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Complementary medicine regulations
Patient Education and Counseling 73 (2008) 166–167
Contents lists available at ScienceDirect
Patient Education and Counseling journal homepage: www.elsevier.com/locate/pateducou
Letter to the Editor Complementary medicine regulations
A R T I C L E I N F O
Keywords: Complementary medicine Alternative medicine Oncology Regulations
A B S T R A C T
There is a need for regulations in applying complementary and alternative medicine methods, especially in the case of oncology patients. ß 2008 Published by Elsevier Ireland Ltd.
I have read with great interest the article by Ben-Arye et al. (Patient Education and Counseling, 2008, 70, 395–402) about attitudes toward integrating complementary and alternative medicine (CAM) in primary care and take much satisfaction from the conclusion that family physicians should play a central role in referral and even practice of CAM. Over the past few years, we have witnessed the growing popularity of CAM in diverse domains of medicine, including oncology. Therefore, I feel that the point has been reached making it essential to create regulations for the application of CAM. Lack of such regulations may lead to unnecessary suffering in those terminal patients, who, understandably cling to any hope offered. Let me present as an example the case of one of our patients, a 28-year-old woman suffering from Malignant Astrocytoma. She had undergone numerous treatments, including experimental chemotherapy, bio-therapy, surgery, and radiation therapy. Despite all efforts, the tumor recurred repeatedly, and 6 months before the case was referred to us, the patient and her family were informed that no further treatment was possible. According to her husband’s report, she was told that she had only 3 months to live. During a hospital visit, the husband heard from other patients of a treatment available in Germany, using hyperthermia and several kinds of herbal remedies. The attending oncologist gave a very aggressive and negative opinion, which the patient’s family regarded skeptically, as it came from a conventional source. The family decided to try the new approach as a last resort, particularly after the medical consultation in Germany, in the course of which she was told she had 70% chance of complete recovery. As a result of this decision, they sold their belongings, took loans, and flew to Germany. At the hospital in Germany, the patient was treated with microwave hypothermia to the brain, in addition to a variety of herbs, which were prescribed to ‘‘enhance her natural immunity.’’ She also received chemotherapy, which, according to blood sensitivity tests, consisted of high doses of Dexamethazone and Manitol I.V. A very short
0738-3991/$ – see front matter ß 2008 Published by Elsevier Ireland Ltd. doi:10.1016/j.pec.2008.07.002
remission was observed after the first treatments, but within a short time her condition deteriorated to such an extent that, for her last trip to Germany, it was necessary to tie her into her seat. The patient died 1 month after her final treatment. She spent her terminal weeks in an almost complete state of confusion and was hospitalized repeatedly for high fever, sepsis, and urinary tract infections. She was unable to eat or drink. Her family, and particularly her husband, was determined to feed her via a central line, as he was convinced that she would be cured as promised in Germany. Although the final result is not in question, I feel that, had the patient and the patient’s family been given the necessary information regarding this experimental treatment, they might have been spared a lot of unnecessary suffering. Hyperthermia is a known anti-cancer treatment, used in conjunction with chemotherapy and radiation therapy, but it is still considered experimental. As was pointed out in the September 2001 edition of Lancet Oncology [1], this treatment must not be recommended to patients as a standard treatment, but only as a phase 3 study. Our contention is that this must be clearly explained to a potential patient. It is imperative that the physician have sufficient knowledge of CAM, in order to be able to advice patients either in favor of, or against, their use [2,3]. Until recently, conventional medicine turned a blind eye to most forms of CAM. Present medical literature discusses widely the subject of CAM and the psychological characteristics of patients likely to be attracted to it. It appears that these are more likely to be patients suffering from emotional distress and who do not find sufficient response and support in conventional medicine [4], possibly because their diagnosis was delayed, they lack confidence in the medical staff, or they have been told that there is no further treatment possible. Our opinion, shared by many physicians, is that due to our previous lack of interest in CAM, this niche has been filled by ‘‘alternative doctors,’’ who are able and willing to devote time to each individual patient, giving them their
Letter to the Editor / Patient Education and Counseling 73 (2008) 166–167
point of view, but without informing them sufficiently of the possibilities of side effects and negative influences. It is painful to watch terminal patients suffering, due to the treatment and unfulfillable promises given, not to mention the financial expenses involved. References [1] Wust P. Hyperthermia in combined treatment of cancer. Lancet Oncol 2002;3:3487–97. [2] De Smet PAGM. Herbal remedies. N Eng J Med 2002;25:2046–56. [3] Buck ML. Talking with families about herbal therapies. J Pediatr 2000;136: 673–8. [4] Gallagher RM. Treatment planning in pain medicine: integrating medical, physical, and behavioral therapies. Med Clin North Am 1999;83:823–49.
