Would you consult with an ND (naturopath)?

[biogirl215]

I was reading something by a small cell lung cancer patient the other day. The pt. said they wanted to bring a naturopath on their medical "team" to consult on nutrition, complementary therapies, etc., but their oncologist flat-out refused to consult with the ND. If you were dealing with a patient who was compliant and accepting of traditional treatment, would you consult with an ND at the patient's request, especially in cases like SCLC where the "success" rate is low?

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[Doctor Bagel]

I'd consider it, especially if the patient desires it and it might improve (or help uphold) patient compliance. It would probably depend on the ND and his/her training, meaning no online degrees.

 

[PeepshowJohnny]

Hmm, it'd be a fine line to walk.

I'd probably tell the patient that in my medical opinion, naturopaths haven't got enough of an evidence based practice that I could support them being part of a treatment team. I would tell the patient that I would not mind them consulting an ND of their own, but that I'd like to know of any treatments they're prescribed so I can hopefully minimize any reactions.

Basically I want to tell them A) I don't think what they have works B) I can't stop you from consulting one on your own and C) If you do, I just want to make sure they do nothing instead of harming you.

 

[NCF145]

It's the pt.'s right to have an ND, if they want one. It is also my right to not listen to anything the ND has to say.

 

[dilated]

Define "consult". I'm certainly not going to page a ND to get their opinion on whether I should give docetaxel or not. If the patient wants to see a ND or show them their medical records, it's a free country. If they want the ND to show up at tumor board to discuss their case and determine treatment recommendations ... lollerskates.

 

[soeagerun2or]

I was reading something by a small cell lung cancer patient the other day. The pt. said they wanted to bring a naturopath on their medical "team" to consult on nutrition, complementary therapies, etc., but their oncologist flat-out refused to consult with the ND. If you were dealing with a patient who was compliant and accepting of traditional treatment, would you consult with an ND at the patient's request, especially in cases like SCLC where the "success" rate is low?

My personal opinion aside, they don't have hospital privileges in allopathic hospitals.

 

[Crixivan]

In the absence of peer-reviewed evidence to support the recommendations of someone who isn't a medical practitioner, the scope of my medical opinion would not include non-medical therapy. It's not a personal judgment about what my viewpoint is regarding natural alternatives to medicine, it's just that I have an obligation to the board that certifies me to narrow my focus to the scope of my specialty.

With that said, Western medicine today can not offer much to somebody with an oat cell carcinoma. If a patient wants to attempt to seek out non-medical treatment, I have no objection.

Aside from a potential interaction as noted above, I would tend to be supportive of a patient who seeks out the most psychologically comforting and optimistic environment possible.

 

[OncoCaP]

I was reading something by a small cell lung cancer patient the other day. The pt. said they wanted to bring a naturopath on their medical "team" to consult on nutrition, complementary therapies, etc., but their oncologist flat-out refused to consult with the ND. If you were dealing with a patient who was compliant and accepting of traditional treatment, would you consult with an ND at the patient's request, especially in cases like SCLC where the "success" rate is low?

Sure, to whatever extent allowed by law and other rules.

 

[sgglaze]

In this case I think the best course of action is to mock the patient THEN refuse to consult with the ND.

 

[biogirl215]

Define "consult". I'm certainly not going to page a ND to get their opinion on whether I should give docetaxel or not. If the patient wants to see a ND or show them their medical records, it's a free country. If they want the ND to show up at tumor board to discuss their case and determine treatment recommendations

The second one: the patient wanted to add the ND to the treatment team (consisting of many MDs from a variety of specialities)... Won't this actually be better when it comes to preventing adverse interactions than just having the patient go to the MD without the attending's knowledge?

In this case I think the best course of action is to mock the patient THEN refuse to consult with the ND.

Ouch! I hope you wouldn't do that to a cancer patient (the mocking, I mean)...

 

[dilated]

The second one: the patient wanted to add the ND to the treatment team (consisting of many MDs from a variety of specialities)... Won't this actually be better when it comes to preventing adverse interactions than just having the patient go to the MD without the attending's knowledge?

