stand must be taken by nurses relating to this trend. This article will examine some major issues related to this phenomenon. Alternative therapies include modalities such as meditation, imagery, acupuncture, prayer, Reiki, biofeedback, crystals, magnets, herbs, therapeutic touch,6 and iridology.7 When subjected to valid scientific testing, some of these modalities have shown some degree of significance for effectiveness in treating specific disorders. Research at the National Institutes of Health8 found acupuncture to be effective in relief of pain and relief of nausea. Although there is no scientific evidence that the original theory basis used to explain acupuncture (that there is a flow of Qi, an energy force in the body which acupuncture corrects when it becomes distorted) is valid, the result is important. As hand washing was an effective measure in prevention of infection before our knowledge of germ theory, a therapy need only to be empirically shown to be beneficial to legitimate its inclusion into practice. Studies of a wide variety of herbs have shown some to have a degree of effectiveness, depending on active ingredients. Examples are St Johns Wort, used to treat depression, and estrogen-containing Moylan
259
Alternative Treatment Modalities: The Need for a Rational Response by the Nursing Profession
plant sources used to decrease symptoms related to menopause.9 Many other modalities report significant research findings, but a review of the related literature shows these findings to be invalid by scientific standards (ie, no use, or improper use, of controls to account for placebo effect, too few subjects, lack of randomization of subjects, failure to use blind or double-blind methodology as appropriate to the experimental design).10,11 Examples of this flawed research are contained in a discussion of iridology studies reported by Holl7 and a report of her own study, which was seriously flawed in its own methodology. Studies of therapeutic touch were found to be seriously flawed,10,12 and documentation exists of practitioners refusing to be tested on their practice.10,13 Evidence of efficacy cited by proponents of alternative therapies is often anecdotal or taken from unscientific reports in nonprofessional publications, newsletters, bulletins, and family magazines.14 An alarming trend that has developed is the proliferation of information on the Internet, which offers incomplete, erroneous, or undocumented material concerning alternative modalities of health care. Literally hundreds of these sites can be located via the search engines Alta Vista, Excite, Lycos, etc, by using the search term “alternative medicine.” For example, I counted more than 12 sites in a search of less than 30 minutes in which ginkgo biloba is recommended for memory loss or memory enhancement, and no mention is made of the risk of taking this herb along with anticoagulant medication. Yet the population most affected by memory loss is often taking these prescribed drugs. Of specific concern to the nursing profession are the sites where persons identify themselves as registered nurses and promote specific alternative modalities and herbal remedies without identifying potential risks or the untested nature of these treatments. Ethical concerns are involved in the use of untested alternative therapies. Many consequences can arise that are well documented in the literature. Use of herbal remedies has often resulted in serious deleterious effects. Even when the active ingredient present in the herb may be effective for prescribed symptoms, lack of dosage consistency and other quality control measures can cause serious or even deadly effects.15,16 Senior16 reports that imported herbs have been found to be contaminated and, in one case, heavy metal contamination caused toxicity. Digitalis toxicity and central nervous system depression related to use of herbal remedies were also reported by Senior. It has recently been reported that gingko biloba, commonly used to treat memory loss in the elderly, has caused cerebral bleeding.17 As a result of the lack of regulation and the often informal structure of many alternative care practitioner settings, information related to the prevalence of adverse events are not systematically collected or reported. Because herbal use is not regulated by law, nurses are currently able to recommend them in their practice, which can be an extremely dangerous situation of which we, as professionals, must remain acutely aware. Recommendation of therapies by nurses that result in harmful effects violates the ethical responsibility of nonmaleficence.18 Even in cases in which the treatment itself is innocuous, patient care may suffer. A placebo effect is often achieved by any 260
Moylan
