Considering the alternatives - Complementary and Alternative Medicine - What's alternative?

Physician Executive, Nov-Dec, 1998 by David O. Weber

But not all unorthodox health care practices complement one another, notes Wesley Wong. MD, Medical Director of the John 5, Marten Center for Complementary Medicine and Pain Management at St. Vincent's Hospital and Health System in Indianapolis. A patient who takes the herb St. John's Wort for depression, for instance, is in danger of suffering an adverse reaction if a psychiatrist unknowingly prescribes a standard selective serotonin uptake inhibitor like Zoloft or Prozac too. The herb gingko biloba affects platelets and increases bleeding time. Yoga can be fatal after open heart surgery

'Unconventional' is another misleading term, observes Jonathan Lin, MD, of Columbia University's College of Physicians and Surgeons. "While most allopathic physicians may not recommend the use of energy healing to their ill patients" he says, "they might recommend other practices such as the use of vitamins." Indeed, if allowing a patient go to a weight loss clinic, pray, exercise, or pop a few vitamins is considered the practice of alternative medicine, says CAM critic Wallace Sampson, MD, "count me in."

And alternatives are, in fact, the stock in trade of orthodox physicians, stresses William London, Director of Public Health at the American Council on Science and Health in New York. The rub is that not all alternatives are created equal

A patient with an enlarged prostate, for example, may be counseled on several options, each with advantages and disadvantages: surgery, drug treatment, or watchful waiting. Each of these alternatives has been proved viable by carefully randomized, controlled, double-blind clinical trials. Their benefits, when selected appropriately, have been shown scientifically to outweigh their potential for harm.

A second type of alternative, says London, rests on less solid ground. This is the type of treatment that is still in the experimental stage but is based on a strong, scientifically plausible rationale. A physician, says London, may legitimately provide such an alternative to a patient. but only with the latter's informed consent. The therapy should never be aggressively marketed, he argues; in fact, even charging patients for it is problematic.

Finally, there are alternatives that fail to pass medical muster because they lack for convincing evidence of safety and effectiveness, and their proposed mechanisms are so incongruous according to prevailing standards of scientific merit that research funding cannot be justified. Depending on how these alternatives are marketed, says London, they may be considered "questionable, dubious, or fraudulent."

The Office of Alternative Medicine (CAM) of the National Institutes of Health has developed a classification scheme that groups unconventional therapies into several broad categories. This list, the agency notes, is neither complete nor authoritative (nor, of course, should it be construed as implying endorsement by the government).

OAM CLASSIFICATION SCHEME

"The NIH cautions users not to seek the therapies described... without the consultation of a licensed health care provider," a disclaimer adds.