First Do No Harm

"Integrative Medicine" has become a catch phrase in our society and most alternative health practitioners would probably say it's a no-brainer to define. A short operative definition of "Integrative Medicine" might characterize it as the combining of the best of conventional medicine and the best of alternative medicine usually beginning with the least invasive therapies first.

For example, if a patient's health problem allows, a health practitioner knowledgeable in "integrative medicine" would more than likely initially decide to hold off on prescription drugs which often have destructive and toxic side-effects. Instead, the practitioner would begin with a gentler approach that encourages the patient's body to mount a defense of its own to overcome the health challenge (leaving the immune system stronger and more vigorous).

As most of us who prefer living naturally know, gentler yet very effective approaches include an encyclopedic list from acupuncture to nutritional therapy (my personal favorite) to yoga. Of course, you wouldn't tell somebody to drink carrot juice if they were just carried in from a car wreck. I suspect we'd all want the marvels of drugs and surgery on our side in such a case. (I'd drink the carrot juice sometime after they wired my jaw and the pain meds wore off!)

A perfect case in point for the harmonious meshing of alternative and conventional medicine is the work of Chicago-based Jon Pangborn, Ph.D. Dr. Pangborn, a specialist in nutritional medicine as it relates to the mindboggling intricacies of metabolic pathways, works with physicians who prescribe surgery, radiation and chemotherapy for their cancer patients. Through sophisticated nutritional analysis, Dr. Pangborn consults with the patients before cancer treatment to get them into "tip-top nutritional condition" to weather the rigors of the therapy.

"We certainly do need the cancer treatment that we have," he says, "because we don't know how else to deal with it but the treatment can be very, very stressful on the body's physiology." Following the treatments, he then resumes nutritional therapy. Dr. Pangborn says of patients with whom he's worked, "Frankly, they were a nutritional disaster after the (cancer) program. They were certainly free of cancer and I must commend the doctors for absolutely wiping out the cancer but they also pretty much wiped out the individual's nutritional status and [the doctors] admittedly...acknowledge this."

Unfortunately, despite all the talk of the new and unbeatable combination of conventional and alternative medicine (CAM), there's still a vast schism between the fantasy and reality of it all. Research shows that over half of Americans entering the conventional medical system have already made forays into complementary medicine, yet many are reluctant to talk about alternative approaches with their conventional doctors. What's wrong with this picture? I think Dr. Tieraona Low Dog, M.D. and herbalist in Albuquerque, NM summed it up nicely when she mused that patients would be better off talking to their doctor's receptionist about herbs rather then asking the doctor himself. I'm sure this could apply to MD's knowledge of other alternative therapies as well.

As I see it, the problem with making "integrative medicine" an effective and inclusive dimension of our health care is multi-faceted. Despite the increased visits to alternative practitioners, conventional physicians still clearly form the backbone (so to speak) of our healthcare. If I can draw from personal experience, regardless of my "alternative" bent, nearly everyone in my family who has a health problem automatically speaks in terms of seeing a conventional physician first. Therefore, as the gatekeepers to other therapies, these physicians must learn to become comfortable with referring out to alternative practitioners just as they do to other MD specialists. (Granted, there are holistic medical clinics that house various health providers-including MD's- but it only goes to show that there is a "we have to stick together to survive" mentality.)

Obviously, how can a referral be given when a physician doesn't have a clue as to what a particular therapy is or how it might benefit a patient? I think we should look beyond the petty argument that physicians want to keep all the business for themselves. I believe most physicians are so saddled with the frantic pace of their practices that they have little time to investigate CAM therapies. And it may be a few years before we have oodles of informed MD's pouring out of the country's medical schools. A study from 1998 showed that 42 out of 117 U.S. medical schools do not require CAM courses or offer them as electives.

Another issue involves patient compassion. As health providers at last year's International Conference on Integrative Medicine so elegantly pointed out, the toolbox of therapies is getting bigger but that doesn't make very much difference if it's still being served up in the same quick, cold and impersonal manner for which our medical system has become known. Two giants in this area of concern, Elliott Dacher, MD, researcher/author (Whole Healing and Intentional Healing) and Harvard Medical School's Arthur Kleinman, MD bemoan a healthcare system in which its healers are short on patient empathy, compassion and moral engagement. After all, they contend, these qualities are vital underpinnings to the healing process. Evidence shows that patients have turned to alternative healing, in part, for the quality of the relationships which they expect to be less dehumanized than those found in conventional medicine. But Dacher and Kleinman worry that the alternative healing arts, which are also steeped in a culture that rewards efficiency and profit, may become fraught with the same impersonality. Of course, discussing the blending of alternative and conventional medicine always brings up the much-debated aspect of insurance coverage. But, once CAM therapies gain momentum, I suspect the insurance companies will gladly fall into line. A handful of insurance companies have already stepped forward to cover CAM therapies. In addition, there are also a few brave and forward-thinking MD's (specializing in CAM) who have refused to kowtow to the insurance companies. These healers feel they can't let insurance company manuals dictate how they treat patients. So they simply stopped taking insurance reimbursements and work on a cash basis to apply the healing techniques they believe best serve their patients. Interestingly, patients have beaten a path to their doors.

If only we could wake up tomorrow and experience a world in which healers had mutual respect and understanding for one another. A world where health insurance would cover the most effective therapy of choice. And a world where the Rights of a Health Consumer always included a healer who treats you like family (or better!).


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