While pressure mounts to get doctors to follow “best practices,” getting patients to follow them will be even more difficult. A 2007 Harris Interactive poll found that 43% of Americans say they are concerned about overly aggressive treatment. And 44% have ignored a doctor’s advice or sought a second opinion because they felt a doctor’s treatment was unnecessary or too aggressive. More than a quarter left a prescription unfilled because they thought it was not needed, and 13% failed to get a recommended diagnostic test. Among respondents who chose not to follow a doctor’s advice, 89% said that nothing negative happened as a result (Wall St J 3/15/07).
More than 35% of Americans report using some form of alternative medicine, according to a survey conducted by Thomson Medstat (www.Thomson.com 2/17/07). Nearly half (49.9%) of all households with incomes greater than $100,000/yr, and 49.6% of those with postgraduate degrees used alternative medicine. Utilization dropped to 18% among those without a high school diploma.
Herbal supplements and massage/chiropractic care were the most common modalities used, followed by mind/body practices, energy therapies, and naturopathy. About two-thirds of respondents said that their regular physicians were aware of their use of these practices.
Almost half of the physicians surveyed at three U.S. medical schools admit to prescribing placebos, defined as remedies they expected to have no physical effect, but only 4% told the patients that the prescription was a placebo. This included antibiotics for colds and ibuprofen, as well as vitamins and herbal supplements. Doctors may give a prescription to “boost patient morale,” although the practice is widely unacknowledged (Tom Randall, Bloomberg News 1/4/08).
Some medical boards are issuing guidelines about the use of “alternative,” “complementary,” or “integrative” medicine. Believing that this signals a significant change, the Pima County (Arizona) Medical Society has resumed meetings of a committee on such practices, which were suspended out of fear that physicians could be considered guilty of unprofessional conduct if they listened to physicians explaining their use of nonstandard treatments and did not report them to the medical board.
The definition of “alternative” is treacherous, as it includes practices that may be based on Western scientific concepts but are not generally “made available.” Moreover, it is possible that medical boards could employ a double standard in evaluating evidence for efficacy and safety of practices deemed “alternative,” cautioned AAPS Executive Director Jane Orient, M.D.