COMMENTARY

Is CAM Always a SCAM? Physicians Are Talking

Brandon Cohen

Disclosures

July 19, 2011

"How do you counsel patients interested in complementary or alternative therapies?" asked a neurologist, citing a recent study that failed to show a benefit for cranial osteopathy in children with cerebral palsy.[1] This sparked a discussion on Medscape's Physician Connect, an all-physician discussion group, and evinced some sharp contrasts in physicians' attitudes and practices concerning treatments that fall outside of the scientific mainstream.

Some doctors vigorously opposed alternative approaches. Several referred to alternative practitioners as quacks. One oncologist wrote, "I tell patients that there is a lot of evidence that almost all SCAM therapies (supplements, complementary, and alternative medicines) do not work but are expensive."

A general practitioner from Singapore concurred: "Those patients who practice it are doing it out of blind faith. Trying to talk them out of it is like talking religion to them. It is impossible as it is no longer a matter of rational reasoning, but a matter of faith."

Another oncologist grimly added, "My terminal cancer patients often come up with 'treatments' and frequently state that they know the FDA or insurance or whoever is keeping these 'cures' from the public. Of course these treatments are generally completely mad...I tell all of them to try it, but please come back to my office in a year and let me know that it worked! So far, no one has made it that long."

But some colleagues strongly disagreed with these dismissals of alternative medicine.

"Why the narrow mind?" asked a general practitioner. "We are trying to solve medical puzzles. We ought to want to use every tool available. If you [only] knew the detailed understanding of biochemistry, endocrinology, genetics, and immunology that well-trained naturopaths (for example) possess and utilize...you might be a little shamed."

An enthusiastic pulmonary specialist agreed and wrote, "I welcome the opportunity to collaborate and provide something that will be synergistically beneficial for those in my care."

A number of physicians continued along these lines, with several citing the antiquity of some herbal remedies as a recommendation: "Many great and ancient civilizations have natural treatments for various ailments that are safe and effective. Drugs developed in a Petri dish are not the only answer," offered an oncologist.

An allergist tried to temper this passion for the ancient and organic by writing, "In regards to natural medicines, I usually remind my patients that just because they are natural they are not [necessarily] safe."

Others were undeterred. One general practitioner proclaimed, "Complementary medicine is here to stay, and actually herbal medicine is the grandmother of many of our first drugs, so when a doctor says that herbal medicine is dangerous, he may be just showing his own ignorance."

"I wonder whether what is considered 'alternative' today that may become tomorrow's 'standard of care,'" speculated a pathologist.

Among the doctors who advised against alternative treatment, many reported that their counsel was frequently ignored. One oncologist reported that his warnings to patients about the dangers of nontraditional medicine often had no effect: "Of course, they do it anyway."

Other physicians contemplated the causes of this indomitable lure and put some of the blame at the feet of contemporary medical practices. One doctor wrote, "Physicians have trended so far away from direct patient care that patients seek medical information and remedies elsewhere. Medicine has reached the point where...patients self-diagnose via the Internet and visit nonphysician providers who spend the time with them, to sit, to listen and simply acknowledge their own humanity."

An internist added, "I've found that many people looking for alternative medicine 'cures' are dissatisfied with their current treatment. Medication prices are too high; [there are] unpleasant side effects [and] less than optimal results."

Another topic raised was the undeniable effectiveness of the placebo. "Placebo is so effective that most every clinical study has to have a placebo group to compare with the study group. What we fail to consider is that if a patient responds to placebo by reducing both symptoms and signs, it must be because a self-healing mechanism exists. Do we ask, if the patient has an internal self-healing mechanism, how does it work? Or, if the patient has an internal self-healing mechanism, why isn't the patient using it unaided? No we don't, and this represents gross negligence," wrote an anesthesiologist.

"Placebo effect could be a way to diagnose a certain disease -- ok! But it is a dangerous avenue when this drug becomes the treatment instead of the real one," countered a neurosurgeon.

And an anesthesiologist pointed out, "If the practitioner knows the treatment is placebo yet pretends it's real -- that's fraud."

An accompanying poll showed that 31% of respondents supported their patients' use of alternate paths of treatment. Only 18% discouraged it as a general rule, and a full 38% advocated "telling [patients] there is little evidence one way or the other and leaving it open."

It is likely that this will remain an open question among physicians, as few involved in the debate seemed liable to persuasion by counterarguments; and as long as there are willing patients, alternative medicine itself is not going to disappear.

The full discussion of this topic is available at: http://boards.medscape.com/forums/.2a0a4aac. Note, this is open to physicians only.

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