Summary: Issues and Implications of TCM in the United States
The International Conference in Hong Kong is important to US rheumatologists for several reasons:
Patients are using these interventions at an increasingly high rate; it has been estimated that in 1990 the annual number of visit to alternative care providers (425 million) exceeded the number of visits to all US primary care provides (388 million). More than 70% of patients using alternative care medications never mentioned these products to their physicians. Thus, an invisible "mainstream" of alternative care exists in the United States, and little is known by physicians about its safety, efficacy, and mechanism of action.
In the past several years, third-party insurance carriers in the United States have begun to provide reimbursement for "alternative care" when prescribed by their primary care physicians. This trend presents a predicament for US physicians on how to responsibly advise patients who seek alternative therapies that have not been validated as safe or effective, using the techniques familiar to us in the form of double-blind trials.
What is the risk to the patient? These medications may interact with other drugs such as certain herbs that have pro-coagulant activities that could promote the tendency of nonsteroidal anti-inflammatory drugs to cause bleeding ulcers. The risk of unexpected side effects also remains unknown but has recently been highlighted with the side effects of ephedra, which is the active ingredient of the herb ma huang.
What is the risk to the physician? In the United States, the unavoidable question is "Will I be sued if I knowingly co-manage a patient who sees an alternative therapy practitioner and the patient experiences a bad outcome from the interaction of that therapy with my medication?" This is made more difficult when the alternative medicine is "endorsed" by the insurance company.
It is no longer acceptable for the US clinician to simply state that herbal treatments "don't work" or to claim ignorance regarding their use. Healthcare professionals are obligated to advise patients based upon accurate, scientific information, which in many cases is lacking in western medical education. Given that many herbal treatments have the potential for interactions with standard pharmaceuticals and have their own side effect profiles, physicians should not discourage their patients from discussing their use of herbal products; otherwise, this may have deleterious consequences to the patient. and put the physician at risk for malpractice. Both physicians and patients should be advised to obtain answers to their direct questions regarding herbal products. For further information, visitthe United States National Center for Complementary and Alternative Medicine at https://nccam.nih.gov/.
Medscape Rheumatology. 2005;7(2) © 2005 Medscape
Cite this: Highlights of the International Conference and Exhibition of the Modernization of Traditional Chinese Medicine and Health Products - Medscape - Sep 15, 2005.