A Complement to Medicine
Posted on February 20, 2008
Filed Under Medical Students, Medical (MD, DO)
by Brittany Warrick and Sarah M. Lawrence
SDN Staff Writers
As health care providers, we are certain to encounter a patient who uses some form of complementary or alternative medicine (CAM). According to the National Center for Complementary and Alternative Medicine (NCCAM), 36% of adults have used some form of CAM in the past 12 months. Most patients who use CAM do so as an adjunct to conventional medicine. The very real potential for interactions between pharmaceuticals, herbs, and nutritional supplements highlights the need for regular communication between doctors, pharmacists and patients about CAM. Understanding the appeal of CAM is the first step in facilitating such conversations.
Patients are drawn to CAM for various reasons. One way this can be characterized is in terms of “push” and “pull” factors. Patients dissatisfied with conventional medical treatments may feel “pushed” towards CAM by issues such as drug side effects, perceived lack of efficacy of traditional treatments, toxicities and poor patient-practitioner communication. On the flip side, it can be said that many CAM treatments provide “pull” factors that appeal to patients. These may include a belief that CAM treatments are “more natural,” a perception that CAM practitioners are more patient-centered and encouraging of patient participation, or the appeal of the mind-body connection that is often neglected in traditional medicine.
Professionals in all health care disciplines should familiarize themselves with the different modalities of CAM. With knowledge and a willingness to discuss these treatments with patients in a supportive, non-judgmental manner, practitioners can assist patients in making good decisions about their health care. While this article is not meant to be a complete source of information about CAM, it is designed to give some basic insights into the types of alternative treatments patients may be using.
Domains of CAM
Energy medicine uses energy fields as treatment. There are two main types. One is biofield therapies or putative energy medicine and is intended to affect the energy field that surrounds and penetrates the body. Practitioners manipulate this energy by touching or putting one’s hands through the energy field. Common names for this therapy are gi gong, reiki, and therapeutic touch. The second type of energy medicine deals with bioelectromagnetic fields. Practitioners access these fields in unconventional ways to treat the patient.
Manipulative and body-based practices use manipulation or movement of one or more body parts. These modalities include massage therapy, reflexology, and chiropractic manipulation, which is the most common CAM therapy for back pain. Chiropractics’ main principle is that joint misalignment interferes with the central nervous system and can lead to other ailments. Chiropractors will also suggest lifestyle changes such as diet and exercise to their patients. Acupuncture is the stimulation of anatomical points on the body through the use of a variety of techniques. The most studied form of acupuncture is the use of needles to penetrate the skin.
Mind-body medicine uses various techniques to enhance the mind’s ability to affect bodily function and symptoms. Some mind-body techniques that were once considered to be alternative therapies are now mainstream ideas, such as support groups and cognitive-behavioral therapy. Other techniques such as meditation, yoga and hypnotherapy are considered subsets of mind-body medicine. Prayer, often cited as the most frequently used modality of CAM, is also included here.
Biologically-based practices are the use of substances found in nature to produce desired clinical effects. When prayer is not included, this is the most frequently used domain of CAM. It is estimated that 21.9% of people will use some sort of biologically-based alternative product, including herbs, vitamins, minerals, and animal-derived products. Another practice included in this domain is special diet, such as the macrobiotic diet. Prebiotics and probiotics are also included in this domain.
The last domain of CAM is whole health systems. This domain includes homeopathy and naturopathy. The goal of homeopathy is to stimulate the body’s own healing response. One principle that homeopathy uses is the “principle of similar,” which says that substances that cause symptoms in a healthy patient will cure similar symptoms in the sick patient.
Another mainstay of homeopathy is vitalism. Homeopathic practitioners say that every person has a vital force and that when this vital force is disrupted or imbalanced, health problems can develop. A third principle of homeopathy is that malfunctions of any organ or body system can affect the entire body. Homeopathic practitioners believe that only one disease process can occur at a time and so only a single therapeutic agent is used to treat a single disease. Treatment should be individualized and based on the total picture.
Homeopathic practitioners believe that only a small stimulus is needed to start the healing processes, so serial dilution is used to prepare homeopathic remedies. It is important to note that in homeopathic remedies, the “High Potency” products are more dilute than the “Low Potency” products.
The FDA has some requirements for homeopathic remedies, requiring them to meet certain standards for strength, quality, purity and packaging. Labeling must state indications for use, ingredients, dilutions, and instructions for safe use. However, the FDA does not require pre-marketing proof of safety and effectiveness. The guidelines can be found in the Homeopathic Pharmacopoeia of the United States.
