kaymcee Posted February 6, 2007 Report Share Posted February 6, 2007 Dr. Howard recommended that a patient see a homeopathic doctor, even though Dr. Howard doesn't believe the therapy will be effective. Is this okay? I've been told that it's unethical because a doctor shouldn't recommend something that he doesn't believe will be effective. I understand that position, and I would be opposed to a doctor prescribing medicine that is not warranted for a certain condition (say zithromycin for a cold or something blatant like that). The question is missing lots of details, but it seems as though the doctor is expanding treatment options for the patient rather than limiting them because he doesn't believe in homeopathic remedies. Thoughts? Link to comment Share on other sites More sharing options...
The Law Posted February 6, 2007 Report Share Posted February 6, 2007 It depends on what you mean by "recommended"... if he talked about the possibility of homeopathic alternatives, then it isn't. He is simply giving his patients more options. I don't think it hurts to let your patients know of their options, as long as you're honest with them about what you feel the chances are of such a treatment improving the condition they're having a problem with. Link to comment Share on other sites More sharing options...
Madz25 Posted February 6, 2007 Report Share Posted February 6, 2007 The placebo effect can be very strong....lol I agree with The Law, if the patient believes in homeopathic treatment and the doctor doesn't - there's nothing wrong with letting the patient explore that option as long as you let him/her know what your thoughts are. As long as the treatment doesnt have any adverse side-effects, it may end up helping the patient since he/she believes in it...placebo effect. Link to comment Share on other sites More sharing options...
kaymcee Posted February 6, 2007 Author Report Share Posted February 6, 2007 Thank you for seeing eye-to-eye with me on this. My friend took the hard line stance of, "If he doesn't think it will work, it's unethical." I don't think that's necessarily the case here with an "alternative" treatment like homeopathy/naturopathy/accupuncture/accupressure/etc. (And thanks for making my title better) Link to comment Share on other sites More sharing options...
Satsuma Posted February 6, 2007 Report Share Posted February 6, 2007 Actually, I would say it is unethical to "recommend" something that isn`t standard care and that you don`t think will be of any benefit to your pt. It is one thing if your pt brought it up as something they would like to explore. In that case, you could inform the pt of any medical risks the Tx may pose vs the benefits you are aware of. Other than that, it is really up to the patient to pursue this avenue on their own. If you as the physician is recommending a treatment though, you really should have some evidence to support it. Link to comment Share on other sites More sharing options...
Madz25 Posted February 6, 2007 Report Share Posted February 6, 2007 There are few 'hard and fast' rules in medicine...most scenarios are multi-faceted with no right or wrong answer. It is your responsibility as a physician to try and inform the patient to the best of your ability...what they choose to do is ultimately up to them. Link to comment Share on other sites More sharing options...
katerade Posted February 6, 2007 Report Share Posted February 6, 2007 I think it is unethical to recommend homeopathic treatments because the side effects/cross reactivities are simply not known for the majority. in fact, it is not even regulated period .... sometime homeopathic remedies dont even contain what they say they will. they also are not required to test for or label known side effects, and are do not need to prove the claims that they are marketed for. all of these are reasons that homeopathic remedies are not part of standard care. i think that as a physician it is your duty to remind a patient of all of this, and let them make their own decision. Link to comment Share on other sites More sharing options...
TimmyMax Posted February 6, 2007 Report Share Posted February 6, 2007 Hey, I agree with the above few posts. If you, as an MD, recommend something like homeopathy to a patient and they end up having an adverse or even fatal reaction to the combination of the homeopathic treatment and whatever other drugs that they're on, then it will ultimately be YOU (the MD) that is responsible for this bad outcome and YOU (the MD) that they will come looking for when the patient and/or family decides that they want to be compensated for their misfortune. I highly doubt that the Royal College will find in your favour on this one. Sorry. That said, if you do go ahead like another poster mentioned and explain the possible drawbacks of the proposed alternative treatment and document this in your chart WITHOUT explicitly recommending the treatment, leaving the patient to ultimately make up his or her own mind, then you should be good from a medicolegal standpoint. Patients are free to make up their own minds, but if you mislead or misguide them as a health care professional, then you're risking malpractice. Just a little something to keep in mind. Link to comment Share on other sites More sharing options...