In theory, maybe. In practice, this seems pointless. What is their presence necessary for? Are they going to critique the chemo regimen, the path read or the radiotherapy plan? "While I like the PTV contours on your radiotherapy plan, I suggest you drop the D90 to 40Gy because the St. John's Wort I'm giving will take care of the rest."

I have no idea what their role would possibly be beyond "be aware I am giving this person X in case something may interact with it". The patient could just make a list of what the ND is giving them and the problem is solved.

 

[PeepshowJohnny]

In theory, maybe. In practice, this seems pointless. What is their presence necessary for? Are they going to critique the chemo regimen, the path read or the radiotherapy plan? "While I like the PTV contours on your radiotherapy plan, I suggest you drop the D90 to 40Gy because the St. John's Wort I'm giving will take care of the rest."

I have no idea what their role would possibly be beyond "be aware I am giving this person X in case something may interact with it". The patient could just make a list of what the ND is giving them and the problem is solved.

I agree, however patients aren't aware that their ND is not going to care what genetic markers their tumor has. It may be a simple gesture of desperation to try to get every last chance. I think both the oncologist and ND would both gently tell the patient that the strategy wouldn't be fruitful.

I think the first is most likely and frequent.

 

[OncoCaP]

I would rather know what is going on than have the patient taking a bunch of stuff I wasn't aware of. I would not trust the patient to be able to explain what is going on. Looks like these cats are doing stuff IV. This goes waaayyy beyond St. John's Wort. I wouldn't want to miss my chance to recommend something that didn't interfere with my treatment plan.

http://www.behealthyamerica.com/envitasite/cancer.cfm

 

[Law2Doc]

I was reading something by a small cell lung cancer patient the other day. The pt. said they wanted to bring a naturopath on their medical "team" to consult on nutrition, complementary therapies, etc., but their oncologist flat-out refused to consult with the ND. If you were dealing with a patient who was compliant and accepting of traditional treatment, would you consult with an ND at the patient's request, especially in cases like SCLC where the "success" rate is low?

There will be patients where there isn't much you can do for a patient based on evidence based medicine, and all you can offer is palliative care. If at that point (and only at that point) the patient wants to go out and find someone who uses something non-evidence based, with some anecdotal but unproven claim of success, I don't think many doctors would object. But you wouldn't add them to the treatment team or consult with them in most cases. You'd simply be telling the patient, "there is no cure", but you are free to do what you'd like. You have no objections to that, but can't in good faith recommend something that hasn't been borne out by objective tests. As others have mentioned, you would want to be given a list of the substances a patient is given by the naturopath, to try and minimize side effects as well as interactions with the meds you have put the patient on; there are always side effects, regardless of whether something is herbal or chemical.

 

[devildoc2]

I would rather know what is going on than have the patient taking a bunch of stuff I wasn't aware of. I would not trust the patient to be able to explain what is going on. Looks like these cats are doing stuff IV. This goes waaayyy beyond St. John's Wort. I wouldn't want to miss my chance to recommend something that didn't interfere with my treatment plan.

http://www.behealthyamerica.com/envitasite/cancer.cfm

Wow I didnt know what these naturopaths are up to. Intravenous ozone injections? WTH is that?

As for team rounds, the only way I would allow that is if the ND brings me evidence-based papers every day to justify their recommendations. No papers = no rounds. I think that would clear this up very quickly.

 

[devildoc2]

I would rather know what is going on than have the patient taking a bunch of stuff I wasn't aware of. I would not trust the patient to be able to explain what is going on. Looks like these cats are doing stuff IV. This goes waaayyy beyond St. John's Wort. I wouldn't want to miss my chance to recommend something that didn't interfere with my treatment plan.

http://www.behealthyamerica.com/envitasite/cancer.cfm

So what if the ND recommends something thats directly contradictory to proven evidence-based medicine? Are you going to call them out on it or pull this wimpy "well it might work we dont know for sure" crap?

