alternative and integrative medicine

by Dr. Donna Douglas

Once upon a time, individuals facing cancer felt they had to choose between one of two options - surgery and chemotherapy or alternative treatment. But a new breed of medicine is emerging, one that bridges the gap between the two worlds and offers the best of each. It's called integrative medicine and world-renowned medical centers such as Harvard and Stanford are pioneering training programs for the physician of the future.

A Brief History of Alternative Medicine

"Alternative medicine" was probably the first 'other medicine' term to gain popularity in the US and refers to treatments not taught in Western medical schools. This includes the use of vitamins, herbs and mind-body techniques. Essential to the alternative approach is a belief in the body's ability to heal itself and that health is more than simply the absence of disease. Increasing consumer use of alternative medicine in the early 1990's led to the creation of the Office of Alternative medicine as part of the government's National Institutes of Health. This growing 'new' medicine gained popular media attention in the 1993 New England Journal of Medicine article by Harvard alumni David Eisenberg, MD. The article estimated that in 1993, unconventional medicine users spent approximately $13.7 billion out of pocket on herbal remedies that are not covered by health insurance companies. By 1997, out-of-pocket alternative medicine consumer spending had increased to $27 billion. Eisenberg's study also showed that most Americans used both conventional and alternative medicine, not one or the other. The attempt to complement perceived weaknesses in each system was a revelation to the medical establishment and, in 1998, the Office of Alternative Medicine was renamed the National Center for Complementary and Alternative Medicine (NCCAM). The era of complementary medicine was born.

By early 2000, larger medical centers began offering complementary medicine programs. Patients receive the same type of care as before but have the opportunity to receive services such as acupuncture, yoga classes, art and music therapy programs under the guidance of the medical center. But the evolution was not at an end. Americans wondered whether these complementary approaches could benefit them not just as an add-on to the standard medical care, but as an integral part of their care.

There was a 'great divide' between the two medical systems due to the difference in approach and methodology. Western trained physicians are not required to study botanical pharmacology or mind-body influences and Western medical schools do not offer alternative medicine certification. For those practicing in either camp, the possibility that either medical practice has the ability to influence the effects of the other within the body, and the fact that practitioners are often unaware of each other was disturbing. There was a need to better understand the interplay but more importantly, understand if/how it can benefit the patient.

Enter the Naturopath. Naturopathic physicians are trained in one of four accredited medical colleges in the United States and practice integrative medicine using standard diagnostic techniques, pharmaceuticals and surgery when necessary. The American Association of Naturopathic Physicians operates a searchable database making it quick to find licensed care.

From a global point of view, integrative medicine is not new. Other developed nations such as France, Germany and Japan have practiced integrative medicine for decades. The novelty is in the terms as defined by different cultures. In Asia, traditional treatments (which would be considered alternative in the West) are still revered and passed down from mentor to student over thousands of years while conventional medicine (that taught by Western medical schools) is a comparatively new practice.

What to expect in a complementary treatment program.

Current complementary medicine programs at institutional treatment centers provide complementary approaches as an option. Surgery, radiation and chemotherapy are the standard of care for cancer. Optional treatments may include nutritional support, naturopathic medicine, mind-body medicine, physical therapy, pain management and others. Clinical trials investigating new treatments may be available (http://nccam.nih.gov/clinicaltrials/alltrials.htm) but the nature of clinical studies does not accommodate customization.

What to expect from an integrative medicine program.

In the integrative setting, practitioners collaborate in patient care - the entire team is fully aware of all treatment protocols. Nutritional therapy, botanical preparations, mind-body medicine and physical therapies are coordinated into a single treatment plan. Examples of current integrative treatments include MRI-guided hyperthermia (heat treatment) in conjunction with radiation therapy of breast cancer, and botanical adjuvants in standard chemotherapy.

For future and current physicians, the University of Arizona has initiated training in integrative medicine, including a fellowship and distance learning program. The reality is that any new therapy is an 'alternative' therapy until it is sufficiently proven by science to recommend its use. We are still in the process of testing the 'new medicine' but there is much to gain from what we already know.

Note: Advanced cancer presents special medical challenges. Therefore, it should be addressed in a facility that has the capacity to diagnose and address complications that may arise. This is essential when considering a treatment center.

Resources

National Center for Complementary and Alternative Medicine. http://nccam.nih.gov/

Clinical Trials involving Complementary Medicine.
http://nccam.nih.gov/research/clinicaltrials/

Video Clips: Physicians and Scientists from Harvard Medical School, University of California Medical School, University of Maryland and others discuss integrative medicine. http://thenewmedicine.org/professionals_and_educators

University of Maryland Searchable Database of Complementary and Alternative Medicine. http://www.umm.edu/altmed/

American Association of Naturopathic Physicians. Physician locator.
http://www.naturopathic.org/

Directory of Integrative Cancer Treatment Centers.
http://www.DrDonnaDouglas.com/consultation.html

Posted July 2007