Time Stamps

Show Notes

  1. What is CAM?
    • “Alternative whole medical systems” (Ex: Homeopathy, Naturopathic, Chinese, Ayurvedic medicine)
    • Mind-body interventions (Ex: Meditation, yoga, tai-chi)
    • Manipulative/body-based methods (Ex: massage, acupuncture, chiropractic manipulation)
    • Energy therapies (Ex: qi gong, reiki)
    • Biologically based therapies (Ex: supplements, botanicals)
  2. How popular is it?
  3. Why do patients turn to CAM?
    • Healing traditions
    • Whole person approach
    • Full philosophies of care
    • Empowerment/active participation
    • Looking for hope
  4. How can we adapt our practices?
    1. Curiosity/Humility
      • Start by taking patients seriously!
      • Ask about specific practices
        • What worked/Didn’t work
        • Why they chose it
    2. Support patient engagement/motivation
    3. Learning more about CAM
  5. Setting limits
    1. Assess risks/benefits
      • Supplements and quality control
      • Being wary of unscrupulous practices
      • Low risk practices
      • Caveats to body-based manipulation
    2. Looking at the “Big Picture”

Resources:

Transcript

Jafar: I’ve disagreed with patients before.  I’ve struggled with unrealistic expectations for aggressive ICU care, and seen plenty of patients ignore the advice I’ve given for weight loss or smoking. But I’ve never seen it play out so painfully in front of me, or felt so helpless to stop it. 

She was in her mid 30s, among the youngest I’ve seen with metastatic breast cancer. Even so, she had reasons to be hopeful–survival for her disease had never been better, at least five years with the latest combinations of treatments, probably more. But she wouldn’t let us talk about those treatments, and it wasn’t her first time hearing about them. She had been offered it seven months ago, but she chose instead to seek treatment in Mexico, where she could get IV vitamin C, and instructions on a diet that would “starve” her cancer.

And despite the growing back pain and leg weakness, she continued down that road. When she could finally no longer walk, her parents literally dragged her into the hospital. I met her there to discuss the obvious–metastatic cancer had eaten away at her spine, and the inevitable fractures now compromised her spinal cord. 

She took this all in with absolute clarity, and just as calmly asked when she could leave. She didn’t want surgery, radiation, chemotherapy, or even simple hormonal based treatments. Despite what she was living through, the pain and debility right in front of her, she saw a better way out than what we in conventional Western medicine had to offer.

This was one extreme example of something I came to see over and over again: the patient’s quest for outside cures, for new or different answers to the problems we as doctors were describing to them. What were we doing wrong, that led so many people astray? Or on the other side, how did these alternative medicine folks win the trust that we had lost?

I. INTRODUCTION

Jafar: I’m Jafar

Tamar: I’m Tamar 

Margot: And I’m Margot

Jafar: Welcome back to At the Bedside. So that case left me with a lot of questions and concerns about this big mysterious world of Complementary and Alternative Medicine, or CAM. And it was more than just wanting to know a little more about the evidence behind acupuncture or nutraceuticals–I felt like I needed to know why this young woman would fully commit herself to CAM treatments. And yeah definitely, her case was extreme, but diving deeper into it taught me all about the ways that so many people choose to pursue their health, beyond what traditional Western, allopathic medicine offers–not just what they practice but why they practice it, and where I as their doctor sit within that journey. 

We’ll start off today by discussing definitions of CAM, and its overall prevalence. Then we’ll go into some of the reasons why so many patients find it so appealing. We’ll finish by discussing how we can use these insights to improve our practice, and what CAM practices we should be aware of in assessing risks and benefits.  Ultimately, confronting CAM practices pushes us to understand what we in the Western tradition really believe about health, where those limits can grow, but also where those limits need to be enforced. 

With us to discuss these issues are three physician experts on CAM, each with their own story to tell living at the intersection between allopathic medicine and the frontiers of different CAM practices.

