As a cardiologist who trained in a quaternary care hospital, I am used to treating the sickest patients, such as those with large heart attacks, shock and cardiac arrest. When I go to my weekly clinic, I have to suddenly shift my focus. Much healthier people walk through the door and we spend the majority of the time discussing preventive strategies to reduce their risk of future heart events through prescription treatments and lifestyle changes.
In my clinic, I am exclusively focused on treating or preventing heart disease using a defined armamentarium of evidence-based approaches that I’ve learned over my years of training. As healthcare providers, we set a cut-off of patient conditions and respective treatments that are “doctor-worthy.” Those are health complaints that are serious enough for us to treat, and their treatments have met high thresholds of evidence to make recommendation guidelines. The reality however is that health is not merely the absence of disease, and patient priorities regarding their health are not always aligned with our recommended item list. They realize that their priorities might be “non-doctor worthy,” so they turn behind our backs to online and community resources for guidance.
If you’re a healthcare provider, the next time you review a patient’s medication list, I encourage you to look at the number of naturals, vitamins, and supplements on it. When I did this exercise myself, I found that around 90% of my patients take at least one non-prescribed item, and often several of them. I then researched the statistics and found that my patients are not far off from the general U.S. population. More than two-thirds of Americans take a vitamin, mineral or supplement. Nearly half of older Americans take vitamins and minerals. Almost 18% of adults take a natural product, including the 7.8% of Americans who take fish oil. This does not include complementary therapies such as acupuncture, massage, and mind-body practices which are used by more than 30% of adults.
This flurry of complementary health approaches is happening behind our backs. As a result, people are left unguided and sometimes misguided by a flourishing market. For example, there are thousands of ingredients, each being packaged and marketed in hundreds of products. For a single health condition, people can choose from a list of nearly a thousand products. The result is a fruit salad containing the effective and the ineffective, the safe and the unsafe, the appropriate and the inappropriate…
Turning our backs is not the answer. Complementary health approaches could be powerful resource to help with patient’s wellness. Integrating those approaches into mainstream medicine is key. This is why many top academic centers now have integrative medicine departments, and the NIH dedicates an agency for scientific research on the subject.
Guidance is critical for three reasons. First, it ensures that people only use complementary approaches when appropriate. This means that they do not replace treatments by their doctors with less potent or effective approaches and they do not not delay seeking medical care when necessary. Second, it is important to distinguish ingredients and practices with the highest level of evidence for effectiveness for a condition (the minority), from those with evidence for lack of effectiveness or those with insufficient evidence (the majority). Third, guidance regarding safety of naturals, vitamins, and supplements as well as their interactions with prescription medications would help avoid detrimental consequences.
Climbing the ladder starts with a first step. I recently started asking my patients about their vitamins, naturals, and supplements, including why they take them, how they learned about them, and what are the results they’re achieving. You should do the same. You’ll be surprised!