Doctors call for greater understanding of alternative medicine

Drs. Jeremy Sugarman and Larry Burk addressed the role of conventional doctors in unconventional healing in Wednesday's issue of the Journal of the American Medical Association.

Their perspective is part of JAMA's Nov. 11 edition highlighting research on alternative medicine.

Burk, associate clinical professor of radiology, and Sugarman, associate professor of general medicine, argue that medicine's ethical principles of justice, beneficence, nonmaleficence and respect for persons should be expanded to emphasize each physicians' duty to assist patients who are considering alternative therapies.

"We're trying to show how those ethical obligations manifest themselves when you are trying to consider alternative medicine," Sugarman said.

The principles by which physicians stand do not change, he continued, but "how they manifest themselves might."

Joseph Talley, associate clinical professor in the department of psychiatry and behavioral sciences and staff psychologist at Counseling And Psychological Services, said that patients' interest in alternative therapies has increased during the past 10 years.

When approaching clients interested in alternative therapies, "I'd like to be sure that the person has thought about their options," he said.

Dr. Harmony Gades, a first-year resident in pediatrics, said that alternative medications are becoming increasingly mainstream.

"They're also not medications that patients view as medications," she said.

It is every physician's responsibility to be educated about alternative treatments and to be able to give their patients professional advice, Sugarman said. Specialists in alternative and conventional medicine have the same goal-the patient's well-being-and both should be aware of the options contained within the other's expertise.

The article also said that physicians would be remiss to allow dangerous bacterial infections to be treated simply by such alternative remedies as herbal tea.

Dr. Edward Halperin, professor of radiation oncology, places little stock in alternative treatments. "In my opinion," he said, "physicians have an ethical obligation to provide patients with safe and effective treatments, demonstrated, to the extent possible, as useful via the scientific method. We have no obligation to promote or condone quackery."

But Sugarman said in some situations alternative therapies have been shown to be safe and effective. "Doctors need to help their patients make good decisions so they can at least meet their health-related goals," Sugarman said.

Talley added that when a patient expresses interest in alternative therapies, he will often refer them to a competent specialist.

Halperin remains steadfast in his rejection of nontraditional therapies. "Alternative medicine is distinguished by its denial or ignorance of fundamental physiology and biologic mechanisms of action and its lack of standardization," he said.

Money spent on alternative medicine research, he continued, "has diverted money that could be spent on the scientific investigation of the causes, prevention and treatment of disease into studies of bee pollen, non-existent force fields and homeopathy."

Burk maintained that alternative therapies are gaining greater mainstream acceptance, and with that comes the need for physician knowledge and scientific data. Thus, he argued, scientists need more data about these techniques.

Physician-patient communication is especially important in cases in which nontraditional therapy plays a role. Gades and other researchers reported in Wednesday's JAMA a case study about an elderly man who experienced heart failure following a surgical procedure at the Medical Center.

Gades, who was a medical student in her psychiatry rotation at the time, said that the patient's experiences were attributed to his withdrawal from volarian root, an herbal medicine he was taking about which he had never informed his doctors.


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