There seems to be a major rift between Western medicine and what is frequently known as complementary and alternative medicine (CAM).  I think it is unnecessary, but I also believe that both parties have contributed to it.

Although there is some antipathy from a few CAM practitioners toward Western medicine, most of the antagonism is in the other direction: patients are not only frequently unsupported in their use of CAM modalities by their doctors, they are often strongly dissuaded from using them. Here’s one example from my own experience. Several years ago I was diagnosed with Grave’s disease (a hyperactive thyroid). When I told my endocrinologist that I wished to try to bring my thyroid back to normal through other modalities instead of taking drugs for the rest of my life or having my thyroid destroyed by radioactive iodine, she told me, “go ahead but you’re wasting your time.” And that, unfortunately, is a direct quote. My hyperthyroidism finally started to resolve only when I began seeing a Western herbalist (at the San Francisco Botanical Medicine Clinic, http://www.sfbmc.org/) who concocts unique formulas for each patient. I am now taking a sixth of the prescription meds. I once was, and I’m in the process of cutting back on that.

Despite abundant anecdotal evidence that many CAM modalities are effective, I think there are several reasons why these modalities are not readily accepted by Western medicine. Here are a few, in no particular order:

1.   Western medicine practitioners are often critical of CAM because many of the modalities that fall under the CAM umbrella don’t currently live up to the Western medicine criteria of being evidence-based.

Although that is currently true, it’s a classic Catch 22. CAM modalities are not trusted because of the scarcity of studies, yet there are few decent studies, most likely because (1) many potential researchers don’t want to be branded as less-than-scientific by looking seriously at a modality that “everyone knows is quackery,” and (2) researchers who do have the curiosity—and courage—to study CAM often don’t really understand the modality they are studying. They rarely look at how it is utilized by its practitioners or how it is expected to benefit its recipients, or they treat the modality as if it were a pharmaceutical and attempt to use a “sham” technique as a placebo. I have seen studies claiming to use sham Reiki, whatever that is. As a result many studies tend to be flawed in their design and therefore frequently yield misleading or negative results.

2.   There is little money available for testing CAM. Most research is paid for by pharmaceutical companies or medical equipment manufacturers for the purpose of testing the efficacy of their products, and there is little incentive to spend money to test procedures that won’t eventually result in money coming in.

3.   Researchers or practitioners who believe that CAM is quackery disregard evidence to the contrary and focus instead on evidence that supports their preconceived ideas. All too often believing is seeing rather than the other way around.

4.   Some CAM offerings seem to be ignored simply because they have not been devised by accepted developers—namely, the major pharmaceutical manufacturers.

Here’s an example of a widely available yet often ignored therapy: There have been articles recently on the difficulties in controlling Clostridium difficile, a gastrointestinal bacterium which often sickens elderly patients and those with compromised immune systems. Ironically, it is especially virulent in those who are on broad-spectrum antibiotics. The problem is that such antibiotics not only kill the targeted organism but also the normal intestinal bacteria that keep C. difficile under control. Current approaches to curing the infection include using antibiotics that are known to control C. difficile, or doing what they call a “stool transplant”—taking fecal matter from a healthy person and inserting it into the colon of an infected person in the hope that the normal bacteria in the healthy specimen will colonize the gut of the infected person. In lay terms, they take s**t from someone else and insert it into your gut.  (I’m afraid my reaction to that one is a rather unprofessional “Ick!”)

That’s the background. Now here’s the interesting part:  The article I recently read cited one researcher as saying, “scientists are studying just what bacteria are required for a healthy gut, with the hope of developing a probiotic that could replace the need for a stool transplant.” (http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2012/03/24/MN4R1NPENT.DTL) I found that rather interesting, since probiotics have been available in my local health food store, and even in the supplements section of Rite Aid, for years yet the article reads as if there is no such thing available. If I have to take an antibiotic for any reason I routinely take probiotics between the doses of the antibiotic, which I have found ensures that I will have a healthily functioning gut. If I don’t take the probiotics, let’s just say that I am aware of the difference.

