Up to 42% of people who use this medicine don’t tell their doctors

A growing number of Americans are using complementary and alternative medicine (CAM), but many don’t disclose this information to their doctors—a concerning finding, given the potential for adverse drug interactions.

In one analysis of data from the 2012 National Health Interview Survey (NHIS), 42.3% of eligible respondents who reported using CAM did not disclose their most used CAM modality to their primary care physicians.

“Not telling primary care providers about using CAM can be dangerous, especially if the type of CAM being used creates adverse interactions with any medical treatments that a patient might be undergoing concurrently,” said lead author Judy Jou, PhD candidate, Division of Health Policy and Management, the School of Public Health, University of Minnesota, Minneapolis, MN.

In another analysis of data from the 2012 NHIS, other researchers found that about one-third of patients with cancer (29.3%) did not disclose their CAM use to their physicians.  

Lead author Nina N. Sanford, MD, assistant professor, Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, explained how this could bode ill for patients and providers alike in an interview with The ASCO Post:

“In general, supplements are not approved by the US Food and Drug Administration, so a lot of companies make claims that are not supported by robust research. A concern is that patients could be taking supplements instead of what is prescribed, thinking the supplement could either cure their cancer or prevent it from coming back. If that happens in a survivorship setting, it is possible that they may not follow up as recommended.”

So, why are so many Americans withholding this important information from their healthcare providers? Let’s delve a little deeper into the subject, starting with what exactly CAM is.

What is CAM?

According to the NIH, “CAM is a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine. Complementary medicine is used together with conventional medicine, and alternative medicine is used in place of conventional medicine.”

CAM therapies can range from the use of Ayurvedic medicine and acupuncture to yoga and diet-based therapies like the Atkins diet. Even prayer (for your health or on behalf of another) is considered to be a CAM modality.

Two modalities that have seen significant growth in recent years are yoga and meditation. According to data from the 2017 NHIS, which focused on complementary practices not included in other large national surveys, US adult use of yoga increased from 9.5% in 2012 to 14.3% in 2017, while meditation rose threefold, from 4.1% in 2012 to 14.2% in 2017.

Other popular, common complementary health approaches include the use of nonvitamin/nonmineral dietary supplements (eg, fish oil), deep-breathing exercises, chiropractic manipulation, and massage therapy.

Why do people turn to CAM?

Many adults use CAM for a wide range of health conditions and diseases, especially musculoskeletal pain relief. Indeed, among the health issues for which CAM is most frequently used, back pain comes in first place, according to the latest government data. Other leading health conditions for which CAM is used include joint pain, arthritis, neck pain, and anxiety.

People have also reported using CAM for the following reasons:

·         Belief that it would help them when combined with conventional medical treatments

·         Belief that conventional medical treatments would not help them with their health problems

·         Simple interest in trying it out

·         Recommendation by a conventional medical professional

·         High cost of conventional medicine

Why don’t patients tell their doctors about their CAM use? 

In the study led by Jou, nondisclosure of CAM use was most common among those using yoga (64.7%) and meditation (64.0%), and least common among those using herbs and/or supplements (24.9%) and acupuncture (35.5%). 

The most common reasons for patients not disclosing their CAM included physicians not asking about CAM (57.0%) and respondents believing that physicians did not need to know about their CAM use (46.2%).

Echoing these findings were those from Dr. Sanford’s study, in which nondisclosure of CAM use was greater among those using spiritual and mindfulness meditation (58.2%) and lower among those using herbal supplements (11.8%).

Furthermore, similar to Jou’s study findings, the two most commonly reported reasons why patients withheld information about their CAM use from their physicians were because physicians did not ask (57.4%) and patients did not think their physicians needed to know (47.4%).

Implications

Although nondisclosure of CAM use was lower among those using herbs and/or supplements, it is still an area of concern, with up to one-quarter of people failing to inform their healthcare providers. As MDLinx previously reported, certain supplements can adversely interact with prescription medications. St. John’s wort, for example, may decrease the efficacy of various other drug types, including certain antidepressants, immunosuppressants, statins, anti-HIV drugs, and chemotherapeutic agents.

“Herbal supplements can be quite harmful. They could potentially interfere with how some medications are metabolized and may interfere with the efficacy of chemotherapy,” Dr. Sanford told The ASCO Post. She specifically called out St. John’s wort, noting that it “is a commonly used supplement and interferes with how certain drugs are metabolized throughout the body. So, it could interfere with the levels of chemotherapy in the body.”

However, Jou notes that it’s not just potential adverse drug interactions that physicians and patients need to worry about. Other types of CAM approaches may affect other health conditions. Someone already receiving treatment for back pain from a chiropractor, for example, may not require additional treatment from their primary care physician. More importantly, physicians run the risk of patients using undisclosed CAM instead of what they’ve been prescribed. Doing so can not only drive up patient and practice costs through unnecessary testing but negatively impact patient outcomes as well.

“Encouraging discussion of CAM use can help prevent medical complications that may arise from simultaneous use of conventional and CAM treatments,” Jou said.

What can physicians do?

Nondisclosure of CAM use may not only harm patients but also affect physicians by wasting valuable time and resources that could otherwise be used to help another patient or reduce administrative burdens.   

“Our findings suggest that nondisclosure is most often due to lack of provider-initiated conversation about CAM, rather than patients’ concerns about providers discouraging the use of CAM,” Jou said.

Dr. Sanford agreed, offering a two-step solution: “[T]he first step would be to better educate ourselves about complementary and alternative medicines and to make sure we have an improved understanding of what the different modalities are. The second step would be simply to broach the topic with patients, take the initiative to ask about any alternative therapies they may be using or interested in using, and actively engage patients in the discussion.”