What is Alternative Medicine?-An overview
Conventional medical care is also called “mainstream”, “allopathic”, “orthodox”, or “standard”. It is sanctioned by the government, recognized by insurance companies, and supported by the pharmaceutical and device industries. This form of Western medicine is the most accepted in this country. Emphasizing pathology and intervention, its greatest successes are in diagnosing and treating acute disease, and life support. Emphasis on disease and high technology, rather than on health and individualized care, results in an office visit which may be impersonal, with attention to a disease, not the entire human being. Recently, there has been great interest in other systems of medicine.
He who has health has hope… and he who has hope, has everything.
–Old Arab Proverb
Alternative medicine, according to the National Center for Alternative and Complementary Medicine (NCCAM), part of the National Institutes of Health, is any practice which is not used or accepted by conventional physicians. In their words, “CAM is a group of diverse medical and health care systems, practices, and products that are not presently considered to be a part of conventional medicine.” It is also “interventions neither taught widely in medical schools nor generally available in US hospitals” and not usually covered by insurance. This distinction has blurred of late, since there are now physicians who do accept and practice certain ideas which were formerly considered alternative, and many hospitals now incorporate alternative and complementary medicine clinics. Alternative medicine treatments are used instead of conventional ones.
Medical schools and “teaching” alternative medicine
On November 2, 2009, the Associated Press reported that the government has spent over $22 million to help teach about alternative medicine in medical schools. Officials say that primary physicians, or “PCPs”, need to know how to discuss popular remedies. But behind the rhetoric, critics say that asking students to do this compromises them, because alternative medicine is a “pseudoscience.” Nonetheless, Dr. Joseph Jacobs, former head of the federal Office of Alternative Medicine, said “the real issue is not whether alternative medicine should be taught, but how.” The very creation and existence of the National Center for Complementary and Alternative Medicine makes ”merging alternative and mainstream medicine ‘a central and overarching goal.’”
Complementary medicine refers to treatments used together with conventional medicine. Many allopathic doctors are more comfortable with alternative techniques used in conjunction with their therapies. Many believe that alternative medicine should frequently complement conventional care, and actively seek to work within the framework of existing, prescribed, orthodox treatment plans. Some providers expand traditional goals in pursuing optimum wellness, mental sharpness (cognition), performance, and happiness, rather than just the absence of disease.
Patients should not have to choose between alternative and conventional medicine. Integrative medicine is another term for complementary and alternative medicine, and refers to the blending of alternative and conventional medicine by the same doctor. In one sense, all of medicine can be grouped together under the heading of “integrative.” Many drugs with the greatest successes over time-aspirin, digitalis, and cancer drugs-were found and developed from plants. Most hormones used in therapy were originally harvested, studied and replaced using natural sources, not synthetic. Many gastroenterologists now prescribe betaine and probiotics, formerly considered “alternative”. Cardiologists are recommending CoQ10 and plant stanols, and ophthalmologists are prescribing antioxidants and fish oil for patients with acute macular degeneration, etc, etc. Alternative medicine has now affected nearly every conventional medical subspecialty. Mental imagery is now a standard preoperative technique before cancer surgery. Nutrition and dietary interventions are often the first line in disease prevention and treatment guidelines, and can play a major role in therapy of most diseases.
The bottom line: there is no competition between conventional medicine and “alternative”—they are different sides of the same coin: health. Any perceived competition is a result of human interpretation and agendas. Cardiologists do not anticipate nor fear fish oil will replace statin drugs, nor do naturopaths expect statins to replace fish oil. Increasingly research suggests they enhance each other both at the molecular and clinical levels. More important, there are many diseases for which there are no answers from alternative or naturopathic medicine. For instance, there is nothing which can compare with modern invasive procedures in cardiology, surgery, etc.
The addition of what was, or still is, called an alternative technique to a patient’s treatment plan may add a rich dimension to his or her medical care. This is one of the reasons alternative medicine is becoming so popular in the last few years, and increasingly so. Alternative and complementary medicine is also less expensive over the long run, so that usage may again be additive with conventional medicine.