katerade Posted February 7, 2007 Report Share Posted February 7, 2007 i agree .... alternatively, if you propose a treatment that is scientifically proven to be effective and safe and the patient still has an adverse event or even dies, you are still covered, and are not at fault. not that you should think about this only from a legal perspective, but your job as a phsician is to prescribe or recommend the most appropriate treatments which are EVIDENCE BASED. any person on the street can recommend any number of treatments, be they proven or not, but as a doctor you do not have that liberty. Link to comment Share on other sites More sharing options...
edge_w Posted February 7, 2007 Report Share Posted February 7, 2007 I hope I'm not being ignorant here.... but aren't homeopathic remedies so diluted in water that they end up being just... well.. water? Link to comment Share on other sites More sharing options...
lurkergonepublic Posted February 7, 2007 Report Share Posted February 7, 2007 I agree with the general consensus that a doctor should not 'recommend' homeopathy, but there's nothing wrong with telling a patient (who brings it up) that they're welcome to try. I would however, feel obligated to tell the patient what I think about it. It's up to them to try it, but also to pay for it - and I think they're being fleeced for a worthless treatment. It's important to be honest (and firm with something that may be dangerous), but not too come down as appearing totally close minded, otherwise your patient will no longer tell you what alternative therapies they are trying - and that could be dangerous. As for homeopathy, it is theoretically impossible for it to interact with anything, as it is, in fact, nothing. Water. Maybe a little sugar. Look into it more if that seems strange, but after 1000 serial dilutions of anything, you mathematically no longer have a molecule of the original substance left. Herbals and such however certainly can contain potent compounds, so I think that becomes an issue of 'try it if you like, but be sure to tell me what you are using.' Link to comment Share on other sites More sharing options...
Satsuma Posted February 7, 2007 Report Share Posted February 7, 2007 You aren't being ignorant! In fact you are correct, homeopathic remedies are essentially too dilute to cause any fear of pharmacological type effects. The real risk is waste of money, time and the pt relying on these remedies and not seeking more effective medical care. Naturopathy is a different story. But many don`t realize the difference between homeopathy and naturopathy and use the terms rather interchangeably Link to comment Share on other sites More sharing options...
katerade Posted February 7, 2007 Report Share Posted February 7, 2007 i agree that it is important not to bash it too much, and try to not seem too closed minded. i also think that if a patient is trying something which could effect their health you do have a reponsibility to tell them the possible risks, and that in fact most of the risks are not knowsn. but you must distinguish this from your own opinion, which in my case would be rather difficult. and yes, i guess i was using homeopathy to include naturopathy as well (i know it doesnt mean the same thing, but they seem to be used interchangably now). several common natural remedies have serious interactions with commonly prescribed drugs or cause adverse reactions on their own. Link to comment Share on other sites More sharing options...
wanttobedoc Posted February 7, 2007 Report Share Posted February 7, 2007 What are the risks vs benefit of the homeopathic treatment in question? If there is any evidence on it, the doc could review it, make sure it does not counteract with any of the patient's other meds....and if it causes no harm to the patient...and the patient "believes" in it, then I think the doctor should support the patient in his/her decision to take it and respect the patient's autonomy. Even though I personally do not "believe" in homeopathy, as a doctor I would not place that value on my patient. I think it is most important to keep open lines of communication with the patient because if the patient detects the doctor is not supportive or open to their "alternative ways", the patient may stop telling you things you need to know and then therapeutic rapport is lost...and from there things could deescalate. Link to comment Share on other sites More sharing options...
