Today's News

Thursday, March 1, 2001

Orthopaedists need to keep in touch with CAM

By Camille Mojica Rey

The widespread use of complementary and alternative medicine (CAM) is leading to exciting new research, weeding out promising therapies from useless and harmful ones. Orthopaedic patients are using therapies ranging from yoga for the treatment of mild cases of scoliosis to glucosamine for the reduction of inflammation of the joints. The increasing presence of these therapies into the mainstream, however, means the job of the physician has become much more complicated.

Physicians must be able to give their patients informed opinion of the therapies they use or are considering using, said Harris Gellman, MD, a professor of orthopaedics and rehabilitation at the University of Miami. "We need to present ourselves to patients in an unbiased fashion," Dr. Gellman said.

Despite the added complexity, Dr. Gellman said physicians must not only be willing to discuss CAMs with their patients they should be open to the possibility that some CAMs may work when all other treatments have failed. More likely, he added, many CAMs have been show to work well in conjunction with allopathic treatments.

Dr. Gellman chaired Wednesday's panel discussion on the use and study of CAMs. The panelists agreed that while physicians should include discussions of CAMs in their practices, the scientific uncertainty surrounding them needs to be clearly communicated to their patients. Additionally, a complete history of a patient should always include questions on whether the patient is taking supplements or receiving care from a non-allopathic practitioner. Having this knowledge is the only way health care providers can avoid potentially adverse reactions in their patients.

Having these discussions means more homework and more time spent discussing treatment alternatives with their patients. Physicians have the added responsibilities of protecting patients from harmful interventions, as well as from "charlatans," said panelist David L. Skaggs, MD, of Children's Hospital Los Angeles. "It's also the doctor's job to protect patients from what's not working," explained Dr. Skaggs who is also a professor of orthopaedic surgery, University of Southern California's School of Medicine. Doctors must also see that patients do not delay necessary treatments in the name of experimenting with unproven therapies, Dr. Skaggs added.

The panel supported the notion that scientific investigations into the efficacy of individual CAMs must continue. "Anecdotes are important, but they are not what we need or what our patients need," said Charles Kennedy, MD, professor of orthopaedic surgery at the University of Texas, San Antonio.

Dr. Kennedy uses magnets personally and in his practice to relieve pain. But, he said, "somebody needs to look at this and understand how it is working." This kind of knowledge about CAMs will allow physicians to scientifically weigh the efficacy of a therapy against its risks.

Researchers must begin by putting CAMs through the same tests required for allopathic treatments. "Medicine in this country is thought to be the best in the world. We got to this point by using the scientific method," Dr. Skaggs argued. But, scientists have had difficulty studying CAMs in this way, Dr. Gellman suggested. Allopathic medicine, he said, is based on a materials approach while many CAMs, such as accupuncture, are energy-based. The problem arises when investigators look for something to measure other than outcomes, Dr. Gellman explained. "We have to find some way of bridging the gap between the two types of medicines," he said.

Until research-based recommendations can be made, physicians will have to learn to be comfortable with a certain amount of uncertainty when it comes to CAMs, said William Arnold, MD, of the Illinois Bone and Joint Institute in Des Plaines, Ill. "Just because we don't know how something works, doesn't mean it doesn't work," Dr. Arnold said. CAMs are a great way to give patients some control and more options for ways of being active participants in their own care, he said. "We have to be comfortable with not knowing."

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