First meet Dr. Edzard Ernst. Professor Emeritus of Complementary Medicine at the University of Exeter in the United Kingdom.

Edzard: When I had graduated, uh, by coincidence, I ended up in the only homeopathic hospital in Germany at the time. I learned that this is all rubbish, but patients did get better. And I started thinking maybe not everything was true that I had learned at medical school.

Jafar: Dr. Ernst is perhaps the world’s foremost CAM researcher, having written over 1000 peer reviewed articles, 100 book chapters, and over 50 books, and still currently maintains a daily blog critically reviewing issues in CAM. Also with us is Dr. Aashini Master, Assistant professor of hematology/oncology at UCLA, who is board certified in integrative medicine 

Aashini: It’s really more of how I approach medicine, which really goes back to how I was raised. I do recall seeing a pediatrician regularly, but I also recall seeing a homeopath regularly, and seeing sort of nontraditional practitioners fairly regularly. Just having that understanding and that exposure at very young age, that there is more than just Western medicine. 

Jafar: Finally, we’re joined with Dr. Ka-kit Hui, Wallis Annenberg Professor of Integrative Medicine at UCLA and Director of the UCLA Center of East-West Medicine.  

Ka-kit Hui: So my first twenty-some years at UCLA was a try to integrate and Western medicine and I’ve been a bench researcher. I’ve been a drug developer and I have been trying to figure out like, what, what is good about the medicine that, you know, we have what the biomedical approach, and then what are the healing traditions, particularly Chinese medicine.

II. WHAT IS CAM?

Margot: So what is CAM? CAM is a catch-all term for healing practices that you don’t tend to get through a doctor’s office. It’s generally split into five categories:

First, there are what are called “alternative whole medical systems” – this includes homeopathic and naturopathic medicine, as well as Chinese and Ayurvedic medicine. Second, there are mind-body interventions, including meditation, yoga, and tai-chi. Third are manipulative and body-based methods including massage, acupuncture, and chiropractic manipulation. Fourth, there’s energy therapies like qi gong and Reiki.

Finally, there are biologically based therapies, and these are compounds found in nature like herbs, certain foods (like turmeric), vitamins, and dietary supplements. Dr. Ernst explains how these can be powerful substances themselves:

Edzard: Quite a few herbal remedies, which are effective for certain conditions, which is hardly surprising if we consider that about half of our pharmacopeia, modern pharmacopeia, originated from, uh, the plant kingdom.

Margot: As you can probably tell from that description, the practices we lump under the term CAM are incredibly heterogenous, each coming with its own risk profile and cultural background. Different practices appeal to different people for different reasons. Definitions are also tough to pin down because some practices that were alternative are now being incorporated into mainstream medical practice; many medical centers are now promoting practices like yoga, massage, and acupuncture. The themes we’ll talk about today are pretty broad, so for the details on individual practices, we’ll have a list of resources in the show notes.

III. HOW POPULAR IS IT?

Tamar: Some of us may consider CAM practices outside our ideas of traditional medicine or they’re at least outside the bounds of what we learned in medical school. But we wanted to make the point that the prevalence of use alone makes a convincing argument for why we should be seeking out a better understanding of these practices, the evidence of their benefit, and their possible toxicities. So many of our patients may be engaging in complementary or alternative practices. Data from a survey done by the CDC’s National Center for Health Statistics back in 2007 estimated that “almost 4 out of 10 adults had used CAM therapy in the past 12 months.” Now this took into account nutritional supplements and breathing exercises, but still, that’s a higher proportion than I’d recognized. And CAM use is even higher in certain subsets of patients, like those with chronic back pain, patients with cancer, and cancer survivors. Which also explains why there’s been an increasing trend in including exposure to CAM in medical curricula:

Ka-kit Hui: 72 health systems and medical schools have programs in integrative medicine and health, and that doing research, doing teaching and have clinical programs. Johns Hopkins, uh, Harvard and at MD Anderson and a lot of the, you know national comprehensive centers entry have integrative oncology programs as well. So, so I think that we believe that integrative health should be part of everyone’s health 101.