167
Frida Barak Gilles Lugacy Departments of Oncology and Hematology, Barzilai Medical Center, Ashkelon, Israel Shulamith Kreitler* Department of Psychology, Tel Aviv University and Psychooncology Research Center, Sheba Medical Center, Tel Hashomer, Ramat-Aviv, 69978 Tel Aviv, Israel *Corresponding author. Tel.: +972 544-526434; fax: +972 3 5225371 E-mail address: [email protected] (S. Kreitler) 14 April 2008
Contents lists available at ScienceDirect
Patient Education and Counseling journal homepage: www.elsevier.com/locate/pateducou
Letter to the Editor Complementary medicine regulations
A R T I C L E I N F O
Keywords: Complementary medicine Alternative medicine Oncology Regulations
A B S T R A C T
There is a need for regulations in applying complementary and alternative medicine methods, especially in the case of oncology patients. ß 2008 Published by Elsevier Ireland Ltd.
I have read with great interest the article by Ben-Arye et al. (Patient Education and Counseling, 2008, 70, 395–402) about attitudes toward integrating complementary and alternative medicine (CAM) in primary care and take much satisfaction from the conclusion that family physicians should play a central role in referral and even practice of CAM. Over the past few years, we have witnessed the growing popularity of CAM in diverse domains of medicine, including oncology. Therefore, I feel that the point has been reached making it essential to create regulations for the application of CAM. Lack of such regulations may lead to unnecessary suffering in those terminal patients, who, understandably cling to any hope offered. Let me present as an example the case of one of our patients, a 28-year-old woman suffering from Malignant Astrocytoma. She had undergone numerous treatments, including experimental chemotherapy, bio-therapy, surgery, and radiation therapy. Despite all efforts, the tumor recurred repeatedly, and 6 months before the case was referred to us, the patient and her family were informed that no further treatment was possible. According to her husband’s report, she was told that she had only 3 months to live. During a hospital visit, the husband heard from other patients of a treatment available in Germany, using hyperthermia and several kinds of herbal remedies. The attending oncologist gave a very aggressive and negative opinion, which the patient’s family regarded skeptically, as it came from a conventional source. The family decided to try the new approach as a last resort, particularly after the medical consultation in Germany, in the course of which she was told she had 70% chance of complete recovery. As a result of this decision, they sold their belongings, took loans, and flew to Germany. At the hospital in Germany, the patient was treated with microwave hypothermia to the brain, in addition to a variety of herbs, which were prescribed to ‘‘enhance her natural immunity.’’ She also received chemotherapy, which, according to blood sensitivity tests, consisted of high doses of Dexamethazone and Manitol I.V. A very short
0738-3991/$ – see front matter ß 2008 Published by Elsevier Ireland Ltd. doi:10.1016/j.pec.2008.07.002
remission was observed after the first treatments, but within a short time her condition deteriorated to such an extent that, for her last trip to Germany, it was necessary to tie her into her seat. The patient died 1 month after her final treatment. She spent her terminal weeks in an almost complete state of confusion and was hospitalized repeatedly for high fever, sepsis, and urinary tract infections. She was unable to eat or drink. Her family, and particularly her husband, was determined to feed her via a central line, as he was convinced that she would be cured as promised in Germany. Although the final result is not in question, I feel that, had the patient and the patient’s family been given the necessary information regarding this experimental treatment, they might have been spared a lot of unnecessary suffering. Hyperthermia is a known anti-cancer treatment, used in conjunction with chemotherapy and radiation therapy, but it is still considered experimental. As was pointed out in the September 2001 edition of Lancet Oncology [1], this treatment must not be recommended to patients as a standard treatment, but only as a phase 3 study. Our contention is that this must be clearly explained to a potential patient. It is imperative that the physician have sufficient knowledge of CAM, in order to be able to advice patients either in favor of, or against, their use [2,3]. Until recently, conventional medicine turned a blind eye to most forms of CAM. Present medical literature discusses widely the subject of CAM and the psychological characteristics of patients likely to be attracted to it. It appears that these are more likely to be patients suffering from emotional distress and who do not find sufficient response and support in conventional medicine [4], possibly because their diagnosis was delayed, they lack confidence in the medical staff, or they have been told that there is no further treatment possible. Our opinion, shared by many physicians, is that due to our previous lack of interest in CAM, this niche has been filled by ‘‘alternative doctors,’’ who are able and willing to devote time to each individual patient, giving them their
Letter to the Editor / Patient Education and Counseling 73 (2008) 166–167
point of view, but without informing them sufficiently of the possibilities of side effects and negative influences. It is painful to watch terminal patients suffering, due to the treatment and unfulfillable promises given, not to mention the financial expenses involved. References [1] Wust P. Hyperthermia in combined treatment of cancer. Lancet Oncol 2002;3:3487–97. [2] De Smet PAGM. Herbal remedies. N Eng J Med 2002;25:2046–56. [3] Buck ML. Talking with families about herbal therapies. J Pediatr 2000;136: 673–8. [4] Gallagher RM. Treatment planning in pain medicine: integrating medical, physical, and behavioral therapies. Med Clin North Am 1999;83:823–49.
167
Frida Barak Gilles Lugacy Departments of Oncology and Hematology, Barzilai Medical Center, Ashkelon, Israel Shulamith Kreitler* Department of Psychology, Tel Aviv University and Psychooncology Research Center, Sheba Medical Center, Tel Hashomer, Ramat-Aviv, 69978 Tel Aviv, Israel *Corresponding author. Tel.: +972 544-526434; fax: +972 3 5225371 E-mail address: [email protected] (S. Kreitler) 14 April 2008