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Legal Issues in Caring for Patients With Kidney Disease by Selectively Integrating Complementary Therapies

      Clinical integration of complementary and alternative medical (CAM) therapies, such as acupuncture and traditional oriental medicine, chiropractic, herbal medicine, massage therapy, and “mind-body” therapies, into conventional health care raises important legal and risk management issues. Understanding which CAM therapies patients use is legally prudent, as conventional treatment advice may interact with patients’ own efforts toward self-care. In addition, nephrologists may limit potential liability for medical malpractice by classifying any given therapy as follows: (1) the medical evidence supports both safety and efficacy—recommend; (2) the medical evidence supports safety, but evidence regarding efficacy is inconclusive—accept but monitor; (3) the medical evidence supports efficacy, but evidence regarding safety is inconclusive—accept but monitor; and (4) the medical evidence indicates either serious risk or inefficacy—avoid and discourage. Applying this framework whether a therapy is labeled “conventional” or “CAM” is consistent with the key recommendation of the recent report by the Institute of Medicine at the National Academy of Sciences on Complementary and Alternative Medicine, namely, to apply the same principles and standards of evidence of treatment effectiveness to all treatments. Liability risk management also includes going beyond legal and ethical informed consent requirements by engaging the patient in shared decision making concerning all material treatment options, including CAM therapies, if supported by evidence. Physicians further should familiarize themselves with documentation standards suggested by the Federation of State Medical Board Guidelines and whether these are applicable in their state or home institution. These steps aim to enable nephrologists to respond to patient interest in CAM therapies in a way that is clinically responsible, ethically appropriate, and legally defensible.

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      References

        • Cohen M.H.
        • Ruggie M.
        Overcoming legal and social barriers to integrative medicine.
        Medical Law Int. 2004; 6: 339-393
        • Cohen M.H.
        Negotiating integrative medicine.
        Negotiation J. 2004; 30: 409-433
        • Cohen M.H.
        • Ruggie M.
        Integrating complementary and alternative medical therapies in conventional medical settings.
        Cinn L Rev. 2004; 72: 671-729
        • Cohen M.H.
        Complementary and Alternative Medicine. Johns Hopkins University Press, Baltimore, MD1998
        • Cohen M.H.
        Healing at the borderland of medicine and religion.
        J Law Relig. 2004; 18: 373-426
        • Eisenberg D.M.
        • Cohen M.H.
        • Hrbek A.
        • et al.
        Credentialing complementary and alternative medical providers.
        Ann Intern Med. 2002; 137: 965-973
      1. American Medical Association. Liability Insurance Requirements. Available at http://www.ama-assn.org/ama/pub/category/print/4544.html. Accessed March, 9, 2004.

      2. Federation of State Medical Boards, Model Guidelines for Physician Use of Complementary and Alternative Therapies in Medical Practice. Available at: www.fsmb.org. Accessed February 5, 2004.

        • Studdert D.M.
        • Eisenberg D.M.
        • Miller F.H.
        • et al.
        Medical malpractice implications of alternative medicine.
        JAMA. 1998; 280: 1620-1625
        • Cohen M.H.
        • Eisenberg D.M.
        Potential physician malpractice liability associated with complementary/integrative medical therapies.
        Ann Intern Med. 2002; 136: 596-603
        • Schouten R.
        • Cohen M.H.
        Legal issues in integration of complementary therapies into cardiology.
        in: Frishman W.H. Weintraub M.I. Micozzi M.S. Complementary and Integrative Therapies for Cardiovascular Disease. Elsevier, New York, NY2004: 20-55
        • Cicero A.F.
        • Derosa G.
        • Gaddi A.
        What do herbalists suggest to diabetic patients in order to improve glycemic control? Evaluation of scientific evidence and potential risks.
        Acta Diabetol. 2004; 41: 91-98
      3. NIH Technology Assessment Statement. Integration of Behavioral and Relaxation Approaches into the Treatment of Chronic Pain and Insomnia. National Institutes of Health, Bethesda, MD1995 (NIH Pub #PB96113964)
        • Isnard Bagnis C.
        • Deray G.
        • Baumelou A.
        • et al.
        Herbs and the kidney.
        Am J Kidney Dis. 2004; 44: 1-11
        • Institute of Medicine (Board on Health Promotion and Disease Prevention)
        Complementary and Alternative Medicine in the United States. National Academies Press, Washington, DC2005
        • Dumoff A.
        Medical board prohibitions against physician supplements sales.
        Altern Complement Ther. 2000; 6: 226-236
      4. Ohio Rev. Code Ann. § 4731.22 (18)

        • Ernst E.E.
        • Cohen M.H.
        Informed consent in complementary and alternative medicine.
        Arch Intern Med. 2001; 161: 2288-2292
        • Ernst E.
        Second thoughts about safety of St John’s wort.
        Lancet. 1999; 354: 2014-2016
        • Piscitelli S.C.
        • Burstein A.H.
        • Chaitt D.
        • et al.
        Indinavir concentrations and St John’s wort.
        Lancet. 2000; 355: 547-548
      5. Moore v Baker (98 F.2d 1129 [11th Cir 1993])

        • Adams K.E.
        • Cohen M.H.
        • Jonsen A.R.
        • et al.
        Ethical considerations of complementary and alternative medical therapies in conventional medical settings.
        Ann Intern Med. 2002; 137: 660-664
        • Fentiman L.C.
        • Kaufman G.
        • Merton V.
        • et al.
        Current issues in the psychiatrist-patient relationship.
        Pace Law Rev. 2000; 20: 231-262
        • Cohen M.H.
        Beyond Complementary Medicine Legal and Ethical Perspectives on Health Care and Human Evolution. University of Michigan Press, Ann Arbor, MI2000: 47-58
        • Adamson T.E.
        • et al.
        Physician communication skills and malpractice claims. A complex relationship.
        West J Med. 1989; 150: 356-360
        • Gutheil T.G.
        • Simon R.I.
        Abandonment of patients in split treatment.
        Harvard Rev Psychiatry. 2003; 11: 175-179
      6. Schneider v Revici 817 Federal Reporter 2d 987 (2d Cir 1987)

      7. Charell v Gonzales (660 New York Supplement 2d 665, 668 [S.Ct., N.Y. County, 1997]), affirmed and modified to vacate punitive damages award, 673 New York Supplement 2d 685 (App Div, 1st Dept, 1998), reargument denied, appeal denied, 1998 New York Appellate Division LEXIS 10711 (App. Div., 1st Dept., 1998), appeal denied, 706 Northeastern Reporter 2d 1211 (1998)

      8. Tunkl v Regents of the Univ of Calif (383 Pacific Reporter 2d 441 [Cal 1963])

      9. Federation of State Medical Boards: Model Guidelines for Physician Use of Complementary and Alternative Therapies in Medical Practice. Available at: www.fsmb.org. Accessed February, 05, 2004.

        • O’Connell S.
        It won’t hurt you one bit.
        The Times (London). 2002; (June 24)
        • Cohen M.H.
        Legal issues in integrative medicine. National Acupuncture Foundation, Gig Harbor, WA2005