Josephine P. Briggs, M.D.
Complementary and Integrative Health Practices in the Real World
I recently came across an interesting article by Robert P. Cowan, MD in the June 2014 issue of Headache titled “CAM in the Real World: You May Practice Evidence-Based Medicine, but Your Patients Don’t.” Dr. Cowan raises some important challenges that clinicians are facing as their patients seek out complementary or alternative therapies. We know from our research that patients, in large numbers, are using complementary health approaches based on anecdotal or historical rather than scientific evidence. And while clinicians cannot possibly be expected to know about every non-conventional modality available, Dr. Cowan argues that clinicians need to be knowledgeable enough about different therapies to help patients identify helpful treatments and avoid potentially dangerous practices. He argues physicians should not compromise critical thinking, but should be as non-judgmental as possible. These ideas are in line with NCCAM’s efforts to provide useful resources for health professionals and to help improve communication between patients and their providers.
Over the past few weeks, the Center has been conducting an exploratory research initiative among subscribers to the NCCAM Clinical Digest—our monthly e-newsletter for health care professionals providing updates on research in complementary health practice, clinical guidelines, and scientific literature sources—to ascertain how health professionals seek information on complementary health approaches and their preferences for educating themselves on non-conventional therapies. The majority of the health professionals we interviewed stated that when investigating complementary and integrative approaches, they want evidence-based information on the types of approaches used by their patients so they can effectively advise them. Safety, too, is a big concern.
The evidence-base for complementary practices is steadily growing. For example, a recent JAMA review summarizes the sizable body of data pointing to benefits of acupuncture for chronic pain, including headache. But for many practices, particularly many natural products, the evidence is not clear, and commonsense cautions are often appropriate, particularly for patients taking conventional pharmaceutical medicines. We are committed to providing robust information sources on complementary health approaches for health care providers so that they can navigate the complex task of providing guidance to their patients and helping guide them to informed choices.
- Cowan RP. CAM in the real world: You may practice evidence-based medicine, but your patients don’t. Headache. 2014;54(6):1097 1102.
- Vickers AJ, Linde K. Acupuncture for chronic pain. JAMA. 2014;311(9):955 956.