Oct. 25, 2016
Modern medicine is a far cry
from “take two aspirin and call me in the morning.” But it’s not all about new
technology and cutting-edge procedures. Complementary alternative medicine
(CAM) plays a role, too.
Texas physicians have
varying opinions about CAM therapies to treat a patient’s collective mind, body,
and spirit. While some embrace various CAM treatments in their practice, others
are cautious and avoid them. But wherever physicians stand on CAM, all agree on
the need to place patient safety first, according to Texas Medicine,
the Texas Medical Association’s (TMA’s) monthly magazine. That means staying
informed on the latest CAM therapies to answer patient questions, and verifying
that any alternative therapies patients are taking will not conflict with
conventional medicine.
“Complementary” in this
context refers to therapies patients use in conjunction with “traditional”
Western medicine (but are still not considered conventional medicine), while
“alternative” care refers to therapies patients are using in place of conventional medicine. Both types of therapy fall under
the CAM umbrella. Integrative medicine is the combination of CAM and
conventional medicine to treat a patient’s mind, body, and spirit. Integrative
medicine first gained steam during the 1990s, often attracting patients
diagnosed with chronic disease or illness, who seek nonconventional therapies
for support and control.
Since its rise in
popularity, more physicians have incorporated integrative medicine into the
care of their patients. Family medicine physician Julie Reardon, MD, uses
integrative medicine in her practice. She gives each of her patients a plan
incorporating diet, exercise, mindfulness, sleep, and other advice. For
instance, Dr. Reardon said she might suggest a patient with anxiety and
irritable bowel syndrome receive electrostimulation or acupuncture, along with
pharmaceutical-grade probiotics and herbs.
Depending on the therapy,
the CAM approach can be a revelation for some physicians, but others see it
negatively. In many cases, the therapies broadly considered CAM, such as yoga
and tai chi, are recognized across different ages and cultures. And in many
cases, CAM therapies — including many supplements available at a grocery store —
carry less supporting evidence and minimal regulation compared with other nonprescription
or prescription medications.
A group of TMA physician
experts, the Council on Science and Public Health (CSPH), regularly reviews and
monitors the latest developments concerning CAM to guide physicians and
patients. TMA advocates for stronger federal oversight and support for more
high-quality studies on CAM. The organization also encourages physicians to
register for updates on suspected tainted CAM products, and provides advice to
patients (for example, that nonprescribed dietary supplements are unregulated
and health authorities have not determined their quality, effectiveness, and
safety).
Houston neurologist William
Gilmer, MD, a CSPH member who helped study CAM and produce recommendations for
Texas physicians on the subject, stresses physicians must know what
complementary therapies their patients use.
“People spend more than $30
billion a year on it, so … we really have to be aware that patients are using
it and doing it,” Dr. Gilmer said. “They don’t automatically think that it
impacts what their physicians are doing, so they don’t necessarily think that they
need to talk about it with their doctor. The problem with that is that
supplements by themselves might be helping one thing, but they’ve got lots of
drug interactions that people aren’t aware of and really haven’t even been
studied very well.”
Sometimes, said Dr. Gilmer,
what physicians don’t know about a patient’s nonprescribed treatments could end
up hurting the patient.
“We just find out about them
almost accidentally … a complaint or a problem or a death or a visit to the ER,
and then somebody looks and said, ‘Oh, you were taking this much of that
supplement, and you’re on blood thinners and antidepressants and other
medications; it’s no wonder you have a problem.’ ”
Physicians on both sides of
the CAM debate agree CAM therapies and the field of integrative medicine
attempt to fill gaps traditional medical treatment leave in patient care.
Houston pathologist Leslie Haber, MD, said she sees the integrative medicine
movement as “sort of a pushback against the very high-tech, sterile hospital
environment.” For example, she said, some cancer patients seek counseling and
massage therapy.
“I don’t think there’s
anything wrong with trying to make patients feel more comfortable when they’re
in the medical community,” said Dr. Haber. “You get a patient who just got
diagnosed with cancer, and they’re suddenly overwhelmed by this ‘Go here; stand
there; do this; get that done.’ And the idea of bringing in something more
touchy-feely into the system is not a bad one in general. But if we do it by
giving currency to things that don’t work and can’t possibly work, we’re not
doing patients any favors.”
Dr. Reardon said her goal
would be for all physicians to have some level of knowledge about — and comfort
with — CAM therapies, to be the best advocates they can be for patients.
“Different people can get us
across the street in different ways,” she said. “We tend to sometimes, in
allopathic medicine, just see things our way. But we have to step back and look
and realize that there are other ways we may not totally understand. And as the
research evolves and changes, our opinion may change about it.”
TMA is the largest state medical society in the nation,
representing more than 49,000 physician and medical student members. It is
located in Austin and has 110 component county medical societies around the
state. TMA’s key objective since 1853 is to improve the health of all Texans.
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Contact: Brent Annear (512) 370-1381; cell: (512) 656-7320; email: brent.annear[at]texmed[dot]org
Marcus Cooper (512)
370-1382; cell: (512) 650-5336; email: marcus.cooper[at]texmed[dot]org
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