Wholistic therapy

[Brett Jacques]

One of the chief complaints that allopathic medicine has against alternative medicine is the lack of qualified research. While alternative practitioners appreciate and utilize the reductionististic research promulgated by the allopathic community, relying on it as the sole means for determining clinical efficacy compromises the patient's well being.I have always found it interesting that allopaths are not aware of their colleagues research especially validating natural therapies or approaches to treatment.

In alternative medicine (lousy term since allopathy is the new kid on the block), practitioners make use of various modalities to help the patient without harm.

[James Boelter]

Yep. When you spend 10-14 hours a day holding a hammer, you tend to pound screws too. Nicely worded summary of an ongoing 'issue' between the two worlds of medicine, thanks for the 'food for thought'.

[Brett Jacques]

At UCI, the Samueli Center for Alt. and Comp. Medicine spent a lot of time trying to define Alt & Comp Med and then design appropriate research protocols. Unfortunately I believe they failed and if you have read any of the research coming out of their then you'll know why.
Ask too many questions and you get too many whys and so whats.

[bob_stra]

> One of the chief complaints that allopathic medicine has against
> alternative medicine is the lack of qualified research.

Yep.

>While alternative practitioners appreciate and utilize the reductionististic > research promulgated by the allopathic community, relying on it as the > sole means for determining clinical efficacy compromises the patient's > well being.

Yep.

> I have always found it interesting that allopaths are not aware of their > colleagues research especially validating natural therapies or
> approaches to treatment.

LOL ;-)

Yep. But I can't fault the average GP / MD for this. One, they have a *ton* of other material they have to keep to date with. Two, I'm not sure the "culture of medicine" really prioritizes investigation into so called "peripheral approaches".

OTOH It's become somewhat popular to bash allopathy as not being "proactive" / health focused / patient centered. IMHO, people don't make a mental separation between the emergency room and the office of a general practitioner. MD's do a great deal of preventative medicine. Or should.

> In alternative medicine (lousy term since allopathy is the new kid on
> the block)

Good point. The "alternative" is actually the original, "traditional" medicine. Allopathy is what... 300 - 400 years old? Quite young by comparison (2000-5000 yrs old)

> practitioners make use of various modalities to help the patient without > harm.

In an ideal world. But "Alternative" medicine seems to attract a whole truck load of quacks out for a quick buck. IMHO, this may be because there is a lack of professional standards. As alternative medicine gains popularity, levels of education and professionalism increase.

The trick is - how to achieve this without loosing the non academic, trail and error wisdom gained in ages past.

It's a quandary. How to meld the old with the new.

[Brett Jacques]

I don't cut allopaths a lot of slack. A lot of their continuing medical education comes from pharmaceutical reps. Most MDs are not current with the literature and frequently use the excuse that one study a practice change does not make.

Allopaths rule the ER and orthopedics but alt. & comp. med has a place here too.

Most allopaths think that preventive medicine is early detection.

Yes, the popularity of alt med grows but the education is becoming more allopathic. This is true for Naturopathic medicine and TCM.

Each healing discipline is needed and there are plenty of people who need help.

[bob_stra]

> I don't cut allopaths a lot of slack. A lot of their continuing medical
> education comes from pharmaceutical reps.

Can't honestly comment on that because I've never sat a MD down and asked 'em. I can see potential for abuse. OTOH, I can see the same potential between supplement / vitamin manufacturers and naturopaths.

> Most MDs are not current with the literature and frequently use the
>excuse that one study a practice change does not make.

Ironically, Chiropractic takes the polar opposite approach. That might be a chiro specific problem tho. The culture is one that prefers to disseminate knowledge thru small, proprietary based seminars. So, come Monday morning, everyone is full of piss and vinegar, trying to recoup the $450 they shelled out on the weekend ;-)

Of course, IMO, which is often not representative of the truth (tm).

>Allopaths rule the ER and orthopedics but alt. & comp. med has a place >here too.

Details? Orthopedics I can see, but ER? What role do you envision?

> Most allopaths think that preventive medicine is early detection.

Thing is, its really hard to study preventative medicine, no? I don't think any ethics committee anywhere in the world would allow subjects to be actively exposed to disease, just to see what preventative measures *might* have been effective.

Round hole (needs), square peg (methods).

The best we have is long term statistical analysis. But even that can be awfully vague.

It all boils down to same basic problem - we can't see the forest for all the trees. You can't study the synergistic whole by looking at the parts alone. I'm not knowledgeable enough to say whether there are ways by which to "study all the parts" in allopathic models, beyond those of cybernetics and systems theory. Even so, those don't seem too popular. RCT's reign supreme.