Far too many of today's med students are liberal pansies who are too afraid to call out these "alternative" practitioners because they dont want to be seen as hostile, even though they are directly compromising patient care.

 

[Law2Doc]

So what if the ND recommends something thats directly contradictory to proven evidence-based medicine? Are you going to call them out on it or pull this wimpy "well it might work we dont know for sure" crap?

Far too many of today's med students are liberal pansies who are too afraid to call out these "alternative" practitioners because they dont want to be seen as hostile, even though they are directly compromising patient care.

If the patient is dead either way, you don't need to stand in the way of something they want to try. You just don't want to endorse it and give false hope. But hey, if a dude has an inoperable brain tumor and a 6 month prognosis and thinks some herbal soup might help, let him try, and feel like he is fighting to the end. So in that case, I don't have a problem taking the "wimpy" approach. If however, there are real and tested evidence based treatments for the patient's particular ailment, even if the odds are not great, I think you stay the hard line and tell the patient to stick with the real chances promised by medicine rather than the illusory hope promised by something yet untested.

 

[Doctor J]

Far too many of today's med students are liberal pansies who are too afraid to call out these "alternative" practitioners because they dont want to be seen as hostile, even though they are directly compromising patient care.

"Liberal"? Heh.

I'd never consult with an ND. For that matter I'd never consult with a DC, either. Unless some mind-bending and well done primary research shows up and changes the whole paradigm, quackery is quackery.


<--- a liberal who is far more skeptical of alternative therapies than any hard-core conservative he's ever met.

 

[Tired Pigeon]

If the patient is dead either way, you don't need to stand in the way of something they want to try. You just don't want to endorse it and give false hope. But hey, if a dude has an inoperable brain tumor and a 6 month prognosis and thinks some herbal soup might help, let him try, and feel like he is fighting to the end. So in that case, I don't have a problem taking the "wimpy" approach. If however, there are real and tested evidence based treatments for the patient's particular ailment, even if the odds are not great, I think you stay the hard line and tell the patient to stick with the real chances promised by medicine rather than the illusory hope promised by something yet untested.

Agree that this can be an acceptable approach when there are truly no other options, but also agree that you don't want to raise false hopes. Also, I've seen desperate patients get conned out of a lot of $$ by some promoters of "alternative" therapies; this really bugs me.

 

[Doctor Bagel]

"Liberal"? Heh.

I'd never consult with an ND. For that matter I'd never consult with a DC, either. Unless some mind-bending and well done primary research shows up and changes the whole paradigm, quackery is quackery.


<--- a liberal who is far more skeptical of alternative therapies than any hard-core conservative he's ever met.

I can see that. I know a lot of conservatives in my red state who are into prayer therapy, and if you check out the religious cable channels, you'll find a lot of "nutrition experts" promoting all sorts of weird diets. I don't think being interested in alternative health care shows a leftward political bias.

 

[Tired Pigeon]

I can see that. I know a lot of conservatives in my red state who are into prayer therapy, and if you check out the religious cable channels, you'll find a lot of "nutrition experts" promoting all sorts of weird diets. I don't think being interested in alternative health care shows a leftward political bias.

Our school lists 'prayer' as an alternative therapy modality. Same everywhere?

 

[DragonWell]

I think this depends very much on what part of the country you are in. In states with strict and well established licensure requirements for NDs, such as Washington, Oregon, New England, etc. I would expect that physicians are much more likely to have an understanding of what NDs can offer to their patients.

I studied Naturopathic Medicine for a time at Bastyr University, and we had a fair amount of contact with students at UW. I'm sure that those students would be much more likely to refer to an ND in the future, having had an opportunity to get to know more about how NDs practice.

While I'm sure there are examples of it happening, based on my experience, the arguments about NDs getting in the way of allopathic treatments are more fuel for the fire than reflective of reality. I have a hard time believing that any responsible, licensed ND would counsel their patient to ignore the advice of their oncologist and discontinue any potentially life-saving treatment.

