Q: How thorough do I need to be in determining my client’s use of over the counter medication, supplements and CAM treatment? (Part three)A: Sometimes people do the damnedest things. We are all guilty of not doing what is best for us all the time – bad diets, not getting enough exercise… To often we do things that we know are downright bad for us – smoking, drinking and driving. There are other times when people do things that are detrimental to their health without realizing what they are doing. They can make decisions based on limited or faulty information, wishful thinking or denial. In previous newsletters I have discussed the prevalence of Complementary and Alternative Medicine (CAM), as well as over the counter supplements and herbal treatments. I have also pointed out that people often do not tell their doctors that they are using these treatments. Study results vary between 20% and 70% of patients that fail to disclose CAM use to their doctor. In most cases a supplement or two, a few doses of an herbal remedy, some aromatherapy or meditation won’t hurt. It may even do some good. There are times when things can go wrong, however.
Cancer is a Scary WordSeveral studies in recent years have shown that people diagnosed with cancer commonly use CAM treatments. Somewhere around 50% of cancer patients use supplements, herbals, or other CAM treatments. The reasons for their use varies and include nutritional supplementation, treatment of side effects and alternative treatment of their disease. Understandably, people with cancer will reach for almost anything that offers a chance to help cure the disease, or at least ease the symptoms of chemotherapy, radiation treatments or surgery. Many treatments outside the mainstream of medicine can help these people feel better and cope with the physical and psychological stresses of the diagnosis. Unfortunately, people with new or unusual symptoms, or a new lump may try home remedies or seek Alternative Medicine providers. Some will do so before they see a conventional doctor. Among other reasons, they may do this due to financial constraints, cultural biases or fear of what might be found. The more desperate people are, the more likely they become to reach for treatments that are, at best, unproven and at worst, dangerous. The vast majority of cancer patients use these treatments in addition to conventional medical treatments. A rare minority will eschew conventional medicine altogether and opt for an alternative treatment.
Complementary vs. AlternativeComplementary and Alternative Medicine is a catchall term used to describe a mishmash of thousands of treatments and theories varying from special diets to crystal therapy that are not part of conventional medical practice. By strict definition, Complementary Medicine is the use of any of these methods in addition to, or as a complement to, standard care. Alternative Medicine is therefore the use of these methods instead of, or as an alternative to, standard care. As you might imagine, cancer patients that opt for Alternative Medicine have poor outcomes compared to conventional care. ( Johnson et al. Use of Alternative Medicine for Cancer ant Its Impact on Survival. J Natl Cancer Inst 2018 Jan 1; 110(1) djx145 – online. Originally published Aug 2017.) While the dangers of alternative treatment are obvious, those associated with complementary treatment can be subtle. Supplements, herbal and homeopathic remedies are poorly controlled and largely unregulated. They can contain amounts of ingredients much different than on the label or be contaminated with other substances. Some remedies can be toxic in and of themselves (recent case of cyanide poisoning from apricot kernel extract), others can interfere with conventional treatments (steroids and other pharmaceuticals found in supplements and herbal remedies).
Delayed Diagnosis or TreatmentOne of the more common malpractice complaints brought against non-surgical specialties is a delay in diagnosis or treatment of a disease or condition. Life threatening conditions, like cancer, are obviously involved in the most serious cases. I have used the example of cancer and CAM treatment prevalence to illustrate the need to be aware of possibility that patients are not always acting as we might expect. Cancer is obviously not the only health problem impacted by this behavior. Lack of timely treatment of other conditions can also lead to devastating outcomes, such as vascular disease leading to heart attacks, strokes or amputations. Physicians cannot adequately treat patients without knowing all the factors influencing the patient’s health. This includes patient self-treating or using alternative providers. Patient education and communication between patient and providers is key. Some aspects of medical care today do not foster the kind of trust and connection needed to overcome patient’s biases and fears.
Physicians can treat patients best when they have all the pertinent information. The same goes for attorneys handling medical cases. The medical records of the treating physician may not reflect the whole story. Make sure you have all the facts.