All through medical school, on board exams and on certification exams we are trained in answering multiple-choice questions. We throw out the answers that are obviously wrong and pick the one answer or combination of answers that seems closest to the truth.

When it comes to "Alternative Medicine" we, as physicians, have by and large been quick to throw this out as an obviously wrong answer. Our patients, on the other hand view this differently. Patients are much more likely to view this as "Complementary Medicine" and include it along with conventional treatments. Patients seem increasingly likely to answer "All of the Above" when faced with the multiple choice question of how to deal with health issues. 

We must ask ourselves, why the discrepancy? Why do physicians more often view the choices as either/or and patients view the choices as and/or? There are several answers to this question. Simply stated, the answers include: physician denial; educational bias; and patient desperation. 

Some physicians make it very clear that they feel there is no real choice since conventional approaches taught in medical school can be the only right answer. These same physicians feel that "Alternative Medicine" is for the deluded, unscientific masses that are being defrauded and endangered by hucksters. These physicians are in denial and don't face the fact that their patients are making other choices and often not telling them about it. This approach by physicians can actually harm patients not helped by conventional interventions who are seeking other options without useful guidance. The honored tradition of "doing no harm" dictates that we should help our patients make wise choices. 

Years of training in the scientific method tend to foster skepticism and a hunger for data among physicians evaluating unconventional therapies. The rigors of medical training often preclude the same degree of skepticism and data hunger with respect to conventional therapies. In other words conventional wisdom is more likely accepted without testing and substantiation than is unconventional teaching. Patients on the other hand are more inclined to what they can understand and what seems to work than what they can prove through scientific methods. To some extent patients, who are less versed in science and technology than physicians, are skeptical and even afraid of high tech conventional therapies. For both physicians and patients educational biases clearly play a major role in making choices. 

When, as physicians, we have exhausted all the diagnostic and therapeutic tools of conventional medicine and our patients are no better off for our efforts what do we tell them? While some patients will passively accept, "It's all in your head," or "Learn to live with it," more and more are turning elsewhere for answers. Taking away hope actually encourages acts of desperation by patients that are normally very level headed. Telling patients that there are no other choices increases the likelihood that they will make bad choices. 

How can we learn more about alternative/complementary therapies in order to better advise our patients on their use? There are several national organizations worth contacting for information on complementary approaches including the following: 

American Academy of Environmental Medicine - (913) 642-6062,
American Academy for the Advancement of Medicine - (800) 532-3688,
American Holistic Medical Association - (703) 556-9728, 
American Preventive Medical Association - (800) 230-2762. 

There are numerous credible publications dealing with alternative/complementary therapies that are worth subscribing to including the following: 

Alternative Therapies in Health and Medicine - (800) 345-8112, 
Complementary Medicine for the Physician - (800) 553-5426, 
Complementary Medicine International - (617) 899-2702, 
St. AnthonyÕs Business Report on Alternative and Complementary Medicine 
(800) 632-0123. 

There are an ever-increasing number of books targeted at the general public on the subject of complementary therapies. A good book aimed at physicians, which provides an overview of alternative/complementary therapies, is " Fundamentals of Complementary and Alternative Medicine," by Marc Micozzi, MD, PhD, published in 1996 by Churchill Livingstone - (800) 553-5426. Finally, consider the vast array of online information available on the subject. Most of the online services have some sort of health forum which includes abundant information on alternative therapies. Accessing the Internet will provide more information than one person can digest on complementary therapies. Using a search engine like Yahoo you will find well over 150 Internet destinations dealing with alternative medicine. Even Physicians' Online, under the Discussion Groups Menu, has a Clinical Case Discussion category which includes physician questions and answers on alternative/complementary medicine. 

Now that we have access to a wealth of information on alternative/complementary therapies let's try a multiple choice question: 
Complementary Therapies are:
A. Unproven. 
B. Unscientific. 
C. Irrelevant. 
D. Dangerous. 
E. All and none of the above. 

Complementary therapies with centuries, if not millenia, of clinically demonstrated effectiveness may not have double blinded, placebo-controlled studies that meet the methodological criteria of academicians. Do patients care? 

In some cases there are excellent studies, meeting the most stringent criteria, which consistently show benefits from complementary interventions in well-defined situations. However, there may not be a theory or mechanism that explains the outcomes in scientific terms that conventionally trained physicians understand.

With one in three Americans using complementary therapies and out of pocket expenses for complementary therapies exceeding 10 billion dollars per year it is hard to categorize this whole field as irrelevant. Nonetheless, some physicians still believe this is an irrelevant fad that will go the way of the pet rock. 

There are inherent dangers in anything - even chewing gum. When patients are aware of over 100,000 deaths occurring yearly in the U.S.A. from side effects of medications the risks and dangers of complementary therapies seem inconsequential. When, as a physician, I see a patient with metastatic prostate carcinoma who is taking bovine orchic extract recommended to him by a practitioner of applied kinesiology I am alarmed by the potential danger of inappropriately used complementary therapies. 

We see in the four preceding paragraphs that there are clearly two perspectives on each of the multiple choice options. Therefore the only correct answer to the above question must be E. All and none of the above.

Once we acknowledge that there are many possible choices, we make the effort to become informed about the choices and can view these choices through our patients' eyes then, and only then, can we give advice to help them make good choices in the use of both conventional and complementary therapies.