 How CAM hurts its own cause

As a CAM practitioner it’s easy for me to try to put the whole blame on Western medicine for not recognizing where CAM modalities can help with healing, but unfortunately part of the fault lies with how some CAM proponents explain their modalities. A few developers of newer modalities—BodyTalk, is an example—try to tie their techniques to quantum physics or elementary particles such as quarks or speak of electromagnetic fields without really having any scientific confirmation of their claims, casting doubt on their efficacy in the strongly scientific evidence-based medical community. Theories that lack scientific evidence also form a problem for older modalities such as Acupuncture, with its theory of meridians. Meridians are described as energy channels, but they don’t match anything observable in human anatomy. My own field of Reiki is usually described in terms of life-force energy, although science has no way to measure such a thing even if it exists.

For many of these modalities, anecdotal evidence and some well-designed studies have shown their efficacy even if how they work hasn’t yet been explained scientifically. This is certainly true of Acupuncture and is increasingly true of Reiki, and it appears to be growing with BodyTalk as well. When asked, practitioners of all of these—and other—CAM modalities would be wise to simply say “we don’t know how it works” until some scientific evidence exists to show how the modality in question actually does function. Western medicine’s acceptance of CAM modalities is thwarted by pseudoscientific theories, and they should be dropped.

The ideal: Integrative medicine

Based on my own experience and that of my clients, I am a strong believer in integrative medicine—the integration of both Western medicine and CAM—as the best approach to medical care. True integrative medicine will happen when Western medicine practitioners realize that they don’t have the single solution to absolutely every health problem and that CAM modalities can often work effectively in tandem with Western medicine, and that in some circumstances CAM modalities may even offer a better solution.

That ideal world will only occur when CAM modalities stop describing their actions in pseudoscientific terms, which in turn will encourage Western medicine practitioners to stop treating all non-Western medical modalities as “quackery.” That change will make it easier for doctors to support their patients’ use of CAM modalities (since very few if any of those modalities are dangerous, especially when compared with all-too-many pharmaceuticals), and to even prescribe them in relevant cases. There are an increasing number of Western medicine-based integrative practitioners—my own primary MD is one—but in my ideal world all doctors will be supportive of any modality that will help their patients achieve better health.

I recently received an email from an organization that focuses on encouraging patients to consider filing for malpractice if something goes “wrong” with their treatment by someone in the medical field. They wanted me to provide a link on my site to theirs, but my instinctive response is a rather resounding “no!”

My reasoning isn’t that true malpractice doesn’t sometimes occur. Rather, I think it’s possible to make a case that the perceived threat of a lawsuit can cause at least as many, if not more, problems than does poor medical treatment itself. That last thought is the focus of this post.

There is clear evidence(1) that the enormous stress on a physician brought about by a malpractice suit frequently leads to depression and burnout and even thoughts of suicide. For the patient, her or his physician’s stress of a malpractice suit often leads to over-testing, over-medicating, unnecessary surgeries (especially exploratory and biopsies) and over-reliance on test results and technology instead of the patient’s history or the physician’s understanding of a particular patient. The experience of a malpractice suit can even lead to a physician refusing to take some cases. I wouldn’t be surprised if just the perceived threat of a malpractice suit can lead to the same types of over-cautious actions.

A physician’s stress and burnout and over-reliance on technology to try to protect him- or herself not only results in the potential for more errors but quite likely results in less interest in patients—after all, they might sue—which leads to a less personal relationship with the patient as a person. And, of course, a patient who is treated impersonally is more likely to feel alienated from the physician and is therefore more likely to sue.

