Integrating Western and Alternative Medicine

"In the measure to which I think and speak not from my own individual conviction but simply repeating what 'is said' and 'is thought' my life ceases to be mine, I cease to be the supremely individual person that I am, and I act on society's account." Jose Ortega y Gasset

In last month's newsletter I related my youthful doubts about mainstream western medicine and told how I became interested in alternative medicine. The Orgeta y Gasset quotation above, lauding independent thinking, was my favorite at that time. Since that time, I have studied a number of alternatives and have integrated the best methods from many of them into my practice. I may have been early out of the gate, but in the last 15 years, alternative medicines have begun to gain respect. In 1991 Congress established the National Center for Alternative and Complementary Medicine, a branch of the National Institutes of Health, to provide information and encouraging research on alternatives. This month, I'll give a brief survey of the various alternative schools with their pros and cons.

Mainstream Western Medicine

Mainstream medicine comprises methods developed in academia, approved by the government and by insurance companies, and practiced by most licensed physicians. As you know from previous newsletters, there is much to criticize in mainstream medicine, but let me here point out some advantages.

While fads (freezing the stomach in the 1950's, excessive hysterectomies in the 1960's, excessive statin use currently) occur regularly, eventually someone does a study to show the error. Scientific studies constantly scrutinize medicine, so that our ability to keep people alive and improve the quality of their lives increases all the time.
Say what you will about mainstream medicine, few people wake up at 3:00 am with agonizing abdominal pain and call their chiropractor. Run over by a truck, they don't think acupuncture. For 99 percent of the population, mainstream medicine is the court of last resort.
If you want "fast, fast, fast relief" mainstream medicine is your horse to bet on. Just make sure it doesn't step on your foot.

Alternative Medicine Defined

People get confused about the terms alternative, complementary, and holistic medicine. Here are the definitions:

Alternative medicine is as any healing method not associated with mainstream medicine.
Complementary medicine uses non-mainstream methods to complement mainstream medicine.
Holistic Medicine concentrates on the spiritual side of medicine, while using alternative or mainstream techniques depending on the training of the practitioner.

Alternative Schools of Medicine

The following are some of the different schools of alternative medicine, most of them readily available locally and nationally.

Naturopathy
Naturopaths seek to understand and enhance the healing processes in the body, employing botanical, nutritional, homeopathic, and other methods. They have successfully petitioned Washington State to allow them to prescribe antibiotics. A naturopathy license requires a college degree followed by a four year education that includes biochemistry, anatomy, physiology, and many other traditional medical courses, as well as courses in non-pharmaceutical medicine. I've met and learned from some very capable naturopathic physicians, and many of my patients are the better for it. The naturopathy profession correctly recognizes that they still lack the competency-intensive residency programs that turn green medical school graduates (who have their MD, but little front-line experience) into responsible, team-aware physicians.

Chiropractic
Traditionally, chiropractors relieved musculoskeletal pain by manipulation of the tissues and joints. Some chiropractors combine traditional chiropractic with nutrition and physical therapy techniques. Back in 1975 when I worked in Pacific Grove, California, I walked into a chiropractor's office, introduced myself, and asked what he could tell me about chiropractic. In answer, he set me on his table and, to my surprise, twisted my neck quickly to one side, then the other, producing a series of cracking sensations. It did not hurt, nor did I feel any better than before. I know he meant well, but that particular maneuver has a six in 100,000 chance of causing serious harm.

Although some chiropractors claim to be "family doctors," they really cannot replace a family physician. Their training just doesn't stand up to the task. Not all chiropractic colleges require even an undergraduate degree for admission. Chiropractic programs require four years of study and practice.

Acupuncture
When most Americans think of Chinese medicine, they think acupuncture. However, traditional Chinese medicine (TCM) has included internal medicine, surgery, and many other techniques not usually offered by Chinese medicine in this country. Contemporary Chinese physicians use modern pharmaceutical and surgical techniques alongside the traditional methods.

Chinese medicine postulates energy channels (called meridians) through the body. Acupuncture works to influence these channels using needles or heated herbs (moxibustion). I've known patients with sleep disorders and addiction problems to have success with acupuncture, but the results are not consistent. Success seems to depend very much on the individual practitioner. The patients who rave the most to me about Chinese medicine go to Chinatown to get it.

