A taxonomy of risk‐associated alternative health practices: A Delphi study

Abstract

Defining alternative health care and the recording of associated adverse events and harm remains problematic. This Canadian study aimed to establish and classify riskassociated alternative health practices in a Delphi study undertaken with an interdisciplinary panel of 17 health experts in 2020. It provides a new functional definition of alternative health care and an initial taxonomy of risk-associated alternative health care practices. A number of risk-associated practices were identified and categorized into general practices that conflict with biomedical care or largely untested therapies, alternative beliefs systems, physical manipulative alternative therapies, and herbal and nutritional supplements. Some risk significant harms including major physical injuries or even death. The lack of systematic methods for recording adverse events in alternative health care makes establishing the frequency of such events challenging. However, it is important that people engaging with alternative health care understand they are not necessarily risk-free endeavours, and what those risks are.

Demographic and psychometric predictors associated with engagement in risk-associated alternative healthcare behaviours

“…This work builds on prior work that established a taxonomy of RAAH practices [ 2 ]. A web-based survey of public engagement in AH practices in Canada incorporating five psychometric tools (CBI, RBAS, PAS, SOM, and StP-II-B) that are correlated with AH uptake was undertaken.…”

“…Despite many AH practices being physically harmless, some do entail significant risks of adverse events [ 2 , 10 , 11 ]. Research suggests that people are now more frequently engaging in AH practices that involve risk, such as utilizing unproven therapeutics instead of medically established ones [ 2 , 11 , 12 ]. This trend has significant health policy and practice implications.…”

“…The regulation of AH varies across Canada, and a recent study identified four major categories of RAAH behaviours: general RAAH practices that conflict with the patient’s biomedical care (e.g., using AH instead of recommended medical treatment, people failing to inform their physician of use of alternative therapies concurrently with medical treatment, or using untested alternative therapies), specific RAAH therapies based on specific alternative belief systems (e.g., naturopathic intravenous therapy or cupping), physical manipulative RAAH therapies (e.g., forceful chiropractic spinal or cervical manipulative procedures), and RAAH practices involving known hazardous herbal or nutritional supplements [ 2 ]. Although rare, significant adverse events occur from these practices, including major physical injuries and even death, and in all cases the current evidence of efficacy does not appear to support the level of risk in engaging with these therapies.…”

Performance Medicine: a novel and needed paradigm for proactive health care

“…Providers lack time, training, and team to effectively deliver personalized lifestyle-based therapies (6) that have repeatedly been shown to maintain health and enhance wellbeing. Furthermore, the fee-for-service reimbursement structure, still the predominant healthcare financing model, values quantity of services rather than quality of health itself (7).…”

“…Instead, most patients are left to cobble together a patchwork of health solutions in the wild west of "wellness" where gimmicks, snake oil, and fads abound. The lack of standards, dogmatic ideologies, and extreme approaches within the wellness and fitness industries present not only a challenge, but a potential harm to the individual (7). A recent call to action noted that "pseudoscience and so-called "quick fix' interventions undermine initiatives aimed at evoking long-term behavior change, impede the ongoing pursuit of…performance, and lead to serious downstream consequences for clinical practice" (13).…”