Alternative medicine isn’t taught to doctors in medical school

by Crystal Phend

Physicians don’t know much more about complementary and alternative medicine than their patients do, according to a new survey.

Most healthcare professionals who answered an online survey of Drug and Therapeutic Bulletin subscribers said their profession was just as poorly informed about herbal medicines (75.5%) as the general public (86.3%).

And almost half of respondents rated their own knowledge about herbal medicines as “quite” or “very” poor (36.2% and 10.4%, respectively).

Even more worrying, journal editor Ike Iheanacho, MBBS, said in a podcast released in conjunction with the survey, was that medical professionals exhibited a lack of interest in even asking whether patients were taking herbal compounds.

More than half of respondents said they never or only occasionally (8.6% and 46.6%, respectively) ask when reviewing patients’ medications whether they are taking herbal medicines.

This was surprising, commented Linda Anderson, BPharm, PhD, principal pharmaceutical assessor at the British Medicines and Healthcare products Regulatory Agency.

Her agency’s survey of the general population suggested that “most patients were quite willing to tell doctors they were taking herbal medicines and, in fact, expected their doctor to ask,” she explained in the podcast.

Anderson’s interpretation was that physicians don’t ask because they don’t know enough to respond.

Indeed, 89% of those surveyed said their knowledge of herbal medicines was “much poorer” than their knowledge of prescribed medicines.

However, 21.3% of respondents said that if they were faced with a patient taking an herbal medicine they were unfamiliar with, they wouldn’t seek further information about it.

The primary reason cited for this was being unsure where to find such information (60%), followed by being unsure how to assess or use such information even if they were able to find it (42.9%).

This sets up a worrying conflict with patient expectations, Anderson noted.

“Our survey showed that patients thought doctors would be a good source of information,” she said in the journal’s podcast.

Notable, too, was that the largest proportion of medical professionals surveyed — 50% — said they would turn to general searches of the Internet, such as using Google, for reliable information on herbal medicines.

“I would suggest that that’s a terrible source of information where herbal medicine is concerned,” Michael McIntyre, chair of the European Herbal Practitioners Association, commented in the podcast.

“Unless you know what site you’re on, you could get terrible information, wrong information,” added McIntyre, who also serves as a member of the U.K. Department of Health Herbal Medicine Regulatory Working Group.

Patients would likely be horrified to know that physicians were relying on information on the Internet that wasn’t qualified, Anderson agreed.

One reason for healthcare professionals’ lack of information on herbal medicines may be that they feel it’s a step backward, McIntyre said.

Doctors “don’t want to get pulled back into the swamp,” McIntyre suggested in the podcast. “There’s the feeling that we got away from that because we found out what the active constituents are . . . this is science.”

In the Drug and Therapeutic Bulletin survey, 75.3% of physicians thought herbal medicines were helpful in some circumstances, but an equally high proportion said that the general public has misplaced faith in these compounds (71.8%).

The survey garnered response from 164 individuals among a random sample of 1,157 journal subscribers — primarily physicians and pharmacists — representing a response rate of 14%. Among them, 87.8% practiced in Britain.

Crystal Phend is a MedPage Today Senior Staff Writer.

Originally published in MedPage Today. Visit MedPageToday.com for more alternative medicine news.

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  • http://www.ambulancedriverfiles.com Ambulance Driver

    I’d imagine very little of it is taught in medical schools because so much of it isn’t, well… medicine.

  • Lina

    Since medical students and physicians don’t get educated about alternative/herbal/non-pharmacologic treatments, and don’t know where to look for information (since we use Google), can you tell us where we should look for information?

  • ninguem

    They probably don’t gettaught much about the tenets of Christian Science, either.

  • johnnyque

    By definition, isn’t alternative medicine something other than mainstream or evidence based medicine? And if clinical studies were performed on herbal medicine and it was discovered it was effective, it would no longer be “alternative medicine?” The folks that use alternative medicine (who are often leery of modern medicine) would then have to find another herbal remedy that is unproven? Would physicians then have to learn about medicine based on hearsay?

  • http://www.MDWhistleblower.blogspot.com Michael Kirsch, M.D.