Herbalism
Leaving aside shamanism, herbalism must be the oldest form of medicine on this planet and it is still used effectively today. English physician William Withering entered the history books thanks to his observations and deductions regarding the traditional herbal remedy foxglove, source of the heart medication, digitalis. Know anyone with breast cancer? There's a good chance they were treated with paclitaxel, from the Pacific Yew tree. Today, you can go to Oxford University in England and study herbalism to the PhD level. Unfortunately, around 1911 mainstream medicine, with corporate help, succeeded in ending such education in the United States. As a result, there are very few well-trained herbalists in the United States. Most are self-educated with predictably variable results.

Homeopathy
Homeopathy, "like cures like," is based on the theory that if something causes a symptom at high doses, it will reduce the symptom if given in vanishing small amounts. I recall one research study reporting a benefit for allergic rhinitis, but in most studies homeopathy appears to have only a placebo effect. As with herbalism, there are no credentialed schools of homeopathy. I've heard stories of success and failure from patients. Of everything mentioned here, it is least likely to cause harm.

Ayurvedic Medicine
Ayurvedic medicine recognizes that people come in differing psycho-physiologic types, and tailors remedies to each individual. In 1987, the Transcendental Meditation organization offered a course in Ayurvedic medicine near New Delhi, and I decided to take it. While Indian schools of Ayurvedic medicine require over five years of study, our course was only a month in length. The course was heavy on theory, light on practice. I took several supplemental courses after my return to the US. There, I learned some valuable concepts and gained more respect for fully-trained Ayurvedic physicians.

Recently, about 20 percent of Ayurvedic herbs brought into the US were found to contain mercury and other heavy metals; Ayurveda believes these to be important remedies. On the other hand, an Indian organization successfully overthrew a US university's patent on a potent traditional medical herb, arguing that Ayurvedic doctors had known the benefits of and used this herb for centuries. I think a skilled Ayurvedic physician who had also been through a complete mainstream medical training would be able to learn how to integrate the two, and teach the rest of us. The same holds true for chiropractic, TCM and herbalism.

Osteopathic Medicine
Originally, osteopathic medicine focused largely on manipulative methods. Over time, osteopathic medical schools became almost identical to medical schools, with the addition of manipulative techniques to the curriculum. Upon conferral of the DO (Doctor of Osteopathy) degree, students enter residency programs where they join MDs for specialty training. State licensing authorities correctly treat osteopathic doctors as the equivalent of MDs.

Indigenous Medical Systems
Aside from traditional Chinese medicine, herbalism, and Ayurvedic medicine, there are numerous other indigenous systems, including Islamic medicine. Moslem scholars preserved the writings of the ancients, including Galen and Hippocrates, and gave us great physicians of their own such as Avicenna. Today botanists scour the rain forests looking for undiscovered medicinal plants, and the indigenous knowledge of their use.

Integrative Medicine

If we're really in trouble, most of us — myself included — turn to western medicine for help. But the very fact that pharmaceutical companies send botanists out to interview indigenous healers in the rain forests, that Ayurvedic doctors successfully sued for patent infringement, and that herbs like foxglove are the foundation for potent western medicines, tells us that the alternatives have much to offer. Western medicine would do well take a dose of humility and keep its mind and its eyes open for every possible way it can help and heal.

Having spent over three decades involved in botanical medicine, Ayurvedic medicine, naturopathic medicine, traditional western medicine, etc, I prefer to evaluate each individual, discuss the options, and work out an individual treatment plan. This process, integrating western medicine with other schools, is called Integrative Medicine. And just as every school of medicine can be improved, we need to appropriate the best of each school — what it can be, not just what it is. As Arnold Relman, past editor of the New England Journal of Medicine pointed out, "There is no such thing as alternative medicine. There is medicine that works and medicine that does not work."

Coming Next Month

Medicine for People! has not been shy about identifying the warts in mainstream medicine. Next month we'll point out some pitfalls in alternative techniques, especially those designed to entrap desperate folks with promises of magical cures. We've covered this slippery slope previously in

Stay tuned next month for my "Alternative Medicine Hall of Shame."