Michael Stewart, MD, MPH, professor and chairman of otorhinolaryngology and senior associate dean for clinical affairs at Weill Cornell Medical College, uses questions about nasal zinc therapies and other alternative treatments as educational opportunities. He discusses available studies with patients and gives them all the facts he can present and then recommends against using any treatments for which available evidence shows that potential downsides outweigh potential benefits. He can only recommend options to patients, he said.
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October 2010“If I have a stockbroker and I feel like I have to veto every point he makes, then why do I have a stockbroker?” said Dr. Stewart, an ENT Today editorial board member. “You need to have the same sort of relationship with your physician. You have to question and, ultimately, it’s your call, but if [a patient is] questioning everything, then maybe you should find another doctor.”
Dr. Stewart was quick to point out, though, that physicians should not be dismissive of alternative treatments out of hand, especially when many doctors have techniques or treatments that they may rely on despite a lack of evidence-based data.
“I do think there’s a role for homeopathic treatment and being open-minded to these things,” he added. “The reality is there’s a lot about what we do that is not ‘scientifically proven.’ We have to be careful in making sure not to have a double standard.”
Ask the Right Questions
One of the first steps in that process is identifying the homeopathic treatments that a patient may have used in the past, or is currently using, to treat a common cold. Dr. Fong has a category on her patient questionnaire about alternative treatments.
“People will tell you they are not using any medication,” said Dr. Fong, who is also adjunct clinical assistant professor of otolaryngology-head and neck surgery at Stanford University in Palo Alto, Calif. “But if you ask them to list it out, they might tell you 20 supplements, vitamins and over-the-counter medications they are taking.”
This is the point in the process when patients’ preconceived notions of the safety of homeopathic treatments can run counter to a physician’s training and education, said Eric Holbrook, MD, an otolaryngologist at the Massachusetts Eye and Ear Infirmary in Boston.
“It always strikes me as surprising, because they have some belief, for whatever reason, that homeopathic medicines…are safer than conventional medicine,” he added. “But, in reality, a lot of those supplements have not been thoroughly studied and we don’t know what effects they can have.”