Bruce D. Oran, DO
There has been a sudden shift in the way many physicians and patients view what has come to be known as "alternative medicine." Suddenly, physicians who were reluctant to recommend more than a weak multi-vitamin are now advising patients to get acupuncture or take certain homeopathic remedies. Although the terms "alternative medicine," "complementary medicine," "unconventional medicine," "holistic medicine," "natural medicine," and "integrative medicine" have all been used interchangeably, what people understand by such terms is anything but uniform. Some agreement does exist on a basic definition of these terms as referring to diagnostic methods, treatments, and therapies that appear not to conform to mainstream medical practice, or that are not widely taught at Western medical and osteopathic schools. The scope of alternative medicine is broad; it usually includes -- but is not limited to -- such therapies as homeopathy, acupuncture, nutrition, herbal remedies, relaxation techniques, nutritional supplementation, and various types of "hands-on" techniques.
What has happened in the medical community that has made the once hostile conventional physician now a devotee of Andrew Weil and Deepak Chopra? In my view, this dramatic turnaround is due in large part to the same dominant force that has been behind so many forms of social change over the last 50 years -- the Baby Boomers and their behavior as consumers.
Baby Boomers and the "Boom" in Alternative Medicine
This group of approximately 76 million people tends to look for new solutions to treat old problems. They have a desire for wellness and they expect it. Boomers project an aggressive consumerism as well as a healthy disregard for authority and conformity. They do not wish to "grow old gracefully" and they are starving for answers to the age-old puzzle of youth extension. More than any demographic population before them, this group not only wants to hold on to their youth, but also knows it is possible to do so.
Their demand for exploring these alternative health options derives from a number of factors, such as their frustration with the limitations of mainstream medicine in providing them the answers they seek. Other factors include a growing body of scientific literature linking chronic degenerative diseases to nutritional and emotional factors, and a greater awareness of the medical practices of other cultures such as Eastern, Ayurvedic, and Native American.
With this as a backdrop, the stage was set in 1993 for an event which would prove to be the main motivating force in changing physicians' attitudes towards alternative medicine. In the January 28 issue of the New England Journal of Medicine that year, researchers revealed that Americans made an estimated 425 million visits to - and spent an estimated $13.7 billion on - alternative medical practitioners annually. This meant Americans were making more visits to alternative practitioners than to family physicians.
Remarkably, roughly three-fourths of the money spent on alternative medical practitioners was paid out-of-pocket instead of by insurance. By contrast, only 17 percent of the total bill for all physician services that year was paid for out-of-pocket. U.S. Census data reported that in the preceding three years, total spending for alternative care grew by 83%, from $10.3 billion in 1987 to $18.9 billion in 1990, while total expenditures paid to mainstream physicians increased by 56%, from $90 billion to $141 billion. Not since President Nixon brought acupuncture back from China has interest in alternative medicine been so great.
A follow-up study published in the November 11, 1998 issue of the Journal of the AMA reported a 47.3% increase in visits to alternative medicine practitioners, from 427 million in 1990 to 629 million in 1997 - a number that exceeded total visits to all US primary care physicians.
There are other reasons why physicians have had a reason to give nutritional therapies a "second look". One, for example, is the increasing awareness that numerous mainstream therapies are dangerous and that there are many common ailments for which there are no effective conventional therapies. For example, in a study published in the April, 1998 Journal of the AMA, it was found that adverse reactions to prescription drugs, taken as prescribed, was the sixth leading cause of death in the United States, just behind heart disease, cancer and stroke. As a result of these new economic and clinical realities, more physicians than ever before are offering some form of "alternative" medical therapy.
Physicians of the Future
Unfortunately, however, many view the option of non-mainstream care as an either/or proposition. I believe that the future of medicine will be a blend of holistic and conventional medicine tailored to the needs of each patient. What has been considered "alternative" should actually enhance "conventional" medicine. This integrated form of medicine would expand the available options and for all patients.
The November, 1998 Journal of the AMA article mentioned above also notes that nearly one in five individuals taking prescription medications was also taking herbs, high-dose vitamin supplements, or both. This places an estimated 15 million adults at risk for potential adverse interactions involving prescription medications and herbs or vitamins. This fact will encourage the creation of a group of physicians well trained to understand the interrelationship among all available conventional and "alternative" medical therapies.
There are large numbers of patients for whom there are no effective allopathic treatments or for whom the available therapies are either poorly tolerated or only partially helpful. A physician who has the knowledge to help these patients is working with a tremendous advantage. An example of this would be the patient with infectious mononucleosis - a disorder for which there is no mainstream treatment. A physician who expands his or her practice to include other therapies might, in addition to standard diagnostic and therapeutic regimens, offer herbs to stimulate the patient's immune system. He or she could perform acupuncture to help reduce the swelling of the spleen and calm the liver, or prescribe a homeopathic remedy to reduce the severity and duration of the illness.
Now that a large number of physicians have gone on record as being willing to include non-mainstream therapies in their practice, or at least to acknowledge their potential value to patients, it is too late for the medical profession to go back to ignoring these therapies. The concepts on which medicine is based must now expand to assimilate these ideas and improve upon them.
Similarly, those of us who have for so long utilized natural treatments based on concepts hundreds or thousands of years old, must now be willing to accept research and scientific validation that might prove some alternative therapies useless.
As new and old ideas come together, a novel paradigm will emerge that will enrich both patient and practitioner. Once we are willing to look at the notion of health and disease just a little differently, the benefits will be incalculable.
(c) 2001 Healthology, Inc.