The full content of Annals is available to subscribers

Subscribe/Learn More  >
Academia and the Profession |

Ethical Considerations of Complementary and Alternative Medical Therapies in Conventional Medical Settings

Karen E. Adams, MD; Michael H. Cohen, JD, MBA, MFA; David Eisenberg, MD; and Albert R. Jonsen, PhD
[+] Article, Author, and Disclosure Information

From Oregon Health and Science University, Portland, Oregon; Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts; and University of Washington Medical Center, Seattle, Washington.

Acknowledgments: The authors thank the two patients who allowed us to share their stories, Debbie Mosley for invaluable technical assistance, and Martin Donohoe for critical comments.

Grant Support: By unrestricted educational grants from the American Specialty Health Plans, San Diego, California; the Medtronic Foundation, Minneapolis, Minnesota; and the Friends of Beth Israel Deaconess Medical Center, Boston, Massachusetts.

Requests for Single Reprints: Karen E. Adams, MD, Department of Obstetrics and Gynecology UHNSO, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239; e-mail, adamsk@ohsu.edu.

Current Author Addresses: Dr. Adams: Department of Obstetrics and Gynecology UHNSO, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239.

Mr. Cohen and Dr. Eisenberg: Center for Alternative Medicine Research and Education, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215

Dr. Jonsen: University of Washington (Emeritus), 1333 Jones Street, San Francisco, CA 94109.

Ann Intern Med. 2002;137(8):660-664. doi:10.7326/0003-4819-137-8-200210150-00010
Text Size: A A A

Increasing use of complementary and alternative medical (CAM) therapies by patients, health care providers, and institutions has made it imperative that physicians consider their ethical obligations when recommending, tolerating, or proscribing these therapies. The authors present a risk–benefit framework that can be applied to determine the appropriateness of using CAM therapies in various clinical scenarios. The major relevant issues are the severity and acuteness of illness; the curability of the illness by conventional forms of treatment; the degree of invasiveness, associated toxicities, and side effects of the conventional treatment; the availability and quality of evidence of utility and safety of the desired CAM treatment; the level of understanding of risks and benefits of the CAM treatment combined with the patient's knowing and voluntary acceptance of those risks; and the patient's persistence of intention to use CAM therapies. Even in the absence of scientific evidence for CAM therapies, by considering these relevant issues, providers can formulate a plan that is clinically sound, ethically appropriate, and targeted to the unique circumstances of individual patients. Physicians are encouraged to remain engaged in problem-solving with their patients and to attempt to elucidate and clarify the patient's core values and beliefs when counseling about CAM therapies.







Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.