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Advising Patients Who Seek Alternative Medical Therapies

David M. Eisenberg, MD
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From Beth Israel Deaconess Medical Center, Boston, Massachusetts. For the current author address, see end of text. Acknowledgments: The author thanks Ellen Meisels, JD, MPH, Janis Claflin, PhD, and Rabbi Elaine Zecher for their contributions; Janet Walzer, MEd, Christopher Tuttle, Thomas Delbanco, MD, Thomas Inui, MD, and Debi Arcarese for editorial suggestions; and Debora Fischer for technical assistance. Grant Support: In part by National Institutes of Health grant U24 AR43441, the John E. Fetzer Institute, the Waletzky Charitable Trust, the Friends of Beth Israel Hospital, and the Kenneth J. Germeshausen Foundation. Requests for Reprints: David M. Eisenberg, MD, the Center for Alternative Medicine Research, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1997;127(1):61-69. doi:10.7326/0003-4819-127-1-199707010-00010
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Alternative medical therapies, such as chiropractic, acupuncture, homeopathy, and herbal remedies, are in great public demand. Some managed care organizations now offer these therapies as an “expanded benefit.” Because the safety and efficacy of these practices remain largely unknown, advising patients who use or seek alternative treatments presents a professional challenge. A step-by-step strategy is proposed whereby conventionally trained medical providers and their patients can proactively discuss the use or avoidance of alternative therapies. This strategy involves a formal discussion of patients' preferences and expectations, the maintenance of symptom diaries, and follow-up visits to monitor for potentially harmful situations. In the absence of professional medical and legal guidelines, the proposed management plan emphasizes patient safety, the need for documentation in the patient record, and the importance of shared decision making.


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Figure 1.
Proposed process for managing alternative therapy.

* = assumes that medical evaluation has been completed and conventional options have been offered.

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Figure 2.
State licensure of alternative medicine practitioners.

Asterisks indicate state licensure. The absence of state licensure does not necessarily imply the absence of state or local regulatory authority. For additional information, contact Federation of State Medical Licensing, 400 Fuller Wiser Road, Suite 300, Euless, TX 76039; phone 817-868-4000; e-mail http://FSMB.org. See Appendix 2 for information on organizations for each individual therapy.

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