Let doctors know if you’re using alternative medicine

Lots of people are using complementary and alternative medicine (CAM) these days—things like vitamins, homeopathic or herbal medicine, chiropractors, acupuncture or massage therapy. But they don’t always tell their doctors about it.

In a study in the journal Pediatrics, researchers in Canada found that among kids with chronic health problems, 64.5 percent of them were using some form of CAM—but more than a third didn’t tell their doctor. That’s actually pretty good—other studies have shown that among the general population, as many as three-quarters of the people who use CAM don’t tell their doctors.

There are three reasons patients keep their mouths shut:

  • They are afraid their doctor won’t be happy they are using CAM
  • They don’t think the doctor needs to know
  • The doctor didn’t ask

But it’s really important that patients talk to their doctors about any CAM they use.

First of all, we really need to know every medication a patient is taking, even if it’s only vitamins. Medications can have interactions, and some of them can be unexpected—I’ve certainly been surprised by some. Safety is always first and foremost, and we can’t know that we are being safe in our prescribing if we don’t know absolutely everything our patient is taking.

And while most vitamins, homeopathic remedies and herbs are safe, some can have dangerous side effects that people don’t realize. In the study, the most common way people learned about particular kinds of CAM was from family—and while we can always learn from the experience of others, it’s nice to have some input from someone with some clinical or scientific training (which not all family members have).

For similar reasons, it’s really important that we know everything a patient is doing, even if it’s just massage. Chances are we’re not going to discourage something like massage, but we want to be sure that we’re all working together, that the physical therapy or other regimens we’re prescribing work with what you are doing at home.

See, that’s the thing: medicine works best when the doctor and the family work as a team. It really helps to know not only what you are doing, but why. Did you use CAM because what we were doing wasn’t working? Then give us a chance to try something else. Did you use CAM out of curiosity or because you thought it might help? Then let’s think together about whether it’s the best approach—and whether there might be other things we should try instead or as well. Did you use CAM because it made your child better? Then definitely tell us, so that we can learn from it—and help other patients.

When I went to medical school, they didn’t teach us much about CAM. Granted, that was a long time ago, and things could be different now—but I’m guessing that for most medical schools, it’s not a big part of the curriculum. We doctors have a strong (and understandable) tendency to think within our own traditional medicine worlds.

But there is a much bigger world than traditional medicine when it comes to making patients feel and get better. And sometimes it’s patients who need to teach doctors.

I remember one mother who brought me a whole box of homeopathic medicines she used routinely to treat her children. I had never heard of most of them. I wrote down all the names and visited the website of the National Center for Complementary and Alternative Medicine (NCCAM) and read about each one—and learned a ton. Not only was I able to call the mother and talk about which ones might be helpful and which ones she should use with caution or avoid, but I gained a whole new understanding of homeopathy and herbs. Maybe I would have learned it all eventually, but it was that mother and her box of pills that got me to do it—and I will always be grateful.

Now, I can’t guarantee that every health care practitioner is going to be positive and want to spend time looking things up. But I think that more and more of us are open to different ways of treating things and want to learn more—and we just may need patients to help us learn. And we absolutely need to know everything that is going on with our patients in order to give them the best care, which is what is most important to us.

So don’t keep your mouth shut if you’ve tried an herbal remedy or been to the chiropractor or massage therapist. Even if we don’t ask, let us know. Let’s do things, and learn things, together.

Claire McCarthy is a primary care physician and the medical director of Boston Children’s Hospital’s Martha Eliot Health Center.  She blogs at Thriving, the Boston Children’s Hospital blog, Vector, the Boston Children’s Hospital science and clinical innovation blog, and MD Mama at Boston.com.

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  • ColdHands

    There’s a reason medical school doesn’t cover CAM. it’s because all CAM therapies have either not been proven to work, or (especially in the case of homeopathy) proven not to work. When something does work, it’s called medicine.

    • http://ClinicalPosters.com/ ClinicalPosters

      Or it’s called funded research. Little if any money is allocated to non-pharmeceutical research. Hence, its efficacy is primarily anecdotal.

      • ColdHands

        Rubbish. There are swathes of research into various alternatives, but they fall into 3 categories. First is things that are simply impossible, like water remembering tiny amounts of a homeopathic substance but forgetting all the excrement it’s had in it. The second is things that are usually sensible like diet, nutrition, exercise, and part of medicine already, but stretching it way beyond what research has shown. The third is taking bits of information, little nibblets about a study on a substance that has no definitive answer but is ope.n to more research, and extrapolating to make it into some wonder drug or the newest miracle fat burner. Medicine isn’t perfect, but at least it has it’s feet in the scientific method.

        • http://ClinicalPosters.com/ ClinicalPosters

          Thank you for your comments though I fail to understand what is considered “rubbish.” In most points we are in agreement. I have been supporting science-based clinical studies for years. Any promoted benefits of supplements can only be anecdotal in the absence of the scientific method.

          I also recognize that it is often best to address root causes of conditions that result from poor nutrition, physical inactivity or environmental allergies before spending large sums of money or exposing oneself to potential side effects of pharmaceutical remedies.

