Consider the Alternatives

“The road to health is through moderation, harmony, a sound mind, in a sound body.” Hippocrates 460–375 B.C.

If you have used at least one alternative therapy since 1997, you have plenty of company. Studies indicate that in 1997 alone, at least half of Americans included alternative therapies in their health care–ranging from chiropractic, to acupuncture, to herbal remedies and homeopathy. But, please understand that some studies include such activities as massage therapy, nutritional counseling, and vitamin supplementation as alternative therapies. With increasing conviction, I believe the term, ‘integrated therapies’, is more appropriate in describing both the content and the effects of combined therapies. Patients (now generically referred to as consumers) are the driving force to include alternative therapies in the conventional practice of American medicine. Annual expenditures for alternative care are now in the $30 billion range and rising. And, most of these therapies still lack insurance coverage; people are paying out-of-pocket for treatments they want.

What forces drive the public interest in alternative therapies? There are several major ones. Obviously, doctors and patients alike understand that no specific treatment plan will work for all people, no matter how sound the scientific basis might be. Telecommunications have enabled us to expand individual and collective knowledge about treatments utilized throughout the world. Add to these two points the Managed Care environment with its emphasis on volume which abbreviates the amount of time most physicians spend with their patients, and it becomes obvious why people are “looking for more.” A large, highly regulated system tends to become impersonal; we all want personal attention and the sense that communication is adequate. When the science of medicine and the art of medicine meld, it’s ideal. But, when conventional medical venues do not provide these feelings, people look elsewhere.

The National Institutes of Health now have a division: the National Center for Complementary Medicine and Alternative Medicine, under the directorship of Stephen Strauss, M.D. For the year 2000, the budget is $68 million. The role of NCCAM is not to recommend specific therapies. Rather, it evaluates the risks and benefits of therapies which are unconventional in Western medicine. It is currently studying a variety of herbs and supplements, acupuncture, and shark cartilage in regard to claims of efficacy for illnesses ranging from colds to cancer. Many critics feel that the success of most alternative therapies is due to placebo effect, i.e. if one believes a treatment will work, it will. NCCAM studies will be valuable in clarifying such issues. I plan to devote future Insights to examining specific complementary therapies in more detail.

As a science-based, conventionally trained physician, I realize that I do not have the answers for all medical problems. So, how do I best ‘doctor’ my patients who have no effective treatment options within the conventional/science-based model? I encourage patients to explore a variety of treatment options–to educate themselves broadly and to examine their levels of comfort pursuing other therapies. Jointly, I’m trying to educate myself about alternative therapies as well. Although I practice conventional medicine in my own office, I want to be able to provide educated advice to my patients who seek additional medical options. I need to be competent to advise patients responsibly about potential risks and benefits of numerous therapies–both conventional and complementary. One of the basic tenants of patient care is Primum Non Noncere–“First, do no harm.”

Whatever form of medical assistance you choose, remember, self-care must remain the heart, the core of health care–regardless of labels. Relinquishing the maintenance of your mind and body to capsules, potions, or energy work is equally foolish in each instance. A person must accept the primary role in creating and maintaining a healthy lifestyle. . .utilizing a provider as an educated consultant. Some physicians who oppose the use of alternative therapies maintain that such therapies basically give patients alternative excuses for healthy lifestyle changes. Whatever you decide, my patients and my friends, you must acknowledge accountability for your individual health maintenance. There is no alternative for responsible nurturing of your own body and mind.

“Each patient carries his own doctor inside him. They come to us not knowing that truth. We are at our best when we give the doctor who resides within each patient a chance to go to work.”Albert Schweitzer

Stephen L. Hines, M.D.
August 2000