What is called "holistic medicine" in the U.S. is actually considered mainstream in other modern countries. The fastest growing area of medicine in the U.S., by an order of magnitude, is Holistic or Alternative medicine.
The National Institutes of Health report that at least one-third of all Americans used some form of alternative medicine in 1990.1
A 1995 study found that two-thirds of all households had at least one member who had used some type of alternative medicine within the previous two years.2
These patients paid over $13.7 billion in 1990 (the last year for which the NIH has figures), three-quarters of it out-of-pockets. Some insurers are even reimbursing for alternative therapies, most often acupuncture and chiropractic care.
Actually, It’s Traditional
In considering alternative medicine, we need to realize that only in the United States and a few other developed countries view these disciplines as “alternative.”
The World Health Organization (WHO) estimates that 65-80 percent of the world’s population relies on what it calls traditional (alternative) care.4 To put that figure into perspective, consider that China, India and Africa are all areas where rural populations are much more likely to seek care from a traditional healer than a practitioner of Western medicine.
These disciplines have existed much longer than our Western medicine, which dates back only a few centuries, and are only now being investigated by our mainstream medical community. CNN says that one-half of U.S. medical schools now offer courses in alternative medicine, and one in three prescriptions in Germany is for an herb.3
The growing trend toward alternative or complementary medicine in the United States is largely patient-driven. In fact, the NIH study found that 72 percent of those who use alternative medicine hide it from their mainstream primary care physician.1
In this country, the trend is to combine alternative cures with mainstream medicine, hence the newer term, “complementary” medicine. Even the U.S. Navy has begun using some alternative therapies in conjunction with mainstream medicine, and has “healing-touch” practitioners on staff in many of its hospitals. You’d be hard-pressed to find a Western practitioner who hasn’t dabbled in some form of alternative therapy, if only to recommend vitamin supplements or echinacea during cold and flu season.
Who & What?
The term alternative includes practices from the traditional medicine of many cultures to the application of magnetoresonance spectroscopy. The NIH’s Office of Alternative Medicine classifies 63 common alternative therapies used in this country into seven categories:
• Alternative Systems of Medical Practice
• Bioelectromagnetic Applications
• Diet/ Nutrition/Lifestyle Changes
• Herbal Medicine
• Manual Healing
• Mind/Body Control
• Pharmacological/Biological Treatments
The classifications are somewhat arbitrary. For example, osteopathy is listed as manual healing although osteopaths are virtually indistinguishable from M.D.s.
To give you a better idea what your patients might be experimenting with, here are descriptions of the most common forms of alternative medicine. Although this is not an exhaustive list, it will give you a greater appreciation of the variety of resources available to patients today.
This is one of the alternative therapies most familiar to Americans. It is often practiced in conjunction with Western medicine and reimbursed by insurance plans. WHO’s 1990 estimates were that 62,000 of Europe’s 88,000 trained acupuncturists were medical doctors.4 Most often used for control of pain, especially chronic pain, the technique involves inserting fine needles along specific body meridians.
As there are many meridians and they are often far removed from their point of effect, this technique requires extensive training. (For example, you might place a needle behind the ear to eradicate low back pain). Studies have also shown that acupuncture may be used to enhance the immune system by stimulating the production of T-lymphocytes, B-cells and boosting the levels of immunoglobulin G and A.
This discipline was jet-propelled into the American consciousness by famed M.D.s Deepak Chopra and Dean Ornish. This discipline is the traditional healing method of India and includes a comprehensive mix of diet, exercise (yoga), massage, meditation and herbs. The ayurvedic physician denies the separation of spirit and body, and insists on treating both to accomplish a cure. Much so-called “new age” medicine has its roots in ayurveda.
Popular media-savvy physicians such as Dr. Ornish have created empires by blending ayurvedic with Western medicine. Many cardiac patients would be surprised to learn their treatment includes some elements of this 5,000-plus-year-old practice.5
This approach has achieved such mainstream acceptance that some question its place in a discussion of alternative medicine. Chiropractic believes that the body cannot properly function without proper skeletal alignment. Therefore the practice of this discipline will at minimum include physical manipulation of the spine or joints.
