Review finds 11 tests commonly ordered by CAM practitioners lack clinical validity and utility, writes Lydia Hales
Patients are increasingly being exposed to direct-to-consumer lab tests and ‘dubious’ alternative medicine tests that are costly and can even be harmful, pathologists warn.
A group of Australian and British pathologists have reviewed the evidence for 11 tests commonly ordered by complementary and alternative medicine (CAM) practitioners and found they lack clinical validity and utility (see box, below).
They say diagnostic testing is increasingly popular among CAM practitioners as technological advances have led to more in-house tests being developed by labs specialising in CAM tests.
Testing also “adds an element of science” to consultations and may justify the sale of supplements or therapies by the practitioner, the researchers say.
They say regulatory oversight of CAM laboratory testing is still inadequate in Australia, the US and the UK.
In Australia, however, the TGA has cracked down on laboratories offering in-house tests as since mid-2017 they have to be accredited by the National Association of Testing Authorities (NATA), the researchers say.
“In practice, this is likely to remove many in-house CAM laboratory tests from the marketplace in Australia as NATA accreditation requires that tests be shown to have clinical validity and utility as well as analytical validity,” they write.
Although CAM tests are not covered by Medicare, their use by patients can be a drain on government-funded healthcare, they add.
“Most patients receiving an abnormal result from a ‘self-test’ of any kind will consult a doctor and may ask for follow-up investigations or treatment … [that] takes up valuable GP time.”
|Commonly ordered CAM tests reviewed|
|The test||The verdict|
|Food intolerance tests using serum food antigen-specific IgG4 antibodies to detect causes of symptoms such as bloating, abdominal pain, fatigue or depression.||No utility for this purpose. Dietary exclusion based on results could result in over-treatment and unnecessary dietary restriction, particularly in children.|
|Urine kryptopyrrole is a test for so-called ‘mauve factor’ linked to vitamin deficiency said to indicate bipolar disorder, schizophrenia or depression.||This theory was debunked in the 1980s. There is no evidence in mainstream peer-reviewed literature that the test is useful for any clinical purpose.|
|Adrenal stress profile. Patients collect saliva several times a day and it is analysed for cortisol and DHEAS said to reflect ‘adrenal fatigue’. Such a diagnosis is not recognised medically.||Test results are often used to justify prescription of nutritional supplements. Unstimulated saliva cortisol is not considered useful for detecting subclinical adrenal dysfunction.|
|Post-chelator challenge. Patients deemed to have heavy metal toxicity on the basis of urine tests may be given powerful chelating agents to ‘detoxify’ the body.||There are no validated reference intervals and cut-offs for clinical toxicity. Chelating agents can have serious side effects and have caused fatalities.|