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How to Use Alternative and Complementary Medicine
Introduction
During the past decade, the American public's
interest in alternative medicine has skyrocketed. The evidence
for this trend is everywhere—in the media, in the growing
number of popular books on "wellness" and non-traditional
therapies for illness, and in booming sales of supplements
and herbs.
The magnitude of this trend was highlighted
in a report by David Eisenberg, M.D., of Harvard Medical School
published in a 1993 issue of the New England Journal of
Medicine. Eisenberg estimated that Americans made approximately
425 million visits to alternative therapy providers during
1990 and that expenditures associated with these therapies
were comparable to non-reimbursed expenses incurred for all
hospitalizations.
The growth in the use of alternative medicine
has been accompanied by more subtle changes in the attitudes
of both patients and physicians. Though still widely used,
the term "alternative medicine" has been gradually
falling out of favor in recent years. Many who work in the
field feel that the term reinforces the old and divisive (and
inaccurate) stereotype of desperate and naive patients foregoing
promising mainstream therapies in favor of unproven or "alternative"
therapies offered by "quack" practitioners.
This view began to change with the publication
of a 1988 study by Barrie Cassileth, Ph.D. Cassileth's survey
suggested that, for the most part, unconventional therapies
in the United States are offered by licensed physicians or
other credentialed health care practitioners who believe in
the therapies they offer, who are not charging excessive fees
for treatment, and who are treating patients of above-average
education and income. Further, these patients are likely to
be more deeply engaged than the average patient in exploring
their choices. Significantly, in the large majority of cases,
these patients also choose to remain under the care of a mainstream
physician. Generally, patients who completely leave mainstream
medicine do so only because doctors have said there is nothing
more they can do for them.
More and more patients are finding that alternative
medicine has a great deal to offer, especially for treating
chronic conditions with which Western Medicine has little
success. The vast majority of patients, however, do not see
conventional and unconventional therapies as an either/or
proposition. Rather, they seek to make informed, personal
choices about how to integrate both. For this reason, "complementary"
or "integrative" medicine have become the favored
designations for this emerging field.
A vast array of approaches fall under the
heading of complementary medicine. Some, such as acupuncture
and Ayurveda (the traditional medicine of India), are ancient
traditions used by millions of people over thousands of years.
Most cultures have also developed herbal traditions based
upon the local medicinal plants. Other approaches, such as
macrobiotics or Anthroposophy are branches of wider philosophical
systems applied to medicine. Chiropractic and homeopathy are
examples of systems that arose in the West—alongside orthodox
medicine—that view disease processes much differently than
mainstream medicine. Mind-body therapies (e.g., stress reduction
techniques, biofeedback, meditation) comprise a large class
of approaches that owe a great deal to the spiritual traditions
of the East.
The most effective use of complementary therapies
is often in combination with mainstream therapies. There is
evidence, for example, that Chinese herbs can potentiate the
effectiveness and lessen the side effects of some chemotherapies
and that acupuncture can greatly reduce the nausea connected
with cancer therapy. In the same way, chiropractic or acupuncture
can greatly reduce or even eliminate the need for analgesics
for chronic back pain.
Complementary Therapies Are Not Always
Harmless
It is important to know that complementary
therapies are not by definition harmless. They run the gamut
in terms of their potential for harm, though many do tend
to be quite benign. If you choose to use complementary medicine,
it is a good idea to consider using one or more therapies
that are considered to be intrinsically health promoting regardless
of whether one is ill or not. As Michael Lerner has pointed
out in his book Choices in Healing, these "lifestyle
therapies" can give you a sense of taking charge of your
own health and often enable you to better tolerate difficult
therapeutic regimes.
The spiritual and mind-body approaches are
primary among lifestyle therapies. Prayer, meditation, psychological
therapy, imagery and support can, at the very least, bring
about a transformation in the way you view illness and your
own body. These approaches can also affect the way pain is
perceived, and there is evidence they may actually affect
the course of the illness itself in some cases. Nutritional
approaches (if not carried to extremes) and physical approaches,
like massage, exercise and yoga, are also generally health
promoting.
At the other end of the spectrum are some
of the unconventional pharmacological, herbal and vitamin
supplementation approaches where overdoses and other toxicities
are possible, as well as interactions with prescription drugs.