    Medical school is where we learn medicine. Therapies that have no scientific basis or supporting medical evidence are extracurricular, and should not be included in formal medical training. Same point for residency and fellowship training. Should gastroenterologists like me have learned (or performed) high colonics in fellowship training?

    • http://notwithstandingblog.wordpress.com The Notwithstanding Blog

      Yes and no?

      I agree wholeheartedly that these “remedies” and techniques shouldn’t be taught per se to medical students or residents. However, when substantial numbers of people are taking herbal supplements or similar things on a regular basis, it would be useful for a physician to understand what is known about them in the context of interactions with other medications, and what ill effects (or other effects) they may have.

      An analogy might be made with substances such as cocaine or tobacco. Physicians aren’t taught to encourage their use (at least I hope not), but should be able to tell what they do to the body, and to alter therapeutic regimens accordingly.

      • V

        I disagree. Your analogy is flawed because people aren’t taking alternative medicines due to addiction, they take them because they believe in voodoo magic. And I believe the extent we should have to deal w/ alternative medicine in real medicine is, at most, to inform our patients we are not familiar with what they do, we recommend they stop them, and that should they continue to take them they do so at their own risk.

        • Clare

          “they take them because they believe in voodoo magic”

          We take them because we are frustrated with the state of medicine and are hopeful we can find something that keeps us out of the doctor’s office.

        • http://notwithstandingblog.wordpress.com The Notwithstanding Blog

          You’re right that my analogy is weaker than I thought at first. I’m not sure that your recommendations as to how to deal with the patient are sufficient. I agree that in an ideal world what you suggest should be the extent of physicians’ dealings with alternative medicines.

          However, it’s up to the patient to follow that advice, and as in many other cases (take your pick) where the patient doesn’t follow the physician’s advice, the physician would ideally have some knowledge of how to deal with the consequences, or at least where to turn for information and how to evaluate it.

          The fact is that physicians will always have to deal with the effects of patients doing things that are not recommended. Alternative medicines may have appeal due to “voodoo magic,” as you put it, but if they have real effects on patient health (whether it be through interactions with physician-prescribed drugs, overdoses, or whatever else), physicians should know how to deal with those effects, or at least where to turn to learn more.

          • http://www.musclerepairshop.com Butch Phelps

            Just the fact that alternative medicines are called voodoo medicine says it is not helpful to the human body. The truth is,the so called alternative medicines are actually things our bodies are suppose to be getting through our foods. The problem is, is our foods are so badly mass produced we are not getting them. As for what is called main stream medicine, it is actually the alternative. All doctors know about pharmaceuticals are what the drug companies tell them. The scary part about that is, the drug are biased as they are working to make a profit on their info. So in my mind, we all should be more knowledgeable about the “alternative medicines,’ so we can be very clear about what our bodies need before we start taking”pharmaceutical grade medicine” and having to pay for all the side effects, which are learned after we take them. I don’t know about you, but that scares me more than anything else.

  • EJH

    This study being discussed has nothing to do with what is currently being taught in medical schools– this post has a very misleading title!

    I’m a current medical student who has been taught to ask a patient whether they use any herbal supplements, etc.; I’ve also been taught how to find & interpret information from reliable resources. I think this is an appropriate preparation for dealing with a topic that is certainly relevant (for better or for worse) in patient care, but does not belong with the basic sciences.

  • http://www.doceo.co.uk James A

    The survey appears to be rubbish, so ignore that.

    BUT–”alternative medicine” can be actively toxic (viz. levels of lead in TCM and ayurvedic remedies) and even if not toxic on its own, can interact adversely with real medication, as well as deterring people from seeking evidence-based treatment. So medics need to know about that.

  • Depressed

    Modern Medicine – antidepressants are no better than a placebo.

    Herbal Medicine – St. John’s wart is no better than a placebo.

    At least chocolate tastes good.

  • http://www.ambulancedriverfiles.com Ambulance_Driver

    The history of medicine:

    100 AD: “Here, eat this root.”

    1700: “That root is heathen and sinful. Here, drink this tonic.”

    1950: “That tonic is dangerous and ineffective. Take this antibiotic instead.”

