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Veterinary Forum April 2007 (Vol 24, No 4)

Editor's Note: "CAM — The Big Secret No One Is Telling You"

by Marie Rosenthal

    When I was interviewing veterinarians for this month's cover story on osteoarthritis, I thought I was having déjà  vu: The comments about using complementary and alternative medicine (CAM) were so familiar after covering human medicine for 16 years.

    On one side are those who want proof, and on the other are practitioners who embrace CAM. Somewhere in the middle are veterinarians who are willing to consider CAM but would like more information about its effects.

    I can understand their position — I have mixed feelings about CAM, too. Everyone from my dad and husband to all of our dogs are taking a glucosamine supplement, but Echinacea caused an allergic reaction when I tried it. More often than not when I'm sick and miserable, I want a traditional doctor giving me a traditional treatment.

    In a 2004 report, though, the National Institutes of Health said that 36% to 60% of American adults practiced CAM, depending on one's definition of these diverse medical practices. What they consume could interact with what doctors prescribe. However, patients don't always admit their CAM use. In a study released this year, 69% of people older than 50 that are using CAM failed to mention this fact to their doctor.

    Many people believe that CAM is safer than traditional medicine because it is natural, which is not necessarily the case. Louis-Philippe de Lorimier, DVM, DACVIM (Oncology), told me that medical oncologists press patients about their CAM use, including mega doses of vitamins, because it can interfere with cancer therapy.

    Anthony Carr, DVM, DACVIM cited St. John's wort as an example of a natural product that isn't necessarily less harmful than traditional products. St John's wort is a popular herbal treatment for depression, but when combined with many other medications, including indinavir, irinotecan, cyclosporine, digoxin, warfarin and antidepressants, the combination can trigger an adverse reaction.

    Even when used alone, the possible side effects of St. John's wort include anxiety, fatigue, headache or sexual dysfunction, which doesn't sound as if it would make a depressed person feel better.

    What is a practitioner suppose to advise? It's hard to answer that question because there are so many types of CAM, and the research is variable. However, the National Center for Complementary and Alternative Medicine (NCCAM) is weighing the evidence available for certain CAMs and is funding research in areas in which data are limited. Free reports issued by NCCAM are available on the Internet (http://nccam.nih.gov/) and include reports on acupuncture, glucosamine and chiropractic.

    Whether you would consider CAM, ignore it or embrace it, you owe it to your clients to find out what they are giving to their animals. That prescription you want to write could interact with the natural product they are giving. And if you want people to confide in you, the discussion has to be nonjudgmental. Be willing to direct them to someone or someplace that you trust for more information, if they want it. But don't be shy about telling them what you think. After all, you are the expert.

    Because if you don't, I'm sure someone on the Internet will be glad to sell them a bottle of snake oil.

    NEXT: Expert describes cytauxzoonosis — an ounce of prevention best for this disease with no cure