Diann Shaddox Foundation for Essential Tremor
What Are the Biggest Misconceptions People Have About Alternative Medicine?
There are a lot of misconceptions out there about alternative medicine, whose advocates—and skeptics—seem to be perpetually armed with new studies and trials to support their differing perspectives.
With this in mind, we posed the following question to The Experts: What is the biggest misconception people have about alternative medicine?
But alternative medicine is a $33.9 billion dollar industry with its own well-funded lobbyists and slick marketing. The alternative-medicine giants typically don't show much in the way of scientific evidence for the efficacy of their products or services, mostly because we as consumers rarely hold them to the same scrutiny as we do mainstream medicine.
This doesn't mean alternative medicine is always a bad idea, just that it is a mistake to assume its purveyors always have your best interests in mind when they sell their products. They should be held to the same scrutiny and skepticism you hold any other salesperson or health-care provider.
Leah Binder is president and chief executive officer of Leapfrog Group, a national organization based in Washington, D.C., representing employer purchasers of health care and calling for improvements in the safety and quality of the nation's hospitals.
Far more helpful is thoughtful assessment of "complementary" therapies, which often come to mind after consideration of the whole person and his or her lifestyle. For example, many clinicians are open to potential benefits of massage and chiropractor contributions, after or even before expensive surgical options have been exhausted. Another example might be how certified nurse-midwives empower women to explore non-pharmacological approaches to pain management, such as guided imagery, doula support, acupressure, and acupuncture.
Management of the dichotomy starts with education. We teach nursing students to use evidence-based criteria to evaluate the risks and benefits of various healing modalities. We emphasize the need to involve patients and families in decision-making around care options, and to explore what they value and what is relevant to them. This is the best care model now and for the future
The U.S. health system as a whole, and many patients individually, can no longer afford to discount tradition, innovation, and a world of approaches to healing.
Kathleen Potempa (@KathleenPotempa) is the dean of the University of Michigan School of Nursing.
A recent purity-testing study of 44 herbal products, using a state-of-the-art technology called DNA bar coding, found that one-third of herbal products had substitution with fillers (http://www.biomedcentral.com/1741-7015/11/222/abstract). Prior studies have also found adulteration of some herbal products with traces of metals or prescription drugs (e.g. steroids). Readers can turn to ConsumerLab.com to see purity results for specific herbal brands. Other safety issues, such as human toxicity, drug interactions, and optimal dose have yet to be determined for many of 29,000 herbal products on the market today.
These studies bear truth to the adage that "capsules don't grow on trees"—we have to ask ourselves if the real contamination comes from nature or from the nature of man.
Dr. P. Murali Doraiswamy is professor of psychiatry and medicine at Duke University Medical Center, where he also serves as a member of the Duke Institute of Brain Sciences and as a senior fellow at the Duke Center for the Study of Aging and Human Development.
Dr. Marisa C. Weiss (@drmarisaweiss) is the founder and president of Breastcancer.org. She is also director of breast-radiation oncology and breast-health outreach at the Lankenau Medical Center in Wynnewood, Pa.
Dr. Amit Sood, a colleague at the Mayo Clinic and author of the soon-to-be-released book, "The Mayo Clinic Guide to Stress-Free Living," recommends that the best definition of integrative medicine is "the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, health-care professionals and disciplines to achieve optimal health and healing" as defined by the Consortium of Academic Health Centers for Integrative Medicine.
Traditional medicine, which has focused solely on the use of diagnostic tools, drugs and procedures and ignored the mind and spirit dimensions, has been slow to change. It typically takes 17 years to adopt evidence-based practices and even then we plateau at about 55% of use. It isn't surprising that fringe pseudoscience alternative practices have filled the gap.
However, a sea change is occurring. The Mayo Clinic and other great academic institutions that are ever-vigilant in providing the best evidence-based care are bringing the rest of the world into the mainstream. Anyone who watches "Empathy: The Human Connection to Patient Care" by the Cleveland Clinic on YouTube will be profoundly touched and hopeful.
