Complementary Alternative Medicine Boon or Boondoggle?

Article excerpt

Dr. Harry K. Ziel is Emeritus Clinical Associate Professor, Department Ob/Gyn at the University of Southern California School of Medicine. He served as the Director of Ob/Gyn at Kaiser Hospital, Los Angeles, from 1980-1991, as Residency Director from 1970-1980, and as Medical Education Director from 1962-1970. He is a graduate of Harvard University and attended the University of Pennsylvania medical school. His study of alternative medicine grew Out of a concern for a dramatic increase in the interest in these alternative modalities at his hospital, as well as in the profession in general.


FOR THE PAST FOUR DECADES I HAVE BEEN PRACTICING what is known as allopathic medicine, also called traditional or conventional medicine. For the past century it is this version of medical practice that has been in vogue in North America and is seen today as the standard of medical care. The medical methodology centers around a physician who takes the patient's chief complaint and health history, performs a physical examination, makes a provisional diagnosis, orders laboratory testing, requests referral if needed, outlines therapy, and prescribes medication and/or surgery. This relationship is based on scientific evidence that the proposed therapy is the optimal treatment. Medications prescribed are sanctioned by the Food and Drug Administration. Outcome data are screened and subjected to peer review through quality of care committees. Feedback to the physician of these outcome data with suggested recommendations, if any, for improvement in care closes the information loop.

Over the past decade, however, there has been a sharp increase in what is called complementary or alternative medicine (CAM) that is viewed as an accessory to or replacement of standard medical care. CAM care involves additional, nonconventional modes of therapy Examples fall into four distinct categories:

1. Diet, Nutritional, and Lifestyle Changes: Nutritional counseling, herbal

medicine, exercise routines, etc.

2. Mind-Body Control: Biofeedback, Psychotherapy, Hypnotherapy, Support Groups, Yoga, Tai-Chi, Meditation, Stress Reduction, etc.

3. Manual Healing: Osteopathic manipulation, Chiropractic manipulation, Physical therapy Accupressure, etc.

4. Alternative Systems: Preventive Medicine, Acupuncture, Acupuncture with Electric Stimulation, Homeopathy Naturopathy, Chinese Medicine, etc.

It's a war out there. Both sides hold strong opinions and clash over every aspect of healing. Physicians practicing traditional allopathic medicine (TAM) feel they've done their job when they make the diagnosis and prescribe the therapy. They might comment, "If my patient throws away my prescription once he's left my presence, the patient has only himself to blame for his failure to get well." On the other hand, the patient who discards the prescription might retort, "The doctor didn't listen. I know that he had 10 minutes set aside to see me and he's under the gun to complete a tight appointment schedule, but how can I know that he really knows my problem? How can I know that he is really doing his best for me?"

This noncompliant patient is today's fastest growing group of unsatisfied people. Who are these patients? The majority are white college-educated women, age 25 and up. Their annual family income exceeds $50,000. In 1997, the number of visits to CAM providers exceeded the number of visits to TAM providers. From 1990 to 1997, the number of visits to CAM providers increased by 47 percent, from 427 to 629 million visits.

Alarmingly, only 40 percent of patients who utilize CAM inform their regular physician that they are doing so. Dangerous drug interactions can result. For instance, when patients who fail to tell their physicians that they are taking herbs or megavitamins are then prescribed traditional coumadin anticoagulant medication, anticoagulant therapy regulation is pushed in and out of therapeutic range. …