Texas Physicians Debate Complementary and Alternative Medicine Therapies' Role in Health Care

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@texmed.org

Marcus Cooper (512) 370-1382; cell: (512) 650-5336; email: marcus.cooper@texmed.org

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Published On

October 25, 2016