Portal de Periódicos da CAPES

When Patients Choose CAM over EBM—How to Negotiate Treatment

2011; American Medical Association; Volume: 13; Issue: 6 Linguagem: Inglês

10.1001/virtualmentor.2011.13.6.ccas1-1106

2376-6980

Michael Fisch, Richard Lee,

Palliative Care and End-of-Life Issues

his primary care physician after experiencing several months of fever, night sweats, nonspecific back pain, and "lumps in his shoulders and chest."After a meticulous workup, including a biopsy that revealed Reed-Sternberg cells, he was promptly referred to Dr. Randolph, an experienced and reputable oncologist.After Mr. Crowley was seated in his office, Dr. Randolph pulled up his own chair, leaned forward, and explained that Mr. Crowley had classic stage I Hodgkin lymphoma.He added that the survival rate was generally 90 percent or better with chemotherapy, which made the prognosis a good one-most patients who entered remission lived normal, healthy lives.Dr. Randolph could see that Mr. Crowley, an active and previously healthy man in his 50s, was upset.He said he would go home to consider his options before proceeding, so Dr. Randolph scheduled an appointment for one week later to finalize the treatment course.At his return visit, it was clear Mr. Crowley had come to a decision.After taking a deep breath, he began, "Doctor, I know that you think chemotherapy is best for me, but I think I want to try a macrobiotic diet instead.Chemo will only introduce its own harmful chemicals, and that really seems like the last thing I need right now.At the very least, I want to attempt a few months of macrobiotic cleanses before I even think about chemotherapy."At this point Dr. Randolph began to speak more firmly: "I understand where you're coming from-chemo is a frightening and unpleasant prospect.But without it, the risk of death rises to 95 percent.Even delaying treatment could be detrimental, resulting in rapid tumor growth, which may happen if you follow the regimen you suggest."Mr. Crowley shook his head."I'm sorry, but I need a second opinion, from someone who is…more open-minded about alternative therapies."Dr. Randolph considered the situation.He had heard anecdotes about the benefits of macrobiotic diets but knew there was no scientific evidence that they could treat cancer successfully.He cared about patient autonomy-and Mr. Crowley was clearly a competent adult-but was he really informed enough scientifically to make a proper decision?Perhaps negotiating a treatment plan that included a macrobiotic cleanse was necessary, but was it ethical?