Cohen Michael H
Harvard Medical School, Harvard School of Public Health, Law Offices, 1811 NW 51 St., Suite 1289, Fort Lauderdale, FL 33309, USA.
J Pediatr Hematol Oncol. 2006 Mar;28(3):190-3. doi: 10.1097/01.mph.0000210401.28685.57.
Pediatricians increasingly are asked to advise pediatric patients and their families concerning integration into conventional care (including hematology and oncology) of complementary and alternative medical (CAM) therapies such as chiropractic, massage therapy, and herbal medicine. Inclusion of CAM therapies in pediatric oncology and hematology--as in any medical subspecialty--is not itself "unethical," clinically inadvisable, or legally risky; the danger comes from over-reliance on one or more CAM therapies (particularly those with evidence of danger and/or paltry evidence of success) to the exclusion of conventional care that is curative and imminently necessary. Pediatricians can help address potential malpractice liability issues by evaluating the level of clinical risk, engaging the patient in shared decision making and documenting this in the medical record, continuing to monitor conventionally, and being prepared to intervene conventionally when medically required.
越来越多的儿科医生被要求就诸如整脊疗法、按摩疗法和草药等补充和替代医学（CAM）疗法融入常规医疗（包括血液学和肿瘤学）的问题向儿科患者及其家属提供建议。在儿科肿瘤学和血液学中纳入补充和替代医学疗法——与任何医学亚专业一样——其本身并非“不道德”、临床不可取或存在法律风险；危险来自过度依赖一种或多种补充和替代医学疗法（特别是那些有危险证据和/或成功证据不足的疗法）而排斥具有治愈性且迫切需要的常规医疗。儿科医生可以通过评估临床风险水平、让患者参与共同决策并在病历中记录、持续进行常规监测以及在医学需要时准备好进行常规干预，来帮助解决潜在的医疗事故责任问题。
