Moshe Frenkel

How Should Complementary Practitioners and Physicians Communicate? A Cross-Sectional Study from Israel

Objectives: The extensive use of complementary and alternative medicine for patients can complicate dialogue between physicians and complementary and alternative medicine practitioners, but not much data have been collected on the expectations and attitudes of physicians and complementary and alternative medicine practitioners concerning their communication and collaboration. In this study, we compared the results of a cross-sectional survey of both groups to elucidate the attitudes and expectations regarding communication and collaboration. Methods: Questionnaires were mailed electronically or through the mail to 2532 primary care physicians and 450 complementary and alternative medicine practitioners employed by Clalit Health Services, the largest health maintenance organization in Israel. Results: Questionnaires were returned by 333 physicians (response rate of 13%) and 241 practitioners (response rate of 54%). According to our results, the majority of both groups expressed an interest in clinical practice collaboration (69% and 77% of physicians and practitioners, respectively; P = .043); preferred using a medical letter to communicate with each other; and expected to consult with each other about mutual patients to formulate treatment plans. However, the practitioners were more interested than the physicians in collaborative scientific research (15% vs 42%, respectively; P < .0001) and collaborative medical education (2% vs 27%, respectively; P < .0001). The physicians also supported a physician-guided model of teamwork in clinical practice, whereas the practitioners supported a more collaborative model. Conclusions: Educational programs for primary care physicians and complementary and alternative medicine practitioners should focus on aspects of communication between the groups and practical methods for writing referral or medical letters.

Acupuncture for Treatment of Uncontrolled Pain in Cancer Patients: A Pragmatic Pilot Study

Purpose. Pain control is an ongoing challenge in the oncology setting. Prior to implementing a large randomized trial at our institution, we investigated the feasibility, safety, and initial efficacy of acupuncture for uncontrolled pain among cancer patients. Hypotheses. Our hypotheses were that the acupuncture treatments provided would be (a) feasible, (b) safe, and (c) a beneficial adjunct to pain management. Study Design. This was a single arm, nonrandomized pragmatic pilot study. Methods. Participants experiencing pain ≥4 on a 0 to 10 numeric rating scale received a maximum of 10 treatments on an individualized basis. Recruitment, attrition, compliance, and adverse events (AEs) were assessed. Pain (Brief Pain Inventory–Short Form), quality of life (MD Anderson Symptom Inventory [MDASI]), and patient satisfaction were assessed at baseline and at the end of treatment. Results. Of 115 patients screened, 52 (45%) were eligible and agreed to participate. Eleven (21%) were lost to follow-up, leaving 41 who completed all study procedures. No AEs were reported. Mean pain severity was 6.0 ± 1.3 at baseline and 3.8 ± 2.0 at follow-up (P < .0001). Pain interference was 6.2 ± 2.3 at baseline and 4.3 ± 2.8 at follow-up (P < .0011). On the MDASI, the mean symptom severity was 4.6 ± 1.8 at baseline and 3.2 ± 1.9 at follow-up (P < .0001), and mean symptom interference was 5.8 ± 2.4 at baseline and 4.1 ± 2.9 at follow-up (P < .002). Prescribed pain medications decreased across the course of the study. Patient satisfaction was high: 87% reported that their expectations were met “very well” or “extremely well”; 90% said they were likely to participate again; 95% said they were likely to recommend acupuncture to others; and 90% reported they found the service to be “useful” or “very useful.” Conclusions. Acupuncture was feasible, safe, and a helpful treatment adjunct for cancer patients experiencing uncontrolled pain in this study. Randomized placebo-controlled trials are needed to confirm these results.

Teaching complementary medicine at an academic oncology department

Background. The increased use of complementary and alternative medicine (CAM) by patients with cancer is a significant phenomenon in cancer care and suggests the need for increased knowledge by clinicians of these therapies. Methods. Aiming at bridging the gap in knowledge of the philosophy and practice of major CAM modalities in cancer care, an elective course was offered to physicians and nurses in a large academic center. Results. The course also aimed at providing the tools necessary to establish open and trusting clinician-patient dialogue regarding CAM. Conclusions. Exposure to the course was successful in improving knowledge and attitudes.

Complementary and alternative medicine.

The objective of medicine is to address people’s unavoidable needs for emotional and physical healing. The discipline has evolved over millennia by drawing on the religious beliefs and social structures of numerous indigenous peoples, by exploiting natural products in their environments, and more recently by developing and validating therapeutic and preventive approaches using the scientific method. Public health and medical practices have now advanced to a point at which people can anticipate—and even feel entitled to—lives that are longer and of better quality than ever before in human history. Yet despite the pervasiveness, power, and promise of contemporary medical science, large segments of humanity either cannot access its benefits or choose not to do so. More than 80 percent of people in developing nations can barely afford the most basic medical procedures, drugs, and vaccines. In the industrial nations, a surprisingly large proportion of people opt for practices and products for which proof as to their safety and efficacy is modest at best, practices that in the aggregate are known as complementary and alternative medicine (CAM) or as traditional medicine (TM). Much of this book considers the formidable challenges to advancing human health through the further dispersion of effective and economical medical practices. This chapter considers both proven and unproven but popular CAM and TM approaches and attempts to portray their current and potential place in the overall practice of medicine. With globalization, the pattern of disease in developing countries is changing. Unlike in the past, when communicable diseases dominated, now 50 percent of the health burden in developing nations is due to noncommunicable diseases, such as cardiovascular diseases, diabetes, hypertension, depression, and use of tobacco and other addictive substances. Because lifestyle, diet, obesity, lack of exercise, and stress are important contributing factors in the causation of these noncommunicable diseases, CAM and TM approaches to these factors in particular will be increasingly important for the development of future health care strategies for the developing world.