The majority of the co-management I've seen revolves around optimizing the patient's health and immune status, while attempting to minimize the damage caused by conventional treatments. Bear in mind that NDs receive as much didactic pharmacology and pathology training as an MD or DO, so while they don't use most drugs, they're far from clueless about them.

 

[MossPoh]

I lived with a naturpath for about 6 months in Germany. She constantly studied her trade, but she was kind of a nut job. I have no doubt that the meditative properties and mental gains help. It is the supplements and what not that I'm sketchy about. Most people begin to rely on that because they have lost their faith in traditional medicine through bad experiences. they view it as a last resort. It is usually those people with chronic pain and sickness. I wouldn't say I'd "refuse" to work with them, but I'd keep them on a short leash when it came to treatment. I would not appreciate them undermining my decisions without significant empirical evidence backing them. If it is to supplement the care then I really don't see the harm. The patient's state of mind is important to me too, and if they feel it gets them better along WITH traditional treatments, then I don't mind.

 

[MossPoh]

Our school lists 'prayer' as an alternative therapy modality. Same everywhere?

It is considered alternative therapy. Goes with that whole mind over matter thing. Some consider it a form of meditation from what I've heard.

 

[Hurricane95]

No.

 

[BlackSails]

Wow I didnt know what these naturopaths are up to. Intravenous ozone injections? WTH is that?

To think of all my lovely double bonds being oxidized by this pernicious 1,3 dipole, and converted into ketones/carboxylic acids!


Ozone is not good for you.

 

[Monica Lewinsky]

Obviously, we want to know what the ND is telling the patient to do, but I'm not going to waste my time bringing it into the treatment plan unless it affects the treatments I'm giving or if there is some truly evidence-based methods behind the NDs treatments. The patient is free to take Echinacea and herbs if they think it'll cure the cancer, but I will tell the patient if the treatment they are receiving is in anyway harmful or counteracting to the treatment I am giving.

 

[NSAIDAllergy]

The patient deserves the best that we can provide.

Naturopaths do not provide anything other than doubt without backing. Why allow them on the same stage and give them the illusion of legitimacy?

just my two $0.01s

 

[Tired]

While we're at it, I think we should also consult wizards and fairies to assist with managing this complex patient.

 

[funkless]

I would never consult an herbalist (or whatever they're calling themselves), but I wouldn't advise against it if the patient is adamant. As I see it, a fool and his money were lucky enough to get together in the first place. I would want to know what they're taking, however.

Me, I chose radiology for a reason. Enjoy fighting off these quacks, guys.

 

[Blondbondgirl]

Let's talk about the placebo effect.
Will it cure cancer? No.
Is it often effective and synergistic with other things we do to help our patients and improve our relationship with them? yes.


P.S.- "everything in moderation"; evidence-based medicine has its limitations, we seem to forget that we ourselves defined the standards for research, and that 1 p-value cannot alter reality!

just some food for thought...

 

[Green Chimneys]

I would definitely advise against it. I could not abandon a patient regardless of their decision on the matter, but I could sure make it clear that I thought it was a bad idea. I notice many of you would be okay with this scenario as long as you know what treatments the ND is prescribing so you can be aware of any interactions. In actuality though, would knowing this make any difference? We have received no training in this sort of quackery and the published research is sparse at best. Most doctors would have no idea how to alter a chemo regimen running concurrent with a number of naturopathic treatments. Sure there are some that we know about very well, but there are far more that we don't. It's one thing to tacitly approve benign alternative treatments that will not harm your patient. It's another altogether to allow another "doctor" to put your patient at risk beyond the scope of scientific knowledge in the name of alternative medicine.

 

[rickthetwinkie]

Far too many of today's med students are liberal pansies who are too afraid to call out these "alternative" practitioners because they dont want to be seen as hostile, even though they are directly compromising patient care.

This is not a liberal notion. I'm about as far left as you can go, but I call bs when there's bs.