intervention, which can result in marked positive effects. Although a treatment may have no specific action, the healing environment created by the treatment restores a sense of control and provides a powerful antidote to illness.19 Yet the underlying pathology may continue to progress. If a patient believes the alternative treatment is effective, he or she may not seek out or not continue with a scientifically documented treatment regime. A delay in seeking effective treatment or a discontinuation of effective treatment can result in harm to the patient, which violates the ethical responsibilities of beneficence.18 Issues of practitioner expertise and qualifications are of great concern in the practice of alternative treatments.20 Keegan and Cerra21 report that in a survey of nurses attending a healing workshop, 85% of the participants used alternative therapies including acupressure, herbs, meditation, and therapeutic touch. Yet, many of these modalities have no recognized standardized preparation, testing, certification, scope of practice, regulatory body, or statutory authorization. Nurses with varying degrees, levels of education, and levels of preparation are currently using alternative therapies. Wolfe22 identified the need to “Demand state licensing and regulatory standards, accrediting agencies, federally recognized schools, nationally standardized exams and malpractice insurance for all providers of health care.” The argument has been offered by many practitioners of alternative therapies that these modalities do not lend themselves to empirical research methodologies.23 Yet, if a registered nurse is recommending a treatment and implying that a treatment is effective, it stands to reason that results of the treatment must be reproducible. Although nursing is both an art and a science, these aspects of practice are complementary; they can not be mutually exclusive. The New York State Nurses Association6 is clear in its policy concerning complementary therapies that full disclosure is necessary regarding the lack of validating information, the need for further research, and the need for concomitant conventional nursing and medical therapy. The ability to predict outcomes is exactly what is tested in a quantitative clinical study. Only through obtaining reproducible results to a quantifiable level of certainty can a nurse ethically claim that a therapy is effective and safe. Qualitative methodologies are valuable in generating new knowledge and in developing theory, but only quantitative methodologies can identify with a predictable degree of certainty a cause and effect relationship.4 Currently, the National Institutes of Health is in the process of carrying out rigorous scientific studies specifically focused on the effectiveness of alternative medical modalities. The findings engendered by this research may prove helpful in the direction nursing takes in the acceptance of specific alternative modalities. All professional health care providers should be concerned about the incorporation of alternative methodologies into their practice. History has shown that many new innovations, which proved to be highly beneficial, were initially resisted. Others were accepted without empirical validation and later proved to be fallacious. Some of the new modalities may prove to be highly effective. Others may be ineffective. At worst, some may be found to be deleterious. When assessing new VOLUME 48 • NUMBER 6
NURSING OUTLOOK
Alternative Treatment Modalities: The Need for a Rational Response by the Nursing Profession
techniques and therapies, Harris14 identifies signs that are often present in questionable modalities and indicate a lack of credibility. These are that the treatment is purported to be effective in a broad range of diagnoses, a broad range of body systems are affected by the one treatment, the theory basis is incongruent with current knowledge in the fields of anatomy and physiology, and no controlled studies are reported in a reputable peer-reviewed journal. Nurses want to incorporate new modalities into their practice for many reasons. As professional health care practitioners, nurses are aware of the many limitations and shortcomings of mainstream medicine. Medical science is an inexact science. In spite of the tremendous strides that have been made during the last century, many chronic and acute illnesses remain incurable. In addition, many of the commonly accepted therapies for these illnesses are devastating to the person in their effect on quality of life, bringing into question the risk/benefit ratio. Some medical interventions ignore the holistic nature of caring and healing in the human experience—an area that has always been a strength of nursing—and focus solely on a biomechanistic model. Mainstream medicine does not always encourage significant patient participation in health care decision making or offer a wide selection of options. A