IV. WHY DO PATIENTS TURN TO CAM?

a. Healing Traditions

Jafar: So what attracts patients to start using CAM?  Well, for many communities, these practices are ingrained healing traditions, used alongside and, indeed, long before Western medicine:

Aashini: I do think it’s very cultural. If, you know, particularly we’re seeing people who are, you know, immigrants or first generation, I think there is a strong cultural component. This is the way it’s done in, in, you know, my country. Um, and so that might be driving them and, you know, the other, probably largest proportion of it.

When we look at traditional Chinese medicine or Ayurvedic medicine, these have been in practice for centuries, much longer than, Western allopathic medicine has been.

b. Whole Person Approach

Jafar: As Margot mentioned earlier, some people practice CAM not just as individual modalities, but whole medical systems, where every part of a person’s health can be appreciated and addressed together, in ways that modern medicine often compartmentalizes into different subspecialities

Edzard: The claim that, alternative practitioners practice holistic medicine, and by implication that mainstream medicine is reductionistic and, neglecting the whole person, just treating diagnostic labels rather than whole people, sadly this is, uh, perhaps sometimes true.

Jafar: Those needs, unfortunately, may have more to do with the broader structures of traditional medicine, where both patients and clinicians feel the frustration of limited time together.

Edzard: I don’t know any doctor who wouldn’t like to have more time with patients, but patients don’t know that.  

Aashini: The truth of it is, the way our medical system is set up, we really don’t have the time to do it… because it does, it takes time. It takes sitting with a patient, it takes listening to them, really teasing out what their priorities are, where, what their background is, where they’re coming from, what their relationship with the medical system is.

c. Full Philosophies of Care

Jafar: And it’s not just that CAM practitioners offer their time, they also offer philosophies of care that are similarly holistic, comprehensive, and easy to understand. Multiple large surveys of patients have shown that it is not so much that patients embrace CAM practices because they reject conventional medicine–it’s because these other modalities are more culturally and philosophically aligned with them.  The way we’re taught medicine, we’re taught to prevent and treat specific diseases. CAM and integrative medicine are really what fills in the gaps between diseases with compelling philosophies of the whole system.

Ka-kit Hui: In general, Western medicine use the reductionistic approach. We try to sort of look at a symptom and trace it to an organ, to a tissue, to a molecule when we try to treat by either removing it, replacing it, we try to do by blocking and stimulating. We do not do enough on modulating and trying to understand why the balance is off. I think that the reductionistic approach is useful when we deal with something that’s acute. Okay. But when you try to focus on prevention, when you focus on things that are just like either very early, or when things are very advanced and there’s so many factors, you know, melt, multifactorial issues then we become relatively impotent. 

d. Empowerment/Active Participation

Jafar: Even more than just giving us deeper concepts of health and illness, what many CAM modalities also offer is a chance for more active engagement in the healing process itself–something sorely missed by those who may feel lost and existentially distressed by the process of illness:

Aashini: They’ve lost all sense of control going through the process and they’re just looking for something they can hold on to, to feel like I’m doing something for myself.  They’re like, I’ve done everything, right. I exercise, you know, six hours a week and I’m vegan and I’m, you know, all of these things, why did this happen to me? Western medicine doesn’t have an answer. Um, and maybe in seeking some other, you know, alternative therapies, I will, maybe they will have an answer for me. 

