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Tara Wend-Barbour

Professor Lake

English 102

March 21, 2012

An Integrative Approach to the Practice of Medicine

Cancer, heart disease, chronic stress-related illnesses, chemical and alcohol

dependencies, diabetes and many other physical maladies take a huge toll on people’s health and

well-being. To treat people as though they are the illness or disease they are suffering from and

not an entire person with a body, mind, and intuitive spirit leaves a divide between the essence of

the human and the ailment that the person is suffering from.

Conventional procedures are based on zoning in and attacking the ailment or invasive

agent that is causing harm to one’s health. Scientific medical treatments are much needed and

help save hundreds of thousands of lives every year, yet there seems to be disconnect and a lack

in communication amongst the patient and their healthcare providers. In the article, “Bridging

the Gap: Decision-Making Processes of Women with Breast Cancer Using Complementary and

Alternative Medicine (CAM)”, it mentions an expectation held by patients that their

conventional physicians would be open minded and knowledgeable to implementing the use of

CAM therapies and have a willingness to assist in communication with professionals trained in

CAM to use alongside of the cancer treatments.

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It is essentially a “role conflict” and a huge burden on the patient when they feel

misguided, confused, and on their own about the direction they should take in treatment options.

Not only do these women have to learn to cope with a different type of role, such as being a

cancer patient, but also, as the article points out, “…additional roles associated with making the

decision to use CAM, including being an information gatherer and evaluator, a liaison between

conventional and CAM health professionals, and a decision maker” (Balneaves et al.). Here is

one woman’s account of the burden she feels in her experience with breast cancer:

And so there’s nothing neutral or unbiased that’s telling me that this

would be the direction I needed to go. I’m frustrated that I don’t have

that information. I’m frustrated that the oncologist does not meet with

the naturopathic doctor and I asked them, “Why don’t you guys get

together and talk? This is my life and what I would prefer.” And they

just don’t do that. It’s just that he personally doesn’t work with any

naturopathic doctors (Balneaves et al.).

When faced with having to choose a treatment there is a tendency for a patient to feel as

though the medical doctors don’t recognize the important parts of their being, or essentially the

core of the individual; inner feelings and fears, self-perception, emotional triggers, beliefs and

desires that the individual carries. This type of situation leaves people feeling powerless,

frustrated, and lacking in trust. The lack in trust is not from insufficient evidence or science.

The trust issue is deeper than science. It is the feeling that medicine and science do not treat the

person as a whole human being. Luckily for people, a shift in the medical world has been

occurring for a few decades. Conventional Western medicine and alternative therapies have been

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slowly integrating into a whole, well-rounded system of treating disease, ailments, and medical

conditions with a collaboration of therapies that are not limited to medications and surgeries.

For a long time, the practice of medicine in the United States has been centered on

scientific discoveries that are backed up by evidence from extensive, research studies. If a

person has a particular disease or illness, the focus is on attacking the invading agents through

medication, radiation, chemotherapy, and other conventional treatment processes. The majority

of the validity in scientific findings is based on objective evidence. This is evidence built on facts

using analysis, measurements, and other forms of research that can be independently assessed

(Sade).

The research also involves empirical evidence found through experiments that are

measurable, repeatable studies following the scientific method. Science based medicine is

necessary and effective. Evidence differs and the effects from treatments and drugs vary from

patient to patient, so it can be dangerous to make decisions through word of mouth. Empirically

based medicine “looks at all the research that there is about a disease or treatment.” This is why

it is important for medical doctors to look at the treatment options that are based on what the

research says about the medical condition the patient is suffering from. Then a confident and

sound decision can be made based on that (Best Health).

There are a few types of studies that experts examine; randomized controlled trials,

systematic reviews, and observational studies. Randomized controlled trials are studies where

researchers create two groups and randomly select a sample of people to be placed in each group.

If it is a drug they are testing, for example, one group will be given the actual drug that is being

tested and the other will be given a placebo. Placebos are inactive and ineffective substances that

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are given to the test subjects for comparing results of the actual medication. Neither the

researchers nor the participants of the study are allowed knowledge of which group the people

are being placed in and whether they are receiving the actual drug or the placebo, this is known

as a blind study. It allows researchers to measure and compare the results in an unbiased way

and gains the most accurate results. Sometimes these kinds of studies don’t give the researchers

enough information on the subject being studied or the results may vary from the differing ways

the studies are conducted. This is when systemic reviews come into play (Best Health).

A systemic review is a type of study that gathers multiple randomized trials and takes a

look at the results summarizing the risks and benefits into one study. Systemic reviews use

statistical analysis to add up the results. However, it is important to understand that they are not

“foolproof”. The characteristics of these studies are only as good as the quality of the research

that are included, so if the studies were not preformed accurately and contain failing factors, then

the results of the systemic study will be effected (Best Health).

