Complementary and alternative medicine (CAM): a review for the primary care physician

It is difficult to find a satisfactory title for this review, because both the word "complementary" and "alternative"-are not very politically correct currently. It is probable that there is no fully politically correct word, except for "non-allopathic," which is unfamiliar to many MDs. Accurately used, the term "allopathic" is as opposed to "homeopathic," so from its origins, "allopathic medicine" should include herbal medicine. However, in practice, herbal and many other non-homeopathic treatments are called "non-allopathic," whereas conventional medicine is called "allopathic." "Complementary" usually would include practices that are used with conventional western medical treatments, and "alternative" would include those practices that are used instead of western medical treatments. For most of this review, the terms "non-allopathic," "alternative," and "complementary" could be used interchangeably. This topic has gained interest, and received some allopathic legitimacy, in part because of an article that David Eisenberg, M.D., published in the New England Journal.' In 1990, he performed a telephone survey of about 1,500 adults in the U.S. and asked them about the use of treatments and practices that were "alternative," which he defined as not generally being taught in the U.S. medical schools and not being readily available in U.S. hospitals. From his sample, he extrapolated that in 1990, about 60 million Americans used alternative medical treatments, at an estimated cost of $13.7 billion. There were more visits to alternative healers than to primary care MDs that year, and over two-thirds of people who did use alternative medical treatments did not tell their doctors about it. Now that third party figures are becoming interested in paying for alternative medical practices (especially naturopathic, chiropractic, and acupuncture services), allopathic physicians will be increasing in the position of being able to refer people to alternative providers, and insurers will pay for services that MDs approve. Therefore, it will become increasingly important for physicians to have a degree of familiarity with alternative treatments (including efficacy and risks). So far, to date, there have been no cases of malpractice for giving advice about the use of alternative medical treatments, but liability will certainly exist to anyone who delivers treatments, such as acupuncture or spinal manipulation, in the event of an adverse effect. This review will briefly introduce some of the most common alternative practices likely to be seen in Hawaii communities: Homeopathy, Herbs, Naturopathy, Chinese Medicine and Acupuncture, and Chiropractic and spinal manipulation, and a brief discussion of Dr. Eisenberg's recent position paper on advising patients about alternative practices.