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During the past decade, the American public's interest in alternative medicine has skyrocketed. The evidence for this trend is everywhere -- in the media, in the growing number of popular books on "wellness" and non-traditional therapies for illness, and in booming sales of supplements and herbs.
The magnitude of this trend was highlighted in a report by David Eisenberg, M.D., of Harvard Medical School published in a 1993 issue of the New England Journal of Medicine. Eisenberg estimated that Americans made approximately 425 million visits to alternative therapy providers during 1990 and that expenditures associated with these therapies were comparable to non-reimbursed expenses incurred for all hospitalizations.
The growth in the use of alternative medicine has been accompanied by more subtle changes in the attitudes of both patients and physicians. Though still widely used, the term "alternative medicine" has been gradually falling out of favor in recent years. Many who work in the field feel that the term reinforces the old and divisive (and inaccurate) stereotype of desperate and naive patients foregoing promising mainstream therapies in favor of unproven or "alternative" therapies offered by "quack" practitioners.
This view began to change with the publication of a 1988 study by Barrie Cassileth, Ph.D. Cassileth's survey suggested that, for the most part, unconventional therapies in the United States are offered by licensed physicians or other credentialed health care practitioners who believe in the therapies they offer, who are not charging excessive fees for treatment, and who are treating patients of above-average education and income. Further, these patients are likely to be more deeply engaged than the average patient in exploring their choices. Significantly, in the large majority of cases, these patients also choose to remain under the care of a mainstream physician. Generally, patients who completely leave mainstream medicine do so only because doctors have said there is nothing more they can do for them.
More and more patients are finding that alternative medicine has a great deal to offer, especially for treating chronic conditions with which Western Medicine has little success. The vast majority of patients, however, do not see conventional and unconventional therapies as an either/or proposition. Rather, they seek to make informed, personal choices about how to integrate both. For this reason, "complementary" or "integrative" medicine have become the favored designations for this emerging field.
A vast array of approaches fall under the heading of complementary medicine. Some, such as acupuncture and Ayurveda (the traditional medicine of India), are ancient traditions used by millions of people over thousands of years. Most cultures have also developed herbal traditions based upon the local medicinal plants. Other approaches, such as macrobiotics or Anthroposophy are branches of wider philosophical systems applied to medicine. Chiropractic and homeopathy are examples of systems that arose in the West -- alongside orthodox medicine -- that view disease processes much differently than mainstream medicine. Mind-body therapies (e.g., stress reduction techniques, biofeedback, meditation) comprise a large class of approaches that owe a great deal to the spiritual traditions of the East.
The most effective use of complementary therapies is often in combination with mainstream therapies. There is evidence, for example, that Chinese herbs can potentiate the effectiveness and lessen the side effects of some chemotherapies and that acupuncture can greatly reduce the nausea connected with cancer therapy. In the same way, chiropractic or acupuncture can greatly reduce or even eliminate the need for analgesics for chronic back pain.
Complementary Therapies Are Not Always Harmless
It is important to know that complementary therapies are not by definition harmless. They run the gamut in terms of their potential for harm, though many do tend to be quite benign. If you choose to use complementary medicine, it is a good idea to consider using one or more therapies that are considered to be intrinsically health promoting regardless of whether one is ill or not. As Michael Lerner has pointed out in his book Choices in Healing, these "lifestyle therapies" can give you a sense of taking charge of your own health and often enable you to better tolerate difficult therapeutic regimes.
The spiritual and mind-body approaches are primary among lifestyle therapies. Prayer, meditation, psychological therapy, imagery and support can, at the very least, bring about a transformation in the way you view illness and your own body. These approaches can also affect the way pain is perceived, and there is evidence they may actually affect the course of the illness itself in some cases. Nutritional approaches (if not carried to extremes) and physical approaches, like massage, exercise and yoga, are also generally health promoting.
At the other end of the spectrum are some of the unconventional pharmacological, herbal and vitamin supplementation approaches where overdoses and other toxicities are possible, as well as interactions with prescription drugs. Extreme dietary approaches can also lead to unhealthy weight loss and nutritional imbalances.
