There is something brewing in the world of medicine and it’s a lot stronger than a cup of chamomile tea.  In a shift in thinking that confounds nearly everyone, alternative treatments such as acupuncture, herbal and botanical remedies, and various mind and body techniques are not only gaining greater acceptance among patients and alternative practitioners, but by many medical doctors, as well.  Ever since the National Institutes of Health created its Office of Alternative Medicine in 1992 to study popular techniques and modalities that fall outside the realm of conventional treatment, there has been a growing — albeit cautious —  discussion of  these methods, some of which have been around for centuries.

The creation of this NIH Office followed closely on the heels of a now frequently quoted study published in the New England Journal of Medicine, conducted by Harvard Medical School.  This landmark research reported that, in 1990, an astonishing one-in-three Americans had used some form of alternative therapy during the previous year.  According to NIH, 425 million visits were made that year to alternative health practitioners, compared to 388 million visits to conventional primary care physicians. Consumers made more visits to chiropractors, acupuncturists, homeopaths, herbalists, and other alternative healers than to all primary care physicians combined.  Even more impressive is that the cost of all those trips to alternative caregivers — an estimated $14 billion — were mostly paid out-of-pocket because alternative treatments are not generally covered by insurance plans.  This amount is more than the sum total of all our hospital bills that year.  Today, more health plans and insurers are agreeing to pay for some alternative therapies.

Until quite recently, however, most U.S. physicians scoffed at the very idea that anything outside their strictly Western-based style of medicine could help their patients.  Average consumers were reticent, as well, to experiment with forms of treatment that — in their own minds at least — a) were shrouded in mystery, b) belonged back in the 60s with the Hippies, and, c) somehow smacked of sorcery and hocus-pocus.  Now there appears to be a grudging truce between the camps, although allegations are still flying.  Medical doctors accuse alternative practitioners of selling unscientific and ineffective therapies, and the alternative camp hurls charges that too many physicians are insensitive and quick to promote invasive procedures as cures. 

What has happened to begin the thaw?  Probably the most significant contribution to the popularity of non-traditional therapies has been the gnawing dissatisfaction of patients with a health care system that has become increasingly depersonalized and remote.  They complain that all too often, after taking expensive pharmacological treatments, they have simply traded symptoms for side-effects.  This is a problem for patients with chronic illnesses especially, who say it is necessary for them to regain control over their disease.  They believe there might be something beyond the limits of conventional medicine that could offer a cure or at least a more humane treatment....all they have to do is find it.

Even the best doctors are frustrated that combining the art of healing with the science of medicine is getting harder and harder to do.  They point out that the time it takes to get to know their patients, to listen, counsel and reassure, is — unfortunately — at a premium.  For many, this is the void that alternative medicine appears to be filling.

Alternative Medicine...What Is It?

One of the components in the alternative medicine debate is the lack of agreement on a central definition.  Some define alternative therapies as those that are not widely practiced in hospitals or taught in U.S. medical schools; therapies that have their own philosophy and techniques.  The cornerstone of alternative medicine appears to be the importance of the patient’s unique relationships, values, attitudes, beliefs, spirituality, and emotions — central to which is the unwavering belief in the body’s ability to heal itself.  Another focus is on “holism,” or the tenet that all aspects of a person — body, mind and spirit — are somehow interrelated and should be treated as a whole.  The concept is concerned with a person’s balance — with himself, his life and his environment.  Tying this whole package together is energy, or the force necessary to achieve the all-important balance.  The success of alternative techniques is often judged by the overall well-being of the patient, and does not just concentrate on the disease itself.

Alternative therapies appeal to patients who have grown exasperated with the treatment they have received in traditional care modalities.  Many complain about being treated as part of an assembly line or as an “internal organ” instead of the person attached to it.  There is one thing that everyone in this debate can agree upon: medicine is as much an art as it is a science, and that the relationship between a patient and his health care provider is paramount.

From the medical side, one of the leaders in alternative and complementary cancer treatments, Barrie R. Cassileth, Ph.D. (Adjunct Professor of Medicine at Harvard University, Duke University and the University of North Carolina), recently completed an international review of the literature on prevalence of use of alternative therapies.  She found it appropriate to draw a distinction between a complementary therapy (“promoted for use not to cure cancer, but to ameliorate symptoms, enhance quality of life, and improve well-being”) and alternative therapies  (“those promoted for use instead of mainstream cancer treatment”).  In her book, “The Alternative Medicine Handbook: The Complete Reference Guide to Alternative and Complementary Therapies,” Dr. Cassileth includes such things as massage or drinking peppermint tea in the complementary category, and ‘biological cancer treatments,’ an herbal mix called “Essiac” said to have anticancer effects, and immunoaugmentative therapy on the alternative side.  Some approaches, she says, fall into both categories.
 

