Archief Roodbont

Medscape gastro-enterology

published: 9-8-09

What is the attraction of alternative medicin?

Therapeutic modalities once considered outside the realm of conventional medicine are gradually being integrated into medical practice, partly because evidence shows that they provide benefit and partly because of their growing popularity.

The National Center for Complementary and Alternative Medicine (NCCAM) estimates that in the United States about 38% of adults and 12% of children use some form of complementary and alternative medicine (CAM).^[1] According to the 2007 National Health Interview Survey, which polled over 12,000 persons, CAM use among adults in the United States is greater among women and those who have higher levels of education and higher incomes.

The growing popularity of CAM therapies has prompted contributors to Medscape's Physician Connect (MPC), an all-physician discussion board, to ask why so many persons are attracted to these treatments.

"People are trying different solutions because the official treatment does not work or because they are opponents of the chemical way of thinking," says a general practice doctor. "Western medicine has become a technical and chemical factory. We forget that the psyche of the patient plays a very important part."

"I see it as a sign that the disease in question is probably not one that responds well to traditional Western medicine," says an internist. "For many of the symptoms people seek relief from, we have little to offer, and while I don't think colon cleanse will cure fatigue, I'm not terribly confident in my SSRI [selective serotonin reuptake inhibitor]/CPAP [continuous positive airway pressure]/B12/weight loss prescriptions either."

Another contributor considers the interest in CAM therapies to be an indication of the public's ignorance of the scientific method. "Many people believe something is true because their cleaning lady's neighbor's aunt heard it. Progress in medicine in the last 50 years has been based on controlled studies that replaced the often erroneous opinion of some respected authority." The contributor finds it ironic that "the public accepts claims for untested herbal therapies, colonic cleansing, magnets, etc, but worries about the safety of extensively tested drugs."

The NCCAM defines CAM as a group of diverse medical and healthcare systems, practices, and products that are not generally considered part of conventional medicine.^[1] Complementary medicine is used together with conventional medicine, whereas alternative medicine is used in place of conventional medicine -- although the NCCAM Website does not generally distinguish between the 2 types. Among the CAM therapies included in the 2007 National Health Interview Survey were acupuncture, ayurveda, biofeedback, chiropractic, diet-based therapies (eg, vegetarian diet), energy healing (eg, Reiki), guided imagery, homeopathic treatments, natural products (eg, herbs and enzymes), tradition healers (eg, shaman), and yoga.^[1]

Nonvitamin and nonmineral natural products are the most commonly used CAM therapies among adults,^[1] and this gives MPC contributors cause for concern. "Who knows what impurities lurk in the preparations now available?" posits a psychiatrist. "My mom was poisoned by eating bone meal tablets. The cow bones they were made from had accumulated arsenic. She developed a neuropathy from it."

The Website www.ConsumerLab.com provides information about the contents of unregulated supplements, such as echinacea, glucosamine, and vitamins. An internist familiar with the Website says, "This not-for-profit group of chemists analyze[d] OTC [over-the-counter] alternative products to determine if the brand actually contains the substance they claim. No surprise that many brands do not."

In addition to issues of product content, most MPC contributors are concerned that there is little evidence to suggest that many CAM therapies provide any benefit whatsoever.

"Anecdotal evidence of relief from one type of alternative approach or another is worthless without controls and without greater understanding of the process that allegedly results in improvement or cure," says an orthopaedic surgeon.

"The difference between evidence-based medicine and alternative medicine is that evidence-based medicine is willing to examine a therapeutic modality and determine if it is more valuable than a placebo," a pediatrician comments.

"On the other hand," comments another MPC contributor, "try to look at all this from the alternative healer's viewpoint, who would say we docs are relatively new to evidence-based medicine, and much of what we offer our patients is pretty much based on faith, just as his stuff is."

The anecdotal claims are gradually being subjected to a growing number of clinical trials. In addition, organizations, such as the Cochrane Library, evaluate the quality of evidence provided by these trials addressing CAM efficacy.^[2] A recent noteworthy addition to the evidence-based literature is the ACP Evidence-Based Guide to Complementary and Alternative Medicine, published by the American College of Physicians.^[3]

In the forward to the ACP Guide, Ralph Snyderman, MD, Chancellor Emeritus of Duke University, Durham, North Carolina, states a case for an integrated medicine that combines the best approaches of CAM and conventional medicine. "The conventional healthcare system focuses on powerful therapies designed to specifically deal with established disease using approaches that frequently have significant side effects. CAM, on the other hand, offers choices that are designed to enhance or restore wellness and often involve hands-on and ongoing relationships with the caregiver. Integrating the best of scientific medicine with CAM strategies is termed integrative medicine and is, in my view, a more effective as well as compassionate approach to healthcare."

Several MPC contributors see value in combining conventional and CAM approaches into integrative medicine. "The question is not whether Western medicine is better than alternative medicine, but how those systems could work together to improve health," comments a pulmonologist.

A psychiatrist remarks, "The point of alternative medicine is that it is helpful for chronic illnesses where conventional medicine shines in the treatment of acute illnesses. There are many very well-trained physicians who have a foot in each camp."

An internist, who has written a book on acupuncture, says that he uses the modality daily in his practice: "It works great -- for pain, especially."

"A friend of mine is a physical medicine and rehabilitation guy, and he strongly advocates alternative medicine -- especially acupuncture -- instead of narcotics for chronic pain," comments a general medicine physician. "The reason for this is clear enough -- as [a way of] preventing narcotic dependence. Who is more of a sucker? The narcotic-dependent patient or the acupuncture user? Maybe the former."

An MPC contributor agrees, "Having a patient who says acupuncture helps is more satisfying than writing yet another Percocet® script."

The full discussion about alternative medicine is available at: http://boards.medscape.com/forums/.29f3846e.

View this and other discussions in Physician Connect (physicians only; click here to learn more)