    2010: “Those antibiotics are over-prescribed and ineffective against viral syndromes. Here, eat this root.”

  • http://www.silvercensus.com/ Steffan Lozinak

    I think this is one of the major problems with most fields in general nowadays. Many doctors have spent years and years learning about chemical processes, bodily functions, and lots and lots of different diseases and illnesses… But none the less their knowledge on WHY exactly many of these things happen in these ways I think is still pretty limited. Sure they may know why in the sense of what happens after the event, but why that path? Why those particular chemicals? Why at that angle? Why in that location?

    The fact is, everything we are is from nature. All our medicine comes from nature. Everything that is, is natural. In many ways, some alternative medicines may work better than than the medicines we make, as their may be some other “ingredients” in the natural substance that we are simply unaware are being used.

  • http://www.consentcare.com Martin Young

    Alternative medicines are hardly “safe”! Ask any surgeon who has struggled to control bleeding brought on by arnica or gingko biloba!! This is dangerous stuff!!

    Doctors need to know about it for its dangers, and not for any “benefits!”

  • Greg

    @Steffan Lozinak

    Science is fundamentally the study of “HOW,” not “WHY.” We learn about how we age, how we die, etc, but the study of why we die assumes teleological processes which are best left to philosophy, myth, literature, and religion. In a stochastic art such as medicine, learning about the “how” of pathology is useful in lessening suffering and staving off death. Trying to figure out the “why” of pathology puts us in no better evidential place than religion does, what with its epidemics blamed on the work of the devil and so forth. The age of reason taught us that focusing on the “how” gets us results which are reproducible and better approximate reality. Focusing on the “why,” especially in the context of medical issues, slides us back to the middle ages.

    The problem is that the average public has a yearning to know “why,” whether or not this is grounded in fact. It takes a great deal of mental discipline to focus on the “how” and leave that niggling question of “why” unanswered. So while doctors stick to the “how” in medical school, a great number of believers and charlatans of all stripes seduce people into believing that they can reveal the “why,” despite the fact that it is largely unknowable in the scientific sense. In an America where scientific literacy is quite poor (remember over 50% of Americans think the universe is less than 10,000 years old), this lisle bait-and-switch is all too easy to do.

  • Mark

    I run across alternative healthcare providers all the time. They’re called chiropractors. Oh and they always introduce themselves as “Dr.” even when they know you’re a physician. I wonder why that is?

  • http://www.brightonyourhealth.com Mary Brighton, MS, RD

    I also believe that alternative medicine shouldn’t be taught in medical school, however, the question “do you take any alternative/complementary” medicines/vitamins, should be a part of a general doctor’s questionnaire.
    Let’s face it, a lot of people do take vitamins, herbs, homeopathy, tonics…some people more than others…some can approach dangerous levels (especially with some vitamins/herbs). In Europe (France) where I live, a hugh majority of people use complementary medicine, mostly in the form of homeopathy.
    As a part of a general doctor or other health professional evaluation of a patient, i feel the question should be asked on a client’s intake of alternative medicines or vitamins.
    Knowing the overall situation of a patient is the key to a proper assessment of this client’s health.
    The solution? As mine was after I left graduate school with also no education/courses at all on alternative medicines. I educated myself, lots of research, lots of time, also some experimenting (especially with homeopathy). Why? I want to know what my clients are talking about, why they are taking complementary medicines…their health issues. Because I want to perform my job to best of my abilities. If my doctor knows something or asks me about my intake of alternative medicines, they are a star in my book.
    Mary Brighton

  • greg zurbay

    There are many educated people that don’t realize what they don’t know. Hypnotism a sham? Acupuncture – now being shown how it affects the brain. Willow bark – aspirin. Chinese red rice – blood thinners. Ginsing – used by Russian soldiers to enhance alertness and energy levels. Chinese herbal bruise medicines – some are effective in eliminating swelling in injuries. Warnings not to eat licorice if taking anti rejection drugs, cancels the anti rejection effect. Honey found effective as controlling infection. The use of viral phages to kill bacteria before antibiotics in Russia. The mounting evidence that high levels of vitamin D fights cancer, infections, etc. Scientific research that probiotics can fight intestinal infections.

