Complementary and Alternative Medicine

By David J. Hass, MD, FACG

Complementary and alternative medicine (CAM) is defined broadly as medical practices neither taught widely in medical schools nor generally available in U.S. hospitals. In recent years, the prevalence of CAM therapies has increased at an exponential rate both in national and international medical communities. Estimated annual expenditures for CAM therapies are in excess of $27 billion, a sum that is equivalent to patients’ out-of-pocket expenditures for all U.S. physician-based services. Given the widespread use of these modalities and the continued trend toward their increased utilization, an understanding of CAM therapies, including their potential risks and benefits, is necessary for the practicing gastroenterologist as well as the patient. A thorough knowledge of these practices allows physicians to provide comprehensive medical care and may help further a therapeutic rapport between physicians and their patients.

Digestive disorders rank among the most common disease states for which people seek the advice of complementary practitioners. The attraction of CAM therapies is multifaceted. First, they provide patients who may not have a medical background with a sense of control over their own bodies and health. Second, they provide patients with therapeutic alternatives when conventional medical therapies have failed to alleviate their symptoms or cure diseases. Lastly, complementary therapies are attractive to patients who feel dissatisfied with the ways in which their physicians demonstrate understanding of their illnesses or handle their complaints.

This brief article focuses on the areas in gastroenterology that are addressed most often by CAM therapies: (1) nausea and vomiting; (2) irritable bowel syndrome (IBS); and (3) liver disease. For each area, the data supporting the most frequently used CAM modalities are reviewed in table format, along with their potential benefits and adverse effects.

 

 

Safety and Regulations of CAM Therapies

It is important that consumers understand the regulatory mechanisms, or lack thereof, that are in place for these modalities, so that effective safety measures can be employed to protect your welfare. Total yearly sales of herbal supplements are approximately $13.9 billion and steadily increasing in the United States. An estimated 15 million adults take prescription medications concurrently with herbal supplements. Therefore, the safety of concurrent administration of herbal supplements and traditional medications is a concern to many physicians. In 1994, the U.S. Congress implemented the Dietary Supplement Health and Education Act (DSHEA). This legislation was developed to prevent the U.S. Food and Drug Administration (FDA) from regulating dietary supplements "excessively" and to ensure that safe and appropriately labeled supplements remain available to those persons who wish to use them.

Additional FDA guidelines specify that supplement manufacturers themselves are responsible for determining the safety of their products and for providing the evidence, if asked, to substantiate the claims made by their individual products. Approval from the FDA is not required prior to marketing of most of these agents. Additionally, supplement manufacturers are not required to report adverse events that occur with use of their products. It is the responsibility of the FDA to prove that products are unsafe before their use can be restricted. The FDA relies on physicians and other health care professionals to report suspected adverse events for an inquiry to be established for a particular agent.

Therefore, it is of utmost importance that all health care professionals be aware of their patients’ use of supplements both to provide safe care and to know when to suspect adverse effects or medication interactions. Suspected adverse events or medication interactions can be reported online at http://www.fda.gov/medwatch. It is hoped that through continued educational efforts at all levels of medical training, the data regarding the efficacy on CAM therapies, as well as their potential benefits and dangers will be increasingly understood. Health care professionals and patients alike will then be able to maintain a healthy therapeutic rapport, while at the same time incorporating these therapeutic modalities if clinically appropriate, in a safe and effective manner.