The Mayo Clinic on Integrative Medicine

There was an interesting article offered by Edzard Ernst, MD, PhD from the prestigioius Mayo Clinic Proceedings regarding the concept of ‘integrative medicine.   In it he attempts to differentiate two aspects of this concept–the  label of ‘holistic’ versus the actual therapies that are utilized .

He forwards the same points that I have noted:  holism, the integration of mind,body and spirit in dealing with patients should be the goal of all medicine.  He admits, however, that traditional [allopathic] medicine has failed to provide this approach.  Again, I must agree.His additional point, of which I also concur, is that holistic medicine and good science are not incompatible at all.

He then goes on to criticize the use of some complementary and alternative therapies [CAM] which have not been ‘proven’ to work. He seems to decry the ‘patient choice’ approach to healthcare because he does not believe that patients are truly aware consumers.  He is correct about this point. There is so much ‘imis-nformation’ available to patients that it is impossible to distinguish good info from self-promoting advertising and nonsense.

I agree, as well, that no one is in a position to deny anyone the right to choose any type of health care they want to purchase.  But evidence must be sought for any such choice.  In my mind, this applies to conventional therapy as well as complementary.

Differences of opinion, however, will arise over what constitutes ‘evidence’.  There are several types of medical studies and they are not perfect in producing ultimate ‘truth’.  They should be explored, however, with the awareness that scientific truth remains ‘conditional’.  It can be changed by newer and better science as well as by the repetition of experiments and confirmation of results by several other research centers.

If we, the consumers of health-care info would leap to embrace the conclusions of every single study, we would be bouncing around like a ping pong ball. The list of studies whose results could never be duplicated is astounding, yet some individuals will latch on to the one study which seemed to confirm their prior beliefs and go with it.

The evidence-based approach to health care applies to traditional/conventional medicine as well as the alternative approaches such as homeopathy, naturopathy, energy healing modalities etc. None of them should be rejected because we don’t ‘understand’ how they work.  That attitude kept acupuncture away from Americans for decades.  We may not undrstand the ‘pathophysiology’ of its effectivenss, but that doesn’t matter.  Excellent randomized controlled studies have shown that it does work!  That is the bottom-line criteria.

It also passes the risk/benefit ratio analysis.  The benefit of performing the treatments greatly outweighs the risks of complications. This analysis allows many to ‘experiment’ with alternative therapies which pose little risk.  But a caveat again is to be noted–the judicious use of small amounts of any therapy is wise because toxicities can be unpredictable, highly specific for the patient, and often dangerous.

Recently the time-honored approach to treating diverticulitis and preventing attacks with avoidance of nuts/seeds/corn has been called into question.  It seems that actual scientific studies fail to provide evidence that they do what they claim, to prevent attacks.

Traditional medicine is on the defensive, and rightfully so.  Because of an ingrained sense of arrogance, many in my profession have never developed their empathic skills.  They may or may not have been trained to regard the patient as a whole being. But they may not have the attitudes and personal warmth to do what needs to be done.  But such skills can be taught only when they are acknowledged as important. Traditional medicine has been losing patients to the alternative world for precisely this reason.  They should be embarrased and ashamed by this truth.

I choose to remain hopeful that in the 21st century we all will be concerned with viewing the patient as a whole person and seeking evidence for any type of therapy instituted.

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