ALTERNATIVE DOCTOR, LLC

Healthcare Choices

An Introduction to Alternative Medicine

Dr. LLoyd May

The rapid rise of alternative medicine worldwide is a recent phenomenon. Most people have an intuitive idea of what is meant by alternative medicine. In general, the best explanation of alternative medicine is any treatment or therapy not usually taught in Western medical schools, nor routinely used or prescribed by medical doctors.

The lit of therapies which belong to this category is extensive. In fact, any list of alternative therapies is quickly outdated as new therapies and medications arise. In the United States, the principal alternative therapy is prayer for one’s health or prayer for another’s health.

Other widely used modalities include chiropractic, herbs and supplements, massage therapy, traditional Chinese medicine and acupuncture, and yoga.

It seems that there are two parallel and non-intersecting methods of health care in the United States, Western Europe, and Canada. The first is traditional medical care, consisting of physicians, nurses, working in a private office, clinic, or hospital setting. The usual scenario involves making an appointment, seeing the health care provider, tests being ordered, and either drugs prescribed or possibly surgical intervention suggested as an option. The tests ordered are sometimes benign, such as phlebotomy, but the technology of testing now includes a panoply of radiological and invasive testing. Also acute medical emergency care, or trauma, usually involves direct hospitalization through an emergency room.

But, for a variety of reasons, most patients, while not abandoning their primary care physician, usually try self-care first, even before making an appointment. And, even while seeing a physician, patients continue to use alternative modalities, in addition to their prescription medications. But it is critically important that patients share to their physician exactly what alternative therapies or treatments he or she is using to treat.

This is important for several reasons. The first reason is that side effects may occur between prescription drugs and over the counter or herbal medications or supplements, which may be innocuous, or they may be important and dangerous. The second reason, which is usually not emphasized, is that the alternative therapies may actually have beneficial synergistic effects with medical therapy. Or in some cases, the alternative therapy is providing a therapeutic option that by itself is efficacious. So it is important to have as many tools or therapeutic options available to affect health and healing.

The reasons for this dichotomy are many, and there is no simple answer as to the lack of communication between patients and their physicians. And what is the reason for the popularity of alternative medicine, contrasted with the dislike of the current practice of medicine. Modern scientific medicine is high tech and pharmaceutical driven, which can sometimes yield spectacular results-and these results are highly publicized on the nightly news. But many of our disease are chronic, and seemingly incurable, and less dramatically responsive to pharmaceutical or technology alone. Likewise, these new treatments are usually very expensive, and can have significant toxicities, most of which are unknown to patient and physician alike.

In addition, there is a perception that natural medicine is a safer, less toxic approach. The unfortunate aspect of this dichotomy is the lack of communication between doctor and patients, and with many patients not revealing all the therapies they are using. Although not always the case, physicians tend to be suspicious of anything not medically based. This attitude is changing, and progress is being made in many medical schools. One example of such a program is that of the University of Arizona, through their program in Integrative Medicine.

Although health care is a two trillion dollar industry in the United States, alternative health care costs are only a fraction of the total dollar spent (about fifty billion dollars). There is a significant difference in these two expenditures, however. Almost all money spent on alternative health care is out of pocket, cash, not through the intermediary of insurance companies. So patients who choose alternative medicine vote with their pocketbook, and their feet. The number of patient visits to alternative medicine practitioners exceeds the number of doctor visits by at least two to one. So it is vitally important that all healthcare providers be aware of the therapies available that patients are using to intelligently approach their total healthcare.

There are other forces at play. People are increasingly skeptical of the pharmaceutical industry, who sometimes seem more driven by profit than by patient care. And the focus on wellness has never been primarily emphasized by the medical community. Our Byzantine insurance industry in general only pays for acute critical care, even when preventive healthcare has been shown to be cost effective. The most glaring example is cardiovascular disease, which accounts for 30% of the healthcare dollar. Glitzy interventions such as drug eluting stents, or cardiac bypass surgery, can cost over $30,000 and much higher with this costs being covered by insurance, but dietary and exercise treatments usually are not covered by insurance. And more radical alternative treatments, such as the Ornish program, which cost only a fraction of the above, are covered only by a few insurance companies, in scattered locations. His "radical" program consists of vegetarian diets, exercises, group therapy, and meditation and yoga.