Homeopathic practitioners in the United States go through a diploma or certificate course. Currently three states (Connecticut, Arizona and Nevada) have licensing requirements for homeopathic practitioners.
A second whole health system practice is naturopathy. This method proposes a healing power in the body that establishes, maintains and restores health through treatments such as nutrition and lifestyle counseling, medicinal plants, exercise, homeopathy, and traditional Chinese medicine. Some of the basic beliefs of naturopathy include the idea that prevention is the best cure and that treating diseases, not symptoms, is the best course of action. The naturopathic physician takes the role of educator and motivator, so the patient will take control of his or her own health.
In naturopathy there are three levels of practitioners. The first type is a naturopathic physician, who goes through a four-year graduate program at a naturopathic medical school accredited by the Council on Naturopathic Education. The second type is traditional naturopaths, who are trained through correspondence courses, apprenticeships or self-learning.
The last group is conventional providers with naturopathic training. These providers can be nurses or physicians. It is important to note that for naturopaths and conventional providers trained in naturopathy, the level of education and the quality is not uniform.
Armed with the knowledge of some basic facts about CAM, health care providers can begin conversations with their patients that may reveal what other types of treatment or modalities patients are using in combination with or instead of conventional medicine. Most patients will not spontaneously disclose this information to their physician or pharmacist so it is important that the health care provider be proactive.
Questions to ask your patients:
- What other health care providers are involved in your care?
- Are you taking any over-the-counter medications, supplements or herbal remedies?
- What are you using these medications for and who recommended them?
- Have you or are you currently participating in treatments such as chiropractic, massage or meditation? How do you feel these treatments are working for you?
- How do you feel the treatments I’ve provided are addressing your medical concerns? Do you have any untreated conditions or new problems I should be aware of?
It is also essential that practitioners be able to direct patients to reliable, unbiased sources of information about CAM. The National Center for Complementary and Alternative Medicine is a well-known, thorough source of information for practitioners wishing to educate themselves and provide quality information to their patients.
References:
National Center for Complementary and Alternative Medicine. http://nccam.nih.gov/
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14 Responses to “A Complement to Medicine”
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As I knew nothing about Naturopathic Physicians, I did some research.
I think some of the main goals of natural therapies are great!
I’ve seen a lot of people hooked on narcotics, and natural pain relief seems like a valid way to help:
1. Alleviate pain
2. Offer alternatives to narcotics.
As someone who is currently finishing my education in Homeopathic Medicine (3 years on top of my university degree) This is a great article.
Patient’s are going to use alternative therapies whether you tell them to or not. All health care professions need to accept that. Whether or not you believe that they are effective, for the sake of your patient’s, you need to be open to the fact that some of your patient’s do.
I have come across many patient’s who have asked us not to let their doctor know that they have come to see us. Some are afraid of insulting their MD, other’s are afraid of being fired as patient’s (it’s Ontario - it can happen).
Rest assured, I am not taking your patients. All must sign a waiver that acknowledges that I am not an MD, that I do not encourage them to stop seeing their MD, and I will not in anyway, advise that they change their med’s. I am offering complimentary health care, not alternative.
It will benifit everyone, especially the patient’s if we are accepting of what they are inevitably going to do anyway.
To: “Anonymous on February 22nd, 2008 11:50 am”
The reason a lot of MDs have a problem with Homeopaths is that we don’t believe you are doing any good… you are merely making money. Not that some docs can’t be labeled the same, but in general, MDs practice evidence-based medicine. Homeopaths practice voodoo.
Nice article
I practice alternative (read energy, holistic med) and am a med student. The positive results in combining the both are almost overwhelming. A little love goes along way
While allopathic medicine works on the symptoms, holistic medicine (when practiced efficiently) works on the root cause.
Another interesting thing though is the ‘placebo effect’- it just amazes me and reaffirms the power of the human mind
Thanks for the wonderful article.
-Maya
Root cause? Don’t know what crap medical school you’re going to, but real medicine does not just treat symptoms. That’s just BS propagated by CAM practitioners to peddle their wares.
Second the placebo does not just involve the human mind. Many diseases and conditions get better on their own over time and to attribute that to “mind healing” is deceiving.
I’m worried that there’s going to be a generation of physicians trained to believe that water and hand-waving are legitimate forms of treatment (that’s homeopathy and reiki, respectively).
