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Doctors Urged to Bone Up on Alternative Medicine

Bone surgeons say its increasing popularity can't be ignored any more

FRIDAY, Jan. 11, 2002 (HealthDayNews) -- Complementary and alternative medicine (CAM) is the elephant in the waiting room that doctors can no longer ignore, the nation's leading group of orthopaedic surgeons says.

Almost one half of Americans have tried some form of alternative medicine, according to the American Association of Orthopaedic Surgeons (AAOS). Doctors need to understand that alternative treatments -- like yoga or chiropractics -- can be useful in easing the symptoms and pain of osteoarthritis or back problems.

On the flip side, the group adds, physicians should also be aware that certain herbal supplements can interact dangerously with prescription drugs.

"We want to educate our fellow orthopaedic surgeons to the frequent utilization of complementary and alternative medicine by outpatients," says Dr. John Wickenden, chairman of the association's Complementary and Alternative Medicine Committee in Camden Maine. "Very commonly, during visits to the doctor's office, use of these modalities are not acknowledged by patients, and doctors tend not to ask."

Orthopaedic surgeons specialize in correcting musculoskeletal disorders.

To deal with the increasing trend, the AAOS established a committee and worked for two years to study the different philosophies, treatments and therapies advocated by alternative medicine.

"We needed to educate ourselves first, because none of us had any deep knowledge of CAM," Wickenden says. "And then we needed to understand why patients are turning to CAM."

The committee's research failed to show that patients were using one form of medicine to the exclusion of the other, Wickenden says. "They are seeking CAM as an adjunct to their treatment, perhaps as a way to take back control of their own treatment, or because they are looking for a 'high touch' addition to their treatment in the context of this world of high-tech medicine."

The committee focused early on herbal supplements and their potential for dangerous interaction with prescription drugs, Wickenden explains.

"Some of these herbs pose discrete risks, such as excessive bleeding during surgery or interaction with anesthetics," Wickenden explains. "Physicians need to be aware that dong quai, ginger, garlic, ginkgo biloba, ginseng and St. John's wort may increase bleeding."

He adds, "St. John's wort, which is an antidepressant, should be of particular concern to physicians because it significantly diminishes the efficacy of some of the antiviral medications -- and that could have some impact with AIDS patients, for instance."

Dong quai is an ancient Chinese herb used to ease menstrual cramps. Garlic, which alternative medicine advocates say reduces cholesterol, may have the potential to lessen the risk of heart disease and cancer. Ginger is a leading folk remedy for nausea and digestive problems, and ginkgo leaf extract is supposed to modestly help improve thinking and memory. Ginseng has been used in China for many thousands of years as an all-purpose health tonic.

Alternative medicine has some important lessons for today's doctor, Wickenden adds. "Frequently we M.D. types are too focused on the narrow pathology we are pursuing. But obviously this pathology occurs in a whole person."

Some CAM therapies have potential value, Wickenden says, adding that acupuncture is effective for pain relief. "And orthopaedic surgeons may have to drop their hostility to chiropractics," he says. "We need to acknowledge that chiropractors are there, that we both have different concepts of underlying pathologies, and while communication may be difficult, we should at least be more tolerant and accepting of each other."

"Patients are using both of us," he adds.

What to Do: For more CAM information on orthopaedics, visit the American Association of Orthopaedic Surgeons. And for more information on the use of CAM, visit the National Center for Complementary and Alternative Medicine.

SOURCES: Interview with John Wickenden, M.D., chairman, American Association of Orthopaedic Surgeons' Complementary and Alternative Medicine Committee, Camden Maine; American Association of Orthopaedic Surgeons press release
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