Complementary Medicine Grudgingly Moves Ahead
At the recently concluded European Breast Cancer Conference, a symposium session assessed the rapidly growing role of complementary and alternative medicines (CAM) in breast cancer care. One presentation focused on a recent study commissioned by the Royal College of Physicians that found "disbelief" in complementary therapy had been replaced by "healthy skepticism" among most general doctors. Unfortunately, the majority of practitioners also reported that the clinical demands on their time were so extensive as to preclude justifying the effort or financial burdens to study complementary therapy, especially in the absence of firm clinical evidence regarding their effectiveness.
Last year, the American Society of Clinical Oncology and the American Cancer Society hosted their first-ever symposium on complementary and alternative medicine. While cautious about endorsing any specific CAM approach, the panelists agreed that physicians need to learn more about non-standard care-if for no other reason than to be able to better field questions from patients. Complementary and alternative therapies "are not going away," said Mary Ann Richardson, Ph.D., of the Center for Alternative Medicine Research at the University of Texas in Houston. On the contrary, she said, CAM research "is just getting warmed up."
When the Journal of the American Medical Association reported back in 1998 that patient visits to complementary and alternative (CAM) practioners had increased by 47 percent between 1990 and 1997, it took many in the medical community by surprise. Many doctors were well aware that some of their patents were undertaking CAM therapies themselves. But others were appalled that seemingly rational patients were defecting from high-tech medicine and regularly supplementing their care with remedies that were mostly unproven by standard medical techniques.
A recent poll by InterSurvey found that two-thirds of Americans have tried at least one form of alternative or complementary treatment, with herbal medicines, chiropractic services, and massage being the most popular therapies. More than one-third of the respondents noted they have tried all three of the above.
The findings by InterSurvey were based upon a representative sample of 1,148 adults. Half of those responding reported taking vitamin supplements in the two weeks before the survey. Twenty-three percent reported taking herbs, while 26 percent to 42 percent reported taking nonprescription painkillers such as aspirin and Tylenol.
In addition, the survey found that women are more likely than men to have tried almost all of the alternative medicine treatments, except for chiropractic service, which is slightly more popular with men than women. Also, while one-third of those interviewed have tried herbal medicines (38 percent), chiropractic (37 percent), massage (35 percent), and meditation (14 percent), less than 10 percent of them have tried acupuncture, yoga, homeopathy, hypnosis, Chinese medicine, and Tai Chi.
The most important reason people tried alternative medicine was the recommendation of a friend or family member (cited by sixty-two percent of the respondents). Other reasons mentioned included: traditional treatments were not working (28 percent); looking for a complement to a health routine (23 percent); recommendation from a doctor (22 percent); and information from a newspaper, magazine, or Internet source (20 percent).
For the one-third of respondents who have not tried any alternative medicine, most cited their reason as traditional medicines not working well for them. Others mentioned safety concerns and lack of insurance coverage.
More doctors are now recognizing the link between a patient's spiritual beliefs, social beliefs and general emotional outlook and their ability to heal. A growing number of doctors are admitting that certain patients benefit from complementary and alternative therapies.
More research is now being done to investigate CAM therapies than ever before. The National Center for Complementary and Alternative Medicine's budget, including research grant monies, has grown from $2 million in 1993 to $68.7 million this year. And at least 100 hospitals-many of them highly prestigious medical centers-are developing CAM programs for patients.
Furthermore, courses in CAM are currently being offered at 75 of the 125 accredited U.S. medical schools, and 19 medical schools and medical centers now offer post-graduate and CME courses for practicing doctors. Seven organizations, including the Association of American Medical Colleges, the Society of Teachers in Family Medicine and the American Public Health Association, currently have initiatives to create standardized CAM curricula.
Alarmingly, studies show that less than 40 percent of patients disclosed their CAM therapies to their doctors. One reason behind the non-disclosure is that patients fear their doctors will reject their decisions.
Virtually all researchers agree that doctors should actively question patients about what they're doing on their own-and about what they want in treatment-without being patronizing or judgmental. To do that though, physicians must make more of an effort to understand what therapies are circulating in the popular culture, which ones have been studied, and what research has shown as to their effectiveness.
SOURCES:
Physicians Financial News, 2000; 18(9); 1,28,29
Second Annual European Breast Cancer Conference
University of Texas Center for Alternative Medicine Research
National Center for Complementary and Alternative Medicine, National Institutes of Health (http://nccam.nih.gov)
InterSurvey
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