Not all studies can be performed through randomized or systemic trials. For one,

randomized trials can be time consuming and expensive. There also may be ethical issues that

could be too risky to go ahead with the actual study. When these issues come up researchers may

choose to do an observational study. In an observational study, researchers observe and record

behavior and characteristics of the people being watched. Unfortunately, these types of studies

are not always the best for finding evidence to support medical treatments, since they can’t

measure and prove the effectiveness of a drug or treatment/cure. It can be a daunting task in

trying to pick the best drug or treatment for your particular needs and this is why having a

relationship built on trust with your medical practitioner is important. Ideally, the doctor would

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sit down and practice in a shared-decision making process to ensure all the patient’s questions

and concerns are taken into consideration before moving forward with a treatment.

In some cases a person may opt out of empirically based medicine completely. They may

choose to pursue the other end of the spectrum in what is known as alternative or naturopathic

medicine. The word naturopathy evolved from the Greek words “nature” and “disease”.

Hippocrates, the Greek “father of medicine”, was known for being one of the earliest

“naturopathic and homeopathic physicians”. It is a theory that “provokes natures healing power

by using herbs, water, fasting, diet, and other noninvasive, gentle treatments” to assist a patient

in treating their ailments. Naturopathic medicine was popular in the early part of the twentieth

century. Into the 1920’s there were numerous naturopathic medical schools and physicians, so

many people were open to using the therapies. As scientific medicine evolved, pharmaceutical

treatments using antibiotics and new technologies began to override the natural remedies, the

practice of naturopathy began to decline and controversies amongst clinical professionals grew.

However, by the 1970’s people started catching on to the limitations and costs that

scientific/conventional medicine entailed and so naturopathic and alternative therapies began to

gain popularity among individuals seeking treatments (Navarra).

The practice of naturopathic and alternative medicine has many critics and conflicts

surrounding the use. Researching treatments for symptoms such as pain, for example, are less

reliable because pain cannot be independently assessed and is therefore a subjective form of

research. Subjective evidence cannot be evaluated, it is "in the eye of the beholder", you have to

trust what the person is relaying to the researcher and either accept it or reject it. With that said,

even though CAM may not be able to go through the rigorous objective studies and standard

scientific methods, there is other “rational techniques and are established as valid sources of

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knowledge: qualitative investigative methods, phenomenology, and ethnography, for example

(Sade).

Lawrence Schneiderman is a Western physician and huge critic of CAM. He describes

his definition of medicine as, “A discipline that deals with restoration of health and alleviation of

suffering through disease prevention and treatment. Any activity attached to the term medicine

should be measured by standards of evidence for efficacy." He also explains that the evidence

must come from "randomized clinical trials that feature groups of study and control subjects,

randomized assignment to the study groups, clearly defined interventions and outcome measures,

blinded data collection, and statistical analysis." He recognizes that human beings have the need

for fulfillment in many areas of their lives and have the right to seek that fulfillment in whatever

way they choose. However, he believes that any kind of alternative therapies a patient seeks for

their fulfillment cannot be considered “a part of medicine, rather they are alternatives to

medicine". Another point Schneiderman makes is that scientifically trained physicians should

take a deep look into what may be lacking in the way they interact with patients, and why CAM

therapies are becoming more appealing to their patients (Sade).

Schneiderman’s view is shared with many other conventional physicians. Perhaps, if

more physicians took a deeper look at the problems in their practices and the lack of connection

on a deeper level in healthcare, a shift in perceptions would occur and an understanding of why

an integration of systems would be valuable. If more health providers would develop openness

with their patients in using CAM therapies and work towards a partnership in creating health and

well-being, the trust and confidence in the medical world could be replenished. As much as

physicians such as Schneiderman believe in what they do, there is no doubt that in the last couple

decades, a more balanced system has been emerging.

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This system is combining ancient healing arts and natural remedies and using them

alongside conventional empirically-based medicine. This integration of systems is extremely

beneficial to the treatment of diseases and the creation of health and has a promising future.

There is a shifting in attitudes and what is now known as Integrative Medicine, is morphing into

mainstream acceptance and will continue to add to the sustainability of our health, wellness, and

mental states.

When this holistic way of treating patients emerged it was known as alternative medicine,

which really means anything outside of conventional scientific medicine. The goal was to

incorporate alternative and natural therapies with science based discoveries, so the name

alternative medicine evolved into complementary medicine. Naturally the two words combined

after some time into complementary and alternative medicine (CAM). Then in the last decade,

CAM has evolved into the name Integrative medicine, which really is the best of both worlds.

Integrative medicine is combining alternative, complementary, and conventional therapies and

working to form a partnership with the patient and the health care practitioner with an evidence

base to back up the validity of the therapies (Randall).

Integrative medicine respects both systems of care and the importance of validity in

backing up treatments is keen. There are centers devoted to the discovery of benefits and risks of

alternative treatments and how they can or cannot work alongside conventional treatments. The

National Center for Complementary and Alternative Medicine (NCCAM) is devoted to

providing well-informed research and the most accurate information when it comes to alternative

therapies. NCCAM has classified natural and alternative treatments into five wide-ranging

categories: alternative medical systems, mind-body interventions, biologically-based therapies,

manipulative and body-based methods, and energy therapies (Briggs).