It’s a vicious circle, but one that potentially can be avoided or escaped, and often the patient needs to take the initiative. Based on various sources—including my own experience with Western medicine—here are some of my thoughts on how you might work more effectively with your doctor:

• Engage your physician as your partner. Be up-front with your doctor about your values, concerns, goals, etc., and be sure he or she really hears you.
• Avoid being adversarial. Be polite and respectful. Treat your doctor as your ally, not your enemy, and she or he will respond accordingly. It is often helpful to openly acknowledge to your doctor how you think she or he views you. For example you might say “You probably see me as argumentative and stubborn, but . . . .”
• Be an active participant in your care. Question what your doctor says, but politely, to be sure you fully understand what he or she is telling you. Ask the doctor to explain your disorder and the treatment options in lay terms and repeat them back to be sure you fully understand what is being said to you, and write everything down for later reference. In fact you may want to bring a family member or friend with you to an appointment so you don’t miss something important.
• Don’t hesitate to look up everything on the Internet to clarify your understanding. In addition, you might want to get a second or even a third opinion, depending on your problem. A good doctor will respect you for being thorough.
• Although there is a perception that Western medicine can work miracles, the costs of some tests and treatments—and not just in monetary terms—may be higher than you would like to pay, so ask for details, especially including the potential outcomes (positive and negative, and the probabilities of each) of a procedure or the expected benefits and side effects from possible medications. Ask how other patients of your doctor have fared under the same treatment. A highly touted cancer therapy might give you an extra few months of life, but those few extra weeks may be at the expense of your quality of life.
• If you engage your doctor in a candid dialog, you might be surprised that she or he agrees with your misgivings. Not all doctors think that the most aggressive treatment is necessarily the best option(2).
• Consult with close family and friends, as well as your doctor (or doctors), to be sure you are all on the same page. If necessary, change doctors.
• Look into CAM (complementary and alternative medicine) therapies to see how they might complement—or even replace (if that is your inclination)—the Western options that are available to you. But get a firm diagnosis first, since your CAM providers need to be clear about what they are treating you for and, by law, they cannot offer you a diagnosis.

Two final points:

• When you have done all your homework, the final decision about what you do and do not want to do needs to be made by you.
• And always remember, your doctor is a person, too(3)!

_______________

References:

1.   Chen, Pauline W., MD: “When the Doctor Faces a Lawsuit” New York Times, December 15, 2011. http://well.blogs.nytimes.com/2011/12/15/when-the-doctor-gets-sued-2/?ref=malpractice

2.   Murray, Ken, MD: “How Doctors Die.” http://zocalopublicsquare.org/thepublicsquare/2011/11/30/how-doctors-die/read/nexus/)

3.   Groopman, Jerome, MD:  How Doctors Think by Jerome Groopman, MD (Houghton Mifflin Co., © 2007).

After writing my first post describing my goals for this blog I did some thinking about how to really begin, and it’s clear that there is only one place to start: with the individual who is at the core of the whole healthcare system, the one without whom there would be no healthcare system. In other words, I want to begin with the patient.

Just out of curiosity I looked up the word “patient” in my American Heritage Dictionary and discovered that it comes from a Middle English word that means “one who suffers.”  Its Latin root means “to endure.” The first definition of the word in its adjectival form is “Bearing or enduring pain, difficulty, provocation, or annoyance with calmness.” I bet those definitions resonate with at least some of your dealings with the Western healthcare system. I know they reflect some of my own experiences.

One of the current trends in Western medicine is “patient-centered health care,” so the industry is beginning to recognize the problem with how patients are frequently treated. If you’ll pardon a little irony, health care can be (and often is) insurance-centered, medical staff (especially MD)-centered, hospital- or medical center-centered, pharmaceutical-centered, medical equipment-centered, test- and lab work-centered, procedure-centered, paperwork-centered and, of course, (encompassing the others), money-centered. As for the patient, the spotlight is generally on a disease or disorder of some sort or on an organ. Whatever the focus, too often it is not on the whole person—the unique living being who includes not only organs in a physical body but also a mind, emotions, spirit, culture, age, gender, community, etc.—who is asking for help.

