Wednesday, November 2, 2011

Buzz Words and Health Care Realities

I’d like to take a moment to explain some common ‘buzz’ words related to health and medicine. What do we mean when we say things like conventional medicine, alternative medicine, complementary medicine and integrative medicine?
Here’s what many of us in the West grew up thinking of as simply “medicine:” a sprawling doctor’s office complex bustling with people in white coats, stethoscopes and scrubs; large, noisy machines to which you submit for one test or another; taking a small white piece of paper to a pharmacy to exchange for an orange bottle containing Western pharmaceuticals; surgery and other procedures commonly done in hospitals. All of this comes under the umbrella of Conventional Medicine, especially when compared to other forms of medicine that are increasingly being used in the West.
In contrast to this very Western-based perspective are medicines such as acupuncture and Chinese herbal medicines, conventionally used in China, and Ayurvedic medicine in India. These types of medicine, regardless of the fact that they have been used for thousands of years, are not considered conventional medicine here in the West, but instead get classified as Complementary and Alternative Medicine (CAM).
While often grouped together, “complementary” and “alternative” medicines are not really one and the same. “Alternative medicine: implies that it is an alternative to conventional medicine. In other words, the patient would not get a standard conventional treatment, but instead would get an alternative treatment. For instance, acupuncture and herbal medicine might be used instead of removing the gallbladder for cholecystitis (inflammation of the gallbladder, often due to gallstones). Another example might be the use of tuina (deep manual bodywork techniques) and acupuncture to realign the structure, open the joint spaces, and increase the circulation of qi to treat complications due to herniated discs. This might be used as an alternative to back surgery, pain medications, cortisone injections and or physical therapy.
On the other hand, “complementary medicine” implies that nonconventional treatments are used as a complement to conventional care. For the herniated disc example, this might be a combination of conventional treatment options, such as pain and anti-inflammatory medication and physical therapy, used in combination with acupuncture and tuina.
For the example of gallstones, there is a standard therapy used in China that involves the combined use of Chinese herbal therapy, acupuncture and Western pharmaceuticals, with the goal of expelling these stones. If this was done in the West, the herbal medicinals and acupuncture would be considered complementary medicine.
However, the entire combined treatment plan could be referred to as integrative medicine. The National Center for Complementary and Alternative Medicine defines integrative medicine as medicine that combines mainstream medical therapies and CAM therapies for which there is some high-quality scientific evidence of safety and effectiveness.
Dr. Andrew Weil’s website has a">fantastic discussion of integrative medicine and points to several principles inherent in this medicine, such as being inquiry-driven rather than dogmatic in patient interaction, and neither rejecting conventional medicine nor accepting alternative medicine uncritically. Also, integrated medicine should use less invasive and natural options whenever possible, with treatment based not solely on disease eradication, but also on disease prevention and health promotion.
And finally, practitioners should develop themselves to become models of health and healing. This is possibly the most important principle; the self-exploration and development thus gained leads to a profound understanding of health and transforms the practitioner’s use of this knowledge to make good clinical decisions and work together with patients toward their ultimate best health.
There is much to admire in this model, and I feel that it would greatly help America navigate through the current healthcare crisis. The barrage of discussion on healthcare reform since President Obama was elected has largely been a discussion of how healthcare is paid for, which is a political issue I do not care to get into. However, we need a larger discussion on how healthcare is delivered in America.
Despite major advancements in Western medicine over the last century, there are still many places where it fails to deliver good results. Interestingly, many of the best CAM therapies excel in precisely these areas, and these therapies can achieve results at a fraction of the cost. Using them together in an integrative model allows for better results with fewer and less severe side effects, and lower dosages where pharmaceuticals are used.
I think that this next decade will see the medical establishment trying to determine how to integrate the best CAM therapies with conventional treatment for the overall betterment of patient welfare. At Ideal Balance Center For Acupuncture And Integrative Medicine, we are committed to this integrative model and excited to be part of this transformation in patient care.