Natural medicine, or naturopathy, is a system of medicine within the field of alternative medicine. It is the art and science of relieving ill health in harmony with the laws of nature. Naturopathic Medicine, according to Lise Alschuler ND, is a system that restores health by following a set of specific rules. A fundamental assumption is that nature is orderly, and this orderliness is designed to result in an ongoing healthy life and well-being. This dependable orderliness is guided by a basic inner wisdom of the body. By supporting the processes the body itself uses to recover, full health returns quickly. By disrupting or blocking the body’s attempts to heal, full health remains elusive.
While naturopathy nearly disappeared during the mid-twentieth century because of the popularity of drugs and surgery, naturopathic medicine is increasingly recognized as effective, safe, less expensive (overall), and particularly suited to treatment of chronic diseases. Practitioners are licensed in 16 states, but not in Texas. There is considerable opposition to this movement, and criticism of limited clinical training, lack of hospital experience, with little exposure to many serious diseases and modern management among them. There is no training in many conditions, as noted by Arnold Relman MD, and no consideration of a wide number of important diseases in standard naturopathic practice and textbooks. Resistance to accepting any natural remedy to manage disease remains high, despite an increasing database of evidence.
Naturopaths spend much more time with patients than allopaths, and the value of the bond that results is well recognized.
Preventive medicine is a well-established specialty within conventional medicine in the public health sphere. Epidemiology is the study of those things affecting health and illness in populations, and what is found determines policies in public health and preventive medicine. On a practical basis, nutrition and dietetics, habits, lifestyle are all factors of importance to both public and individual health.
Functional medicine refers to a newer view of the relationships between organs and systems in the body, de-emphasizing the symptom-drug, disease-prescribe reflex. Two informative and highly recommended videos from the Institute of Functional Medicine are available at http://www.youtube.com/watch?v=mQIkzTPcNlE and http://www.youtube.com/watch?v=TzrMgN-FH34
The Institute for Functional Medicine’s guiding principles are:
- Biochemical individuality describes the importance of individual variations in metabolic function that derive from genetic and environmental differences among individuals.
- Patient-centered medicine emphasizes “patient care” rather than “disease care,” following Sir William Osler’s admonition that “It is more important to know what patient has the disease than to know what disease the patient has.”
- Dynamic balance of internal and external factors.
- Web-like interconnections of physiological factors – an abundance of research now supports the view that the human body functions as an orchestrated network of interconnected systems, rather than individual systems functioning autonomously and without effect on each other. For example, it is now known that immunological dysfunctions can promote cardiovascular disease, dietary imbalances can cause hormonal disturbances, and that environmental exposures can precipitate neurologic syndromes such as Parkinson’s disease.
- Health as a positive vitality – not merely the absence of disease.
- Promotion of organ reserve as the means to enhance health span.
The complex interrelationships among some bodily systems, the environment, and the mind, spirit, emotions.
Functional medicine is anchored by an examination of the core clinical imbalances that underlie various disease conditions. Those imbalances arise as environmental inputs such as diet, nutrients (including air and water), exercise, and trauma are processed by one’s body, mind, and spirit through a unique set of genetic predispositions, attitudes, and beliefs. The fundamental physiological processes include communication, both outside and inside the cell; bioenergetics, or the transformation of food into energy; replication, repair, and maintenance of structural integrity, from the cellular to the whole body level; elimination of waste; protection and defense; and transport and circulation. The core clinical imbalances that arise from malfunctions within this complex system include:
- Global stress to the whole organism
- Mitochondropathy-mitochondrial energy depletion and disturbances
- Oxidation-reduction imbalances-oxidative stress within cells
- Detoxification and bio-transformational imbalances
- Hormonal and neurotransmitter imbalances
- Immune imbalances
- Inflammatory imbalances
- Digestive, absorptive, and microbiological imbalances
- Enzyme depletion or malfunction
- Glycation, carbonylation, and lipo-oxidation
- Mutation, or cancerous deterioration of cells
- Nutrient depletions due to drugs, lifestyle, and drug-nutrient/food-drug/drug-drug interactions and side effects
- Structural imbalances from cellular membrane function to the musculoskeletal system
Imbalances such as these are the precursors to the signs and symptoms by 
which are detected and labeled (diagnosed) as organ system disease. Improving balance–in the individual’s environmental inputs and in the body’s fundamental physiological processes–is the precursor to restoring health, and it involves much more than treating the symptoms. Functional medicine is dedicated to improving the management of complex, chronic health problems by intervening at multiple levels to address these core clinical imbalances and to restore each person’s functionality and health. Functional medicine is not a unique and separate body of knowledge. It is grounded in scientific principles and information widely available in medicine today, combining research from various disciplines into highly detailed yet clinically relevant models of disease pathogenesis and effective clinical management.