wanttobedoc Posted February 7, 2007 Report Share Posted February 7, 2007 oops...I re-read the question originally posted. I did not realize it was the doc recommending the homeo treatment....I guess that is a little different. I don't really understand why a doctor would recommend something he/she sees no value in, has no evidence-base, and is not based on basic medical guidelines? My answer above is for when a patient brings up "homeopathic" treatments to the doc.... I would need to think about it further (too late now:confused: )...but, I do think it is futile to recommend something that you know won't work and unethical as Satsuma already indicated. Link to comment Share on other sites More sharing options...
lucy98 Posted February 7, 2007 Report Share Posted February 7, 2007 Actually, (some) doctors do this everyday - prescribe something to their patients that they know will have no real effect: antibiotics for colds/flu. Of course, this could have a placebo effect, but the broader consequences of prescribing antibiotics unnecessarily are much worse than the potential adverse effects of homeopathy. Lucy Link to comment Share on other sites More sharing options...
BigFace Posted February 7, 2007 Report Share Posted February 7, 2007 Hi North America is the only place where homeopathy is not a standard practice in medicine...read up on the flexnarian paradigm and aim to change it....however, Dr Weil and others @ harvard are changing this. Homeopathy is quite useful. As to the issue of dilutions in the magnitude of avagadros number, they still work...yes some placebo...but also biochemically...this has been documented. Look up the unique properties that water has when solutes are added, its more then just "water". BigFace, Link to comment Share on other sites More sharing options...
wanttobedoc Posted February 7, 2007 Report Share Posted February 7, 2007 Actually, (some) doctors do this everyday - prescribe something to their patients that they know will have no real effect: antibiotics for colds/flu. Of course, this could have a placebo effect, but the broader consequences of prescribing antibiotics unnecessarily are much worse than the potential adverse effects of homeopathy. Lucy yes...but just because it is happening everyday, that does not make it ethically right. Link to comment Share on other sites More sharing options...
lucy98 Posted February 7, 2007 Report Share Posted February 7, 2007 Hey WanttobeDoc, I definitely agree with you that it does not make it ethically right. I just thought I'd point out the similarity between the two scenarios. Food for thought...that's all Lucy Link to comment Share on other sites More sharing options...
Smurfette Posted February 7, 2007 Report Share Posted February 7, 2007 I don't think it's ethical for a doctor to recommend something that he does not feel will work and for which there is no accepted scientific evidence to support it (within standard medical literature anyways - there's always some evidence from case studies and from the sellers of the medicines themselves). In fact, I don't even think it's ethical for a doctor to prescribe a placebo. A patient trusts a doctor's judgement because he/she knows that it is based on rationale, scientific fact. If a doctor recommends homeopathic therapy (or even just prescribes sugar pill for the placebo effect, the doctor is essentially LYING to the patient. How can a doctor develop TRUST if he just recommends anything? However, if a patient asks a doctor about homeopathic medicine, I think the doctor can tell that the patient that there is not known solid scientific foundation for such treatments, but he/she can feel free to try them if he/she wishes because they may have benefits and will not likely do any harm. (Provided that is what the doctor feels - if he feels that they can be harmful, then of course, that is not the appropriate answer). Link to comment Share on other sites More sharing options...
Darla Posted February 7, 2007 Report Share Posted February 7, 2007 It's important to be honest (and firm with something that may be dangerous), but not too come down as appearing totally close minded, otherwise your patient will no longer tell you what alternative therapies they are trying - and that could be dangerous. This is an incredibly good point. My father decided to undergo "chelation therapy" for his heart condition despite my pointing out that it was bunk. His doctor went to the trouble of printing off a medical article that researched the usefullness of the tx (none) and alienated my father as a patient. My father views this sort of "medicine" almost like a religion that he has an enormous amount of faith in and challenging that faith was detrimental to the relationship between my father and his primary care physician. We would get into arguments all the time about the lack of evidence before the MD performing these txs (illegally) was caught. Just throwing that into the mix to consider as well But what I would do is listen, offer to help them make the decision based on research from medical journals instead of just the internet and insist on a follow up appointment to make sure I'm kept in the treatment loop. http://en.wikipedia.org/wiki/Chelation_therapy http://www.bhf.org.uk/questions/index.asp?secondlevel=1157&thirdlevel=1231 c.f. http://www.americanheart.org/presenter.jhtml?identifier=4493 Link to comment Share on other sites More sharing options...