Jafar: This quest for answers and empowerment may be why CAM modalities are more often sought by patients who are more highly educated, patients under increased psychosocial distress, or who are given diagnoses with a poor prognosis.  Patients can get especially motivated to look for alternatives when they feel their health is at risk by undergoing conventional treatment, a feeling I’ve seen come up a lot with chemotherapy:

Aashini: We refer to this therapy as cytotoxic, you know, you say that word to a patient and their, their immediate retort is me. Why do you want to give me something that is toxic to me? Well, I want to give it to you because I know it can potentially cure your cancer. Um, but that can be a difficult hurdle to overcome.

e. Looking for Hope 

Jafar: The problem gets even worse when we’re faced with chronic diseases that are poorly understood or lack effective treatments. Many studies have shown increased usage of CAM amongst patients with chronic back pain, chronic neurologic, psychiatric, rheumatologic, and GI issues, asthma, and gynecologic disorders. If we’re being honest with ourselves, not all of our treatments really work all that well. I think of what a patient with uncontrolled fibromyalgia must go through, and to me that kind of justifies looking outside of what conventional medicine offers.

Edzard: So there’s a lot of disappointment with conventional medicine and some of it is justified, not all of it. And with this disappointment people look elsewhere.

Jafar: Essentially, what some patients are looking for his hope beyond with conventional medicine has offered them, and so it’s no wonder that the sickest patients often appeal to CAM therapies for hope.

Edzard: Somebody who is fighting for his or her life would be clinging to any, any straw that offers, uh, stability or help, uh, in any sort of way. And as you well know, you go on the internet. And for instance, cancer patients get promised all sorts of, uh, things about alternative medicine that is, that is cures conditions, or that it helps with coping or side effects, improving quality of life, et cetera, et cetera. So, so all of this is of course, very, very attractive to anybody who is desperate.

Jafar: Even one of our clinician guests spoke about her experience looking to outside sources because of feelings of desperation.

Aashini: I get it, you know, I was horribly ill with hyperemesis, both my pregnancies. I was doing the same thing, I did not, I did not feel supported by my, you know, by my obstetrician the way I hoped for.  It was one of those, you know, “It’s okay. You know, if this medication doesn’t work, we’ll use this one.” And this one, well, all of the medications were having their own set of side effects, you know? So I was trying to find something else I could do to, you know, work and, you know, with my second pregnancy take care of a toddler and, you know, and I, so you look for things, you get to a point of desperation. And I completely understand it having, you know, been through my own experience.

V. HOW DO WE CHANGE OUR PRACTICES?

Tamar: We’re going to turn now to the main reason we wanted to dedicate an episode to this topic: How does all this information affect our practice? How do we integrate it into our clinical approach? 

Aashini: I personally believe that there is a role for both of them that while we are, you know, using our science and our data and our randomized clinical trials to provide the best therapies for patients that ultimately there’s a lot that we don’t know about the human body and, you know, how it, this, this self healing capacity that it has that I think that we can support with other modalities.

Tamar: And this was the first thing we heard from our experts over and over again — the importance of humility, curiosity, and being open-minded about a place for CAM practices and the impact they have on our patients.

Ka-kit Hui: We think that, you know, uh, we have the only know how for healthcare, when in fact there are other cultural healing traditions that actually can be very helpful as well, that would compliment. That’s why we call complementary medicine that will complement our current approach.How do you care for the patient? How do you motivate a patient to be a partner in the overall journey of their recovery?

a. Partnering/motivating patients, engendering trust

Tamar: And with that in mind, we need to really understand our patients’ experiences with CAM — Why they chose certain modalities, what worked for them and what didn’t? — So that we can better understand what they need from us in their medical care. 

Aashini: I think a lot of people are looking for a sense of control and a sense of purpose in their treatment plan. Um, and I think we can provide that for people if we really partner them and we partner with them and have an open discussion about, you know, what their belief system is and how we can help support that and integrate it into their treatment plan. I think that there is a level of trust that I have been successful in creating with my patients, because from the start, we do have an open dialogue about their desire to engage in complementary therapies. And because we’ve had that, they know that I will listen to them, um, and engage them in that conversation. So if I think it is something that will be harmful to them or that is unnecessary, for the most part, I find that they will respect my opinion, but I, you know, I think ultimately that stems from the fact that we have laid the foundation early on for this relationship, in this open dialogue, instead of me saying to them, just, I don’t believe in these things or these things have never been proven, so I don’t think that you should do them. Because then patients feel they feel written off and they don’t feel that they’re being heard.

