CAM vs. conventional: who should be the educators?

For the study, patients who attended the Canadian College of Naturopathic Medicine in March 2003 were asked to complete a questionnaire about their use of conventional medicine and CAM and discussions with doctors about the two approaches.

Researchers analyzed their responses and published their findings in this month's Mayo Clinic Proceedings​ (2005;80(5):616-623). Of the 174 respondents, 161 (92.5 percent) said they made use of natural products, and 37 percent of these said they did not discuss them with their primary care physician.

Physician enquiries were seen to be the most important factor influencing discussions about natural product use, but almost 70 percent of respondents said that the physician did not ask.

"Our findings suggest that disclosure rates could be improved by physicians taking a more active role in asking their patients about natural product use,"​ wrote the researchers.

Consumers' enthusiasm for healing themselves is a powerful force, which physicians could tap into and steer towards helping to achieve an overall improvement in the health of the nation.

But if they fail to do so, it could fall to the natural products industry to educate consumers about the benefits and, conversely, the dangers of CAM. Government regulations pose restrictions to the advice they can offer, however.

While physicians are licensed to dispense advice on treatments for certain ailments, natural products cannot claim to treat or cure illnesses. Instead, they can only carry labels stating that they may help alleviate symptoms of conditions - and then only if they are supported by a body of scientific evidence.

Certainly these are good regulations, which protect the consumer against fraudulent claims and companies looking to make a quick buck out of other people's poor health. They mean the industry has to be creative to promote itself and, as an extension of this, look for creative ways to educate consumers about how CAM can help them.

The Centers for Disease Control and Prevention's (CDC) 2002 National Health Interview Survey showed that the most commonly used CAM approaches were for relatively minor conditions, such as back pain, colds, neck pain, joint pain, anxiety or mild depression.

But evidence of dangerous interactions between drugs and natural products used to help alleviate the symptoms of serious conditions has come to light, meaning that in certain situations, a gung-ho attitude to CAM could compromise a patient's health rather than boost it.

For example, a recent study at Yale School of Medicine suggested that black cohosh, a plant commonly used by breast cancer patients to alleviate the menopause-like side effects of therapy, may alter the effects anticancer drugs.

But whether CAM is used for serious or trivial complaints, the CDC study also showed that disillusionment with the medical profession could underlie the trend. About 28 per cent of people who used CAM said they did so because they believed conventional medical treatments would not help them with their health problem.

This statistic is supported by data collected by Ohio State University, which found that 71 percent of over-50s use some form of alternative medicine. Sixty-three percent of respondents in this study said they had tried alternative therapies because they were not satisfied with the mainstream healthcare they were receiving.

Given the faith that these users are placing in CAM over conventional medicine, it is likely that they will be receptive to advice offered by natural products manufacturers.

But rather than working against physicians, the industry could work with them.

Changing the opinion of the entire medical establishment might be a task of Herculean proportions, but if consumers broach the subject of CAM after being advised to do so by labels on natural products, more physicians may realize that CAM is not a flash-in-the-pan phenomenon, and that they should be taking it seriously.

Companies may also add their voices to those represented by the industry associations, which do a sterling job of communicating the benefits of CAM, especially when negative reports appear in the media which could confuse or misguide consumers.

The American Herbal Productions Association, Council for Responsible Nutrition and National Nutritional Foods Association regularly lobby the government on legislative issues, and come out in support of measures that will help inform and protect consumers.

Last month the National Center for Complementary and Alternative Medicine (NCCAM) and the Office of Dietary Supplements, both National Institutes of Health agencies, announced that they had stumped up millions of dollars in funding towards furthering our knowledge of their mechanisms and phytochemical constituents at five university-based dietary supplement research centers over the next five years.

"These research centers are critical to helping us determine whether and by what mechanisms botanicals may serve as effective treatments or preventive approaches,"​ said Stephen Straus, director of the NCCAM. The total pledged in the first year across all five centers comes to approximately $6.75 million.

So it seems consumers are not the only ones taking CAM seriously: the government is starting to sit up and take notice. More than that, it is putting its money where its mouth is. And with a little coaching from the industry, health care professionals of every sort could soon be singing from the same song-sheet.