The complex interrelationships among some bodily systems, the environment, and the mind, spirit, emotions
Functional medicine emphasizes a definable and teachable process of integrating multiple knowledge bases within a pragmatic intellectual matrix that focuses on functionality at many levels, rather than a single treatment for a single diagnosis. Functional medicine uses the patient’s story as a key tool for integrating diagnosis, signs and symptoms, and evidence of clinical imbalances into a comprehensive approach to improve both the person’s environmental inputs and his or her physiological function.”
Functional medicine is, conceptually and practically, one of the most progressive and most well-received movements in the field of medicine and improved health care today. While founded by a PhD in nutrition, followers and members are interdisciplinary, united by the common beliefs outlined above.
Lifestyle Medicine (LM), according to the American College of Lifestyle Medicine, is the use of lifestyle interventions in the treatment and management of disease. Such interventions include diet (nutrition), exercise, stress management, smoking cessation, and a variety of other non-drug modalities. A growing body of scientific evidence has demonstrated that lifestyle intervention is an essential component in the treatment of chronic disease that can be as effective as medication, but without the risks and unwanted side-effects.
The field of lifestyle medicine has been growing by leaps and bounds over the last two decades. In the 1999 landmark textbook entitled “Lifestyle Medicine,” editor James Rippe, MD, expressed the hope it would “open an entire new branch of medicine…” This is embodied in the American Journal of Lifestyle Medicine, whose sponsor is the Lifestyle Medicine Association. LM is becoming a preferred modality for not only prevention, but the treatment of most chronic diseases, including type-2 diabetes, coronary heart disease, hypertension, obesity, insulin resistance syndrome, and osteoporosis.
Although the practice of LM incorporates many public health approaches, it remains primarily a clinical discipline. Lifestyle interventions are typically outpatient services. Brief, intensive group interventions in a residential setting are often more effective and may be necessary for severe or intractable cases.
While LM interventions typically do not emphasize prescription medications. they remain necessary and essential in chronic disease. As LM progresses, however, medication may require re-titration and reduction of doses prescribed before the lifestyle intervention. It is often necessary to lower insulin dosing in patients with diabetes who receive lifestyle interventions, and reduce dosing of anti-hypertensive medications for patients with hypertension. Others may also require a change of medications entirely. For example, a person with type-2 diabetes may be able to reduce the dose or discontinue insulin but need metformin, a thiazolidinedione (TZD), a sulfonylurea, or a related combination.
In some cases lifestyle interventions are more effective when augmented with appropriate medications, as with tobacco use where cessation is 2-3 times more successful when buproprion is prescribed with the lifestyle modifications.
The American College of Lifestyle Medicine (ACLM) is a national professional society for clinicians specializing in the use of lifestyle interventions in the treatment and management of disease. ACLM’s members are clinicians engaged in lifestyle medicine practice, teaching and/or research. Many serve on ACLM committees contributing to the organization’s role as a national resource of expertise in the use of lifestyle intervention for the treatment and management of disease. Discussion paper re developing new Lifestyle Medicine specialty.
Holistic medicine is an older term for alternative medicine, but is more closely related to natural medicine. The principles of holistic medical practice defined by the American Board of Holistic Medicine are incorporated into our beliefs as discussed earlier. Key elements are caring for the whole person-body, mind, and spirit, and empowering people to achieve a condition of optimal health far beyond the absence of disease. This level of health comes from within, at least to a good degree.