Ka-kit Hui: So, so it’s important for the general internist or family medicine physician to try to integrate all the, the guidelines and try to come up with what is best for that person.

b. Learning more

Tamar: And to make an integrated plan, we also need to be open minded about the limitations of our knowledge, and learn more about the science and evidence behind CAM practices we may not be so familiar with in order to properly counsel our patients. 

Edzard: Obviously one needs to take patients seriously with their concerns and one needs to advise them responsibly, uh, responsible advice can only be advice based on good evidence. 

Tamar: And so again, we encourage you to check out some of the resources in our show notes, which we gathered with the guidance of our expert discussants. As a place to start, there are great point-of-care references such as Dr. Ernst’s book published last year, titled Alternative Medicine: A Critical Assessment of 150 Modalities. Similarly, Memorial Sloan Kettering Cancer Center has a searchable database that includes the mechanisms of action and potential interactions of supplements, herbs, and other compounds. There are also hundreds of Cochrane systematic reviews on complementary therapies and great online learning modules for clinicians.   

VI. Setting Limits 

Margot: As Tamar and Jafar have just discussed, there are lessons that western medicine can take from CAM. But there are definitely times when CAM practices can be harmful – so where do you draw the line? I’m going to go over some strategies for weighing risks and benefits.

A. Supplements and Quality Control

First we’ll talk about supplements. Supplements are very commonly used, but also can be really difficult to accurately assess risk for. Part of the problem is that supplements aren’t regulated as closely as medications, so you don’t really know what’s in the pill your patient is taking. This also makes them difficult to study in clinical trials, so the data we have on supplements just aren’t as rigorous. Here’s a strategy Dr. Master has used to advise her patients:

Aashini: I encourage them to add these things to their diet and to consume them in their natural form. We know that food works synergistically. So you’re going to have a much greater benefit from probably a much smaller amount if you are cooking with it. And then you don’t have to worry about the potential toxicity because it’s unlikely you could ingest that much without having side effects from it if you’re taking it in its natural form.

Margot: It’s also important to warn patients not to suddenly stop their supplements: if a medication interacts with a supplement, it can reach a steady state that could get disrupted.

B. Being wary of unscrupulous CAM practices

Margot: Another problem our experts touched on is the lack of oversight of the CAM practitioners themselves. While many CAM practitioners go through a formal path of education and certification, their practices don’t tend to get the same degree of scrutiny as conventional medicine. It’s important to warn your patient if they seem to be working with an unscrupulous CAM practitioner.

Aashini: I have patients who come in with, you know, pamphlets they’ve picked up from, down the street from our clinic where they are, you know, they literally have a, just a list, like a menu of options that patients can go through. Patients who are on chemotherapy can go through and they can kind of pick and choose which complimentary therapies they want to use. So it, it almost feels like no one is guiding them. They’re just going through and saying, yes, I want to do this. I want to do this. I want this ozone therapy. They are looking at the, you know, the prices are on there. It’s like, you’re going into a salon and, or, you know, getting your nails done and you’re choosing out what color you want. And then there you go. Um, so that is really distressing to me.

i. Low Risk Practices  

Margot: On the other hand, there are many practices that pose little to no risk. Specifically, mind-body interventions, energy healing, and body-based methods don’t run into the same risks that our patients might face with infusions and unregulated supplements.

Aashini: The way I looked that, you know, when we talk about healing touch, when we talked about relaxation techniques, when we talk about prayer, um, you know, energy therapies, I think there’s very little downside to it. The chance of doing harm with any of those techniques is so low. I mean, we know that support groups provide benefit for patients. In the same vein, I think if you are doing, you know, some kind of relaxation therapy or healing touch, you know, the way I look at that is that might be an hour of someone’s time, where they are focusing on themselves.

