Chairman’s summary: Education of Health Professionals in Complementary/Alternative Medicine, February 2001
- Josiah Macy, Jr., Foundation
- Available from the Foundation,
One day last year, I was examining a long-time patient whom I’ll call Mrs. Smith. She was diagnosed with atrial fibrillation about 10 years previously, and throughout the course of her treatment we’ve become friends, often chatting about our grandchildren. We both have grandsons who play Little League baseball. On this particular visit, she complained about increasing fatigue and asked whether the beta-blocker dose might be reduced. She felt that her household duties took longer to finish, and she had to stop often to regain her strength. As we discussed the pros and cons of a dose reduction, she said, “I think the herbal supplements I’ve begun taking are helping prevent the fibrillation, so maybe you can decrease the beta-blocker. I haven’t had any episodes of palpitations since I started to take them. One of my friends learned from something she found on the Internet that they give you more energy, and I’ve been taking them since the last time I saw you.” I was startled and immediately concerned about the possibility of drug interactions, particularly with her warfarin. I had asked her whether she had been taking the drugs I had prescribed, but I chided myself for not asking whether she had taken any other drugs since her last visit, even though I knew I was the only doctor she saw. It turned out that she was taking some sort of a multivitamin preparation and a garlic supplement. I took the opportunity to tell her that there are many complementary and alternative therapies available over the counter these days and, while some may have great potential, others can be harmful and most haven’t been well tested. Whether or not the supplements were affecting the atrial fibrillation was questionable, but maybe they were helping, if for no other reason than she believed they would. But I was worried about their impact on her warfarin. I suggested that she could continue taking the medications I had prescribed as well as the supplements she chose, but we agreed to monitor her condition, particularly the level of anticoagulation, extra carefully. We also agreed that she would take no other medications, regardless of the type, without consulting me first.