In "Home Runs Come Hard Against Alternative Medicine," (Physician's Management, 6-97), Dr. Eric G. Anderson tells us that "the times they are a changin'." He suggests that for our own good we should at least pretend we are also changing lest we lose patients to our opponents/competition in alternative medicine. Using a baseball analogy Dr. Anderson implies that we can only expect to make some "base hits" against such a formidable and increasingly popular opponent. Using the most egregious examples and derogatory of terminology he then proceeds to strike several low blows against alternative medicine. 

Rather than taking an "us vs. them" attitude we should, as physicians, learn which claims in the field of complementary/alternative medicine (CAM) are well founded, which are unfounded, and which have clearly been disproven. Other than quoting the NIH Office of Alternative Medicine, as he questions its very raison d'etre, Dr. Anderson never uses the term complementary to refer to the use of CAM in conjunction with Western allopathic medicine. By the tone of his article I wonder if he thinks that complementary medicine is merely a politically correct term for quackery. The words Dr. Anderson did choose to use ("screwballs, loonies, quack, three-headed alien babies, snake oil and Wizard of Oz") are clearly demagoguery intended to polarize and in no way conducive to constructive dialogue. The only dialogue Dr. Anderson encourages is to listen to alternative practitioners without comment. In other words, gather information that you plan to use against them without engaging them in any sort of discussion. 

Dr. Anderson suggests that, as physicians, our professional image is tarnished and that we need to eat some humble pie for PR purposes. I couldn't agree more but this advice sounds hollow in an article that is condescending to CAM practitioners as well as patients and physicians. He also suggests that we educate ourselves about CAM by glancing at consumer magazines and scanning "their" (CAM) publications. Does glancing and scanning imply gaining a thorough understanding of CAM or merely reinforcing what we already think we know on the subject? Do you know any physicians who have used this same study method to get through medical school? Does glancing and scanning allow a full understanding of electrolyte imbalance, diabetic ketoacidosis and torsade de pointes? Rather than accusing physicians who study and use CAM of being too lazy to keep up-to-date Dr. Anderson should revise the shoddy educational recommendations he is giving with respect to CAM. There are reputable textbooks and courses by physicians and for physicians on CAM. Education requires time, effort and reliable, objective information. A superficial look at sources of information deemed questionable hardly qualifies as an education on anything. 

Having strongly disagreed with Dr. Anderson on most of the points made in his article I agree completely with him that the times are in fact changing and change is difficult. From an "allocentric" perspective the "Health Care Crisis" has not been kind to physicians. Physicians often feel assailed by the media, exploited by insurance companies, oppressed by government regulations and challenged by patients. Now to add insult to injury CAM is definitely on the upswing and we see many patients using therapies with which we are unfamiliar and suspect that often they are being exploited if not endangered.

While Dr. Anderson sees this "cup" as half-empty, I see it half full. The health care crisis is in fact an opportunity to improve the health care services being provided, not just to change how we pay for those services. The "us vs. them" attitude displayed by physicians toward CAM, the media, the insurance, the government and even patients (!) is unprofessional, counterproductive and ultimately resisting needed change. The first thing that needs to change is our attitudes. With a "half-full cup" we can engage the above forces constructively and seize the opportunity for positive change. Positive change is much more likely to occur with a strategy of cooperation than one of opposition. 

According to the oft quoted Eisenberg study (NEJM, 1-28-93), one in three of our patients are using CAM, 83% are doing this in conjunction with Western allopathic medicine and 72% are not sharing this information with their physicians. If for no other reason than liability, we should routinely ask our patients about CAM use since one in three may be having potential interactions and complications when the right hand doesn't know what the left hand is doing. Since we need to ask about CAM use it is also incumbent on us to talk intelligently and objectively on the subject in order to give patients sound advice. The only way we can do this is to get educated on CAM by thoroughly studying reliable sources of information. There are many areas in CAM that have not been adequately studied (not unlike much of what we do in Western allopathic medicine). Once again this is an opportunity for physicians to become involved in a positive way. Rather than dwelling negatively on the lack of studies in CAM we should, as physicians, do the needed studies. Only then will we be able to separate the chaff from the wheat. If not us, who? If not now, when?