Margot: But there is an important caveat: while most body based manipulation is low-risk, serious events do happen. Chiropractic manipulations have certain risks:

Edzard: Particularly if the chiropractor manipulates the neck. About 500 people have suffered stroke and many have died from dissection of the vertebral artery, which happens when, when certain manipulations are done by chiropractors. So it’s, it’s by no means risk-free. Informed consent is virtually absent in alternative medicine.

Margot: Given the low but real risk of carotid dissection, cauda equina, and disk herniation, patients who are predisposed to these complications should be advised not to seek chiropractic manipulation. This includes patients with a history of stroke, osteoporosis, spinal instability, and people with bleeding disorders or on blood thinners.

ii. The biggest risk may be INDIRECT

Margot: While we’ve covered some of the direct risks of CAM practices, some of the biggest risks may be indirect:

Edzard: And with, with the risk I include what are often called indirect risks, homeopaths, for instance, tell patients not to use vaccinations. And, uh, the recommendation not to use vaccinations is, is a risk. Uh, not just to that one kid that is being advised not to use vaccinations, but if it happens often enough, um, to the public, we would lose herd immunity. 

Margot: If a CAM practitioner discourages their patient from seeking conventional medical care, that patient loses out on the treatments we have to offer. I think that the patient Jafar told us about at the beginning of the episode is a particularly heartbreaking example of what can happen when patients turn to CAM and refuse conventional care. Another indirect risk is the impact these treatments can have on a patient’s finances. In 2012, a survey estimated that 59 million Americans used CAM, paying over 30 billion dollars out-of-pocket in a year. Nearly 13 billion was spent on supplements, and almost 15 billion was spent on visits to complementary practitioners, including homeopaths, massage therapists, chiropractors, and chelation therapists.

C. Looking at CAM within the “big picture” (anecdote: Lymphatic massage for high burden disease)

Margot: At the end of the day, it’s worth weighing the risks and benefits in the context of the overall clinical picture. Dr. Master shares an example about a patient with advanced breast cancer:

Aashini: Had a surgeon call me today to ask me, um, if lymphedema massage was a concern in a patient who had had, um, over 40 lymph nodes that were positive, um, when she went for her mastectomy. And if there was a risk of potentially, you know, seeding the tumor and resulting in metastatic disease. And, you know, I explained to her in truth, we know that lymphatic massage is beneficial for women who have lymphedema, unfortunately, you know, in a patient with that sort of prognosis, if we really were to step back and look at the big picture, unfortunately, women that, if that we know has micro metastatic disease and is likely to have macro metastatic disease at some point in time. So if we can really, you know, provide her with some relief and some improvement in her quality of life, I think that the risk or potential harm with doing lymphatic massage is, you know, is negligible when we compare it to the potential benefit. When we’re talking about any complementary therapy, I really look at, you know, I try to look at the big picture. I try to look at okay, if, you know, are we dealing with in the metastatic setting where, you know, we need to really have a frank conversation with a patient about what are their priorities? Is it quantity or quality or both. And then what is the safety of these, of the complimentary intervention that we’re doing? And if we’re in the curative setting, maybe even more so, right. Um, we don’t want to do anything that may interfere with our potential for cure, but once we have completed all the standard therapies is really when I feel more comfortable when them pers with them pursuing.

Margot: This is a complicated case, one that is just as much about goals of care as it is about CAM. We wanted to include this to give you insight into how an oncologist might think about a certain patient’s options, not to make you feel like you have to make a decision like this alone. If you find yourself in a similar scenario, talk with the other physicians involved in the patient’s care, which will help shed light on the patient’s prognosis and therapeutic options.