 

[funkless]

Let's talk about the placebo effect.

No, let's not. How could it be ethical to sell someone a placebo???

Will it cure cancer? No.

So, would you agree that cancer patients have no business visiting naturopaths?

Is it often effective and synergistic with other things we do to help our patients and improve our relationship with them? yes.

I'm reasonably sure that the correct answer is "we don't know."

P.S.- "everything in moderation";

Why, yes! Strychnine in moderation! Cyanide in moderation! Everything in moderation!

evidence-based medicine has its limitations, we seem to forget that we ourselves defined the standards for research, and that 1 p-value cannot alter reality!

At least we know the limitations of evidence-based medicine. By definition, it's previously charted territory. It's not a matter of baseless experimentation and dabbling with unproven interventions, praying for "synergy."

 

[DrBubbles]

I'm honestly really surprised at the anti-ND sentiment here. No, they don't take the same pharmacology we do. But they still study medicine for four years. If the patient wants to consult an ND, and she/he can afford it, I'm not seeing how working with the ND to ensure the treatments you are both prescribing is harmful, provided they are unlikely to lead to any adverse effects, and that all treatments will be monitored. I think one area where NDs are actually stronger than MDs is nutrition, and when over 50% of hypertension, obesity, and cardiac events are attributed to activities of daily living, if the allopath is willing to prescribe a statin, then maybe the naturopath can help them balance out their vitamin and mineral intake, since difference meds cause a depletion in different nutrients. Straight-out homeopaths without the ND degree I would be wary of, but I've met some pretty competent NDs, and I'd be happy to work with them any time. What I would be afraid of is if the patient decided to involve the ND, and I wasn't in communication with them--that's when we've got more problems.

 

[facetguy]

Can someone remind me again: Since when does "evidence-based medicine" have the ability to cure everything? And since when does the typical MD have more than a superficial knowledge of nutrition? You'll learn (if you are honest enough with yourself) once you've been around the block a time or two that medicine cannot treat every ill, and that, believe it or not, there are other practitioners out there who will be more successful in helping some cases than you will be. Are there also plenty of quacks out there? Of course, but you will need to remain more open to "alternative" treatments, particularly as this segment of healthcare grows.

And, as DrBubbles suggests, we already know what is best for many patients with so-called 'lifestyle diseases', yet medicine still sucks at winning these battles, despite the mountain of "evidence" that points away from pharmaceutical reliance and toward lifestyle changes.

This is by no means a knock against medicine. It is a dose of reality to those inexperienced enough to still think they have all the answers.

 

[deleted77919]

And, as DrBubbles suggests, we already know what is best for many patients with so-called 'lifestyle diseases', yet medicine still sucks at winning these battles, despite the mountain of "evidence" that points away from pharmaceutical reliance and toward lifestyle changes.

Diet and lifestyle changes for high cholesterol, HTN, diabetes, etc is evidence based medicine. Not recommending these changes would be considered violating the standard of care. Unfortunately, it's hard to get patients to be compliant with statins; it's even tougher to get them to be compliant on lifestyle/dietary changes. I guarantee that a study comparing lifestyle and statins with each patient in the study grouped by "intention to treat" groups, the statins will win. Why? The lifestyle camp just won't be as compliant as the people who take pills. Pts should always be counseled about lifestyle, but in the real world you need to offer alternatives for those who won't or can't be compliant.

The problem with "alternative" medicine is that basically by definition it is not evidence based. If it is evidence based then it isn't alternative anymore. Is it possible that a plant has some beneficial effects, yes, of course. But is eating foxglove extract with any unknown dose of active ingredient and unknown contaminants better than taking digitalis? Anything that's "natural" that has real beneficial side effects can be isolated, purified, and carefully dosed based on real evidence, not anecdotal observation.

 

[facetguy]

Diet and lifestyle changes for high cholesterol, HTN, diabetes, etc is evidence based medicine. Not recommending these changes would be considered violating the standard of care. Unfortunately, it's hard to get patients to be compliant with statins; it's even tougher to get them to be compliant on lifestyle/dietary changes.

