Friday, 4 July 2014

Complementary therapies – should you tell your doctor?

Billions are spent annually on complementary and alternative medicines (CAM) -  vitamins, herbal remedies, homeopathy etc.  These may be prescribed by a so-called health practitioner (I use this term advisedly as there is no equivalent of the medical register so there is no regulation) or self-medicated. Most of them are harmless (and probably useless) but some can be harmful, especially when combined with other medication.

I attended a presentation at the American Society of Clinical Oncology (ASCO) meeting in the USA a few years back where scientists from Sloane Kettering and the Mayo Clinic presented research on CAM: hard-headed scientific research some of which proved efficacy but most didn’t. They gave a statistic that 70% of patients being treated for cancer were taking some form of CAM – this could be as simple as vitamin C or as complicated as Black Cohosh – the latter could have interactions with common treatments for breast cancer. What was worrying was that the majority of patients did not tell their doctor because they were afraid of being disparaged or being told to stop. The former is real but the latter is irrational – if there is evidence (and I repeat evidence) that this will negatively impact a proven treatment, why wouldn’t you stop?

I was reminded of this by a recent blog by Professor Edzard Ernst. He is never afraid of controversy and has had run-ins with various branches of the CAM industry and people in high places..... read the link above. However, he is always worth reading – his research focuses “on the critical evaluation of all aspects of alternative medicine. Unlike most of my colleagues, I do not aim to promote this or that therapy, my goal is to provide objective evidence and reliable information.”

The article is What consumers should know about potentially dangerous interactions with St Johns Wort .  This is also covered in the Sloane Kettering database. Just because it is “natural” doesn’t mean it can’t harm you. Many of our current drugs originate from plants – digitalis (from foxglove) may be a useful drug but wrongly used it will kill you. *

The problem with researching CAM is that you can’t always account for the placebo effect and some trials use CAM without a control group. Just doing something, no matter what, might impact how you feel and we still don’t know enough about how what goes on in our brain affects the working of our body. 

I can be as irrational as the next person though (surely not?) – if I feel the symptoms of a cold, sore throat etc I immediately start taking Vitamin C, even though there is no evidence to show it is effective. It tastes OK and will be excreted if surplus to requirements and I haven’t had a cold in years – probably more due to the fact that I don’t travel on the Underground in the rush hour on a daily basis any more.....

* you should probably also know that humans should not eat the liver of the polar bear – the concentration of vitamin A is so high that it is dangerous.  The Inuit know that......

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