Extreme dietary approaches can also lead to unhealthy weight
loss and nutritional imbalances.
The Research Evidence for Complementary
Therapies
Generally, there is little hard research evidence
for the effectiveness of complementary therapies. This does
not mean that these approaches are not useful—just that
the question is still open. As these approaches are researched,
they either tend to move into the mainstream, as is currently
happening with a range of mind-body therapies and acupuncture,
or they are essentially abandoned, as has largely happened
with laetrile, the popular cancer "cure" derived
from apricot pits.
But cultural and institutional considerations
also play a role in deciding what is and what is not considered
"alternative." Almost by definition, a therapy is
considered "alternative" if it is not taught in
medical schools, even if there is good research evidence for
efficacy as there is for acupuncture, chiropractic and some
herbal therapies. For example, the strength of the research
for the effectiveness of homeopathy for some conditions is
quite compelling, yet because there is no rational scientific
mechanism to explain its action, it is still dismissed by
many researchers. And though the research on promising herbal
therapies is readily available to American doctors, herbal
remedies are rarely prescribed by American physicians. In
Europe, however, this is quite common. In Germany, for example,
the herb St. John's Wort is prescribed much more often for
mild to moderate depression than is the drug Prozac.
Choosing a Complementary Therapy
Most mainstream physicians are of little assistance
when it comes to providing guidance to patients in the area
of complementary medicine. At the same time, there is an explosion
of media "hype" and commercial ventures touting
non-toxic cures for illnesses ranging from acne to cancer.
How does a consumer of health services interested in exploring
complementary therapies make sense of it all?
Obtain a Medical Diagnosis
Always begin by obtaining a medical diagnosis
for your condition from a physician. If you decide to stop
using mainstream medicine, do so only because you have weighed
the benefits and side effects of the treatment and determined
that there is no longer a sufficient reason to continue. Never
abandon a promising mainstream therapy in favor of an unproven
complementary therapy.
Educate Yourself
Once you have a diagnosis and comprehensive
information on mainstream treatments for the condition, it
is well worth your time to educate yourself thoroughly about
the field of complementary medicine for your condition so
that you will have a context for comparing therapies and making
decisions.
It is very common for a patient to hear about
a complementary therapy that has been helpful for someone
else and to expend considerable effort to locate that therapy
for themselves. While it's useful to hear from individuals
who feel they have been helped by a given therapy, keep in
mind that people who were not helped are less likely to talk
about it than those who experienced dramatic positive results.
The person you heard about may be one out of a hundred who
actually benefited from the treatment!
Most medical conditions are self-limiting—they get better eventually even without treatment. Other
conditions, including some serious diseases like multiple
sclerosis, can wax and wane regardless of treatment. In these
cases knowing that someone improved when using an alternative
remedy tells you nothing, because it could have happened even
without the remedy. Also remember that people who use these
therapies often use a number of them at once in addition to
Western medicine. Therefore, it is often impossible to know
exactly which therapy or combination of therapies actually
helped.
Check Resources
There are a number of useful resource books
that may be of great help in understanding the field of complementary
medicine and in choosing specific therapies. Some of these
are listed in the "Resources" section below.
The Internet can be a valuable tool for locating
information about the range of complementary therapies available.
If you have access to a computer, look at the Internet sites
that provide information about your condition. But beware
that the web is full of unreliable information. Remember—just because it appears on the web doesn't mean it's true!
Medically oriented sites generally provide the most reliable
information, but these rarely discuss complementary therapies.
If they do, they are likely to err on the side of conservatism
when it comes to complementary medicine. If a medically oriented
site says a given complementary therapy is unproven, it means
only that—it's unproven, not necessarily ineffective.
Internet sites established by patient advocacy
or support groups are often very good sources of information
about complementary therapies. Discussion groups can give
you a sense of which therapies people are finding helpful.
The same is true of support groups. Hearing from many people
who have tried a particular therapy is a good indication that
you should investigate more closely.
Be wary of web sites that have been set up
by proponents of a particular therapy, especially if a product
line is being promoted. Be skeptical of any information, on
the web or in print, which describes "miraculous"
outcomes or "cures" for conditions that mainstream
medicine considers incurable, or encourages patients to leave
mainstream medicine in favor of an alternative approach.