Agreed.

Pts should always be counseled about lifestyle, but in the real world you need to offer alternatives for those who won't or can't be compliant.

Agreed again. But there needs to be a better system in place that REALLY takes lifestyle changes into consideration. And I'm not saying it is the individual physician's fault, whose schedule is overbooked, whose reimbursements aren't always ideal, who just doesn't always have the time (or expertise) to thoroughly work with patients on these issues. Unfortunately, the advice given to patients is "eat better and exercise more", which isn't real effective. The fault lies with the overall healthcare system in the U.S. Prevention is the key, and no one would disagree with that. There just isn't any incentive built into the current system to encourage more aggressive pursuit of true prevention of these many diseases. That is a primary reason why it is said over and over that our healthcare system is broken. (Insert here the whole issue of who actually funds research, makes policies, and the motivation behind them, etc.)

The problem with "alternative" medicine is that basically by definition it is not evidence based. If it is evidence based then it isn't alternative anymore. Is it possible that a plant has some beneficial effects, yes, of course. But is eating foxglove extract with any unknown dose of active ingredient and unknown contaminants better than taking digitalis? Anything that's "natural" that has real beneficial side effects can be isolated, purified, and carefully dosed based on real evidence, not anecdotal observation.

I understand your point here. Just because something is "natural" doesn't mean it can't be harmful. This is why mainstream docs, like it or not, will need to be more open to conversation with patients about these issues. Right now, your patients are pursuing alternatives, they just aren't telling you (see Eisenberg). In an ideal world, everyone would be on the same page and working toward what is best for the patient at that moment.

 

[Green Chimneys]

Recall, Facetguy, that the topic of the thread was originally about consulting an ND regarding patient management for SCLC. Palliative care for this type of cancer does not typically involve statins and a healthy diet. There are times when I wouldn't have a problem with a patient going to an ND, and there are times when I would. In the face of combination chemotherapy, I would have a problem. In the case of moderate HTN or dyslipidemia, I would not.

In reality though, patients are unlikely to seek alternative medicine for their blood pressure or cholesterol because they feel fine and any poor outcomes will not occur until long down the line. They are much more likely to seek alternative medicine for metastatic cancer because their prognosis is poor and they are desperate. This creates a bit of a problem.

 

[167649]

would you consult with an ND at the patient's request, especially in cases like SCLC where the "success" rate is low?

Hmm, it'd be a fine line to walk.

I'd probably tell the patient that in my medical opinion, naturopaths haven't got enough of an evidence based practice that I could support them being part of a treatment team. I would tell the patient that I would not mind them consulting an ND of their own, but that I'd like to know of any treatments they're prescribed so I can hopefully minimize any reactions.

Basically I want to tell them A) I don't think what they have works B) I can't stop you from consulting one on your own and C) If you do, I just want to make sure they do nothing instead of harming you.

I agree with peepshow. I would not "endorse" or necessarily even consult with an ND, but it is also important to respect the rights and beliefs of the patient. If that is really what they feel will make them better, than I would have a discussion addressing some of the issues with that form of alt. medicine. I would express the views that I and mainstream medicine in general have towards it (mainly, that it is mostly non-evidence based). Plus I would also want to know what treatments were being done so I would know in advance any possible complications.

 

[facetguy]

Recall, Facetguy, that the topic of the thread was originally about consulting an ND regarding patient management for SCLC. Palliative care for this type of cancer does not typically involve statins and a healthy diet. There are times when I wouldn't have a problem with a patient going to an ND, and there are times when I would. In the face of combination chemotherapy, I would have a problem. In the case of moderate HTN or dyslipidemia, I would not.

In reality though, patients are unlikely to seek alternative medicine for their blood pressure or cholesterol because they feel fine and any poor outcomes will not occur until long down the line. They are much more likely to seek alternative medicine for metastatic cancer because their prognosis is poor and they are desperate. This creates a bit of a problem.

