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Back To Vidyya Don't Ask, Don't Tell Policy Of A Different Kind

Patients Withhold Information Regarding Alternative Medicines From Their Physicians

A higher percentage of cancer patients than previously imagined are taking alternative medicines in conjunction with their conventional treatments. The problem, according to ABC News health reporter, Robin Eisner, and the Journal of Clinical Oncology, is that the patients are not discussing their use of alternative medications with their physicians, and their physicians aren't asking any questions either. The result is an odd, unspoken, don't ask, don't tell policy that may result in patients getting hurt.

In a small, single-center survey, 69 percent of 453 cancer patients going to outpatient facilities at the University of Texas M.D. Anderson Cancer Center revealed they were using alternative treatments. The most popular treatments included vitamins and herbs, essiac tea and mistletoe. The majority of those interviewed were also undergoing chemotherapy and radiation. A full two-thirds of the patients believed the herbal medications would improve their quality of life while one third believed the medications could cure them.

Of the patients taking alternative medicines, 60 percent said they had not discussed the use of the therapies with their clinicians. The patients also expressed a desire for their physicians to give them information on the alternative therapies.

An example of the harm that can be done by the ingestion of unknown herbals is illustrated by bleeding problems caused by large doses of vitamin E and gingko biloba-- which can cause a problem for someone undergoing surgery. Also, a very common medication, essiac tea, (one of the most common herbal mixtures found to be used by the cancer patients) contains soy, ginseng and tonic with red clover, which have estrogen-stimulating effects that might hurt women who have breast cancers that grow in response to the hormone. Perhaps the most important issue is that the alternative drugs might be affecting clinical trials of cancer treatments, skewing results without doctors being aware of it.

Physicians who are not in the routine of asking their patients about their use of alternative therapies shouldn't feel too bad about it. Physicians at the MD Anderson Cancer Center do not routinely ask patients about the therapies either. Patients don't ask and physicians don't tell because the compounds are poorly studied and there is a lack of evidence to support or refute their use. Doctors can educate themselves about the alternative medications and should feel comfortable telling patients that there is a limited amount of information that's available about these substances. Patients, with the understanding that certain medications can cause harm, may change their behavior, even if they never ask or tell.

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Editor: Susan K. Boyer, RN
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