When evaluating information on the web or
in print, look for references to research studies. It is fairly
common for whole books to be based on one small study! Look
for numerous citations to different studies. It is the nature
of research that studies are often contradictory and that
only a large body of research can begin to yield definitive
answers. Studies in human subjects are much more important
than studies in animals or in test tubes (sometimes called
in vitro studies).
You can also perform an on-line search for
the medical literature yourself using PubMed, a service developed
by the National Library of Medicine (see Resources for Internet
address). Many hospitals in large cities also have patient
libraries that perform this kind of search for you, usually
for a fee. Staff members in these libraries can also be quite
helpful in locating information for you.
If there is little research evidence for the
therapy, you might ask yourself the following questions:
What is the context from which the therapy
arose?
Is the therapy science-based? Is the scientific foundation
widely accepted?
Is the therapy part of a non-scientific system? If so, what
is that system, and does the system make sense to you as a
worldview?
Did the therapy arise from one of the traditional medicines
of the world with a long history of use?
Is the therapy a "secret formula," or does the proponent
welcome independent evaluation?
Choosing a Practitioner
Once you have settled on a therapy that you
would like to try, the next step is finding a practitioner.
For some therapies this may not be necessary. You can make
modest changes in your diet, for instance, or begin a moderate
exercise regimen unassisted. But if your condition is serious,
the therapy is complex or if the lifestyle change is a major
one, it's wise to seek out some assistance—at least initially.
The advice of a properly trained practitioner
is important in making decisions. It's appealing to simply
go to the natural foods store and pick up some supplements
or herbs. But remember these can have serious interactions
with drugs you may be taking, and the therapy may require
taking higher doses than are indicated on the bottles. Similarly,
Chinese or homeopathic remedies are available over the counter,
but these "formulas" may bear little resemblance
to the prescription a practitioner would write for you since
they are highly individualized treatments. Also, never rely
on "recommendations" by employees of health food
stores—their training in the use of herbs and supplements
usually comes from sales representatives, not schools of naturopathy!
When seeking a practitioner, a personal referral
is best, but it is also wise to talk to many people with the
same condition until one name comes up two or three times.
Support groups are also good places to find this kind of information
as are local branches of support organizations. Referrals
can also be obtained from another practitioner whose opinion
you trust.
If these kinds of direct referrals are not
available, the state or national credentialing organization
for that discipline will often provide referrals. "New
Age" newspapers found at natural food stores and bookstores
may contain ads and listings for local practitioners as well.
If all else fails, try the telephone book!
Once you have located a candidate, don't be
shy about interviewing him or her.
Find out what their training is and how long
they've been in practice.
Ask if they are licensed and credentialed.
Determine if they have worked with many people
with your condition. If you have cancer, find out if they
have worked with other people with the same kind of cancer.
Get a sense of their attitude concerning
mainstream medicine and if they would be willing to work with
your doctor.
If for some reason you decide not to work
with that practitioner, ask for a referral to another.
Before you actually begin the therapy, tell
your physician. If the physician is knowledgeable and open
minded, he or she may agree to work with you to coordinate
care from different sources. Be prepared, however, for the
possibility that you will not be supported in your decision
to use complementary medicine. You may be told you are wasting
your time or even be warned of dire consequences. If this
is the case, try to determine whether or not the physician's
response is based upon an accurate understanding of the therapy
you would like to undertake. If you have been able to locate
research studies on a complementary therapy you find of interest,
show these to your doctor. For some people, the support of
their physician in this area is important enough that they
will decide to seek out a doctor who will be supportive.
Increasing numbers of open minded practitioners
on both sides of the alternative-conventional medicine divide
are coming to understand that the future of medicine clearly
lies in some form of integrated healthcare, where traditional,
mind-body and lifestyle approaches take a place alongside
Western allopathic medicine. But until that time arrives,
it is up to the patient to put these pieces together. The
challenge can seem daunting, but the task is not impossible
and the rewards are well worth the effort.
http://www4.ncbi.nlm.nih.gov/PubMed/overview.html
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