Complementary Medicine

The title was chosen rather than alternative medicine although the NIH has a section of complementary and alternative medicine (CAM).Alternative medicine can be defined as that which is not usually practiced by traditional physicians or taught in Western medical schools.Complementary medicine can be defined as therapies that supplement conventional treatments so that they are utilized in addition to, rather than instead of, conventional treatment.CAM has become sufficiently widely used that is important that clinicians are aware of the benefits and risks.It is clear that we do not  understand whether many treatments are useful, do not have any benefit, or are harmful.Integrative medicine implies that CAM and allopathic (Western) medicine are combined to provide optimal health.

                CAM is used or tried by one-third to one-half of the population including many children.The use of conventional (Western) medicine for chronic illness has not been as useful as it has been for acute medicine and surgery.Alternative medicines are often used by cancer patients; in fact, it is estimated that $ 10 billion is spent on unproven cancer therapies every year.Heart disease, diabetes, asthma, and cancer have been helped by conventional medicine but there are many areas where complementary medicine can be useful, although much of the information regarding efficacy and safety has been from adult studies and there are relatively few studies of children.

                It is clear that alternative medicine therapies are being used by many families with a view to improving the medical condition and/or the quality of life.There are various reasons for this; some are sensible and many are not.It is likely that there are alternative therapies that will improve how the patient feels but whether they alter the course of the illness is often difficult to establish.

                The reason people turn to alternative medicines include:

·         Frustration with conventional medicine.

·         Awareness of the usefulness of nutritional, emotional, and lifestyle strategies.

·         Desire to avoid side effects of conventional medications.

Complementary or alternative therapies are chosen for ailments ranging from stress to life-threatening illness.It is an axiom that unless one can scientifically prove that a therapy is beneficial it should not be used as a treatment.By this criterion acupuncture should not be used to treat  asthma, and indeed many practitioners do not believe that it should.Despite the fact that there are few studies that confirm that acupuncture benefits asthma, both the World Health Organization and the National Institutes of Health consider acupuncture to be a complementary therapy for asthma.

                Children with chronic illness may well receive alternative treatment, particularly when there is a perception that conventional medical treatment is not going to alter the course of the illness.Specific recommendations are difficult to make because of the diversity of childhood illness.It is considered that the clinician should keep an open mind because some therapies are beneficial in ways that we do not understand.It is important that the communication between family and caregiver be good.If it is perceived that the practitioner is firmly againts alternative medicine and the family wishes to try something, it is likely that they will not inform the practitioner because of the anticipated response.This is obviously hazardous if there is a potential conflict between the various therapies that the child is receiving.It makes sense that there is good communication that will allow the therapies to complement one another.As previously noted, we do not understand how or whether many therapies work, and we also do not have data in many cases of the relationship between standard and complementary treatments.This means that the clinician has to weight the benefits against the potential harm.

                Although many physician are unaaccepting of alternative medicine because of the lack of scientific data to support its use, there are many who embrace alternative medicine and recommend therapy for their patients.

                Conventional medicine tries to be evidence-based which implies that there are vaid scientific studies that document the efficacy of the treatments.Complementary medicine works on the principle that if it seems to help it has the potential to be useful.This is exemplified by acupuncture, a pratice which has been around for thousands of years and seems to work.The qualifications of alternative medicine doctors are difficult to understand and the credentials vary from an advanced oriental medicine doctoral program to a certificate given following a Caribbean cruise.

                The approach to CAM is holistic, which views health as the whole person and includes body, mind, and spirit.Many of the approaches to CAM utilize the natural ability of the body to heal itself.The most commonly used CAM treatments are vitamins and health foods, herbal therapy, chiropratic, relaxation techiques, massage, and acupuncture.

                One of the advantages of CAM has been suggested to be prevention.In reality, conventional medicine has played an important role in prevention although it has not always been embraced by the agencies who pay the bills for medical care.Considerations for prevention for conventional medicine include immunizations, screening test, and physicals.Exercise and change in health habits, with smoking cessation and cholesterol reduction as examples, are commonly recommended.

                One of the major problems with CAM is the lack of controls and safety of alternative medicine.It would be wrong to say that, by definition, alternative or natural medicines are safe.Many natural substances and herbal remedies interact with prescription medicines and the actual effect in an individual patient may be difficult tp predict.As more natural treatments are used it is likely that some of these interactions will be identified.Examples that are important include herbal medications taken at the same time as anesthetic agents, which can be a dangerous combination.

                Medicine manufactured in certain countries may be contaminated and the dosage is not always accurate.Also the claims of the effects of CAM treatments are not always truthful.

                It is sensible to discuss with the treating (conventional) physician CAM treatment that are considered before they are tried.If they are tried without prior consultation and symptoms develop it is important to “own up” to what is being taken because keeping quiet may be detrimental.It is important to be able to identify herbal treatments and secret ingredients should be considered to be hazardous.Injections of alternative treatments are unusual and may be unsafe.

                It is important to separate the placebo effect from a treatment effect.The placebo or sugar pill effect is improvement that results from the power of suggestion.This effect is very powerful and in an individual patient may result in effect that are mistakenly attributed to the actions of the drug.This is more likely in children than adults.