The Research Evidence for Complementary Therapies
Generally, there is little hard research evidence for the effectiveness of complementary therapies. This does not mean that these approaches are not useful -- just that the question is still open. As these approaches are researched, they either tend to move into the mainstream, as is currently happening with a range of mind-body therapies and acupuncture, or they are essentially abandoned, as has largely happened with laetrile, the popular cancer "cure" derived from apricot pits.
But cultural and institutional considerations also play a role in deciding what is and what is not considered "alternative." Almost by definition, a therapy is considered "alternative" if it is not taught in medical schools, even if there is good research evidence for efficacy as there is for acupuncture, chiropractic and some herbal therapies. For example, the strength of the research for the effectiveness of homeopathy for some conditions is quite compelling, yet because there is no rational scientific mechanism to explain its action, it is still dismissed by many researchers. And though the research on promising herbal therapies is readily available to American doctors, herbal remedies are rarely prescribed by American physicians. In Europe, however, this is quite common. In Germany, for example, the herb St. John's Wort is prescribed much more often for mild to moderate depression than is the drug Prozac.
Choosing a Complementary Therapy
Most mainstream physicians are of little assistance when it comes to providing guidance to patients in the area of complementary medicine. At the same time, there is an explosion of media "hype" and commercial ventures touting non-toxic cures for illnesses ranging from acne to cancer. How does a consumer of health services interested in exploring complementary therapies make sense of it all?
Obtain a Medical Diagnosis
Always begin by obtaining a medical diagnosis for your condition from a physician. If you decide to stop using mainstream medicine, do so only because you have weighed the benefits and side effects of the treatment and determined that there is no longer a sufficient reason to continue. Never abandon a promising mainstream therapy in favor of an unproven complementary therapy.
Once you have a diagnosis and comprehensive information on mainstream treatments for the condition, it is well worth your time to educate yourself thoroughly about the field of complementary medicine for your condition so that you will have a context for comparing therapies and making decisions.
It is very common for a patient to hear about a complementary therapy that has been helpful for someone else and to expend considerable effort to locate that therapy for themselves. While it's useful to hear from individuals who feel they have been helped by a given therapy, keep in mind that people who were not helped are less likely to talk about it than those who experienced dramatic positive results. The person you heard about may be one out of a hundred who actually benefited from the treatment!
Most medical conditions are self-limiting -- they get better eventually even without treatment. Other conditions, including some serious diseases like multiple sclerosis, can wax and wane regardless of treatment. In these cases knowing that someone improved when using an alternative remedy tells you nothing, because it could have happened even without the remedy. Also remember that people who use these therapies often use a number of them at once in addition to Western medicine. Therefore, it is often impossible to know exactly which therapy or combination of therapies actually helped.
There are a number of useful resource books that may be of great help in understanding the field of complementary medicine and in choosing specific therapies. Some of these are listed in the "Resources" section below.
The Internet can be a valuable tool for locating information about the range of complementary therapies available. If you have access to a computer, look at the Internet sites that provide information about your condition. But beware that the web is full of unreliable information. Remember -- just because it appears on the web doesn't mean it's true! Medically oriented sites generally provide the most reliable information, but these rarely discuss complementary therapies. If they do, they are likely to err on the side of conservatism when it comes to complementary medicine. If a medically oriented site says a given complementary therapy is unproven, it means only that -- it's unproven, not necessarily ineffective.
Internet sites established by patient advocacy or support groups are often very good sources of information about complementary therapies. Discussion groups can give you a sense of which therapies people are finding helpful. The same is true of support groups. Hearing from many people who have tried a particular therapy is a good indication that you should investigate more closely.
Be wary of web sites that have been set up by proponents of a particular therapy, especially if a product line is being promoted. Be skeptical of any information, on the web or in print, which describes "miraculous" outcomes or "cures" for conditions that mainstream medicine considers incurable, or encourages patients to leave mainstream medicine in favor of an alternative approach.
When evaluating information on the web or in print, look for references to research studies. It is fairly common for whole books to be based on one small study! Look for numerous citations to different studies. It is the nature of research that studies are often contradictory and that only a large body of research can begin to yield definitive answers. Studies in human subjects are much more important than studies in animals or in test tubes (sometimes called in vitro studies).
