Orthopaedic surgeons launch CAM web site
Change is driven by market pressures
You can’t beat em, so you may as well join em — advocates of Complimentary and Alternative Medicine (CAM), that is. With a growing number of their patients turning to healing philosophies, approaches and therapies not found in conventional medicine, the Rosemont, IL-based American Academy of Orthopaedic Surgeons (AAOS) has launched an online CAM information site. The site is part of AAOS’s commitment to educate the public on the common usages of some herbs and their interactions with drugs.
"There is a recognition that CAM has become overwhelmingly important in the marketplace to our patients," explains John W. Wickenden, MD, an orthopedic surgeon in Camden, ME, and chair of the academy’s CAM committee. "We know that in the most recent year it was measured, 1997, almost twice as many visits were made in the U.S. to CAM providers as to primary care physicians."
Wickenden readily admits this move is market-driven. "Our patients and our clients — insurance company programs, organized labor, all of the occupational health care units that use us as well as many employers — are looking seriously at CAM. Increasingly, some modalities are being covered by insurance," he notes. From an orthopedic standpoint, he adds, about half of the visits to CAM providers are for muscoloskeletal problems — primarily neck and low-back complaints.
A further motivation, says Wickenden, was the recognition that the great majority of the CAM utilization by patients were not being shared with the MD, setting the stage for potential self-medication problems. "It’s highly likely this holds true with patients in occupational health clinics," he adds.
Meeting an important need
The prevention of such complications is one of the most important functions of the web site, which is designed to be accessible to the public. Occupational health professionals, as well as orthopods,’ can benefit from the content.
"The site includes data about our committee, the charge to the board, an herb/drug interaction chart, and several pages of references," says Wickenden. "In addition, there are 12-15 Frequently Asked Questions and a page of useful web links." (To see the herb/drug interaction chart, click here.)
Many of the supplements and herbal medications used by the public have potential interactions, notes Wickenden. "Six or seven of them prolong bleeding, which is really important information — not only for cutting surgeons, but for those who use anti-inflammatory medications," he says.
Doctors need sufficient knowledge of these potential interactions to properly advise patients. "Outside of orthopedics, one substance that has gotten great recognition in peer-reviewed journals is St. John’s Wort," Wickenden observes. "One of the major concerns is that it inhibits the efficacy of many anti-viral drugs. So you immediately think of people with HIV disease. Many of them are taking, or were taking, St. John’s Wort, yet it shows a very significant inhibition of antiviral meds."
There are also herbal meds and supplements that enhance bleeding, so it’s important to counsel patients to stop taking them two weeks before surgery.
Knowledge is power
Of course, in order for a physician to counsel the patient properly about CAM, they have to know the patient is using alternative treatment therapies. "The major message our committee is trying to pass on to doctors is simply to ask," says Wickenden. "We will always get the meds they take as part of a medical history, but we need to explicitly ask what over-the-counter drugs, herbals or supplements they are taking as well."
This is particularly important because an overwhelming majority of patients do not use CAM to the exclusion of traditional medicine, which sets up the possibility of complications. "Many of our patients realize the historical attitudes manifested by doctors about CAM," Wickenden observes, "so many are reluctant to discuss CAM because of the negative feelings they assume their doctor has. My own attitude is that to enhance our interpersonal relationships with patients, we need to acknowledge — if not respect — their choices. They will use CAM whether we agree with them or not, and it can’t enhance our relationships with our patients if we don’t approach it in a nonjudgmental manner — in fact, it can be counterproductive to react emotionally."
Besides, he adds, some CAM therapies do have potential medical value. "Not that many of them have evidence-based data in peer-reviewed publications, but one that does is acupuncture, for some focused purposes," he says. "Efficacy is indicated in some limited contexts like post-operative nausea, as well as in a handful of other narrow uses, like tennis elbow and carpal tunnel syndrome."
Then, there’s Chiropraxis. "Most orthopods don’t like it, but if you look at the [National Institute of Health] data you will see it’s useful in some contexts," says Wickenden. "And again, our patients are doing it anyway."
[For more information, contact John W. Wickenden, MD. E-mail: [email protected].]
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