[LUM#6] Non-pharmacological interventions: alternative approaches to care
A physical activity program to treat depression? Hypnosis to quit smoking? Non-pharmacological interventions (NPIs) are gaining recognition among both the scientific community and healthcare professionals. Is this the start of a revolution?
They used to be called “alternative medicine,” “old wives’ remedies,” or “alternative therapies”—a collection of vague terms that have a knack for irritating Grégory Ninot. For this researcher at the Epsylon laboratory in Montpellier, it is time to clear up the confusion that has long surrounded therapeutic solutions whose effectiveness is sometimes known but never proven.“It was empirical knowledge, passed down from teacher to student without any real scientific evaluation or understanding of the underlying mechanisms. This led to beliefs and fads taking precedence over genuine, science-based health practices,” explains Grégory Ninot.
Abuses and dangers
The stakes are high, because these NMTs—which encompass practices as varied as meditation, nutritional therapies, hydrotherapy, connected health devices, physical activity programs, and preventive measures—offer hope: the hope of a therapeutic approach that is less one-sided, less invasive, and better tailored to each individual’s specific needs. However, this specialist warns: “NIMs are rarely alternatives but rather complements to conventional treatments” ( Public Lecture, Natural Medicine, Complementary Medicine, Alternative Medicine: What Are We Talking About?). And examples of misuse are legion. “In cancer in particular, there is a lot of talk that the use of dietary supplements will have significant effects on recovery, but serious clinical studies are lacking. Some recommend practices like combat sports for preventing recurrence, once again without evidence… ” Caution is therefore warranted, even for practices that seem harmless at first glance: essential oils, for example, which can prove toxic if precise dosages are not followed (Non-Pharmacological Intervention (NPI): A Concept for Ambiguities in Alternative and Complementary Medicine, in Hegel, 2018).
The result: vulnerable patients being mistreated, and diminished credibility. Hence the urgent need to separate the wheat from the chaff. This is precisely the goal of the CEPS platform in Montpellier, a unique organization in France funded by the State-Region planning contract and supported by the Montpellier Metropolitan Area. Its mission: to help establish a consensus-based paradigm for the evaluation and monitoring of NMI. “We need to do what was done 50 years ago for medications by creating a consensus-based clinical validation process. Today, 19 procedures coexist within NMI, making it impossible to compare their benefits, risks, and cost-effectiveness,” explains Grégory Ninot (Ontology of Non-Pharmacological Interventions, in Revue d’épidémiologie et de santé publique, 2018).
From treatment to prevention
Proving the effectiveness of non-pharmacological interventions (NPIs) would be a first step toward their reimbursement. After all, there is also a financial stake at play: diets and tailored physical activity programs are all NPIs that help prevent the onset of chronic diseases, which are particularly costly to society. These include diabetes, obesity, cancer, and cardiovascular diseases—conditions that are on the rise and currently account for 63% of deaths worldwide.
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