A few things I've learned about CAM

Patients take their copper bracelets and other nostrums very seriously. This doctor realized he'd better, too.

By Louis H. McCormick, MD
Family Physician/Franklin, LA

Doctor!" Mrs. Boucher was gesturing with both hands, "I need my bracelets back before my arthritis flares up and I lose strength."

To prove her point, Agnes Boucher, a 93-year-old patient in the ICU, squeezed my arm. She was amazingly strong for a lady her age. Mrs. Boucher wasn't the only patient in my practice who wore copper bracelets, but she was the oldest. I didn't encourage their use because I never saw any scientific evidence supporting them as an effective treatment for arthritis. But they couldn't hurt a patient, and green skin is easy to clean.

Engaging in a debate with someone like Mrs. Boucher who had accumulated over nine decades of life experience would be counterproductive. So I motioned to the nurse to retrieve her bracelets.

"Thank you, Doctor," Mrs. Boucher remarked as she slipped them on. It was the first time she had smiled since admission.

Lesson: The placebo effect is alive and well even without a doctor's explicit endorsement.

Recent clinical encounters like these have shown me the necessity of learning more about complementary and alternative medicine. If patients are using it—or should be using it—I need to know more about it. Here are some things I've learned.

Approved doesn't mean available

Recently, I read that the Food and Drug Administration approved the claim that 25 grams of soy protein taken daily could reduce heart disease by lowering cholesterol. This scientific proof sounded great. But where are my patients going to get 25 grams of soy protein? After all, tofu isn't sold in Franklin, LA. I did find some soy milk in the store, but only one word describes its taste—nasty. Patients would have to swallow more than 20 ounces a day of something that tasted like it should have been thrown away last week.

I asked a pharmacist friend for help.

"I don't have any soy protein," I could hear Joe moving bottles around, "but barley malt works better."

"I've never heard of that product, Joe. Do you have some in stock?"

"No, you'll have to hop over to the grocery store cooler. Or, you can buy it hot. It comes in plenty of name brands, but no generics."

Thanks a lot, Joe.

Lesson: Scientific proof supporting the effectiveness of an alternative treatment doesn't guarantee that it can be implemented.

Learning about herbs isn't easy

"When can I start my soap opera pills again?" The speaker was Mrs. Mary Elhardy, who was in the office for a pre-op exam prior to oral surgery. "I don't want to confuse Harry with Sidney even though they are both Olivia's half-brothers." Mrs. Elhardy paused to take a breath, "and I can't forget to tape the shows."

I didn't know about the soap opera plot, but I did know what pill Mrs. Elhardy was referring to. Her bottle of Ginkgo biloba was on the exam table.

"And the quarterly report is due this month," Mrs. Elhardy added. She's the chief financial officer at a local bank.

Mrs. Elhardy took Ginkgo biloba because she felt it gave her increased mental alertness to deal with the twists and turns of daytime soaps and financial spreadsheets. The question was whether Mrs. Elhardy's Ginkgo biloba should be discontinued prior to her oral surgery.

The product insert wasn't any help, and there were over 20,000 Web sites on Ginkgo biloba. The surgeons in town didn't worry about Ginkgo biloba, and the nurse anesthetist was only concerned with ma huang, an herb that sounded like somebody's parent, but was loaded with ephedra.

My unlikely source of information turned out to be a pediatrician who gave me a thick handout he had copied from one of his journals. The literature noted that Ginkgo biloba could hinder blood clotting at high doses, so I needed to find out how much my patient was taking.

"Mrs. Elhardy, how long does a bottle of your medicine last?" The bottle held 100 tablets, and at the recommended three times a day dose, it should last her over a month.

"I buy two to three bottles a month," Mrs. Elhardy answered confidently.

A high dose, all right. I told Mrs. Elhardy how long she'd have to be off Ginkgo biloba.

"That's perfect!" Mrs. Elhardy began. "Now I can schedule my oral surgery and start retaking my medicine before Winnifred, who is secretly in love with the groundkeeper's uncle, is supposed to marry the president's son." The meaning of elective surgery wasn't a mystery to Mrs. Elhardy.

Lesson: To prevent potential harm, a doctor needs to be able to access a comprehensive resource on common herbs.

There's a plethora of information on complementary and alternative medicine that I want to learn—and need to learn. Recently, I've noticed on television that most physicians who are experts in complementary and alternative medicine have beards. This makes me feel good. I have a beard. Maybe this means my learning curve is about to take off.

 

Louis McCormick. A few things I've learned about CAM. Medical Economics Oct. 10, 2003;80:89.