Alternative Therapies for Common Medical Problems
Nina Radford, M.D.

Do you take Echinacea for the common cold or use aromatherapy to calm your nerves? Have you surfed the web looking for alternative therapies for common medical problems like high blood pressure or high cholesterol? If so, you are not alone. Complementary/alternative therapies have grown in popularity in recent years, and one population survey in the United States showed that they were used more by women (48.9%) than men (37.8%). A number of studies have shown that from one-third to three quarters of patients with chronic medical problems use alternative or complementary therapies, such as vitamins, prayer, herbs, massage, meditation, acupuncture, chiropractic and nutritional therapies.

As physicians, we often encounter patients who report that they take no "medications" regularly and yet every morning they swallow a dozen different pills aimed at enhancing their wellness. In fact, nearly half of all patients who visit alternative medication practitioners do not disclose these visits to their regular physicians. Why are patients hesitant to discuss these visits? Some patients might fear that their use of alternative therapies could characterize them as quirky or far-out. They may fear that their physicians will view their use of alternative therapies as an indication of their lack of confidence in their "conventional" physician offering "conventional" therapies. Others may believe that the use of these therapies do not require the input or review of their regular physician because these therapies are not "real medicine" and will not interfere with other treatment plans. Well, it is time to clear the air!

A number of recent surveys indicate that the majority of physicians are willing to discuss the use of alternative therapies and that almost half believe the alternative therapies are potentially beneficial. Physicians may be reluctant to discuss a therapy if they are not well informed about it or if there is little data available to review concerning the efficacy and safety of a treatment. The notions that physicians are uniformly close-minded to the idea of alternative medicine or would terminate the physician-patient relationship because a patient used alternative therapies are out-dated.

Why is it so important for you to share information about your use of alternative therapies with your regular physician?

First, the use of an alternative therapy may reflect your dissatisfaction with conventional treatment for a condition and this should be discussed openly. Are you having side effects from a conventional medication or is it not providing the result intended? These are all important issues to discuss. Importantly, alternative therapies can have side effects or important interactions with conventional medications. For example, ginkgo biloba is one of the best selling herbs in the United States. According to the German Commission E and the World Health Organization (WHO) monographs, ginkgo has uses in patients with Alzheimer's and multi-infarct dementia, tinnitus, vertigo, peripheral arterial occlusive disease and Raynaud's disease. The most frequently reported adverse events were abdominal complaints, nausea, and dyspepsia. There are case reports of bleeding complications associated with aspirin plus ginkgo use. Not all patients are aware of potential side effects or drug interactions and your physician would certainly want to know about your use of it if she were evaluating frequent nose bleedsfor example. Other supplements can be just plain dangerous. Ephedrine or Mahuang is found in some supplements intended for weight loss and its use has been associated with serious side effects such as high blood pressure, racing heart beat, seizures, stroke and altered mental status.

Drs Pappas and Perlman published a medical review on the importance of doctor-patient communication in the use of alternative and complementary medicine (Medical Clinics of North America, Volume 86, January 2002) that you might recommend to your health care provider. They recommend that if a patient is considering the use of alternative therapies with a provider about whom they have little information, there are key questions to ask:

1. Is the provider's belief in the effectiveness of the therapy based on clinical experience with similar patients? If so, is it possible to speak with such a patient?

2. What does a therapy consist of? What is the recommended frequency of the therapy?

3. How many weeks of therapy are required before the patient and provider can decide whether the therapy is or is not beneficial?

4. What is the cost per session with or without medication and the anticipated total cost for the specified time period? Is third-party reimbursement available?

5. Are there potential side effects?

6. Is the provider willing to communicate diagnostic findings, therapeutic plans, and follow-up with the patient's primary care provider or subspecialist? Are there any limitations to this communication?

The emergence of alternative and complementary therapies is an exciting development in medicine but their use requires careful study and a critical review of the available data regarding safety and efficacy. Gather as much information as you can before you try a new therapy and by all means, share that information with your regular health care provider. Wellness is a team effort and everyone has to know the game plan.

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