variety of the new therapies are purported to be more effective in treating the pathology and more holistic in their approach, to provide the patient with a better quality of life and treatment experience, and to offer an increase in availability of treatment options. Unfortunately, some nurses embrace new modalities before appropriate validation has been achieved, thinking that no harm can result and that a benefit may occur. This acceptance may be true in some cases, but as discussed previously, illness and injury may result from the therapy itself or from the deferral of traditional medical intervention, which patients may do if they believe an alternative therapy is effective alone as a result of a potential placebo effect. Other nurses may be unduly influenced by a phenomenon that is occurring in our culture in which pseudo science is being purported to be as valid as science.24 This concept is often incorporated into new age philosophies. Some nurse authors are speaking out against the lack of credibility of some alternative therapies.10,13 In addition, several journals are focusing on scientific assessment of alternative treatments, either in full or in part. The Scientific Review of Alternative Medicine is a journal that was established specifically for the purpose of evaluating articles previously published that discuss alternative therapies through the use of standard rational analysis of the claims made in these articles. Yet many other publications continue to report findings that are unsubstantiated by legitimate research. In his book “The Demon Haunted World,” the noted scientist Carl Sagan24 discusses the dangers of accepting pseudo science as fact and proceeding to act on this information. According to this author, these dangers exceed the poten-
NURSING OUTLOOK
NOVEMBER/DECEMBER 2000
Moylan
tial of harm to the person. A greater negative effect is the destructive force such thinking can have on society. Sagan’s polemic should be a clarion call to those of us in the nursing profession. It is incumbent on us to speak out with a unified voice against the misuse of alternative therapies to protect our patients and the credibility of our practice. After years of building a solid foundation on which to base our practice, the imprudent practice of some nurses may act to undermine the reputation of a proud and valuable profession. ■ REFERENCES 1. Herbert RG. Florence Nightingale: saint, reformer or rebel? Malabar (FL): Robert E Krieger; 1981. 2. Nightingale F. Notes on nursing: what it is, and what it is not. Philadelphia (PA): Lippincott; 1859. 3. Ehrenreich B, English D. Witches, midwives and nurses: a history of women healers. New York: The Feminist Press at the City University of New York; 1973. 4. Burns N, Grove S. Understanding nursing research. Philadelphia (PA): WB Saunders; 1995. 5. Schrock R. Conscience and courage: a critical examination of professional conduct. Nurs Educ Today 1990;10:3-9. 6. New York State Nurses Association. Position statement on the use of complementary therapies in the practice of nursing. Latham (NY): Author; 1999 July. 7. Holl R. Iridology: another look. Altern Health Pract 1999;1:25-43. 8. National Institutes of Health. Acupuncture. NIH Consensus Statement November 3-5, 1997;15(5):1-34. 9. Glisson J, Crawford R, Street S. The clinical applications of ginkgo, biloba, St. John’s wort, saw palmetto, and soy. Nurse Pract Am J Primary Health Care 1999;24(6):28, 31, 35-6. 10. Glickman R, Gracely E. Therapeutic touch: investigation of a practitioner. Sci Rev Altern Med 1998;2:43-7. 11. Sampson W. Why a new alternative medicine journal? Sci Rev Altern Med 1997;1:4-6. 12. O’Mathúna D. Therapeutic touch: what could be the harm? Sci Rev Altern Med 1998;2:56-62. 13. Glickman R, Burns J. If therapeutic touch works, prove it. RN 1996;59(12):76. 14. Harris S. How should treatments be critiqued for scientific merit? Phys Ther 1996;76:175-82. 15. Hirsch IB. New therapies: proof or consequences. Clin Diabetes 1999;17:106. 16. Senior K. Herbal medicine under scrutiny [science and medicine news]. Lancet 1998;352:1040. 17. What’s hot [drug update]. RN 1999;62:84,70. 18. Schneiderman L. Medical ethics and alternative medicine. Sci Rev Altern Med 1998;2:63-6. 19. Brown W. The placebo effect. Sci Am 1998;Jan:90-6. 20. Jonas W. Alternative medicine: learning from the past, examining the present, advancing to the future. JAMA 1998;(280):1616-24. 21. Keegan L, Cerrato P. Nurses are embracing holistic healing. RN 1996;59(4):59-61. 22. Wolfe K. Integrating complementary health practices into managed care. Altern Health Pract 1999;5:9-16. 23. Hamilton D, Bechtel G. Research implications for alternative health therapies. Nurs Forum 1996;31:6-11. 24. Sagan C. The demon-haunted world: science as a candle in the dark. New York: Ballantine Books; 1996.
261