For now, as consumers, we must take personal responsibility for closing the care gaps that exist and learn how we can take an active role in learning how to optimize our mind, body and spiritual health. We must become our own "care integrators." To help along the way, contributors, which include the World Health Organization, Google, Mayo Clinic, Cleveland Clinic, Harvard, Sesame Street, and the Clinton Global Initiative, are working together through Care University, an enriched online program, to help consumers and caregivers build the necessary bridges to span the gaps we have in care.
If you aren't getting integrative care from your providers, seek the REAL alternative…
Dr. Charles Denham (@Charles_Denham) is the founder of the nonprofit TMIT medical-research organization and the for-profit HCC Corp., an innovation accelerator.
Dr. David Foster was a co-executive producer of the Fox medical drama "House."
It is also important to mention that just because something is said to be "natural" doesn't mean it is safe or healthy. The environment is full of natural substances that are dangerous—take many mushrooms, for example. Arsenic appears "naturally" in water supplies all the time, but it is carcinogenic. And many naturally occurring substances may be well tolerated in very small doses, but can be harmful when taken in larger amounts. The Food and Drug Administration goes to great lengths to apply all the tools of modern science to assure that the medicines it approves are safe and effective. No similar process protects the public against unsafe, so-called "natural" products that are often promoted as alternatives to traditional medicine.
Dr. David Blumenthal (@DavidBlumenthal) is the president and CEO of the Commonwealth Fund, a national health-care philanthropy based in New York.
Fred Hassan is the chairman of Bausch & Lomb Inc.
The National Institutes of Health defines alternative medicine as a "nonmainstream approach [used] in place of conventional medicine"—effectively exiling it to a desert island and emphasizing that it can only be defined by its relation to mainstream medicine. The NIH notes that true alternative medicine is uncommon, because most people combine it with conventional techniques.
More helpful, I think, is viewing alternative medicine as "proto-medicine," i.e. as techniques that may someday be adopted into conventional medicine if well-conducted clinical trials show a favorable ratio of benefit to harm.
The classic example of an alternative medicine moving into conventional medicine is the heart medicine digitalis. In the 1700s, Dr. William Withering in Shropshire, England heard that a local witch could do something he couldn't: successfully treat dropsy (which is today called "edema"). Gaining the witch's cooperation, Dr. Withering painstakingly discovered that among her potion's dozens of ingredients the foxglove plant provided the therapeutic effect. He proved this by conducting formal trials of foxglove, whose scientific name is digitalis. All of this took nine years, but Dr. Withering, and the unnamed witch, achieved immortality in medical circles, and their work has benefited untold numbers of patients. Digitalis derivatives remain in use today.
Physicians are (or should be) pragmatic. If something is provably successful, it deserves to be adopted into conventional medicine and to shed its "alternative" label. To make such a jump, a high level of evidence is required. Investing time, energy, or self in an approach that is unsupported by evidence, no matter how "natural" it seems, is an invitation to disappointment, and worse.
Dr. John Sotos, a cardiologist and flight surgeon, was a medical technical adviser to the television series "House." He is currently CEO of the medical-expertise search company Expertscape (www.expertscape.com and @expertscapenews).
There are decidedly some good alternative medical strategies out there—approaches that equal or beat conventional Western therapies and are less toxic. But there are plenty of false promises, too, that cost patients money and vital, wasted time—time that could make the difference between life and death. How do we ferret out the good from the rotten? The NIH has taken a stab at applying double-blind, controlled trial principles to some touted alternative and complementary therapies, even if its standards have been called into question. But ultimately we consumers need to learn how to read with a questioning, healthily skeptical mind, and find a reasonable balance, adopting valid alternative therapies to be used in conjunction with tried and true conventional care.
Dr. Carol Cassella (@CarolCassella) is a practicing physician and author of the novels "Oxygen" and "Healer."
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