As physicians driven by our desire and commitment to provide the best possible care, we have a responsibility to inform our patients of all therapies that can be of benefit, regardless of their system of origin. In practice this is challenging, because there are many unanswered questions in the use of complementary and alternative modalities, and because there is no established standard of care. Each physician, together with his or her patient, needs to form his or her own opinions regarding the appropriate integration of CAM therapies. Many patients will want conclusive evidence of any therapy before using it. Others, assured of the relative safety of a therapy, may require less conclusive evidence. Illustrating this dilemma, in a systematic review of randomized trials regarding CAM approaches to PMS, the authors concluded that “despite some positive findings, the evidence was not compelling for any of these therapies, with most trials suffering from various methodological limitations. On the basis of current evidence, no complementary or alternative therapy can be recommended as a treatment for premenstrual syndrome” (131). Although this concept certainly is appealing in its simplicity, it may not be in the best interest of patients. We need to be consistent in our requirement of evidence, using the same levels of evidence for incorporating interventions from CAM as from conventional approaches. As with many clinical decisions we are forced to make with incomplete data, many factors must be considered. The potential risks and benefits must be weighed carefully, and primum non nocere must certainly be our guide.
In many regards, we are in the most challenging time as it relates to integrating appropriate CAM approaches into the practice of gynecology. As more research is done and as medical schools and residency programs incorporate education about these approaches, the gap between our patients’ desires and our standard practices will decrease as appropriate therapies are seamlessly incorporated and ineffective and fraudulent ones are discarded.
1.
Eisenberg DM, Davis RB, Ettner SL, et al. Trends in alternative medicine use in the United States, 1990–1997: results of a follow-up national survey. JAMA 1998;280:1569–1575.
2.
Eisenberg DM, Kessler RC, Foster C, et al. Unconventional medicine in the United States. Prevalence, costs, and patterns of use. N Engl J Med 1993;328:246–252.
3.
Barnes PM, Powell-Griner E, McFann K, et al. Complementary and alternative medicine use among adults: United States, 2002. Adv Data 2004;343:1–19.
4.
Bair YA, Gold EB, Greendale GA, et al. Ethnic differences in use of complementary and alternative medicine at midlife: longitudinal results from SWAN participants. Am J Public Health 2002;92:1832– 1840.
5.
Hollyer T, Boon H, Georgouis A, et al. The use of CAM by women suffering from nausea and vomiting during pregnancy. BMC Complement Altern Med 2002;2:5.
6.
Shen J, Andersen R, Albert PS, et al. Use of complementary/alternative therapies by women with advanced-stage breast cancer. BMC Complement Altern Med 2002;2:8.
7.
Newton KM, Buist DS, Keenan NL, et al. Use of alternative therapies for menopause symptoms: results of a population-based survey. Obstet Gynecol 2002;100:18–25.
8.
Astin JA. Why patients use alternative medicine: results of a national study. JAMA 1998;279:1548–1553.
9.
Adler SR, Fosket JR. Disclosing complementary and alternative medicine use in the medical encounter: a qualitative study in women with breast cancer. J Fam Pract 1999;48:453–458.
10.
U.S. Food and Drug Administration (USFDA). Dietary supplements.