You can also perform an on-line search for the medical literature yourself using PubMed, a service developed by the National Library of Medicine (see Resources for Internet address). Many hospitals in large cities also have patient libraries that perform this kind of search for you, usually for a fee. Staff members in these libraries can also be quite helpful in locating information for you.
If there is little research evidence for the therapy, you might ask yourself the following questions:
- What is the context from which the therapy arose?
- Is the therapy science-based? Is the scientific foundation widely accepted?
- Is the therapy part of a non-scientific system? If so, what is that system, and does the system make sense to you as a worldview?
- Did the therapy arise from one of the traditional medicines of the world with a long history of use?
- Is the therapy a "secret formula," or does the proponent welcome independent evaluation?
Choosing a Practitioner
Once you have settled on a therapy that you would like to try, the next step is finding a practitioner. For some therapies this may not be necessary. You can make modest changes in your diet, for instance, or begin a moderate exercise regimen unassisted. But if your condition is serious, the therapy is complex or if the lifestyle change is a major one, it's wise to seek out some assistance -- at least initially.
The advice of a properly trained practioner is important in making decisions. It's appealing to simply go to the natural foods store and pick up some supplements or herbs. But remember these can have serious interactions with drugs you may be taking, and the therapy may require taking higher doses than are indicated on the bottles. Similarly, Chinese or homeopathic remedies are available over the counter, but these "formulas" may bear little resemblance to the prescription a practitioner would write for you since they are highly individualized treatments. Also, never rely on "recommendations" by employees of health food stores -- their training in the use of herbs and supplements usually comes from sales representatives, not schools of naturopathy!
When seeking a practitioner, a personal referral is best, but it is also wise to talk to many people with the same condition until one name comes up two or three times. Support groups are also good places to find this kind of information as are local branches of support organizations. Referrals can also be obtained from another practitioner whose opinion you trust.
If these kinds of direct referrals are not available, the state or national credentialing organization for that discipline will often provide referrals. "New Age" newspapers found at natural food stores and bookstores may contain ads and listings for local practitioners, as well. If all else fails, try the telephone book!
Once you have located a candidate, don't be shy about interviewing him or her.
- Find out what their training is and how long they've been in practice.
- Ask if they are licensed and credientialled.
- Determine if they have worked with many people with your condition. If you have cancer, find out if they have worked with other people with the same kind of cancer.
- Get a sense of their attitude concerning mainstream medicine and if they would be willing to work with your doctor.
If for some reason you decide not to work with that practitioner, ask for a referral to another.
Before you actually begin the therapy, tell your physician. If the physician is knowledgeable and open minded, he or she may agree to work with you to coordinate care from different sources. Be prepared, however, for the possibility that you will not be supported in your decision to use complementary medicine. You may be told you are wasting your time or even be warned of dire consequences. If this is the case, try to determine whether or not the physician's response is based upon an accurate understanding of the therapy you would like to undertake. If you have been able to locate research studies on a complementary therapy you find of interest, show these to your doctor. For some people, the support of their physician in this area is important enough that they will decide to seek out a doctor who will be supportive.
Increasing numbers of open minded practitioners on both sides of the alternative-conventional medicine divide are coming to understand that the future of medicine clearly lies in some form of integrated healthcare, where traditional, mind-body and lifestyle approaches take a place alongside Western allopathic medicine. But until that time arrives, it is up to the patient to put these pieces together. The challenge can seem daunting, but the task is not impossible and the rewards are well worth the effort.
Internet address for PubMed:
The American Holistic Health Association Complete Guide to Alternative MedicineWilliam B. Collinge, Len Duhl
Paperback, 361 pages
Published by Warner Books
Publication date: December 1997
Choices in Healing : Integrating the Best of Conventional and Complementary Approaches to Cancer
by Michael Lerner
Published by MIT Press
Publication date: April 1996
Encyclopedia of Natural Medicine
by Michael T. Murray, Joseph E. Pizzorno, Joseph Pizzorno
Paperback, 640 pages
Published by Prima Publishing
Publication date: February 1998
Complementary Medicine : An Integrated Approach"Copyright © 1998 WebMD, Inc. All rights reserved."
by Julian Kenyon, Peter Lewis, George Lewith, J Kenyon
Published by Oxford Univ Press
Publication date: August 1996
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