And recent pharmaceutical examples such as the recall of Vioxx have shown that the pharmaceutical industry is consistently emphasizing profit over safety, pushing the margins until the FDA withdraws their drugs. After voluntarily withdrawing advertising on Celebrex, Pfizer recently announced resumption of direct to consumer advertising, albeit with a new warning. And the twenty billion dollars spent by the drug industry on direct physician marketing dwarfs all lobbying dollars in Washington by a factor of ten to one!

So how do you choose what options are available to treat your problem or condition? First, emergency and life threatening conditions would usually be treated by the medical system. And with good reason. This is where the spectacular results of Western medicine are most evident. The list of new pharmaceuticals, and new technology multiplies daily. For more chronic diseases, most of us are interested in at least evaluating other therapies and options. And indeed, eventually, the ideal medical health care system would allow a panoply of choices for patients and even with each system of health care a variety of choices is possible.

Let’s stop for a moment and actually look, worldwide, at how medicine is practiced. It is increasingly important for nurses and doctors to understand multicultural healthcare, and to be attuned to the practices of their local community. According to the World Health Organization, in the United States and Western Europe, allopathic or Western medicine is the dominant healthcare for the general public. But strikingly, within these countries, the use of alternative medicine is significant. Studies show that up to 75% of Americans, and up to 50% of Europeans use at one form or another of alternative medicine. A preferred term to alternative medicine is "traditional medicine." The World Health Organization defines Traditional Medicine as the "health practices, approaches, and knowledge and beliefs incorporating plant, animal, and mineral based therapies, spiritual therapies, manual techniques and exercises, applied singly or in combination to treat, diagnose, and prevent illness and maintain well-being."

Looking at the rest of the world, we see a astounding fact: a significant percent of the world uses Traditional Medicine (or the United States term "alternative medicine") as their primary health care system. This includes Ayurveda, Chinese Traditional Medicine, Homeopathy, Chiropractic, and Unani( or Arabic Medicine).

Stepping back, let us look at some other terms used to describe non-Western medicine.

Unfortunately, the term Traditional Medicine is confusing, since in the United States it usually connotes the regular practice of Western medicine, but actually means just the opposite worldwide! Holistic is an older term, and connotes looking at the complete picture. It is not used as much now, but the term persists. For example, there is a Holistic Nurses Association, and the like. As already mentioned, the WHO uses the term "traditional medicine" to describe "the indigenous medicine of a region in contrast to Western medicine."

Other terms include "integrative medicine" which implies and integration of Western medicine with other modalities. This term was popularized by Dr Andrew Weil, who established the Integrative Medicine Program at the University of Arizona. Another term is complementary medicine. The idea that, for example, massage or acupuncture can complement Western medicine, is emphasized. And so also is for the other term, complementary and alternative medicine.

Another term is indigenous medicine, which to the healing practices of a native region or culture. It is important to realize what context, and who is using the term, in rational discussions. For example, physicians as a group are skeptical of alternative medicine, and usually, even if open-minded, tend to think of it as "only the placebo response." So this would be a pejorative use of the term, as with the word quackery. And, from a historical perspective, it is important to realize the antagonism between physicians and basically all other groups. The American Medical Association forbade referral to chiropractors under threat of loss of licensure, up until recently. And referral to others as well was included, for example, homeopathy. And even today, there are legislative battles between medical doctors and naturopathic doctors, for example. Another historical footnote, the American Medical Association was formed only after a rival organization, the American Homeopathic Association, was formed and deemed a competitive threat.

