Are You Talking to Your Patients About CAM?
Am Fam Physician. 2009 Aug 1;80(3):228-230.
In June 2008, the National Center for Complementary and Alternative Medicine (NCCAM) launched the “Time to Talk” campaign to encourage physicians to discuss complementary and alternative medicine (CAM) therapies with their patients. Data show that a growing number of patients are using CAM. A survey conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics found that nearly one half of adults used CAM at some point in their lifetime.1 Roughly 36 percent of adults reported using CAM in the preceding year.1 Many respondents had chronic conditions, such as back pain, cancer, depression, and diabetes.
Despite the prevalence of CAM use, few patients choose to talk about it with their physician. A survey coordinated by the NCCAM and the AARP found that although more than two thirds of patients older than 50 years used some form of CAM treatment, fewer than one third of these patients engaged in a discussion about CAM with their physician.2 Patients did not mention CAM use for several reasons, such as their physician never asked them about it; they were unaware of the importance of mentioning CAM use; and there was not enough time to discuss it during the visit.2 Those patients who did discuss CAM with their doctors initiated the conversation.
Given the risk of herbal and supplement interactions with medications3 and polypharmacy in aging patients, it is important that physicians inquire about CAM use. For example, studies have demonstrated that herbal-drug combinations can increase the risk of bleeding, increase blood pressure levels, and decrease medication concentrations, such as in human immunodeficiency virus therapy.3–6 Even CAM therapies that are typically safe can have rare complications, including pneumothorax with aggressive yoga moves; and nausea, syncope, and the potential for hepatitis C infection with acupuncture.7,8
Because of these risks, it is appropriate to discuss CAM use with patients of all ages to ensure safe and effective care. One goal of the NCCAM campaign is to raise awareness of the many CAM resources available to us and to our patients (Table 1). The NCCAM also offers a tool kit on its Web site (http://nccam.nih.gov/timetotalk/forphysicians.htm) to help physicians routinely ask patients about CAM use. To begin the discussion, the NCCAM suggests the following strategies: add a question about CAM use on medical history forms; ask for a complete medication and therapy list from patients, including prescription medications, over-the-counter medications, herbal therapies, and other CAM practices; or have a nurse, ancillary staff, or other medical staff member initiate the conversation.
Table 1 Complementary and Alternative Medicine Resources
Complementary and Alternative Medicine Resources
Resources for physicians
Medline Plus: Herbs and Supplements
National Institutes of Health—Office of Dietary Supplements
National Cancer Institute—Office of Cancer Complementary and Alternative Medicine
NCCAM Online Continuing Education Series Video lectures available for continuing medical education credits
CAM on PubMed Journal citations specific to CAM
Resources for patients
Toll free clearinghouse: 1-888-644-6226
Medline Plus: Complementary and Alternative Medicine
National Institute on Aging—Age Page on Dietary Supplements
CAM = complementary and alternative medicine, NCCAM = National Center for Complementary and Alternative Medicine.
The point of the NCCAM's campaign is not to make us CAM experts, nor to insist that we make time for lengthy discussions. The purpose is to teach us to be more open with our patients about the safety considerations with CAM, even if we are not familiar with all the risks and benefits of the therapies that are currently available.
1. Barnes PM, Powell-Griner E, McFann K, Nahin RL. Complementary and alternative medicine use among adults: United States, 2002. Adv Data. 2004;(343):1–19.
2. AARP and the National Center for Complementary and Alternative Medicine. Complementary and alternative medicine: what people 50 and older are using and discussing with their physicians. http://assets.aarp.org/rgcenter/health/cam_2007.pdf. Accessed October 20, 2008.
3. Gardiner P, Phillips R, Shaughnessy AF. Herbal and dietary supplement—drug interactions in patients with chronic illnesses [published correction appears in Am Fam Physician. 2008;78(7):808]. Am Fam Physician. 2008;77(1):73–78.
4. Ladenheim D, Horn O, Werneke U, et al. Potential health risks of complementary alternative medicines in HIV patients. HIV Med. 2008;9(8):653–659.
5. Hu Z, Yang X, Ho PC, et al. Herb-drug interactions: a literature review. Drugs. 2005;65(9):1239–1282.
6. Elmer GW, Lafferty WE, Tyree PT, Lind BK. Potential interactions between complementary/alternative products and conventional medicines in a Medicare population. Ann Pharmacother. 2007;41(10):1617–1624.
7. Johnson DB, Tierney MJ, Sadighi PJ. Kapalabhati pranayama: breath of fire or cause of pneumothorax? A case report. Chest. 2004;125(5):1951–1952.
8. Chung A, Bui L, Mills E. Adverse effects of acupuncture. Which are clinically significant? Can Fam Physician. 2003;49:985–989.
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