Thursday, November 3, 2011

Complimentary and Alternative Medicine

Complimentary and Alternative Medicine (CAM) means many things to many people, but the truth is  that many people use it to try to help a broad range of ailments without much guidance from their physicians.

Why?  Reasons vary.  Some feel that "natural is better."  Others feel that mainstream medicine is not working.  Many people see CAM as a lifestyle choice.  Some don't have access to (or money for) a doctor visit, and CAM is readily available at many locations.  There are many other reasons that people use CAM.
Is it safe? Is it reliable?  Depends on the CAM.

What is CAM?

CAM includes any form of medical treatment that is not a part of mainstream medicine.  It has gained popularity because it is holistic, and people like the idea of treating the whole person and not simply one condition.  It includes many categories of treatments, including natural products (vitamin supplements, herbal medicines, minerals, and probiotics), homeopathy (diluted substances that would typically cause symptoms used to treat those symptoms), acupuncture and manipulative treatments, Oriental medicine (energy fields), and mind-body medicine.

What are potential problems with CAM?
  • Homeopathic medicines and natural products are not regulated by the FDA.
  • Some therapies have been shown to be contaminated with heavy metals (such as lead)
  • Products have been shown to be inconsistent in the amount of active ingredient from bottle to bottle
  • Studies to show the appropriate dose have not been done in most instances 
  •  Studies to show effectiveness have not been done in many cases
  • Many don't share CAM use with their physicians.  Why?
  • Don't want to admit in case doc disagrees
  • Don't think about it and aren't asked specifically 
  • Don't think it will make a difference
  • Many docs don't know how to advise about CAM.
  • If parents ask about herbs, spinal manipulation, or other CAM treatments, physicians often don't have the answers.  
  • Physicians are taught to advise based on an evidenced based platform.  If studies haven't shown a treatment to benefit, we are less likely to recommend it. For many complementary and alternative medicines studies have not been done to show safety and efficacy.  
  • Studies that have been done typically were done in adults, not children.  Children handle medicines and therapies differently than adults, but research is often not done on them. 
  • CAM information does not often make news in medical journals and is not typically discussed at conferences, the places at which your physicians learn. 



Do I recommend CAM?


While there are many CAM treatments that I am not comfortable recommending, I often recommend things that are CAM.

The first and foremost form of alternative medicine I recommend to everyone is healthy diet and lifestyle.  This is widely accepted among mainstream medical doctors.  Healthy diet and exercise helps prevent many health problems, treat some health problems, and even helps mental focus and overall mental health.  

I believe there is solid research supporting fish oil, probiotics, and other vitamin supplements.  The American Academy of Pediatrics recommends Vitamin D for all children. 

I think that relaxation techniques, biofeedback, yoga, prayer, and meditation can all be beneficial and I cannot see how they would be detrimental if used properly.  

In the category of manipulative medicine, I have not been trained specifically, but I refer to physical therapists and sometimes chiropractors.  Massage therapy is a growing field, and has been recommended for children with muscle tightness affecting gait and for those with sports injuries.

Other CAM therapies are difficult for me to recommend.
Herbal therapies might be beneficial, but there is also potential risk of interactions with other therapies.  They are not regulated by the FDA and have been known to be contaminated with things such as lead. There also have been reports of the strength of the supplement to vary widely from what is listed on the bottle and non-listed ingredients to be in the supplement.  This can lead to unknown interactions and consequences.

Most studies of CAM therapies have been done on adults.  Children are not little adults.  Therapies such as lifestyle changes are safe, but those with herbal or homeopathic medications might not be.  There simply is not enough scientific data to support the use of these in children.



Studies do show that about 50% of children have used complementary or alternative medicine (higher numbers if you include vitamin supplements).  Unfortunately most of the time the physician is unaware of these treatments.  Many of the kids using these therapies are those with chronic conditions for which there is no traditional medical therapy that manages the condition well.  This means that more research is needed to show if they are safe or effective.  Are they worth the cost? Is there something better? Should physicians recommend them because they do work?

Why would parents use a treatment that isn't proven? They just want to help. Many parents think "natural" is better.
My answer to that: I would never give my kids organic marijuana to stimulate their appetite.  It is natural.  Organic even.   And it does stimulate the appetite, so it might work.  But I know there are risks to marijuana.  We've all heard those because it is a well known (and unfortunately misused) substance.  Many herbs and other treatments aren't as well known.


How to improve the safety of CAM use in your children:

  • Discuss any therapy you are using with your health care provider. If you have more than one provider, be sure all know each treatment you are using.
  • If you use a CAM provider, be sure to check the education and training of that person.  Are they licensed to practice?  Be sure they have experience with the age group of your child.  (This actually goes for any health care provider you choose!)
  • Ask your pharmacist if there are any known interactions with the supplements and medications you are giving your child.  Be sure to list all prescription, over the counter, and supplements given.
  • Store all medications, supplements, and vitamins out of reach of children.
  • If you notice any ill effects that might be related to CAM or other treatments, be sure to discuss with your provider!



Resources:

AAP News 2008; 29;1
PEDIATRICS Volume 120:1, July 2007
PEDIATRICS Volume 125:2, February 2010
National Center for Complementary and Alternative Medicine (NCCAM)