But a good classification of alternative medicine, I think, comes from the World Health Organization, which lists these major worldwide modalities: Ayurveda, Chinese Traditional Medicine, Homeopathy, Chiropractic, and Unani. These are the major alternative health systems used worldwide by most people.

So the purpose of this book is to serve as a guide to these alternative therapies and systems; to give examples of a typical patient encounter within each of these systems, and to furnish guidance to you, the patient. Eventually the question to be answered for all of us is, given my symptoms, my problems, what can each system do to help, to treat, and to possibly cure. In other words, what are my healthcare choices? This includes not only systems of care, but questions about individual providers and their qualifications. It also will lead us to discuss the cost involved, and which treatment really is the most cost effective for you, the patient. And cost must consider not only dollars, but overall morbidity and mortality; ie which therapies are the safest and the most efficacious.

Let us first look at what is happening in the United States now. According to the National Center for Complementary and Alternative Medicine, in a 2002 survey:

62.1 % of Americans used CAM (complementary and alternative medicine) in the past 12 months.

The ten most common CAM therapies are:

Prayer for one’s self 43.0 %

Prayer for others 24.4

Natural Products 18.9

Deep Breathing 11.6

Prayer group 9.6

Meditation 7.6

Chiropractic 7.5

Yoga 5.1

Massage 5.0

Diets 3.5.

CAM by domain includes the following

Mind Body Medicine 52.6%

Biologically based practice 21.9

Manipulation and Body 10.9

Whole MedicalSystems 2.7

Energy Medicine 0.5

When asked why they used CAM

CAM would improve health when used in combination with conventional medicine 55%

CAM would be interesting to try 50%

Conventional medical treatments would not help 28%

A conventional medical professional suggested using CAM 26%

Conventional medical treatments are too expensive 13%

Most people use CAM along with conventional medicine.

It is also interesting to see which medical problems initiated CAM use:

Back pain 16.8%

Head cold 9.5

Neck pain 6.6

Joint pain 4.9

Arthritis 4.9

Anxiety/depression 4.5

Stomach upset 3.7

Headache 3.1

Recurring pain 2.4

Insomnia 2.2

Finally, it is important to recognize the CAM therapies included in this survey:

* means practitioner based

*acupuncture

*ayurveda

*biofeedback

*chelation therapy

deep breathing exercises

diet based therapies including vegetarian diet, macrobiotic diet, pritikin diet, ornish diet,

atkins diet, and zone diet

*energy healing therapies

*folk medicine

guided imagery

homeopathic treatment

*hypnosis

*massage

meditation

megavitamin therapy

natural products

*naturopathy

prayer for health reasons including prayer for one’s own health, others ever prayed

for your health, participate in prayer group,

healing ritual for self

progressive relaxation

Qi gong

*reiki

tai chi

yoga.

An important question is how to find and to evaluate a practitioner for those therapies requiring a practitioner which include:

Acupuncture, ayurveda, biofeedback, chelation therapy, energy medicine, folk medicine, hypnosis, homeopathy, chiropractic, massage therapy, naturopathy, reiki, and traditional Chinese medicine.

Another focus of this book is to discuss licensure and accreditation, and training for the above specialties.

To recapitulate, WHO defines traditional medicine as health practices, approaches, knowledge, beliefs incorporating plant, animal, and mineral based medicines, spiritual therapies, manual techniques and exercises, applied singularly or in combination, to treat, diagnose, and prevent illness, or maintain well-being. In countries such as Africa, Asia, and Latin America, traditional medicine is used to help meet some of their primary health care needs. In Africa, 80% of the population uses traditional medicine for their primary health care. In industrialized countries, adoption of traditional medicine is call alternative or complementary medicine (WHO).

Ayurveda originated in the 10^th century BC, and the term means the science of life. In ayurvedic philosophy, there is an intimate connection between the individual as a microcosm, and the environment of the macrocosm. Ayurveda is a system of medicine, as well as a way of living to prevent and cure disease. It is practiced widely, in Southeast Asia, Nepal, India, Bangladesh, and Pakistan.

