Monday, October 25, 2010

Complementary and alternative medicine: what should FPs and patients know?

Since 2003, AFP has published an occasional series of articles evaluating the evidence for complementary and alternative medicine (CAM) therapies, ranging from ecinachea to probiotics to yoga and meditation for anxiety and depression. In an editorial introducing the series, associate medical editor Sumi Sexton, MD wrote:

The intent of this new AFP series is to summarize and label the evidence behind various alternative therapies, starting with the most frequently prescribed and well-researched herbal remedies and supplements. ... Currently, an abundance of information on CAM exists in textbooks, journals, newsletters, and Web sites. The purpose of the series is not to replace the existing information or to encourage physicians to prescribe CAM therapies, but rather to extract the most important data in the literature and present it as concisely as possible.

However, as an exchange of letters in the October 15th issue of AFP about an article on acupuncture for pain demonstrates, drawing conclusions about the effectiveness of CAM therapies can be challenging. Dr. Paul Delaney asserts that "in a desire to present information regarding treatments designated as complementary and alternative medicine (CAM), the editors of American Family Physician seem willing to suspend the usual criteria for evidence-based medicine." In rebuttal, Dr. Robert Kelly cites a Cochrane review that supports the effectiveness of acupuncture in relieving chronic low back pain, and Dr. Sexton notes that the article's supporting references "included several RCTs, systematic reviews, and a meta-analysis, which would warrant an evidence level A for any review article."

A recent report from the National Center for Health Statistics found that U.S. adults spent nearly $34 billion in out-of-pocket costs for CAM practitioners and purchases of CAM therapies, classes, and educational materials in 2007. What do you think family physicians and patients should know about CAM, and how would you rate AFP's CAM series at meeting these needs?

1 comment:

  1. Semantic challenges abound in using terms like CAM. There is no "M" in CAM, it's a "T" for therapies or a "P" for practices. CAT or CAP would have served us better for understanding the issue.
    There are easily 400 therapies or practices that are not "the practice of medicine". We physicians know we can't deliver those therapies and charge a fee to a medical insurance company. We also don't have medical liability insurance to deliver those services.
    As any of those therapies or practices are proven effective, they become "medical" and billable and covered under medical liability insurance.
    As a physician trained in several alternative therapies (Reiki, Sound Attunement Therapy, Neurolinguistic Programming, Holistic Chair Massage, Non-Directive Imagery, Aromatherapy, Reflexology) I have a good sense of where the boundary line floats between medicine and "non-medicine". Many physicians want to deliver therapies that are not proven medically. They should be clear about what is alternative, fitting into a separate disclosure to patients, separate billing and separate liability insurance.
    Boundaries and Semantics are important elements in looking at CAT/CAP and openly communicating with patients and each other about them.