INTEGRATING CAM THERAPIES INTO MAINSTREAM PRACTICE – PART VII (FINAL ROUNDUP)
In the past few columns, we have looked at the Complementary and Alternative Medicine (CAM) boom in the United States. Patients are constantly seeking professional advice about a wide spectrum of healing practices. At one time, orthodox medicine used to crusade against alternative medicine but no more; it is trying to accommodate the patients’ beliefs and acceptance of some of these practices that might be beneficial. However, caution is needed when you chose from the hundreds of CAM therapies. And keep in mind that ‘alternative medicine has fluid boundaries and often changing definitions!’
A recent mass e-mail I received extolled the virtues of ‘chelation therapy’ (that has not been reviewed in this column before) in coronary artery disease (CAD) in a patient in Mumbai. The story in short, “This gentleman with a history of heart attack and multiple coronary blockages, suffered from severe chest pains. Since angioplasty was not feasible, coronary bypass surgery was considered but he was thought to be a high risk for surgery. Instead, he underwent ‘chelation therapy’ that made him feel much better!” The message given to the patient was that the chelation therapy cleaned his system and removed all the blockages from the heart.
I wish the treatment for complex CAD was that simple. These types of wild claims and ‘feel-good’ stories are often circulated widely through an e-mail blitz. Chelation therapy using edetic acid (EDTA) has been found to be effective in removing toxic heavy metals such as lead, mercury, arsenic, etc., from the body and is used in such poisonings. It is purported that the removal of calcium ions, an important component of the coronary blocking plaque, by this technique can lead to the regression of CAD. Use of this therapy is FDA approved only in treating heavy metal poisoning but not in CAD. According to American College of Cardiology, “Chelation therapy for vascular occlusive disease is not superior to placebo and is associated with considerable risks and, the benefit from this therapy remains controversial.” Close to a million patient visits are being made for this treatment in the U.S annually.
CAM - The take home message
David M. Eisenberg MD, Director of the Division for Research and Education in Complementary and Integrative Medical Therapies and the Osher Institute at Harvard Medical School and an adviser to the National Institutes of Health and his colleague Dr. Kaptchuk have developed a classification system to “organize the porous, flexible field of complementary and alternative medicine.’” They have suggested eight categories:
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Professional systems, such as chiropractic, acupuncture and homeopathy. Include Ayurveda, naturopathy, Chinese herbals, etc., also in this category.
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Popular health remedies, such as taking vitamins, food supplements or eating special diets
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New-Age healing, such as crystals, magnets, spirits, mediums, Reiki and qigong
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Mind-Body cures, such as biofeedback, hypnosis and guided imagery
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"Non-Normative scientific enterprises," such as chelation therapy, iridology and hair analysis
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Ethno-medicine, such as Haitian voodoo, Puerto-Rican spiritism and Hmong practices
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Religious healing, such as Christian science and charismatic renewal (also other religious rituals for healing)
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Folk medicine, such copper bracelets and chicken soup.
Now you can see the field is wide and diverse. While some of these treatments may be innocuous such as copper bracelets and charismatic renewals, and some others beneficial like ‘yoga’ ‘meditation’ and ‘vegetarian diet,’ some may end up doing considerable damage. Many of them have only ‘placebo’ effect that would wear off eventually. Patients who have chronic, disabling and incurable diseases would try anything and swear by its efficacy. The doctors who practice them may do so partly out of their own conviction but partly for the income.
In the final analysis, if a particular CAM therapy you are trying is administered by an expert in the field and approved by your regular doctor, then it is worth considering. I believe and practice ‘evidence-based medicine’ but I am always open-minded to new therapies. However, if you are stricken with a serious illness, you must make a deliberate effort to diagnose the nature of the ailment by proper scientific techniques and treat with approved therapies that have been properly validated.
This concludes the series
Dr. M. P. Ravindra Nathan is a Brooksville cardiologist.