Why i would recommend complementary or alternative therapies : A physician's perspective

No reasonable person would recommend or partake of useless or harmful complementary or alternative therapies, yet an increasing number of Americans, including physicians and other educated people, are using complementary or alternative modalities. 2,3 Why? Perhaps some of the approaches are not useless. Perhaps an even larger number have not been proven useless and are being given the benefit of the doubt concerning the potential risk–benefit ratio. Perhaps there is confusion about what is and what is not a complementary or alternative therapy. Perhaps we are seeing a public response to some unanticipated and adverse consequences of the success of science and technology. Perhaps there is fear of the potentially harmful power of modern biomedical science. Perhaps certain alternative or complementary therapies are well aligned with deep human needs and values. Perhaps good marketing and the massive media attention directed to alternative therapies have had an impact. Most likely, each of these factors is partially responsible for the increasing use of complementary or alternative therapies. Americans with disease tend to use these therapies as a complement rather than an alternative to conventional therapy. 4 I am not a rheumatologist and claim no special experience or expertise in the treatment of people with arthritis. The purpose of this brief commentary is to share with you how I have come to look at, and evaluate, various complementary or alternative practices as the basis upon which to develop specific recommendations. In a way, I mean to share with you the way I read and assess the specific "therapies" articles in this issue. I believe that spirit, mind, and body are each involved and intimately interactive in our health, healing, and recovery. At times, aspects of spirit, mind, or body may be more important or urgent than the others, but all are always relevant and worthy of attention. Wise physicians understand their patients and themselves well enough to recommend a set of options appropriate to the global and specific needs of the patient and the patient-physician relationship at that time. The classification of a particular health care practice or procedure as complementary or alternative on one hand, or as conventional on the other, is somewhat arbitrary and varies with time, place, and person. Several practices, including hypnosis, biofeedback, vitamin and mineral supplements, guided imagery, diet and nutrition, laughter therapy, art therapy, and therapeutic touch, have been linked to conventional providers for many years. Others are not. Whatever label we apply to a therapy, we should not let that label evoke a knee-jerk judgment, pro or con, of the modality in question. This criticism goes both ways; it is as foolish for an alternative medical practitioner to label all drugs and operations as poisons and butchery, respectively, as it is for a physician or scientist to conclude that all complementary or alternative therapies are snake oil or quackery. My basic approach to looking at complementary or alternative therapies begins with two sets of questions: 1Does the therapy represent an entire system of diagnosis and treatment (e.g., traditional Chinese medicine or Ayurvedic medicine) that differs significantly from that of conventional American medicine? Are the principles on which this system is based indeed incompatible with those of conventional medicine? Or are we dealing with a particular procedure or remedy (e.g., acupuncture, magnets, or ginger) that could be integrated easily with conventional therapy (whatever be the mechanism of action) if data on efficacy and safety exist? 2Is the procedure or modality based on a strong provider-client (or patient) relationship (e.g., massage therapy) or not (e.g., self-directed consumption of chondroitin sulfate)? The answers to both sets of questions have an appreciable impact on the way I approach the evidence and my recommendation.