Out OF Touch By Design

It is estimated that more than 90% of adults experience at least one headache each year. Although the majority of those adults do not seek medical attention for this problem, headache is one of the top reasons for people to seek outpatient medical care.( J Am Board Fam Med November-December 2009 vol. 22 no. 6 633-637)

            The US National Health Interview Survey of over 23,000 individuals reported headache as one of the most common conditions. The government study went on to find that of those headache sufferers  approximately one half of patients with headache reported use of at least 1 Complementary  and Alternative medicine (CAM) therapy. Another survey of headache patients attending a specialty neurology clinic reported CAM use in over 80% of respondents.

            There were 3 categories of CAM therapies most often utilized: biological or herbal agents, systems of care (eg, Ayurvedic or Chinese medicine), and manipulative therapies. Feverfew and coenzyme Q10 were the herbal agents and supplements reported most commonly used. Chiropractic care and massage were the main modalities reported.   A recent critical literature review of 12 studies concluded that a large number of headache patients were satisfied with CAM treatment, with rates ranging from 40% of migraineurs to 60% of those with stress headaches. The majority of these patients reported that they obtained information about the alternative modalities from relatives or friends. Significantly, 80% of headache patients who used CAM reported that their doctor or nurse had never initiated a discussion about CAM use, and in one half of the cases the medical provider considered their CAM use to be irrelevant to their medical care... And therein  lies the problem. An inability for the medical provider to appreciate that some other therapy may even be relevant to their patient's health! Is this lack of orientation serendipitous, or by design?

            Although there are hundreds of studies documenting the efficacy of alternative therapies in dealing with a wide variety of conditions, the money saved by their utilization,  and the low risk of side effects to patients, they are not deemed relevant by the very people who are assigned to be the first contact provider and gatekeeper (main referral source) for the system. Chiropractic, in particular still suffers discriminatory practices both from the medical insurance and the medical community. This even though it is the second largest healthcare alternative in The  U.S.; with hundreds of studies published that demonstrate the positive effects of chiropractic, some even published in renowned medical journals.  Ironically, in this very medical article that I am reviewing, Chiropractic was left out of the Discussion and Definitions portion of CAM in the article. Each CAM therapy mentioned in the study was defined and discussed for its merits, with the exception of Chiropractic. This while the studies included in the article  all stated that chiropractic was the major CAM utilized with high patient satisfaction. Editorial oversight, or design?

            Among health professionals selectively ignoring the existence of viable alternatives for your patients' wellbeing has long been considered to be unconscionable and unethical.