An ethicist in the Oregon Health & Science University Center for Ethics in Health Care has published new guidelines for conventionally trained doctors whose patients are interested in using complementary and alternative medicine (CAM).
The report comes in response to the exploding popularity of CAM among the general public and its expanding use among patients, health care providers and institutions. According to a national survey conducted in 1997, more than 42 per cent of the American public used complementary and alternative medicine, at a cost of $27 billion per year.
CAM therapies include acupuncture, herbs, chiropractic manipulation, mind-body interventions and naturopathic medicine. While there is little scientific information on the effectiveness of most CAM therapies, some treatments such as chiropractic manipulation for temporary back pain, appear to be more successful than conventional therapies.
"It is imperative that physicians consider the ethical obligations when tolerating or recommending for or against CAM therapies. CAM should not be dismissed out of hand or accepted blindly," said Dr Karen Adams, an assistant professor of obstetrics and gynecology in the OHSU School of Medicine and lead author of the paper.
"Many physicians are unfamiliar with CAM therapies. There is also a lack of scientific evidence about most forms of CAM, and some therapies may even be harmful when used alone or in combination with conventional medicine. This provides the potential for serious patient-physician conflict."
To help doctors consulting patients undergoing or considering CAM therapies, authors provided a list of factors that must be considered as part of a risk-benefit analysis. These included severity and acuteness of the illness, curability with conventional treatment, the degree of patient discomfort associated with conventional treatment, and safety of the CAM treatment.
Doctors should also have a degree of understanding of the risks and benefits of the CAM treatment, ensure patient knowledge of those risks, and evaluate the patient's degree of persistence in using CAM treatment, advised the authors.
To illustrate the varying ethical consideration doctors must make when working with patients undergoing CAM therapies, the paper uses real-life case examples. The identities of the doctors and patients involved were concealed to maintain confidentiality.
"One of the major messages of the paper is to thoroughly investigate treatment options and hold in-depth discussions with a patient," added Adams. "The promise to face the future together is one of the obligations of the physician-patient relationship and should not be taken lightly. Our hope is that whatever care options a patient chooses, communication with their conventional medicine provider will continue."
The guidelines are contained in an article published in the 15 October edition of the Annals of Internal Medicine. The article is part of a series of reports on various aspects of CAM treatments appearing in the journal. Collaborators from Beth Israel Deaconess Medical Center, Harvard Medical School and University of Washington Medical Center also contributed to the paper.