New Eisenberg Article Advises MDs How to Approach Alternatives
From Natural Healthline by Peter Barry Chowka |
The article, titled "Advising Patients Who Seek Alternative Medical Therapies," is written by David Eisenberg, MD, director of the Center for Alternative Medicine Research at Beth Israel Deaconess Medical Center in Boston, a major teaching affiliate of Harvard Medical School, and is published in the July 1 issue of the Annals of Internal Medicine. Eisenberg is also the author of a groundbreaking study published in 1993 in the New England Journal of Medicine (N Engl J Med. 1993;328:246-52) which established the surprisingly high degree of utilization of and money spent on complementary alternative medicine by Americans. According to a Beth Israel news release dated June 30, Eisenberg's new article "offers physicians a step-by-step plan to direct and safeguard patients" and "promotes informed and shared decision-making about alternative therapies at a time when hard data to support the safety and efficacy of these interventions are scarce."
Speaking about his article on CNN on June 30 and July 1, Eisenberg urged medical doctors to abandon the "don't ask, don't tell" attitude that he said currently characterizes communication between doctors and patients about alternative medical therapies. "Physicians whose patients want to use alternative therapies should talk with them about their preferences and expectations, have them record their symptoms in a diary, and schedule follow-up visits to make certain there are no harmful side effects from the therapies they decide to use," according to Eisenberg.
In Eisenberg's view, as the Beth Israel Deaconness release notes, "a detailed discussion about a referral to an [alternative] provider should not begin until the patient has undergone a comprehensive conventional medical evaluation and has been advised of conventional interventions. In the ideal (and most common) scenario, the patient has tried or exhausted conventional approaches for his or her condition and rightfully asks, 'So, doctor, what else can I try?'"
Eisenberg's article seems to be largely motivated by his belief, according to the release, that "Americans are using alternative therapies known to be dangerous." The article cites recently documented examples that include the Chinese herbal medicine "ma huang" (herbal ephedrine), "which has been responsible for several deaths." "Patients need to be advised that 'natural' does not necessarily mean safe. Snake venom is natural. It is also deadly," says Eisenberg.
"In the wake of this trend [toward the growing popularity of alternative medicine]," the release suggests, "it is essential that doctors, whose training involves a healthy dose of skepticism about alternative medicine, become actively involved in protecting the health of their patients, while advising them in a responsible and unbiased fashion, according to Eisenberg."
Three of Eisenberg's most important recommendations are: "medical doctors should help patients identify suitable licensed providers, patients should be given an initial list of questions, and follow-up visits should be scheduled to monitor patients' treatment plans and response to treatment." If a disagreement about the alternative therapy between patient and medical doctor arises, Eisenberg says, "the patient's wishes should not override a physicians professional judgment and advice."
An early response to the article came from Kathi Head, ND, a naturopathic physician on the staff of Thorne Research, Inc. in Sandpoint, ID and the director of educational affairs for the American Association of Naturopathic Physicians (AANP). Head noted that the Eisenberg article defined "alternative medical therapies" as "neither taught widely in U.S. medical schools nor generally available in U.S. hospitals." "If this is the case," Head noted, "how are orthodox-trained MDs equipped to evaluate alternative treatment plans or to recommend the most effective alternative course for a patient to take?"
Sheila Quinn, Executive Director of the AANP, commented:
"Wherever acupuncturists, chiropractors, naturopathic physicians, and massage therapists are licensed, guidelines for referrals, standards for initial evaluations and follow-up, and requirements to protect the safety of the patient already exist and are well utilized. Dr. Eisenberg would do better to support the expansion of licensure in the interest of public safety, rather than to expect that MDs -- with no training or clinical experience of, for example, chiropractic or naturopathic medicine -- should guide a patient in selection or evaluation of an 'appropriate' provider."Patricia Fahey commented from a patient-advocate point of view :
"While it's nice that Medicine, Inc. and corporate America are finally waking up to the value of alternative medicine, it's a bit late in the game for these institutions to play gatekeeper. For many years health consumers have been forced to research and experiment with alternative options on their own -- behind the backs of their physicians. Today's health consumers, therefore, often are more knowledgeable about alternative medical modalities and practitioners than either providers or payers. Patients themselves, then, should not be overlooked as, ultimately, the most credible sources of information on any particular modality or practitioner."As these initial responses suggest, debate about the article will no doubt continue as it reaches a wider audience in the weeks to come.
For more information,
Advising Patients Who Seek Alternative Medical Therapies" (full text)
David M. Eisenberg, MD, the Center for Alternative Medicine Research, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215.
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