National Center for Complementary and Alternative Medicine Talks CAM

The National Center for Complementary and Alternative Medicine now has a feature called "Time to Talk."

The site provides information about complementary, alternative and integrative medicine to patients and health care providers. Included is a patient packet and health care provide toolkit.

The site notes:

Patients and their health care providers need to talk openly about all of their health care practices. This includes the use of complementary and alternative medicine (CAM).

The National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health has launched an educational campaign--Time to Talk--to encourage the discussion of CAM use. As the Federal Government's lead agency for scientific research on CAM, NCCAM is committed to providing evidence-based CAM information to help health professionals and the public make health care decisions.

Why Talk?
To ensure safe, coordinated care among all conventional and CAM therapies, it's time to talk. Talking not only allows fully integrated care, but it also minimizes risks of interactions with a patient's conventional treatments. When patients tell their providers about their CAM use, they can better stay in control and more effectively manage their health. When providers ask their patients about CAM use, they can ensure that they are fully informed and can help patients make wise health care decisions.

The usual survey data about national use of CAM therapies is quoted, along with patient tips for discussing CAM with providers, such as:

* When completing patient history forms, be sure to include all therapies and treatments you use. Make a list in advance.

* Tell your health care providers about all therapies or treatments--including over-thecounter and prescription medicines, as well as herbal and dietary supplements.

* Take control. Don't wait for your providers to ask about your CAM use.

* If you are considering a new CAM therapy, ask your health care providers about its safety, effectiveness, and possible interactions with medications (both prescription and over-the-counter).

Health care provider tips include these suggestions:

* Include a question about CAM use on medical history forms.
* Ask your patients to bring a list of all therapies they use, including prescription, over-the-counter, and herbal therapies, and other CAM practices.
* Have your medical staff initiate the conversation.

It would also be a good idea to advise providers to seek legal counsel before providing CAM therapies. Consider medical malpractice and negligence issues, what professional standard of care be applicable, licensure and scope of practice, and how the medical board or other regulatory board may view delivery of specific services.

Is the board, for example, predisposed against therapies such as IV chelation therapy, or does it allow, for instance, therapies that cross over from the integrative medicine to the medical spa domain (such as dermal fillers and laser hair removal) to be provided only under medical supervision? Can chiropractors legally practice acupuncture with only limited supervision? Who can do colon hydrotherapy? Is anything specified by statute or are there case law decisions?

What about informed consent? Should there be a form, and should it look like the standard informed consent form you get in a hospital?

Can physicians sell dietary supplements, or refer patients to products and brands in which they have a financial interest?

How do healthcare providers ensure that their websites are truthful and do not inadvertently make misleading claims? How can they stay clear from breach of contract (breach of promise) claims or inadvertent guarantees?

What about insurance reimbursement, and the tricky arena of healthcare fraud? Can doctors, for example, provide superbills which patients will then send to their insurance companies, seeking reimbursement for off-label therapies, or for dietary supplements?

What kind of training is acceptable before an MD can do acupuncture?

And for patients who believe they have been injured by therapies billed as "holistic" which were in fact ineffective, do they have a legal right to sue?

What about patients who thought they should have had access to less invasive, equally effective alternative therapies (such as chiropractic instead of back surgery and pharmaceutical drugs), but were never given appropriate information?

These are many other legal questions will come to fore as clinicians increasingly delve into complementary medicine services.

NCCAM and other agencies will have to wrestle with these questions as cases and controversies bubble up out from practice and to the surface of the news reports.