Changing Times Call for Smarter Doctors

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.

The principal problem highlighted in David Freedman's article is not a clash of medical philosophies but confusion over terminology. Arguments that don't begin with precise definitions invariably generate more heat than light, and a debate on the merits of conventional, alternative or integrative medicine is fruitless unless the starting point is some agreement on which therapies fit into each of these categories. 

And with an increasing number of conventional medical practitioners recommending treatments previously deemed unconventional, the lines of demarcation are getting blurred. The first step should be to clarify terminology.

Using synthetic drugs and surgery to treat health conditions was known just a few decades ago simply as "medicine." Today, this system is increasingly being termed "conventional medicine," and is the kind of medicine most Americans still encounter in hospitals and clinics. While often expensive and invasive, it is also extremely good for many things, such as medical and surgical emergencies. Some conventional medical approaches are scientifically validated, while others are not.

Any therapy typically excluded by conventional medicine, and that patients use instead of conventional medicine, is known by the catch-all term "alternative medicine." Alternative therapies are generally perceived as being closer to nature, less expensive and less invasive than conventional therapies, although there are exceptions. Some alternative therapies are scientifically validated, some are not. 

When an alternative medicine practice is used in conjunction with a conventional one the approach is called "complementary." Together, complementary and alternative medicines are referred to as CAM.

Integrative medicine can be defined as healing-oriented medicine that takes account of the whole person, including all aspects of diet and lifestyle. It emphasizes the therapeutic relationship and makes use of all appropriate therapies to facilitate the body's innate healing response. Practitioners of integrative medicine neither reject conventional medicine nor accept alternative medicine uncritically, but recognize that good medicine is based in good science and must be open to new paradigms.

Use of alternative medicine is but one component of integrative medicine. It attracts the most attention and the harshest criticism. But is nutrition counseling alternative? How about exercise recommendations? What about prescribing botanicals such as saw palmetto for benign prostatic hyperplasia or red rice yeast to lower cholesterol? There is as much or more hard science establishing the efficacy and safety of these therapies as there is behind drug interventions. 

The difference is that, because they are not based on patentable molecules, their profit potential is modest. Clearly, many effective therapies in the U.S. remain "alternative" simply because they lack the potential to generate vast wealth for stockholders.

The study of traditional systems such as Chinese medicine and Ayurveda, as well other therapeutic approaches, is important because some have great potential to lower health care costs as well as improve outcomes, and because it is necessary to identify the strengths and weaknesses of these interventions. The variety of alternative medicine treatments available runs the gamut from very intelligent to very foolish, and some are dangerous. 

Doctors must be able to discriminate between what is safe and potentially effective for their patients, and what is not. Most users of alternative medicine would welcome the opportunity to meet with a medically trained person, such as an MD, who was intellectually flexible and possessed knowledge of therapeutic approaches beyond conventional medicine and who could objectively advise them.

Integrative medicine has much broader goals than simply bringing appropriate complementary and alternative therapies into mainstream practice. In particular, it aims to:

(1) Restore the focus of medical teaching, research, and practice on health and healing;
(2) Develop "whole person" medicine, in which the mental, emotional and spiritual dimensions of human beings are included in diagnosis and treatment, along with the physical body;
(3) Take all aspects of diet and lifestyle into account in assessing health and the root causes of disease;
(4) Protect and emphasize the practitioner/patient relationship as central to the healing process;
(5) Emphasize disease prevention and health promotion.

I believe that integrative medicine is the future of medicine and healthcare. Integrative medicine doctors, together with like-minded nurses, pharmacists, and others, are best positioned to improve health outcomes for patients and create a functional, cost-effective health care system that serves all of our citizens - one that shifts the focus of medicine from disease and treatment to health and healing.

The debate continues here.