D. Being ok with not pleasing everyone

Margot: Like Tamar and Jafar spoke about earlier, if you put some time in upfront to understand why your patient has turned to CAM, it’ll help build a therapeutic alliance, and make it easier to negotiate with your patient if they’re engaging in a practice you think is unsafe. But we do want to acknowledge that conversation and empathy won’t work for every patient every time. 

Aashini: It can be very frustrating. Um, and I think early on, earlier on in my career, I think I’m still early in my career, but earlier on in my career, I wanted to appease everyone. And then I realized that that’s not necessarily in their best interest, but I found myself trying to compromise with them a lot. Six years into practicing, now I recognize, you are coming to me for my expertise, for my knowledge, and I’m going to give that to you. And if you do not like that, um, certainly there will be a degree of discussion about, what your concerns are and if there are, are alternative options and if not, I think, you know, then I might not be the right oncologist for them or the right person for them. And we cannot expect that every patient who walks into our door is going to be someone who we have a good connection with. We’re all human, right. And I have to somehow sometimes go home and remind myself of that to not take it personally. While I strongly believe patients have to advocate for themselves, um, they also have, you know, they have to work with you. 

VII. CONCLUSION

Jafar: Ok, so it’s worth saying again: Complementary and Alternative Medicine is a huge field, and it might be that there are as many different CAM communities and practices as there are people seeking them, each with their own motivations, philosophies, related risks, and clinical situations. And while the evidence base for many of these practices may be unfamiliar or still in development, at the end of the day we can’t simply ignore what our patients value:

Aashini: I think more and more, and as time goes on, we are going to see more patients utilizing CAM practices. And I think it is important for all clinicians to have some awareness and knowledge about at least the more commonly used ones so that we can appropriately guide our patients. Um, so they’re doing it safely and, um, and truthfully not getting taken advantage of. So while it might not be something that’s high on our priority list, because we do have, you know, we have so many journals to, to read and so many things to get through, but, um, I think it is something that our patients are prioritizing more. So it is incumbent upon us to prioritize it more as well.

Jafar: So to review what we covered today, we learned that CAM practices are widely prevalent, with estimates that 40% of patients subscribing to some form of it, and that this is higher in some of the most vulnerable groups, including patients with cancer, chronic illnesses, and poor prognoses. Patients can gravitate to CAM for empowerment and hope, and also for cultural and philosophical reasons that show us the weaknesses in a reductionistic, subspecialized, and time-pressured healthcare system. We learned how humility, curiosity, and investing a little bit of time up front can pay dividends in creating the trust needed so that they can listen to us when practices run astray. CAM practices are not all benign, particularly supplements and botanicals, and learning with patients about them not only helps us counsel about risks, but perhaps teaches us something important about our own practice. 

Edzard: Final point I would make is be, be self critical. If, if your patient goes off and sees an alternative practitioner, ask yourself, why is he doing that? Is it perhaps because he’s not getting what he, he’s not getting, what he is wanting to get from you?  Should you not be more compassionate? Should you not also have better explanations? We just need to remember that we are doctors and we should be compassionate foremost, and then scientists second.

Jafar: Thanks for tuning in!  We know these topics can stir up more questions than answers, and we look forward to hearing more about your experiences and thoughts about Complimentary and Alternative Medicine. Please continue the conversation with us online at our facebook page, on twitter, or email us directly. Find show notes and contact information for us on our website:  www.coreimpodcast.com/contact/

If you enjoyed listening to our show, and are looking to compliment the experience, please give us a review on itunes or whichever podcast app you use; it helps other people find us. We work really hard on these podcasts so we’d love to hear from you. Let us know what we are doing right and how we can improve. And as always opinions expressed in this podcast are our own and do not represent the opinions of any affiliated institutions. 

Finally, special thanks to all our collaborators on this episode, our wonderful audio editor Julia Skubisz, our illustrator Michael Shen, endless technical support from Harit Shah, moral and executive support from Shreya Triveda, and most importantly thanks to you, our listeners!

References

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