You know, here's a funny thing I read the other day. Even though sciatica has troubled man kind for ages, medical science only recognized the condition in the 1930's. Only then was the link between disc herniation and pressure on the nerve "discovered" by microscopic study (Steinman: AMA book of back care. P53-58). The irony is that this is but one, fairly uncommon cause of sciatic pain. Upto 80% of 40yr olds have some degree of disc herniation, according to a lecture I attended by a local neurosurgeon. Most all are asymptomatic.

Hell it not even a cause, is it? The more apt question would be - what causes disc herniation in the first place?

>Yes, the popularity of alt med grows but the education is becoming more allopathic. This is true for Naturopathic medicine and
>TCM.

Bad thing or good thing?

On one hand - good thing that the educational standards are going up. Practitioners will be more knowledgeable / competent.

OTOH If the prevailing philosophy becomes on of reductionism, then the unique benefit of CAM will be lost.

Personally, I'm all for knowledge. CAM needs to lift is game with respects to competent, professional practitioners.

[Brett Jacques]

Bob, wonderful insights, thanks.

Yes, the vitamin industry influences the Chiro and ND and now the LAc in much the same way. I've been on both sides of that fence.

I know Alt med works for emergencies because I maintained an office in a rural Oregon community that did not believe in conventional medicine but still ate the Standard American Diet, smoked and drank. I treated a lot of cases that should have been in the ER. This created too much stress for me and after a few months I closed the office. Just too much for a recent grad.

I view prevention as lifestyle and familial history review and proffering mitigating suggestions. And with the availability of looking at SNPs, preventive medicine is a reality.

Raising basic science education is a good thing. When studying the ologies (cardiology, endocrinology etc), it would be nice if educators would parallel and compare alt med models to establish relationships, similarities etc.

I think CAM practitioners need to better understand when to say when. A lesson as you have just read, I learned right off the bat.

An interesting example, I had a recent consult and this patient had all the classic symptoms of adult onset Type I diabetes, which is not common in adults. She was being treated by a local "holistic" MD without resolution of symptoms. Her friend was concerned and called me into the case and I immediately marched this woman over to an endocrinologist. Diagnosis-Type I diabetes and she was given insulin. She felt better immediately. Her previous doctor thought he could manage this case using natural methods, he didn't know when to say when. After her insulin dose is regulated, then he could help her. I've seen this scenario repeated over and over involving ND, LAc, DC and MD.

OTH, the cover your butt medicine practiced by most allopaths is much too invasive. They want spinal taps, x-rays blah blah blah in part due to our litigious society and also the skill of the physical exam is lost.

One more example, my baby sitter was concerned one night that my son's temperature (using the ear therm.) was too high and she wasn't able to get a hold of me (I hate cell phones). She took him to the ER like a responsible childcare giver should when it is out the norm. Like all ERs is was terribly slow and I got the message and headed straight to the ER.
I had a big blowout with the ER ped. because she wanted to do a spinal tap on my son. I asked what her findings were to warrant such an invasive procedure. She hadn't done a physical exam (just looked at him)and hadn't ordered blood work. I got her to order blood work and come in with me to do a PE. Based on the PE, blood work and a rectal temperature, she reluctantly agreed with me that my son did not need a spinal tap but she would feel better the procedure was done because you never know. I decided not to avail her of the iatrogenic illness concept especially with such a procedure. She made me sign an additional liability waiver and released my son into my care, imagine that.

[JasonE]

I've tried a lot of medical approaches, new and old, with mixed results.

For acute situations, particularly involving broken bones, torn tissues, and such, the allopathic approach has been pretty effective.

For general illness, the traditional approaches have worked better for me. I hate taking medicine, but I willingly take vitamins and minerals... so my body can fix itself instead of "being fixed".

I usually end up combining traditional and western approaches, depending on what I need. Massages and occasional chiropracty also walk that line.

Unfortunately, it seems that practitioners on both sides are getting so specialized that they simply don't know enough about other approaches to intelligently advise how to combine them effectively. This leaves patients in the uncomfortable position of adopting an all-or-nothing strategy with one care provider, or of getting multiple opinions and trying to sort it out on their own. :? :roll:

I like the Chinese concept: train medical students in both western and traditional modalities, and rigorously test methods of combining them to control costs and still be effective. They already use accupuncture as the primary form of anesthesia, with far less cost and less risk to the patient.

An accrediting body is working to bring up the level of instruction in schools teaching traditional Oriental medicice, and some of those schools are including many western methods of diagnosis as well. Northwestern Health Sciences University in Bloomington, MN is one example of an alternative medical school that has extremely high standards for Massage Therapy, Chiropracty, and Oriental Medicine, all under one roof.

In another century I think the lines will blur more and we will be seeing more cross-pollination between the disciplines.