In conjunction with manipulation, the chiropractor may also treat with massage, nutritional or herbal supplements, electrostimulation and exercise. Chiropractic would probably still be considered a “fringe” profession if it weren’t so successful at reducing lower back pain. Because this is the most common work-related complaint in the country, medical insurers have been anxious to embrace this low-cost and quick-working treatment.
This is the most ironic of alternative/complementary medicines. Until the 17th Century, when Western medicine began to diverge from traditional European healing arts, herbalists were the only mainstream healers. Now Western medicine is again embracing natural remedies, which may lack the strength of synthetics, but work without many of the side-effects and interactions.
In reality, almost all traditional medical practices include the use of herbs. The use of herbal medicines and natural products is increasing worldwide. USA Today reports that the market for herbal remedies is expected to rise 12-16 percent in each of the next four years. Some of this growth will be fueled by the entry of drug giants such as Warner-Lambert, Bayer and SmithKline Beecham into the supplement business.6
Many mainstream physicians now feel comfortable prescribing dietary supplements, and their number is expected to increase as the pharmaceutical detailers continue to educate them about herb use. In fact, Review of Optometry research shows that approximately 85 percent of O.D.s recommend nutritional supplements to their patients.
This form of naturopathic medicine was founded in the 1700s by German physician Samuel Hahnemann. Its credo, “Like may be cured with like,” describes the manner in which homeopathy strives to bring the body into a state of homeostasis, the source of the name.7
Homeopathic remedies contain microscopic amounts of an herb to work almost as an inoculation by stimulating the body’s own defenses, similar in action to a toxin. The amounts of active ingredient per tablet are so minute that adverse response is not a concern, nor is dosage an issue.
For example, a practitioner choosing an analgesic for arthritic human may prescribe two Rhus Tox 6X tablets daily. A homeopathic veterinarian may prescribe the same for a 20-pound Schnauzer.
Traditional Oriental medicine comprises many schools of folk medicine. Using herbs primarily, but also desiccated animal parts and even ground gemstones, these practitioners base diagnoses on listening to the patient’s complaints and physical examination; especially using skin and tongue to search for clues to the source of the ailment. The WHO is highlighting traditional Chinese medicine for dissemination worldwide to meet the health care needs of the 21st century.4
There are hundreds of alternative regimens currently under study worldwide, and these are only a few. Although they certainly differ from each other, there are several striking similarities.
One is that their practitioners are uncanny diagnosticians. The other is the extraordinary amount of time the doctor spends with the patient in achieving this diagnosis. It is not uncommon for a homeopathic physician to set aside an entire morning to spend with a new patient. Time may be the single element that explains the growing interest in alternative medicine in the United States.
Beyond a return to spiritualism, the alternative medicine movement may simply be a reaction to the high-tech, low-touch, sterile health-care environment. Increasingly frustrated by doctors who rush through examinations, many patients may simply be looking for someone to listen to them.
Whether or not you decide to incorporate any elements of alternative medicine into your optometric practice, the amazing growth of these disciplines demands that you at least be familiar with them. Increasingly your patients are seeking out alternative health care. Are you ready to deal with it?
Dr. Schwartz is a health-care marketing consultant in Vista, Calif.
(reposted with a big thank you from http://cms.revoptom.com/archive/issue/ro02f5.htm)
1. National Institutes of Health website:http://altmed.od.nih.gov/oam/resources/present/cam-
2. Freeman JW, Landis J. Alternative/complementary therapies. SDJ Med 1997 Feb;50(2):65-66
3. Alternative Medicine Online web site: http://www.advanced.org/24206/facts-stats.html
4. World Health Organization website: http://www.who.int/dap/trmO.html
5. D. Patrick Miller. Have we been fooling ourselves with diet and exercise?The Yoga Journal 1998 May/June; 140:82-89.
6. Hellmich, N. For the big drug firms, market is ripe for expansion into herbals. USA Today. Wed, Oct. 14, 1998. 1-D.
7. Lockie, Andrew. The Family Guide to Homeopathy. Simon & Schuster. New York, NY. 1989.
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