          Last year I faced a dilemma. Three visits to a chiropractor or months of physical therapy and prescription painkillers. My PCP agreed with the benefits of chiropractic medicine but is not in a position to prescribe it. Less effective PT is offered though the health plan.

          As the article says, we should discuss supplements with our physician. Then use common sense. I like the KevinMD article by Leana Wen MD: “When patients feel trapped by doctors and the medical system.”

          • ColdHands

            The “rubbish” was aimed at the suggestion that no research is done on CAM (or SCAM) therapies. That’s what is rubbish.

            Chiropractic may potentially help musculoskeletal injuries just like any exercise and/or physiotherapy, but the problem is that chiropractic also asserts that it can fix things like asthma, allergies, colic, etc when it has been patently proven not to. The fact that you chose to pay out of pocket for this therapy does nothing to make it any more valid. The fact that this may have been cheaper than the recommended treatment is a problem with the US healthcare system, and that’s a subject for a whole other post.

            And as the old saying goes, anecdotes are not evidence or proof.

          • http://ClinicalPosters.com/ ClinicalPosters

            Thank you for your clarification. I see now that you have a history of disputatious posts.

            I neither indicated what the ailment was or which treatment modality was pursued. Yet you assumed my selection was chiropractic for asthma… Then pointed to this as a problem with the entire US healthcare system.

            As brought out in the main article, physicians who jump to such predisposed conclusions contribute to the lack of conversation about alternative medicine with primary physicians. Of this fact I am in agreement. With that, I extricate myself from this discussion.

          • ColdHands

            From your responses, it appears that either you haven’t read my posts, or that you struggle with comprehension. Please let me clarify for you.

            At no time did I say that you sought chiropractic treatment for asthma. in fact, as you mentioned PT, it seemed you were talking about a musculoskeletal injury, which I actually did specify. It appears as though you were being disingenuousby accusing me of being “disputatious” (sic) when it seems you are manufacturing disagreements.

            You do not need 5 years of medical school and several more of residency in order to be skeptical of CAM therapies. You simply need to be able to think critically and understand the scientific method.

            There is a lot wrong with the current US healthcare system. Anyone with any understanding of the current status quo would realise this, but, as I said, that is a separate discussion.

            However, as you have “extracted yourself” from this discussion after making your rather tenuous assumptions, I suppose that it doesn’t matter what I say.

          • ColdHands

            From your arguments, it appears that either you did not read my post prior to replying, or you have issues with comprehension, so please let me clarify for you. In no way did I say that you, personally, were treating asthma. The fact that you mentioned a choice of physiotherapy versus chiropractic suggests musculoskeletal issues – as I stated. However, chiropractic does suggest it is appropriate for these other ailments. It’s rather disingenuous to suggest that I am the one who is “disputatious” (sic) as it appears that you were the one after a disagreement.
            As for assumptions, you make the assumption that I am a doctor simply because of my skepticism to SCAM therapies. However, you don’t need 5 years of medical school and several more of residency to be skeptical; you simply need to understand the scientific method.
            And yes, there are huge issues with the US healthcare system. Nobody with any understanding of the current situation would dispute that. But as I said, that is a different discussion.
            However, as you have “extracted yourself” from this conversation having jumped to your own tenuous conclusions, I suppose it makes no difference what I say.
            —– Reply message —–

    • Andrew Levin

      Exactly. It should be called SCAM (Supplements and Complimentary and Alternative Medicine)

      • Homeless

        So that vitamin D my doctor insists I take is a scam. Or do you have research that proves that high doses of vitamin D has any value?

        • Andrew Levin

          Taking specific vitamins when you have a deficiency is part of medicine, and not what I’m referencing. For example, echinacea will not cure your cold, and black cohosh will not abate your hot flashes.

          • Homeless

            I don’t have a vitamin D deficiency.

            I had a doctor tell me that vitamin E would help get rid of fibrocystic breast tissue

            My PCP has a handout that lists healthy behaviors that include vitamin D, meditation…more scams?

          • N N

            I’ve noticed that you ALWAYS try to get in arguments. No, Vitamin E will not get RID of fibrocystic breast tissue. Instituting healthy behaviors from the beginning is different from CAM.

    • http://www.facebook.com/profile.php?id=599840205 Christian Kleineidam

      Given the definition of CAM that this article uses your claim is just wrong. This article counts message as CAM. There are a variety of studies that show that message can help with some issues.

      There are various studies that show that a framework like Feldenkrais helps with various health outcomes. At the same time Feldenkrais isn’t covered in medical school.

      • ColdHands

        I suggest that you read my other comments. Just because CAM claims something is “alternative” it doesn’t meant it actually is. As for Feldenkrais, the evidence is poor to say the least, and inconclusive. In my previous post, I explained that certain methods may be somewhat helpful in certain circumstances, though evidence is lacking, but that other claims are sheer fantasy.

    • maryhirzel

      Repeat the mantra……..

  • http://ClinicalPosters.com/ ClinicalPosters

    Thanks for the head’s up doc! Your first reason for silence resonates.