Dr.  Mary Ann Richardson, Program Director and Co-Principal Investigator at the University of Texas Center for Alternative Medicine Research in Houston  (a collaboration between the UT School of Public Health and M.D. Anderson Cancer Center) says alternative medicine has been more often defined by what it is not than by what it is.  “It is NOT taught in medical school,” Richardson says, “it’s NOT reimbursed

by insurance; and it’s NOT evaluated for safety and efficacy.”  She points out that it may be far more advantageous to put aside the labels and definitions and to devote energy instead to studying the therapies to discover what works.  That means working with the alternative practitioners to develop rigorous study designs for basic science to clinical research with standardized, identified compounds.  The product reliability is especially critical for heterogeneous botanicals and herb mixes.

In a recent interview with Oncology Times, Dr. Richardson explained the focus of her Center’s research.  “When conventional medicine says, ‘we can’t do anything more for you,’ you can’t just abandon these patients.  They don’t want to die, they want to keep trying.  [We have to] be willing to monitor, to ask about what they’re doing.   We’re interested in evaluating the impact of combining alternative medicine with conventional therapies.”

Dr. Richardson’s “brand” of doctor/patient interaction might turn out to be the “kinder, gentler approach” everyone is looking for, but the past has been in the way. 

John R. Durant, M.D., Executive Vice President of the American Society of Clinical Oncology, has also expressed concern about the alternatives issue.  “Unfortunately, we’ve had an either/or mind set that says, ‘If you do this, you’re a bad person.’  They’re not bad people — they’re scared.  And we’re a little bit scared, too, because as I see it, we’re about to enter into a life-changing part of somebody else’s life.”

“These are people with real pathos in their life, which is on the line as far as they are concerned,” Durant said.  “If you treat them with kindness and understanding and compassion, it’s a far better approach than to treat them with the ‘slings and arrows’ of outrageous disbelief.  If you take a judgmental role, that pushes everyone away.”
 

Drs. Cassieth and Durant agree with suggestions in a position paper published by the American Society of Clinical Oncology that physicians should remain open to discussion of alternative treatments.  Another part of the solution is for doctors to make every effort to learn about alternative and complementary therapies in order to be able to talk candidly with their patients and share informed opinions about safety and other critical issues.

It is far better for patients to be able to talk over any decision to seek other therapies for their disease than to try to go it on their own.

The Best of Both Worlds...

Research has shown that far from abandoning conventional treatments, approximately 80 percent of patients who use alternative medicine combine it with conventional therapies.  The two are not that far apart philosophically; both practitioners of alternative therapies and medical doctors share the Hippocratic ideal: First, do no harm.

Just about everyone agrees that people who do decide to step outside the lines for nontraditional therapies should obtain as much information as possible about the treatment and the people who will be providing it.

Be honest.  Advise your primary care physicians and any specialists you may be seeing about therapies you might be considering.  There are potential interactions between one therapy and another, so it is best to share the information with all concerned.  This candor might also help avoid duplicating some tests, such as x-rays.

Expect your doctors to be open-minded with you in return.   They should respect your right to choose, not be judgmental, and give you their informed opinion if you ask for it.

Take a look at alternative therapies for conditions that don’t respond well to conventional treatments.  Sometimes, ailments such as back pain, headaches, or chronic pain can be difficult to treat with conventional weapons.  After obtaining a diagnosis to rule out any life-threatening condition, explore which therapies might help, especially for stress-related conditions.  Biofeedback, meditation and yoga can produce excellent results when used appropriately.  Studies have shown that people undergoing treatment for cancer can find pain relief from approaches such as acupuncture and herbal remedies. 

Just because it is “Natural” doesn’t mean it’s harmless.  Herbs and vitamins might be safer than drugs, but they can still cause potentially dangerous side effects.  Do your research about herbal remedies, and don’t experiment.  There are good reference books available on this topic.

Do your homework before choosing an alternative therapist.  Check for appropriate credentialling.  A state license doesn’t guarantee competency, but it helps.  Continue to maintain a relationship with a regular doctor, and follow advice for preventive screenings that allow early detection of cancer and other diseases outside the purview of the alternative therapist.  There are Internet web sites that contain a wealth of information about non-conventional therapies, so there are many convenient avenues from which to obtain current information.