Holistic medicine emphasizes an approach to medical care the importance of all aspects of a person’s health: physical, mental, social, economic, and cultural. Like functional medicine, it is concerned with the integration or relationship between the parts, their interdependence rather than separation. Principle concerns and core values of holistic medicine include
- RESPECT: effective, humane healthcare must consider peoples’ thoughts and feelings, their relationships and spiritual life, as well as their culture
- LIMITS OF TECHNOLOGY: healthcare cannot be based on the body alone. Although the application of technologies to biological faults can be immensely valuable, and indeed lifesaving, there is more to add
- PREVENTION: greater emphasis should be placed on creating health, on preventing disease and the deprivation and environmental decay that promote it
- OPEN-MINDEDNESS: healthcare, like Nature, should encourage diversity and creativity, recognizing that, like motherhood, there are many good ways of being and doing
- COMPASSION: being kind and caring towards others
- COMPETENCE: commitment to ongoing professional and personal development
- OWNERSHIP: self-care through education, researching all drugs proposed, diagnoses made, accepting personal responsibility and working to become healthy citizens
- FULFILLMENT OF GENETIC POTENTIAL: Viewing health as more than simple absence of disease, but an essential tool to fulfill one’s genetic potential-academically, socially, financially, and otherwise
Integrative Medicine, according to Dr. Kenneth R. Pelletier, Clinical Professor of Medicine at the University of Arizona School Of Medicine and the University of California School of Medicine in San Francisco, is the “evidence-based” combination of conventional with complementary and alternative medicine (CAM) for assuring the maximum therapeutic benefit for patients and practitioners. Under the 5 category taxonomy of the NIH National Center for Complementary and Alternative Medicine mentioned above, there are many areas of CAM where there is a substantial and growing body of evidence based on research and clinical practice.
To cite but a few representative examples, there are the domains of:
- Mind-body medicine where such approaches constitute the most extensive body of CAM research documenting the efficacy of such interventions for the largest number of conditions for the greatest number of patients.
- Acupuncture with 16 systematic reviews in the Cochrane Library demonstrating efficacy in conditions as diverse as depression, back pain, Bell’s palsy, dysmenorrhea, arthritis of the knee, and fibromyalgia.
- Specific herbal interventions (www.herbalgram.org) and a growing sophistication regarding drug-herbal interactions (www.herbmed.org; www.healthyroads.com).
- Traditional Chinese medicine (TCM) with several international NCCAM Centers of Excellence to focus on irritable bowel syndrome (IBS), side effects of cancer treatment, and allergic asthma.
- Upwards of 50 ongoing research studies annually from the NIH-NCCAM. Among the many diverse CAM/IM areas being researched are dietary practices and supplements, chiropractic, homeopathy, naturopathy, electromagnetic effects, and Ayurvedic medicine, chelation, and spiritual healing.
Based on the 2006 Institute of Medicine report on CAM, it is clear that integrative medicine is part of a rapidly evolving era of genomics, international medicine, and evidence-based approaches.
Increasingly, evidence shows that partnership with patients through education, self-actualization, and their personal, active participation in health care produces significant improvements in treatment outcomes. In many countries incorporation of such ideas into insurance coverage is controversial, because social responsibility (benefits) may discriminate against people with poor health habits. A healthy citizen may resent having to pay for someone else’s diabetes expenses, since diabetes is a preventable disease. In the individual case however, there is little doubt that individual motivation and responsibility is valuable. In conventional medicine, poor health habits may sabotage even the best of health care, the classic example being the man who undergoes a triple coronary artery bypass, only to go back to his fast food diet and plug up his bypass veins. The truth is that most people’s diets one year after their diagnosis of such heart disease, and after surgery, are actually more atherogenic (artery clogging) than they were the year before! It is not surprising that USA Today said (10/18/2006) ”…the underlying assumption is that [conventional] medical care not only works, it’s virtually magic… the reality is that [conventional] medical care doesn’t produce health by itself…” More and more people are embracing this concept, which has become popular among our youth, unfortunately not enough to slow our national weight gain. Producing health through lifestyle and natural means, nutrition, prudence, moderation, balance, elevated self awareness and health education is what this office is all about. These principles are simultaneously classical Greco-Roman, Biblical, and thoroughly modern. Although many people believe the two approaches are competitive, they are actually two sides of the same coin.
Reflecting how modern and pertinent this philosophy is to national health and all of us today, on October 5, 2009, the American Holistic Medical Association sent an email to members with linking to a N Y Times editorial about current diets and lifestyle in relation to the crushing rates of chronic debilitating disease.
Copyright, Health Science Research, Inc. 2009. All rights reserved.
People want greater knowledge to exert control over their own health issues, and take individual responsibility for their well-being. There is greater openness to frequently-used and most useful therapies from the world’s many different healing traditions.
