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补充与替代医学(CAM):初级保健医生的综述

Complementary and alternative medicine (CAM): a review for the primary care physician.

作者信息

Onopa J

机构信息

University of Hawaii, Department of Medicine, Honolulu 96813, USA.

出版信息

Hawaii Med J. 1999 Feb;58(2):9-19.


DOI:
PMID:10098319
Abstract

It is difficult to find a satisfactory title for this review, because both the word "complementary" and "alternative"-are not very politically correct currently. It is probable that there is no fully politically correct word, except for "non-allopathic," which is unfamiliar to many MDs. Accurately used, the term "allopathic" is as opposed to "homeopathic," so from its origins, "allopathic medicine" should include herbal medicine. However, in practice, herbal and many other non-homeopathic treatments are called "non-allopathic," whereas conventional medicine is called "allopathic." "Complementary" usually would include practices that are used with conventional western medical treatments, and "alternative" would include those practices that are used instead of western medical treatments. For most of this review, the terms "non-allopathic," "alternative," and "complementary" could be used interchangeably. This topic has gained interest, and received some allopathic legitimacy, in part because of an article that David Eisenberg, M.D., published in the New England Journal.' In 1990, he performed a telephone survey of about 1,500 adults in the U.S. and asked them about the use of treatments and practices that were "alternative," which he defined as not generally being taught in the U.S. medical schools and not being readily available in U.S. hospitals. From his sample, he extrapolated that in 1990, about 60 million Americans used alternative medical treatments, at an estimated cost of $13.7 billion. There were more visits to alternative healers than to primary care MDs that year, and over two-thirds of people who did use alternative medical treatments did not tell their doctors about it. Now that third party figures are becoming interested in paying for alternative medical practices (especially naturopathic, chiropractic, and acupuncture services), allopathic physicians will be increasing in the position of being able to refer people to alternative providers, and insurers will pay for services that MDs approve. Therefore, it will become increasingly important for physicians to have a degree of familiarity with alternative treatments (including efficacy and risks). So far, to date, there have been no cases of malpractice for giving advice about the use of alternative medical treatments, but liability will certainly exist to anyone who delivers treatments, such as acupuncture or spinal manipulation, in the event of an adverse effect. This review will briefly introduce some of the most common alternative practices likely to be seen in Hawaii communities: Homeopathy, Herbs, Naturopathy, Chinese Medicine and Acupuncture, and Chiropractic and spinal manipulation, and a brief discussion of Dr. Eisenberg's recent position paper on advising patients about alternative practices.

摘要

为这篇综述找到一个令人满意的标题很困难,因为“补充性”和“替代性”这两个词目前在政治上都不太正确。除了“非对抗疗法的”这个词外,可能没有完全政治正确的词汇,而许多医学博士对这个词并不熟悉。准确地说,“对抗疗法的”一词与“顺势疗法的”相对,所以从其起源来看,“对抗疗法医学”应该包括草药医学。然而,在实践中,草药及许多其他非顺势疗法的治疗被称为“非对抗疗法的”,而传统医学则被称为“对抗疗法的”。“补充性的”通常包括与西方传统医学治疗一起使用的疗法,“替代性的”则包括那些替代西方医学治疗的疗法。在这篇综述的大部分内容中,“非对抗疗法的”“替代性的”和“补充性的”这些术语可以互换使用。这个话题引起了人们的兴趣,并在一定程度上获得了对抗疗法医学的认可,部分原因是医学博士大卫·艾森伯格发表在《新英格兰医学杂志》上的一篇文章。1990年,他对约1500名美国成年人进行了电话调查,询问他们对“替代性”治疗和疗法的使用情况,他将“替代性”定义为在美国医学院通常不讲授且在美国医院不容易获得的。根据他的样本推断,1990年约有6000万美国人使用替代性医学治疗,估计费用为137亿美元。那一年,看替代疗法治疗师的人数比看初级保健医生的人数还多,而且超过三分之二使用替代性医学治疗的人没有告诉他们的医生。既然第三方机构开始有兴趣为替代性医学疗法付费(尤其是自然疗法、脊椎按摩疗法和针灸服务),对抗疗法医生将越来越能够把患者转介给替代疗法提供者,而且保险公司将为医生认可的服务付费。因此,医生对替代疗法(包括疗效和风险)有一定程度的了解将变得越来越重要。到目前为止,还没有因提供关于使用替代医学治疗的建议而出现医疗事故的案例,但对于任何提供治疗的人,如针灸或脊椎推拿治疗,如果出现不良反应,肯定会存在责任问题。这篇综述将简要介绍一些在夏威夷社区可能最常见的替代疗法:顺势疗法、草药、自然疗法、中医与针灸、脊椎按摩疗法和脊椎推拿,并简要讨论艾森伯格博士最近关于就替代疗法向患者提供建议的立场文件。

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