    All this may be outside the doctor’s education, but it’s in the scientific literature – if you look. It is also here and there if you are curious, and play the skeptical inquisitor.

    I can show you the bruise medicine, should anyone be interested. Kevin Garnett bought 10 bottles, when suffering with a leg injury in Minnesota while with the Timberwolves. It saved me from needing surgery to repair a trashed ankle 20 years ago.

  • ninguem

    It is because of this mentality that we get everyone’s pet doctrine shoved down the throats of medical students, then wonder why sometimes they hit the wards lacking basic physical examination skills.

  • MS1

    Yes, I enjoyed Garnett’s chapter in Harrison’s.

  • http://www.jaredhanson.com Alternative medicine NYC

    Regardless of what you may think of herbal medicine or how little you know about it (the two no doubt are related), it is irresponsible not to ask your patients if they are taking any. Most herbs sold over the counter are harmless, but there are some herbs that do interact with medications and this information is something you should know. When recommending alternative therapies, I always ask about what medications patients are taking.

    • Anonymous

      I’m glad that you do. Many people who recommend herbs and “nutritional supplements” at the health food store are just college kids trying to pay their way through school, and not really in a place to consider potential interactions.

    • Susan

      I disagree that most herbs are harmless. There are Chinese herbs that can be dispensed by a practitioner with a Masters degree from an accredited college. You can purchase these types of herbs via the internet. An unskilled person mixing these herbs can get serious side effects.

      Epocrates has a program where you can run your patients drugs, herbs, supplements to check for drug interactions…

      if you do not ask about supplements or herbs then you are not taking a full history and may be treating a side effect of a supplement with a rx med – when you do ask this for this info – you are also bound then to do something with that info – at the minimun run the products through a program like Epocrates to check for interactions – but after getting this info, you cannot just do nothing with it…

  • http://www.MDWhistleblower.blogspot.com Michael Kirsch, M.D.

    Agree that it is useful to know what alternatives patients are taking and why. Endorsing their use is another matter. For althernative medicines, or conventional treatments, show me the science. Otherwise, admit that it is likely to be placebo medicine. Faith does not constitute medical evidence.

    • http://www.musclerepairshop.com Butch Phelps

      I think the biggest disconnect we have in medicine today is that our healthcare system works in a reactive mode versus a proactive mode in alternative medicine. Both worlds can coexist, however one is not necessarily better than the other. No doubt main stream medicine is excellent when you are sick with a major disease. The science is there because the medicine is man made from start to finish. Main stream medicine can pin point the problem and eliminate. However it also eliminates many good things as well which are needed for the long term health of the patient. On the other hand, alternative medicine cannot be as precise and the science of alternative medicine is basically biology 101 and 102. Having said all that, if we taught people about what their bodies actually need from birth and supplied it to them through higher quality foods, then alternative medicine could be applied in the beginning stages of a disease and main stream medicine could focus their time and money on the more serious diseases. What I see today is too much money wasted on the common cold or aches and pains by main stream medicine. I would prefer to see the expertise of doctors and scientist being used to help patients with cancers, MS, and any other serious disease rather than treating the common cold all day. Let alternative medicine focus on the little things and we will find that happy median.

    • Susan

      having worked in pharmaceutical industry for 8 years – do you know the placebo rate of many commonly prescribed medicines?

      some are up to 50%…how do you explain this?

      interesting note….
      The roots of the placebo problem can be traced to a lie told by an Army nurse during World War II as Allied forces stormed the beaches of southern Italy. The nurse was assisting an anesthetist named Henry Beecher, who was tending to US troops under heavy German bombardment. When the morphine supply ran low, the nurse assured a wounded soldier that he was getting a shot of potent painkiller, though her syringe contained only salt water. Amazingly, the bogus injection relieved the soldier’s agony and prevented the onset of shock.

