Ins and Outs of Alternative Medicine

Complementary and Alternative Medicine has been a part of Kaiser Permanente Northern California’s approach for more than a decade.

Interview by Elizabeth Schainbaum

Deep breathing. Acupuncture. St. John’s Wort.

For more than a decade, physicians and clinicians across Kaiser Permanente Northern California have integrated a wide range of Complementary and Alternative Medicine (CAM) approaches with a primary focus on five areas:

  • herbs and supplemental medicine
  • food as medicine
  • manual therapy, such as massage
  • traditional systems, such as acupuncture
  • mind/body medicine, including guided imagery and breathing exercises

Each medical center has a CAM representative, and The Permanente Medical Group conducts research on some CAM therapies and herbal products. According to surveys, about two-thirds of members say CAM is either important or very important to them and a critical aspect of their health care decisions.

To better understand the region’s CAM program, InsideKP Northern California spoke with Harley Goldberg, DO, the program’s regional medical director.

Share with us the process for getting herbal products into KP pharmacies.

There’s a committee that reviews requests to add herbal medicine and supplements to our pharmacies. The committee evaluates the evidence— whether it’s safe or effective— and then makes recommendations to the Regional Chiefs of Pharmacy and Therapeutics, and the Pharmacy Operations group.  We have several products in our pharmacies, such as St. John’s Wort for mild to moderate depression. Another popular product we carry is the supplement glucosamine, which is for joint pain.

KP is the largest employer of acupuncturists in the state, outside of acupuncture schools. Tell us about that.

We’ve had acupuncturists on staff for more than 10 years. Each service area has licensed acupuncturists on staff, and members can be referred to them for two reasons: chronic pain lasting at least three months and to lessen the side effects of nausea and/or vomiting, particularly from chemotherapy. There’s evidence that acupuncture is effective in these cases.

What else should we know about CAM and its uses?

We have limited understanding of CAM and relatively few long-term studies have been done. It’s a growing area of interest, and the studies are growing exponentially, particularly since the creation of the National Center for Complementary and Alternative Medicine at the National Institutes for Health.

One of the biggest misconceptions is that if it’s a natural product, it’s safe. Just because it’s natural doesn’t mean it’s safe. Herbals can have interactions and limitations. For example, St. John’s Wort interacts with many medications and can make birth control pills ineffective, for example.

People need to be careful of some herbal formulas because they can be contaminated with heavy metals or leads or have the wrong herbs.

We worked with the United States Pharmacopeial (USP), a scientific nonprofit that sets standards of medicines, food ingredients, and dietary supplements to come up with a product-quality label. People should look for this USP-verified mark on products because that will guarantee the list of ingredients and that it doesn’t contain harmful levels of contaminants, among other quality-control guidelines.

When considering the use of CAM products, it’s important to understand the risks, so you can make good decisions. That’s why you should always tell your primary care physician about all the medications, even herbs and supplements, that you are taking.

If members are interested in CAM, how should they start?

They should start with their primary care physician for advice. We also have a number of resources online, including an overview of our CAM program. There’s the Natural Standard and Natural Medicine Comprehensive Database, which offers detailed information on its safety, effectiveness, recommended dosages, and more. It’s an unbiased source that’s internationally known.

CAM can be both used as treatment or as preventive medicine. People should look at what’s safe and effective, and how it fits in with conventional medicine because each has its role and place.