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More managed care organizations each year add complementary and alternative therapies to their covered benefits. However, many case managers and providers still are unclear how to integrate these often unproven therapies with more conventional treatment for chronic illness.
The Council on Scientific Affairs of the American Medical Association in Chicago released the following recommendations regarding the use of herbal supplements and other alternative and complementary therapies in 1997:
• Routinely question patients about the use of alternative or unconventional therapies.
• Educate yourself and your patients about the state of scientific knowledge with regard to alternative therapies that may be used or contemplated.
• Courses offered by medical schools on alternative medicine should present the scientific view of unconventional theories, treatments, and practice, as well as therapeutic utility, safety, and efficacy of these modalities.
• Patients who choose alternative therapies should be educated about the hazards that might result from postponing or stopping conventional medical treatment.
Albert Barrocas, MD, FACS, medical director of nutrition support and home health services at Pendleton Memorial Methodist Hospital in New Orleans agrees that case managers always should question patients about their use of herbal supplements as well as other alternative and complementary therapies. He suggests case managers take the following approach to those therapies:
• Keep an open mind.
• Encourage acceptable controlled studies of the therapies.
• Do not ignore or ridicule the potential placebo effect of these therapies.
• Do not accept all new therapies as efficacious.
• Avoid arrogant attitudes toward alternative and complementary therapies and providers.
"Growing up in Cuba, there were many times when home remedies were used instead of or in combination with medications prescribed by doctors," says Barrocas. "I had one young woman with breast cancer. After a radical mastectomy and several months of chemotherapy, distant metastasis became evident and additional chemotherapy offered little hope. She asked me about alternative therapies available. I didn’t have any knowledge about these therapies."
Barrocas offered his patient this advice:
• Find out as much as you can about the therapy.
• Get assurances that the complementary therapy provider will give the medical team timely reports and stop the therapy if no benefits are detected by the patient or the provider.
• Continue your chemotherapy and other conventional therapies until the medical team indicates there is no further benefit or when the ratio of risk to benefit becomes prohibitive.
• Pray and do not give up hope.
"During the next year, the patient and her parents became very close to our practice," notes Barrocas. "Neither traditional therapy nor complementary therapies were successful. When she died, we were all saddened but also satisfied that she had been in control of her decisions all along."
(For more details, see the report of the Council on Scientific Affairs. AMA House of Delegates 1997 Annual Meeting. Council on Scientific Affairs Report. 1997; 12-A:1-20. See also: Barrocas A. Complementary and alternative medicine: Friend, foe, or OWA? J American Dietetic Association 1997; 97:1,371-1,376.)