DAVID MARKS, MD: Welcome to our webcast. I'm Dr. David Marks. Alternative or complementary medicine has become increasingly popular over the last few years, especially in the treatment of arthritis. What are these alternative therapies, and do they work?
Joining us to answer these questions is Dr. Allan Gibofsky. He is Professor of Medicine and Public Health at Cornell, and a Rheumatologist at the Hospital for Special Surgery. Welcome.
Next to him is Dr. Ifeoma Okoronkwo, or Dr. O., who is Clinical Instructor at NYU School of Medicine and is an attending physician at the Rusk Institute. Thanks for being here.
What are the different types of alternative therapy that we have to deal with?
IFEOMA OKORONKWO, MD: Well, there is really a broad spectrum of therapies and interventions. One could look at it as that there are mechanical interventions and there are non-mechanical interventions. Some of the more common mechanical interventions would be acupuncture, massage therapy, chiropractic. More esoteric ones would be healing touch, Reiki, etc.
Some of the non-mechanical interventions include some of the oral modalities and medicines, such as herbs. Glucosamine is a very common vitamin or supplement. And also magnets.
DAVID MARKS, MD: Glucosamine is very hot these days. What's the glucosamine story?
ALLAN GIBOFSKY, MD: Glucosamine is a substance that is ingested, sometimes by itself and sometimes with another substance called chondroitin. These are substances, which either by themselves or together or as alternative forms, may be present in cartilage or other structures of the body. The theory is that ingestion of these substances somehow gets to the site of damage and helps repair it.
There is also a well-known phenomenon in medicine called the placebo effect. A certain percentage of the time when you do nothing to a patient but give them a sugar pill, they will respond to it. So I think what we need are very carefully designed studies to demonstrate the efficacy of these substances over a placebo, over a sugar pill, in studies where neither the patient nor the doctor knows what it is that is being given. Until sufficient numbers of what we call double-blind studies are done, one has to treat the anecdotes that we hear with a healthy degree of skepticism. I'm not saying that they don't work, but skeptical as to why they do.
DAVID MARKS, MD: Dr. O., are there any other vitamins or herbs that can be used for arthritis?
IFEOMA OKORONKWO, MD: Allan mentioned chondroitin, which is often combined with glucosamine. But there, again, may be some efficacy to its usage. All of these medicines are not without side effect. So once again, it's important that you integrate your physician into your decision process as to what you choose to use.
Having said that, we as physicians must also remember that up to one third of our patients are using some form of integrative medicine on their own. So it's important for us to ask them what are they using, what are their interests, what are their questions so that we can be part of their decision making process.
ALLAN GIBOFSKY, MD: Absolutely critical. I think our patients are asking us and challenging us to learn as much as we can, not just about what we're comfortable with, but also the kinds of things that we may be a little bit uncomfortable with because we're always uncomfortable when we're not knowledgeable.
DAVID MARKS, MD: But some of these things may work for some people. The story is that we really need to study them further to see really which ones are more effective and which ones aren't.
ALLAN GIBOFSKY, MD: And when they do work, or when our patients think they work, as long as they are not harming the patient, we need to keep an open mind. I have patients who ask me, "Should I wear a copper bracelet." My response to them is "Absolutely wear a copper bracelet, and remember to put it on when you're reaching for the medication that I prescribed to you." If a medication is working, fine. But if an integrative therapy - and I really love that word. I'm going to begin using it more and more. If an integrative therapy does no harm - and that's the first rubric of our profession, above all do no harm - we really need to be more open-minded and to encourage our patients to make use of what works for them.
DAVID MARKS, MD: Well that's going to be the last word. Thank you both for joining us. And thank you for joining our webcast. I'm Dr. David Marks. Goodbye.