eise Posted February 7, 2007 Report Share Posted February 7, 2007 I don't think it's ethical for a doctor to recommend something that he does not feel will work and for which there is no accepted scientific evidence to support it (within standard medical literature anyways - there's always some evidence from case studies and from the sellers of the medicines themselves). In fact, I don't even think it's ethical for a doctor to prescribe a placebo. A patient trusts a doctor's judgement because he/she knows that it is based on rationale, scientific fact. If a doctor recommends homeopathic therapy (or even just prescribes sugar pill for the placebo effect, the doctor is essentially LYING to the patient. How can a doctor develop TRUST if he just recommends anything? However, if a patient asks a doctor about homeopathic medicine, I think the doctor can tell that the patient that there is not known solid scientific foundation for such treatments, but he/she can feel free to try them if he/she wishes because they may have benefits and will not likely do any harm. (Provided that is what the doctor feels - if he feels that they can be harmful, then of course, that is not the appropriate answer). Prescribing placebos is indeed unethical unless the patient is informed beforehand that they might be given a placebo (in the case of a clinical trial). Link to comment Share on other sites More sharing options...
Satsuma Posted February 7, 2007 Report Share Posted February 7, 2007 Actually, (some) doctors do this everyday - prescribe something to their patients that they know will have no real effect: antibiotics for colds/flu. Of course, this could have a placebo effect, but the broader consequences of prescribing antibiotics unnecessarily are much worse than the potential adverse effects of homeopathy. Lucy What is this comment based on? Physicians don't prescribe antibiotics for viral infections...if they know it is a virus. The problem is sometimes it is tricky to tell the difference. Sometimes it takes a few days to get a culture back and with the pt's hx of asthma/pneumonias whatever (for example) you don`t want to risk things getting worse while you wait. To suggest that physicians will prescribe an antibiotic for a placebo effect just seems a little extreme. Link to comment Share on other sites More sharing options...
eise Posted February 8, 2007 Report Share Posted February 8, 2007 What is this comment based on? Physicians don't prescribe antibiotics for viral infections...if they know it is a virus. The problem is sometimes it is tricky to tell the difference. Sometimes it takes a few days to get a culture back and with the pt's hx of asthma/pneumonias whatever (for example) you don`t want to risk things getting worse while you wait.To suggest that physicians will prescribe an antibiotic for a placebo effect just seems a little extreme. Actually, I think what Lucy might have been suggesting was that sometimes patients request antibiotics for viruses (stupid patients). And sometimes physicians, probably just to shut them up, prescribe them, because it's easier than constantly disagreeing with a patient. Is this right? Probably not due to the possible harm caused by antibiotics and developing resistance. But sometimes it causes greater good than harm in preserving the doctor patient relationship. I have this friend who I swear goes to her family doctor every time she has a cold. I tell her it's a virus and no medication will help, but she goes to her doctor regardless asking for antibiotics....I would assume her doctor has told her MANY times that it won't help, but she swears it does, so he probably just gives them to her because she's super annoying. Link to comment Share on other sites More sharing options...
The Law Posted February 8, 2007 Report Share Posted February 8, 2007 Prescribing placebos is indeed unethical unless the patient is informed beforehand that they might be given a placebo (in the case of a clinical trial). Yeah, but you aren't prescribing a placebo. You are telling your patient about a possible alternative, and informing them that it might not work... the drawbacks, and the benefits. It might work, but it might just be a placebo effect... it's not definitely a placebo effect, but the psychological idea that it is working certainly would not hurt. Link to comment Share on other sites More sharing options...
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