I do want to acknowledge that there are a significant number of physicians and health care centers that already practice true care of the person, and they deserve accolades. But for the rest, there is definitely still work to be done. The current focus on patient-centered care is a very hopeful sign. I did a quick on-line search of “patient-centered health care” and found references to research on bringing patients around to the medical community’s views on their care, and on whether patient-centered health care is necessary and whether patients even want it, but not much on what the phrase really means except for some rather terse definitions. (See http://www.patientsorganizations.org/attach.pl/547/494/IAPO%20Patient-Centred%20Healthcare%20Review%202nd%20edition.pdf for a good overview of current research.) What seems to me to be still missing in much of the discussion of this topic is focus on the patient as an individual.

I believe that patient-centered health care is actually an old, not a new, idea. It was practiced by the old country doctor who knew his “patients” personally, made house calls, and was available at any time. It is practiced by healers in native cultures. And it is frequently practiced by contemporary holistic healers, those who provide what are known as complementary and alternative modalities (CAM), both old and new, such as massage, homeopathy, chiropractic, herbalism, Ayurveda, acupuncture, hypnotherapy, and bio-energy modalities like Reiki.

In my view, these healers nearly always care for each person who comes to them as a unique and whole person. They don’t provide one-size-fits-all medicine. These healers engage the people who come to them as partners in healing by actually listening to them and really seeing them as individuals. These practitioners are frequently truly holistic, actively including, rather than shying away from, the mental, emotional, spiritual, and cultural aspects of their clients.

So based on all of this, here’s my own definition of what a patient-centered health care provider would look like:  Someone who cares about, listens to, and addresses (using understandable English or the person’s native language) the whole person as a unique individual and tailors health options accordingly, either supplied by the health care provider or through referrals, including modalities that are usually considered to be CAM or even indigenous, with the person as a full partner in any decisions about his or her care.

This definition sounds very simple to implement, and it should be, at least in theory.  But there are many factors that are interfering with the easy adoption of this approach—on the side of the prevailing philosophy of Western medicine but also on the part of the patient—and I’ll leave those for future posts.

In the last incarnation of my website I created a set of occasional blogs primarily focused on personal healing that (I confess) were usually very thinly disguised ads for my services. Although I will most likely rewrite and repost some of that material along the way (without the blatant ads), my goals for this version of my blog are a bit broader. I want to write about medicine in general in addition to healing.

My foundation for this blog comes from a perspective that has a variety of sources. First, I am neither a physician nor a nurse. Rather, I guess you can describe my role as being an adjunct to mainstream Western medicine. I have an ongoing association with Western medicine through my experience with chaplaincy and integrative therapies in both hospice and hospital settings. I continue to learn from the clients in my own holistic healing practice and from conversations I have with a variety of other people. Add to that my own personal experience as a patient in both Western medicine and complementary and alternative medicine (CAM), plus the reading I do in the field of health and healing—news items, books, articles and other blogs. In addition, my view of all of these experience is filtered through my background in anthropology, providing a less exclusively Western perspective.

What does all this mean? It means that I believe I can provide insights into health and healing, and Western medicine and CAM, that will be of value to my readers.

Here are some of the topics (in no particular order) I am planning to address:

• What, in my perspective, is wrong—and right—with Western medicine.
• What, in my perspective, is right—and wrong—with CAM.
• Why CAM sometimes works when Western medicine doesn’t.
• What I think are the reasons that Western medicine and CAM are foes, and why they don’t need to be.
• My thoughts on native healing and what we can learn from it.
• My view as to why medicine, whether Western or CAM, needs to be holistic to be truly successful.
• The role of the patient in his or her own healing and curing.
• Some possible reasons why unexpected (sometimes called “spontaneous”) remissions can occur in cancer as well as with other chronic, often considered “incurable,” ailments.

These are just some general categories. Each of these topics can lend themselves to multiple blogs (I want to keep each one fairly brief), and I have no doubt that other issues will spark my attention—and my keyboard—along the way.

I doubt if my observations will always be new, but hopefully they will provide a perspective that will provide food for thought. I will welcome your comments on any of my musings.

Talk to you soon!