If we “aren’t doing any good” and you’re doing all the good, then why do your patient’s come to us? (with great results?)
Thank you for posting this article. It is not enough for a western trained physician to just be aware of and non-judgmental about their patients use of non-western therapies. They should actively seek out literature and information to find out how they can use CAM therapies, in conjunction with their own western therapies, to provide the most optimal patient care.
With that said, the medical student forum has some real fanatical anti-CAM poster, so it won’t be long for their ridiculous dismissal posts of the above article. Fact is, integrative medicine is what people want, it is where medicine is heading. Anyone who dismisses all non-western therapies is both naive and not working in the best interest of their patients (and themselves).
Optimal patient care includes practicing Evidence Based Medicine. That means that we don’t have our patients pay money for “therapies” that have been shown to have no benefit and could not possibly work without violating the fundamental physical laws of the universe. Whether or not patients want “integrative therapies” has no bearing on whether or not those therapies work. It has nothing to do with which hemisphere the ideas come from; it’s about whether there’s any evidence.
here’s a good response to those that claim quackery use is increasing.
http://www.quackwatch.org/11Ind/eisenberg.html
When you include things such as exercise or massage as alternative therapy, of course it’s going to appear that lots of people are using it. The study that showed 36% of people use CAM is a gross misrepresentation to prop up bs.
I see your argument Xerxes. The tricky thing about evidence is that it is merely a suggestion for how to treat a patient. Just because the evidence saying a drug or therapy is effective does not mean you can predict it will help your patient. So many studies are done of populations of 50 year old men… efficacy for them does not mean efficacy for your patient. And on the flip side, if all the research evidence in the world says a therapy has no efficacy, but if for your n of 1 patient the therapy is really helping them, thats all that matters.
As far as violating the fundamental laws of physics, that is a testy subject. You should read about quantum mechanics, and watch the extended version of the movie “what the bleep.” Its really intersting, that laws of physics that work in the physical world break down when you deal with atoms and electrons.
Another problem is with efficacy, and saying things like “those therapies that work.” Where is the end point, what is efficacy? So many things in western medicine are looked at as mortality, and decreased in this or that type of event. Why? Because they are easy data to measure. How do you measure the process of healing? It is about quality of life, about not a decrease in depression for example on a beck depression survey, but that they are able to begin enjoying living again. How do you measure that?
I guess the goal is not to prove all CAM is effective, or to figure out why prayer helps people heal, it is about keeping an open mind, and humility about how little we actually know about our life, existance, healing…
Listen to your patients, ask about their healing, spiritual practices, CAM use, learn from them. There is a reason why so many patients graviate toward CAM and integrative medicine, the more open minded you are the earlier you will figure out why…
“Second the placebo does not just involve the human mind. Many diseases and conditions get better on their own over time and to attribute that to “mind healing” is deceiving.”
Many studies show that the magnitude of the placebo effect is larger than the therapeutic value of many medicines above and beyond the placebo. What I mean is that if you divide patients into 3 groups: no tx, placebo, tx. You would in most cases find that the no tx group is a lot worse off than the placebo group, and the tx group is (hopefully) even better yet. If the placebo effect were based upon the condition getting better on its own, there would be no difference between no tx and placebo. The expectations of patients really do affect their outcomes, so in a sense, the placebo effect is proof that mind healing does occur, to some extent.
What we can conclude based upon this is that even if the CAM is “ineffective” (essentially a placebo if the client believes it is effective), it is still better than nothing so long as it does not harm in the patient in other ways. Contrast that with some drugs, which sometimes have a marginal improvement over a placebo in many patients (like SSRIs), yet introduce side-effects.
There has been research supporting certain homeopathic techniques (above the placebo effect, with meaningful significance #’s), and I think these should be taken into consideration as a valid treatment alternative. With that being said, there are many methods that have no proof what so ever (the hand waving Reiki comment was classic, btw), and those should be questioned. If research cannot be produced to show effectiveness, then it should be at least questioned. There are some things that are hard to quantify, so it isn’t a perfect system, though I’m hesitant to put too much faith in something that can’t be proved.
i really loved that SDN gave some acknowledgment of alternative medicine. I was considering medical school and naturopathic medical school and ended up decided to go DO pathway. I want to follow the ideals of naturopathy/preventative medicines to complement the treatments i will give as a physician. There is still so much we don’t know about how the body works-
GREAT ARTICLE!