An important event occurred on Monday, April 27th. Centura Health, the largest hospital system in the state, put on a conference entitled "Options in Life, Options in Health - A Look at Alternative Medicine." Close to 850 people were there to hear that Centura Health is committing itself to providing medical leadership in the rational integration of complementary and alternative medicine (CAM) with Western medicine. This public commitment by an organization of Centura's size and credibility is a sure sign of change. Change is certainly nothing new in the healthcare field. Until recently most of the change has centered on reimbursement, cost efficiencies, consolidation, delivery systems and the business side of medicine. However, the judicious integration of CAM with Western medicine is a very different type of change. By providing expanded clinical options for patients we are actually seeing change in the services being delivered. 

During the preparatory stages, the conference managed to elicit both cheers and jeers by physicians who either thought it was long overdue or unbefitting. After the fact, conference evaluations by attendees were overwhelmingly positive with an interest in attending similar conferences in the future. Were the people in attendance essentially a self-selected "choir of 850" there to hear their favorite sermon? Hardly. I ran into insurance executives, researchers, clinicians, business people, administrators and people from every walk of life at the conference. Many of these had little or no knowledge of CAM and several brought their healthy skepticism with them. In fact some of the speakers also expressed their skepticism and reservations about the unquestioning acceptance of CAM leading to inappropriate use of these therapies. 

Dr. Herbert Benson, a Harvard trained cardiologist, author and world-renowned authority on mind-body medicine, in his keynote address, went to great lengths to distinguish between unproved CAM therapies and the inarguable scientific basis for mind-body medical interventions. In a private Q&A session held for physicians afterwards he stated that the medical community needs to reclaim its authority and provide direction in an area (CAM) that is currently devoid of credible medical leadership. There are many ways in which physicians can provide leadership. The first step is to be informed about the more widely used CAM therapies in order to give patients good advice. Uninformed advice is worse than no advice. We should above all ensure that any CAM therapies being used are not contraindicated or harmful for the patient and that the use of these therapies will not counteract, delay or substitute for more definitive conventional interventions. We should then consider what evidence exists that a given CAM therapy is efficacious as well as the patient's beliefs regarding that therapy. Also as clinicians we have the opportunity to provide medical leadership by observation, study and formal scientific research of CAM to expand the existing knowledge base in this area. 

The paradox is that despite impressive research documenting efficacy and safety of specific CAM therapies, (mind-body medicine for instance), most physicians have been reluctant to incorporate this into their clinical practices. Dr. Benson would argue that the CAM label does not apply to mind-body medicine because it has been scientifically proven. On the other hand if you loosely define CAM as those therapies which are not routinely taught in medical school or reimbursed by insurances and used by most physicians then mind-body medicine does indeed fall under the CAM umbrella. "A mind is a terrible thing to waste," and yet this is exactly what we do when we treat patients despite their emotions and beliefs - as if these had no relevance to their physiology. The challenge for us as physicians is can we be open minded enough to change but not so open minded that our brains fall out? In other words we should be willing to change our clinical practices to include CAM if there is evidence of efficacy and safety to support the change. The question then becomes, what constitutes adequate evidence?

For the general public anecdotal evidence is often all that is needed to adopt some new therapy. It is no surprise then that in general the public embraces CAM more easily than most physicians who expect a different standard of evidence. A recent Gallup poll showed that over the past year alone the use of herbal remedies has gone up 70%. Another national survey of 1,500 people in the USA last year showed that 42% had used some form of CAM. This compares with 34% using CAM in the 1990 survey done by Dr. Eisenberg ,et al. The data from the more recent survey is available in a 36-page report from Landmark Healthcare (916-569-3326) for $35. 

Clearly patients have many options in life and in health. As physicians we should be aware of the many options, including CAM, available to our patients. We should strive to give patients well informed advice so that they can more easily make good choices and use CAM therapies in the safest and most appropriate manner. We should also be open to changing our clinical practices to incorporate CAM if evidence indicating safety and efficacy is available. With the information overload facing physicians this is not an easy task. I applaud Centura Health for its commitment to educating the community and providing medical leadership in this evolving area of medicine. The Colorado Academy of Family Physicians should also be commended for its efforts in this area. I encourage you to attend the 50th anniversary meeting of the CAFP this October where several sessions will be dedicated to CAM topics.