First, Do No Harm

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This post is part of our forum on David H. Freedman's July/August story, "The Triumph of New Age Medicine." Follow the debate here.

I feel compelled to respond to David Freedman's article with a few definitions.

"Alternative" medicine refers to global healing traditions and modalities not taught in western allopathic medical schools. Traditional Chinese medicine, Ayurveda, and Homeopathy are examples of global healing traditions.

"Allopathic," or conventional, medicine excels in acute care. The "ill to the pill" mentality may be needed to fight an infection; surgery can be lifesaving. But allopathic medicine is not proactive; it is not focused on disease prevention and it has failed at chronic disease management. Allopathic medicine is focused on diagnosing disease after it has occurred, offering treatments based on surgery and pharmaceutical therapy. 

Fix or Fraud?

As a board certified internist, cardiologist, and nuclear cardiologist, I recognize the value of the medicine I was taught at SUNY Downstate, Cornell, and New York University. But as a physician who practices the Hippocratic Oath -- "first do no harm" -- I have been compelled to seek out methods to heal my patients, relieve suffering, and prevent disease that are not part of the allopathic medicine paradigm. 

As a cardiologist, I practice holistic integrative cardiology. "Holistic" means I treat the whole person: body, mind, emotions, and spirit. We know that our environment interacts with our genes, resulting in illness or health. Our environment is both physical and emotional. The air we breathe, the water we drink, micro and macro nutrition, toxins, stress, and our relationships will interact with our genes, leading to health or illness. Through holistic integrative medicine, I am able to address these issues, utilizing the best of western allopathic medicine along with the wisdom and teaching of many global healing traditions. 

Today the foundation of our medical pyramid is drugs and surgery. I believe the apex of the pyramid should be drugs and surgery and the foundation should be clean air, and water, nutrition, sleep, resiliency, and community. 

So why are we arguing over whether or not acupuncture is a placebo?  We have three licensed acupuncturists and two physician acupuncturists at The Scripps Center for Integrative Medicine. I can cite patient after patient who has received benefit from our acupuncture program. And in regard to Dr. Salzberg's post, I have never seen a punctured lung or infection as a result of an acupuncture treatment. While I am sure complications can occur, they are certainly much less common than the hospital-acquired infections I saw as an interventional cardiologist. 

The United States ranks 37th in the world in health outcomes and spends 2.6 trillion dollars per year on chronic disease management. The majority of this expense is attributed to seven chronic diseases -- all of which are preventable. Many of these diseases are man-made, the result of air pollution, high fructose corn syrup, and partially hydrogenated oils.  The Interheart Study, which looked at 30,000 men and women in 52 countries, concluded that 90 percent of first heart attacks are completely preventable through lifestyle change. And multiple studies from the National Library of Medicine's database support an integrative approach:

Research has shown that people with severe coronary heart disease are able to halt disease progression or reverse it without drugs or surgery by making comprehensive lifestyle changes such as managing stress through yoga and meditation, switching to a low-fat vegetarian diet, stopping smoking, exercising moderately, and finding social support.  

• The June 2008 Proceedings of the National Academy of Sciences published a prostate cancer study demonstrating that lifestyle change can affect gene expression. The researchers found that improved nutrition, stress management, walking, and psychosocial support changed the expression of over 500 genes in men with early-stage prostate cancer.  

A long-term randomized controlled trial of patients with coronary heart disease showed that Transcendental Meditation practice was associated with a 47 percent reduction in mortality, nonfatal myocardial infarction, and stroke compared with controls during a five-year follow-up.  

These findings show that alternative medicine is far more than a placebo. Integrative holistic medicine offers the opportunity to treat the whole person. And it recognizes that a reductionist approach to chronic disease management and prevention pales in comparison to a multidisciplinary team that embraces the uniqueness of each individual -- an approach that is personalized, predictive, and proactive. 

The debate continues here.

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Mimi Guarneri, M.D., is a clinical cardiologist and the founder of the Scripps Center for Integrative Medicine in La Jolla, California.

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