Repeatedly studies have shown that the use of complementary/alternative medicine (CAM) by patients is on the increase in North America. The studies done by Dr David Eisenberg which were published in the NEJM (January, 1993) and in JAMA (November, 1998) documented a 25% growth in the use of CAM between 1990 and 1997. During that same time period the use of high dose vitamins more than doubled and the use of herbal products increased over 380%. Based on these figures extrapolations predict that there are 15 million Americans who could be having potential interactions between their prescription medicines and the over the counter supplements they are taking. Unfortunately the studies also consistently show that most patients do not tell their physicians about their use of CAM. What are we to do about this? Are we somehow immune to this phenomenon in Colorado? 

Our own Health Advisor (formerly Ask A Nurse), which fields a high volume of calls for health information from the general public, has noted that between July 1997 and July 1998 there was a 50% increase in requests for physicians familiar with, or open to CAM. From July 1998 through December 1999 there was an additional 30% jump in these requests. While Health Advisor does have the names of a handful of physicians who have identified themselves as open to the use of CAM it is certainly not proportionate to the demand expressed by those calling in. Even though the studies show most patients don't talk to their physicians about CAM they are definitely seeking physicians who they CAN talk to about CAM. Apparently patients want to talk to us about CAM but appear to be uncomfortable doing so unless we have expressed an interest in this area. So how should we respond to this? For those physicians who do have an interest in CAM it may be worthwhile to let Health Advisor know this as it will probably result in a steady stream of new patient referrals. For those physicians who do not have a particular interest in CAM there is still an ethical obligation to routinely ask current patients about their use of CAM. Since patients seem to want this dialogue to occur but appear to be afraid to initiate it the responsibility falls on us to start the discussion. Why should we do this - particularly if we have no training in this area and may not necessarily believe in the use of CAM? For the same reason we ask about drug use or sexual history -because we care about our patients, are interested in their safety and want to help them make good health choices. "Don't ask, don't tell" clearly is not the way to deal with the growing patient use of CAM. 

Just as with collecting a drug or sexual history, when we talk to patients about CAM it should be done in a totally non-judgmental, non-threatening way. Otherwise we are wasting our time. If we disagree with the use of a particular CAM therapy by patients we need to be able to do so in a way that is tactful, respectful and rational. If we are not able to respond in this manner when patients divulge the use of a CAM therapy with which we are not comfortable we lose the opportunity and privilege to favorably influence those patients to make good health choices. If we want to help our patients make good choices in their use of CAM we need to resist the temptation to be demagogues and we need to nurture safe, respectful dialogues.