Chinese traditional medicine is the most widely used traditional or alternative medicine, especially acupuncture. Diagnosis is based on a holistic view of the patient, and his symptoms. Practitioners of Chinese medicine seek to control the body’s energy level through twelve meridians, or energy channels. A variety of modalities are used, including acupuncture, massage, herbs, diet, and breathing exercises. Surgery is rarely used. It is used worldwide.

Chiropractic was founded in the later part of the 19^th century, and is based on an association of the spine and the nervous systems with bodily ills. The self healing properties of the body are encouraged and stimulated. It is practiced widely, and training programs are accredited by the World Federation of Chiropractic.

Homeopathy was first mentioned by Hippocrates, the father of medicine, but developed mainly by Dr Hahnemann. He noted that the pharmaceutical drugs of the time caused more side effects than cure, and developed the laws of similarity, direction of use, principle of a simple remedy, the theory of minimum diluted dose, and the theory of chronic disease. Diseases are treated with remedies that in a healthy patient would produce symptoms similar to the disease. It is practiced worldwide. Homeopathy is integrated in the national health care systems of many countries, including the United Kingdom, Sri Lanka, Pakistan, Mexico, and India.

Unani is based on Hippocratic theories. It is based on Galen, Rhages, and later, Avicenna. Unani draws on the traditional medical systems of China, Egypt, India, Iraq, Iran, and Syria. It is also called Arabic Medicine.

As can be seen from the above, alternative medicine provides important health care to many people, even to those using allopathic medicine. Its major but not exclusive area of usefulness include mental health, disease prevention, treatment of non-communicable diseases, and in the improvement of the quality of life for those suffering from many chronic diseases.

So it is interesting in conclusion to look at some statistics. In the United States, there are areas which are licensed, including osteopathy, medicine, chiropractic, acupuncture, massage therapy (in most locations), and naturopathy (in fourteen states). There are also non-physician homeopaths, herbalists, iridologists, and nutritionists. Also generally unlicensed are homeopathy, hypnosis, biofeedback, biofield or energy therapy, Reiki, Traditional Chinese Medicine, Unani, and Ayurveda.

Approximately 3000 allopathic physicians and other healthcare providers practice homeopathy. There are approximately 65,000 chiropractors, and 60,000 doctors of osteopathic medicine in the US. More than 60% of DO’s are in primary care medicine and deliver 10% of the total US healthcare. Chiropractors see at least 10-15% of the population. There are at least 6000 acupuncture practitioners, and about 3000 medical doctors who have trained in acupuncture. There are over 1000 licensed naturopathic doctors in the US, although this number is rapidly increasing. There are approximately 50,000 biofield practitioners providing 18 million sessions annually. There are at least 75,000 massage therapists, providing 45,000,000 sessions annually. There are ten Ayurvedic clinics, including one hospital, in the US.

Much of medicine and health care falls under regulation. There are six areas of law: licensing, scope of practice, malpractice, professional discipline, third party reimbursement, and access to treatment. The first five of these is regulated by State laws, and can vary state by state. Federal laws govern the last. There is the exception of Traditional Native North American Medicine, which is regulated under the self-determination act.

Homeopathy is regulated in Arizona, Connecticut, and Nevada, and there is a physician licensing board. Homeopathic medicines are recognized and are regulated by the FDA, and are manufactured by pharmaceutical companies

Biofield therapy is currently not licensed. Naturopathy is licensed in fourteen states, and the general practice of medicine and surgery is usually prohibited. Acupuncture is licensed specifically in at least 15 states, with 40 states having guidelines. Finally, manipulative therapy in licensed in all states, although most states require chiropractors to add a qualifying reference to the use of the term "doctor" or "physician."

So, in the chapters to follow, we will examine these major areas of alternative medicine, as well as the use of natural products. Finally, I will review the general practice of allopathic medicine, insurance coverage, and suggestions on how to integrate this information so that you, the patient, can make an informed health choice.