      Returning to his post at Harvard after the war, Beecher became one of the nation’s leading medical reformers. Inspired by the nurse’s healing act of deception, he launched a crusade to promote a method of testing new medicines to find out whether they were truly effective. At the time, the process for vetting drugs was sloppy at best: Pharmaceutical companies would simply dose volunteers with an experimental agent until the side effects swamped the presumed benefits. Beecher proposed that if test subjects could be compared to a group that received a placebo, health officials would finally have an impartial way to determine whether a medicine was actually responsible for making a patient better.

  • http://www.ptable.blogspot.com Bill Gleason

    Where do you draw the line on “alternative medicine?” Take for example, homeopathy:

    The Academic Health Center at the University of Minnesota will help you select a homeopath[sic]!

    http://takingcharge.csh.umn.edu/explore-healing-practices/homeopathy/how-do-i-select-qualified-practitioner

    The director of the Center for Spirituality and Healing has defended homeopathy:

    http://ptable.blogspot.com/2010/02/director-of-university-of-minnesota.html

    Homeopathy=junk science and has no place in an evidence based medical school.

  • Susan

    http://nccam.nih.gov/

    in response to those negative comments about complementary medicine – open your minds guys- up to 50% of patients use complementary alternatives – why is that? maybe traditional medicine does not always get the patient where they want/need to be, if you do not ask about their use of herbs, OTC, etc then you are not taking a complete history – I have posted a great link to the NIH (unless you think that is just propaganda also) there is research published in peer-reviewed journals – and Eastern medicine has been around for thousands of years – the NIH site also has info and flyers to help practitioners encourage this dialogue, MD Anderson Houston has an entire department on complementary medicine and holistic/healing therapies

    the comments about this being bogus and junk science just shows your ignorance on the subject – read the data first

    open your mind and get with the program – it’s about the patients…..as it should be…………….but if you don’t some other practitioner will and your patients will find them

  • Marilyn Blundin

    Visual Thesaurus v. 3.0.2
    Medicine: The branches of science that deal with non surgical technique; (medicine) something that treats or prevents or alleviates the symptoms of disease; the learned profession that is mastered by graduate training in a medical school and that is devoted to preventing or alleviating or curing disease and injuries; punishment for ones’ actions.

    I noted over the last 4.5 years of reading the “Alternative & Complimentary” thread of the discussion boards on a breast cancer site that, during that time, topics migrated from “Alternative” to “Mainstream”.
    Examples of this that come to mine are whole foods, beverages, and herbs that contain vitamins and minerals contained in food sources that “prevent or alleviate or cure diseased cells in the body. I believe that the source of that data was researched by nutritionist who attend post graduate training.
    If I recall, there was concern by anesthesiologist of patients who took herbs before surgery that interfered with the anesthetic…not a small matter. But these questions on intake forms were not commonly asked. I suspect too that once asked, the question assumes knowledge of the response and that has a whole bag full of legal medicine attached to it.
    Even if you wish to argue that the molecular compounds of pharmaceuticals are taken from nature and reproduced and that the physician’s desk reference is that bible. The PDR did not reach far enough to advise that Paxil interfers with the metabolic P450 enzyme in the liver that Arimidex needs as well and thus the two medicines via for metabolism, one winning the battle. This mattered because taking Arimidex is hell for many who need to withstand the side effects of it. Paxil is often prescribed to manage the depression and side effects that follow taking Arimidex.
    Discontinuance of Arimidex has high consequences.
    Discontinuance of Paxil is months of withdrawl.
    The doctors didn’t know this because they trusted the PDR bible.
    I faced this problem. A pharmacist told me to try white horn (bianco spino) and magnesium pidolate. I’ll be eternally grateful to that pharmacist….in Italy.
    As much as we know, there is that much more to learn. It isn’t that this discourse needs to be “either/or”. It really needs to be complementary….like primary care doctors and specialist.

  • mary

    The more I go to M.D.’s the more I need to go to M.D.’s. Alot of the supplements used to be part of mainstream tx. of people, and still is in Europe. U.S. pharma and doctors just can’t make it pay. Besides, it actually works to heal us. Can’t have that. Gotta keep the patient sick and in the O.
    R. so the big bucks keep coming. In France, they pay the doctors when they are well. Docs don’t get paid by pts. who stay sick. I like that.