Why Patients Choose Alternative Medicine

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There is no shortage of non-prescription remedies for all varieties of ailments.  Millions of patients are swallowing zillions of potions to ease their suffering or to prevent disease.  Indeed, doctors need to specifically ask their patients about unorthodox or alternative treatments, as patients may not volunteer this information.  Many of these treatments are untested or even disproven, but they remain popular with the public.  As a gastroenterologist, I am queried from time to time on colonic hydrotherapy, a cleansing procedure that largely cleanses clients of their funds. 

If a patient discloses to his doctor that he is benefiting from an unconventional treatment, how should the physician respond if there is no scientific basis for medical efficacy?

• Chastise the patient for his irresponsible experimentation with an unproven agent.
• Reproach the patient for pursuing a treatment without involving the physician in a treatment discussion.
• Compliment the patient for advocating for his own health.
• Insist that the product be discontinued and that the patient begin a new medicine supported by medical evidence.
• Celebrate the patient’s success and consider recommending the treatment to other patients with similar conditions.
• Verify that the patient’s treatment is safe and won’t interact with other medications.
• Advise the patient that he should seek care elsewhere.

My inclination is to support any treatment that benefits the patient, even when the treatment makes no scientific sense, provided there are no safety concerns. Whether the actual benefit is either real or perceived does not change my view.  If a patient tells me that he is better, then he is better.  The reason that most of these patients pursue alternative approaches is that the conventional treatments their doctors are offering are inadequate.  It is quite understandable that suffering patients would search beyond the realm of evidence-based medicine for a promise of relief. And the marketing of unproven over-the-counter remedies is ubiquitous and highly effective. In an illustrative demonstration, spend a few minutes with your search engine to review the very long list of diseases and symptoms that probiotics claim to alleviate.

Sometimes an alternative route makes sense.

Conventionally trained physicians like me must admit that every day we make treatment recommendations that have no firm medical scientific support. Wouldn’t it be arrogant for us to criticize a practice that we ourselves engage in?  For example, gastroenterologists have been recommending fiber supplements for decades to patients suffering from irritable bowel syndrome.  Do some of them feel better after packing themselves full of fiber?  Definitely.  Is there strong evidence supporting this practice?  Not exactly.

My point is that none of us has all the answers or even most of them.  Sometimes, the patient is right or just lucky with an unconventional approach.  Why would we talk a patient out of anything that is making him or her feel better?