Nature, nurture, or nuisance: The ethical issues that surround alternative medicine

Meadow, a 15-year-old female patient, returns to Dr. Medical Derm (MD) with her father for severe nodulocystic acne that has been treated over many months. She has been compliant with the use of topical treatments (retinoid and benzoyl peroxide) and an oral antibiotic medication but the acne has not improved. The patient and her father are worried about scarring around her jawline. During the last visit, Dr. MD discussed oral isotretinoin as a treatment with Meadow and her father. During today’s appointment, Meadow’s father is frustrated and will not allow Meadow to start treatment with oral isotretinoin due to the potential side effects. He has researched alternative therapies and plans to have Meadow start a ketogenic diet in conjunction with barberry extracts and topical tea tree oil instead of her current medications. Dr. MD should a) explain to Meadow and her father that the efficacy of the alternative therapy they are considering has not been proven and because of concerns of scarring, they should seriously consider treatment with oral isotretinoin despite the potential risks; b) discharge the patient from the practice because the family is noncompliant and unreasonable; c) refer the patient to a university colleague because they are too much trouble to deal with; or d) suggest the family use a combination of alternative therapies with current conventional treatment.