You're right...we did start to drift off course there for a bit (SCLC vs dyslipidemia et al). I can certainly appreciate your position. Complementary care for cancer patients is a very young area with a dearth of data. It is my belief that such integrative treatment will someday prove to be of value to cancer patients (beyond anecdotally), which is very different than saying cancer patients should eschew conventional cancer care in favor of alternative care. But I think we can all agree that there is LOTS of room for improvement in cancer care, despite the best efforts of many caring and dedicated oncology professionals who wake up every morning with the goal of helping as many patients as they can. We don't need to be reckless with care to keep an open mind.

 

[BlackSails]

And since when does the typical MD have more than a superficial knowledge of nutrition?

That is why hospitals usually have nutritionists available for consult.

 

[facetguy]

That is why hospitals usually have nutritionists available for consult.

The value and quality of which can vary significantly.

 

[Maxprime]

That is why hospitals usually have nutritionists available for consult.

In all seriousness - what exactly do nutritionists do? I was under the assumption that they explain things that nobody else has time to explain (i.e. is too expensive to hire for that time). I don't mean to be insulting - I'm truly curious.

 

[SltatryDduction]

I am going to have to agree with facetguy. I'm taking a course on complementary therapies, and yesterday we had a naturopath talk with us for an hour. Since they aren't certified in most states, I'm sure that their quality varies considerably, but in her practice, they have a lot of cancer patients. They are well respected by the medical community here and get a lot of referrals. She says that they NEVER offer a first line cancer treatment, but instead try to treat the entire lifestyle of the patient so they stay as balanced and healthy while on the treatment as they can. In her case, I'd absolutely do it. I think that patient compliance would increase, and it would help the patient feel that they have input into their treatment. Should they be getting herbal treatments instead of chemo? Absolutely not, but I don't see the harm in letting them work with someone else to help them feel better throughout their (hopeful) recovery, or make the rest of their care more manageable and less painful.

 

[facetguy]

I am going to have to agree with facetguy. I'm taking a course on complementary therapies, and yesterday we had a naturopath talk with us for an hour. Since they aren't certified in most states, I'm sure that their quality varies considerably, but in her practice, they have a lot of cancer patients. They are well respected by the medical community here and get a lot of referrals. She says that they NEVER offer a first line cancer treatment, but instead try to treat the entire lifestyle of the patient so they stay as balanced and healthy while on the treatment as they can. In her case, I'd absolutely do it. I think that patient compliance would increase, and it would help the patient feel that they have input into their treatment. Should they be getting herbal treatments instead of chemo? Absolutely not, but I don't see the harm in letting them work with someone else to help them feel better throughout their (hopeful) recovery, or make the rest of their care more manageable and less painful.

Well said. The world of "alternative medicine" is unfortunately unpredictable, meaning one's title doesn't mean much but rather the quality and training of the individual practitioner is what counts. This means mainstream physicians will need to proceed on a case by case basis. Yes, that's a bit of a hassle, but you'll find more and more patients requesting this kind of teamwork. And, as I mentioned earlier, other forms of non-mainstream treatments can be very helpful for many of your patients, whether you currently believe they will or not.

 

[BlackSails]

The value and quality of which can vary significantly.

As opposed to the quality of NDs.

 

[facetguy]

See above.

 

[-Goose-]

I was reading something by a small cell lung cancer patient the other day. The pt. said they wanted to bring a naturopath on their medical "team" to consult on nutrition, complementary therapies, etc., but their oncologist flat-out refused to consult with the ND. If you were dealing with a patient who was compliant and accepting of traditional treatment, would you consult with an ND at the patient's request, especially in cases like SCLC where the "success" rate is low?

I wouldn't consult with her. The patient could do whatever he/she wanted, but I wouldn't waste my time.

 

[Xerxes1729]

I would talk to the ND, just so I could size him up and figure out if he was one of the really dangerous ones who would try to discourage the patient from using real medicine. I certainly wouldn't change my treatment plan on the basis of talking to him.