Epocrates: PDA medical software

Integrative Medicine

Editorial: Dr. Anne Meneghetti, Internist, Epocrates' senior medical editor

Some patients are delighted to learn that a solution to their medical problem might be found in a pill. Other patients are not. Patients attracted to alternative medicine often seek to understand the root cause of their condition and perhaps even discover meaning on the path to self-healing. Many physicians are perplexed when patients choose to forego proven standardized therapies from licensed practitioners and instead forge ahead into the untested territory of natural healing.

Proponents of alternative care wonder why patients would willingly risk potential side effects from artificial chemicals that treat only the superficial manifestations of a condition, without addressing the underlying imbalance in body, mind, and spirit. Patient demand for integrative approaches combining conventional and alternative care is on the rise. According to a U.S. government survey released late last year, approximately 38% of U.S. adults and 12% of children use some form of complementary and alternative medicine (CAM).

Research in the field has presented challenges, as many CAM therapies are difficult to standardize, yet trials and reviews of integrative approaches are finding their way into the literature. A recent review of fish oil suggests that supplementation significantly lowered risk from cardiac death. One small trial suggested fish oil may benefit patients with lupus; another trial demonstrated that it reduced elevated triglycerides in HIV patients on ART. Probiotics showed benefits for patients with irritable bowel syndrome and for children with diarrhea; a recent randomized trial suggested that probiotics may hold promise for patients with hepatic encephalopathy. A systematic review found that peppermint oil soothed symptoms of irritable bowel syndrome. Asthma symptoms improved with breathing exercises in a recent randomized trial. Another randomized trial suggested that B vitamins may reduce the risk of age-related macular degeneration in women. Not all studies were positive: a large trial failed to show a benefit of supplements in preventing prostate cancer; a JAMA report concluded that ginkgo biloba failed to prevent dementia. A review of herbs for menopausal symptoms showed mostly disappointing results.

Clinicians will be increasingly called upon to manage patients who desire integration between conventional care and healing approaches that resonate with their personal health beliefs. Epocrates DocAlert readers can expect to be updated regularly as new integrative medicine research becomes available.