  • http://www.facebook.com/colin.klein.79 Colin Klein

    I’ve heard that medical school doesn’t really even teach nutrition. I know it’s a lot to ask for doctors. And when you think about, how can they even keep up to date on important research that’s STILL being done, like Rongxiang Xu’s natural stem cell treatments in China.

    I don’t envy doctors.

  • http://www.facebook.com/heiko.lade Heiko Lade

    If homeopathic medicine does not exist because its strength is beyond Avagrado’s number, and therefore can’t work, how can they be dangerous?

    • ColdHands

      When people stop taking medication that is keeping them healthy or use it, for example, instead of chemotherapy or radiotherapy for cancer… then it’s dangerous. You are right, however, that it’s the same danger as drinking too much water or consuming too much sugar!

  • http://twitter.com/LtGreenFriend Alex

    I was hesitant to tell my physician that I was using AminoActiv (a natural pain reliever) to treat my back pain. I thought she would roll her eyes and be frustrated with me for not taking Advil like she told me to. Anyway, when I told her, she praised me for being proactive and told me to keep her posted on my progress.

    • ColdHands

      The placebo effect can be very strong. Sometimes, just taking some control back can help.

      • maryhirzel

        “Placebo effect.”

        Dr. McCarthy, please not this comment as the perfect example of why many of us who use and benefit enormously from natural therapies, don’t like to waste even a precious few of those allotted minutes with the doc, on any effort at all to educate a stone wall, which is the all too common mindset in allopathically educated physicians.

        I agree with your assertion that working together would be ideal, but the sad truth is patients are the ones here with the education and experience, not the M.D.s, most of whom just don’t want to know, like ColdHands here……

        • ColdHands

          You know what they say about assuming thing, right? I’ve spent decades researching CAM and yet you assume that because I recognize it for what it is, that I haven’t bothered? Strange how many people say that before dismissing “allopathic” medicine which, whether you like it or not, does at leastperform clinical trials to exclude placebo as being the only reason something helps. Anecdotes, however, aren’t going to do that.

          • maryhirzel

            Try another source for your “research,” which I assume was done entirely on Quackwatch.

            Of course, I don’t know what you are referring to when you simply call it “CAM” or “SCAM.” Perhaps you are looking into junk. Dunno.

            Suggest you look at orthomolecular medicine/functional medicine history/research.

            Running clinical trials is not the only way to determine efficacy and is not even appropriate for approaches that involve more variables than could be accounted for by comparing two groups.

            If that is your only goalpost, then how do you get enough money to run a trial to prove water is safe and effective for treating dehydration?

            No doubt clinical trials are very useful for proving the safety and efficacy of drugs like Vioxx and Avandia, and if you think that’s the gold standard in vetting what works, well, good luck to you.

            I, frankly, couldn’t care less whether allopaths ever get it. Wouldn’t go near a truly faithful one. Haven’t in over 50 years and doing just fine, thanks!

            I’m posting simply because your manners and your cluelessness are an irritation to many of us, like a bedbug.

            Have a nice day. :-)

          • ColdHands

            Like any medicinal product only works on one thing.And again, you assume I am only capable of believing what others have written, rather than make up my own mind from my own research. Pot, meet kettle! And that’s ok, the feeling is mutual. :)

            Feel free to contact me when you come up with something new to justify your beliefs.

  • http://twitter.com/missdreacakes Andrea Goldman

    You sound like a much more intelligent and supportive doctor that most any that I’ve ever worked with. Most doctors have been curt, condescending and not open to any alternative therapy, nor did they respect any research I’d done on my own. Since the age of 22 I’ve had a many painful physical aliments due to what I now know is an autoimmune disorder. I went to regular doctors, specialists, and physical therapists for 8 years, seeking help for my condition. None of them helped me, or understood what was wrong with me, and the only solution they ever presented was taking drugs to mask the symptoms.
    I tried to work with my rheumatologist, and told her I’d been reading about nutritional remedies for my condition. She looked at me like I was a petulant toddler and dismissed my questions.
    I eventually stopped taking their drugs, and stopped going to the rheumatologist. Then, through my own extensive research, and working with a naturopathic doctor (oh, the horror!) and through some trial and error, we figured out how to heal me.
    I had been in massive pain every single day, barely able to walk, many of my other joints stiff and in pain, I was also tired, sluggish, and almost had to go on disability again. A few months later, after merely changing my diet and taking some herbal remedies, my pain was almost completely gone. A year later, I started studying dance again. It’s been three years now, and I’m happy to say that as long as I stay on my diet (nightshade-free paleo diet) that my pain is still gone, and my overall health is incredibly improved. And I’ve found that there are many, many more people like me out there (there was even a story in the NY Times recently called “the boy with the thorn in his joints” about a boy with my condition healed by my exact diet.)
    I don’t regret for a second that I went to an alternative medical practitioner and I wish I’d done it sooner!
    The mainstream medical community needs to wake-up and realize that alternative therapies and holistic nutrition do work, and just shutting their ears and calling it a “SCAM” is doing a disservice to their patients, and also in the long run will make them lose their patients completely.

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