Portland, Ore.Two years ago, a study published in the journal Annals of Internal Medicine examined reasons patients don't tell their doctors about complementary and alternative medical treatments they've been receiving.
The results were astounding. Among survey respondents who used complementary and alternative medicine, or CAM, in the last year and seen a conventional medical doctor, about two-thirds did not disclose at least one type of CAM therapy to the doctor. Their reasons: It wasn't important for the doctor to know; the doctor never asked; it was none of the doctor's business; and the doctor wouldn't understand.
"Certainly, the perception among patients is CAM is being knocked" by conventional physicians, said Barry Oken, M.D., professor of neurology and behavioral neuroscience in the Oregon Health & Science University School of Medicine, and director of OHSU's Oregon Center For Complementary & Alternative Medicine in Neurological Disorders.
"Open dialogue is needed. There needs to be better communication," he said.
Oken hopes a new book he developed and edited spurs this communication by giving conventionally trained health care providers the facts about CAM therapies and the effectiveness of some of them in treating people with neurological diseases.
Titled "Complementary and Alternative Medicine in Neurology: An Evidence-Based Approach to Clinical Practice," the book is targeted to any health care provider who sees people with neurological disorders and is "accessible to even the most scientifically stringent, conventionally trained physicians, including neurologists," according to the preface. It is published by The Parthenon Publishing Group.
The goal of the book is "to increase knowledge of CAM techniques among conventionally trained physicians," Oken said.
Lack of awareness among conventional physicians of the benefits of some complementary therapies, as well as urging from the publisher, prompted Oken to begin writing the book 18 months ago. "It seemed like an open area. A lot of books on the subject have not been scientifically based," Oken said.
Oken also was concerned that the "ignorance about therapies is creating a gap between physicians and patients." Information about potential negative interactions between complementary and conventional treatments simply wasn't getting out.
"Antivirals for HIV, for example, have significant interactions with botanicals," he said.
The book doesn't push all CAM therapies. In fact, despite the widespread use of many complementary treatments, only those for which ample evidence of effectiveness existed are discussed in detail. And any available clinical data on a particular therapy had to apply to treatment of neurological disorders.
The book "tries to draw the line between what's reasonable and what's not reasonable," Oken said.
The book is divided into two sections. The first 12 chapters offer an overview of various CAM therapies, including botanicals, chiropractic, massage therapy, acupuncture and traditional Chinese medicine, naturopathic medicine, Ayurvedic medicine, Hatha yoga and meditation, hypnosis, religious involvement and placebo effect.
"There are some chapters that are missing, especially if there was limited evidence," such as discussions about energy therapies, Oken noted.
The book's last 13 chapters are organized by neurological disorders: headaches; back and neck pain; epilepsy; cerebrovascular disease, such as stroke; multiple sclerosis; dementia; Parkinson's disease; peripheral neuropathy; amyotrophic lateral sclerosis; insomnia; and snoring or obstructive sleep apnea. There also is a chapter about the use of CAM therapies by families of children with disabilities.
Several faculty members from OHSU's School of Medicine contributed chapters to the book. Among them are Amala Soumyanath, Ph.D., assistant professor of neurology, who wrote about botanicals; Lynne Shinto, N.D., M.P.H., research assistant professor of neurology, and Carlo Calabrese, N.D., M.P.H., clinical assistant professor, who discuss naturopathic medicine; Wayne M. Clark, M.D., professor of neurology, who co-wrote a chapter about cerebrovascular disease; Dennis Bourdette, M.D., professor of neurology who co-wrote a chapter about multiple sclerosis; and Jau-Shin Lou, M.D., Ph.D., who wrote chapters about Parkinson's disease and amyotrophic lateral sclerosis.
"I tried to get all disease-based chapters written by conventional physicians," Oken said. "Only one is written by a nonconventional physician."
Not all conventionally trained doctors shun complementary medicine, Oken emphasized. Primary care physicians seem "more attuned to the use of complementary therapies in some form or another." Others, studies have shown, even use some of the CAM therapies they may not yet recommend to their patients.
"There's something about risk-benefit issues that even physicians are willing to take into account for their own consumption," Oken said.