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Homeopathic and naturopathic medicine are included in the alternative medical systems

and include sub-categories, such as acupuncture, Ayurveda, Native American healing practices,

Tibetan medicine, and traditional Chinese medicine. Mind-body interventions are "designed to

enhance the mind's capacity to affect bodily function and symptoms", plus play a role in the

immune response system. Techniques in mind-body intervention include; art therapy,

biofeedback, dance therapy, guided imagery, humor therapy, hypnotherapy, meditation, music

therapy, and yoga.

NCCAM has supported ongoing research and has found meditation can be used for

relieving stress in caregivers for patients with dementia and it can also help with “attention

related abilities” such as focusing and prioritizing (Briggs). Another example of mind-body

intervention is from my personal experience with the practice of Yoga. I have found it to play an

essential role in stress management. In a sense, Yoga is a form of movement meditation,

because a person must focus on breathing and body alignment when holding the poses. When I

practice yoga, it is a time of reflection and connection with my body. It empowers and enables

me to feel the tension and pain that is held in different areas of my body. Additionally, a part of

the awareness process is the deep breath work that plays a role in releasing the tension of the

body.

Biologically based therapies utilize natural substances like herbs, nutrition, vitamins, and

dietary supplements. Nutrition for example, helps manage blood pressure, inflammation, mood-

regulation, and diabetes. There is power in feeding your body properly with sustainable nutrient-

dense foods. Nutrient-dense foods are rich in vitamins, minerals and anti-oxidants. These kinds

of foods include whole grains such as quinoa and couscous, fruits and vegetables, high-protein

meats such as chicken and turkey, and a variety of nuts such as walnuts, almonds, and cashews.

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Nutrition could be considered its own system of healing and should be a top priority in managing

and creating health.

Manipulative and body-based methods use movement and manipulation to decrease

stress and are also used for pain management. Therapies in this category include Chiropractic

care, massage, osteopathy, reflexology, rolfing, and any other kind of therapeutic touch. Energy

Therapies manipulate the energy fields of the body, Reiki, qigong, therapeutic touch are

examples (Briggs). As you can see there is a wide range of treatments and therapies and it is an

individual’s decision to pursue CAM therapies.

There are times when decisions can be treacherous for a patient and guidance from their

doctors would be helpful. Some patients are open to an integrative approach to their treatment,

wanting to try anything that could help them fight the disease or illness. Others may want to stick

to what they are familiar with, maybe there is too much fear involved in reaching outside the

norm of conventional medicine. The research that was conducted and reported in the article,

“Bridging the Gap”, looked into a model that could potentially help in the decision-making

process of individuals facing acute illness and the gap they experience between the conventional

medical system and the CAM system. They did this by developing a unique plan that fits the

individual’s characteristics and personalities. The model is described and illustrated in the article

along with the conflict that they are faced with.

Faced with these paradigmatic differences but wanting to make treatment

choices that would be “best” for their health and be congruent with their

personal knowledge and beliefs, the women engaged in three different

decision-making processes of “bridging the gap,” which included taking a

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step at a time in choosing CAM therapies, playing it safe with regards to

CAM decisions, or bringing it all together in using both CAM and

conventional cancer treatments”.

As the women moved through their cancer treatments and their personal transformations,

the “dynamic” mode of the “Bridging the Gap” model helped in allowing flexibility in their

choices and gave them a clearer understanding of themselves and what will work for them.

Educational strategies for the patient and the family involved also help in their process.

(Balneaves et al.).

As patients grow to accept and acknowledge that non-traditional (Western medicine)

medical disciplines are beneficial and helpful to creating health and fighting disease, along with

conventional treatments, it has pushed a much needed attitude shift amongst medical

professionals. Integrating a more diverse medical practice is not just happening outside of

Doctor’s and Physician’s offices. These professionals are beginning to open up to a broader

view of what medicine is and how to treat the patient with a more holistic technique, without

eliminating technology and conventional medicine.

Jeff Daniels, MD was trained in traditional Western medicine and has based his values on

conventional medicine practice for over 35 years. He reflected on his struggle with the idea of

integrative medicine and CAM. “It’s been hard for me to accept some of the alternative concepts,

and I’ve kept a skeptical “distance” from them. Although he has had a skeptical view of

integrating alternative therapies into his practice, he recently had an experience with one of his

patients who were struggling with long-term constipation. Daniels contends, “I had offered this

patient everything I could think of short of surgery: medication for chronic constipation,

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manipulation of the diet, and bowel cleansing preps-all to no avail.” With the ineffectiveness of

the conventional treatments, his patient decided to visit with Deirdre Thornton, a naturopathic

doctor who is a certified colon hydrotherapist. She “advocates the use of enzymes and probiotics

to keep the colon, and ultimately the patient, healthy.” Daniels was amazed after his patient

began working with Thornton. The individual started feeling normal and reported a “healthy

colon physiology for the first time in many years”. Daniels mentioned he hasn’t checked for the

actual “scientific validity” of the enzyme treatments, however in this case it proved to be of great

benefit for his patient (Thornton and Daniels 31-32).

According to Robert M. Sade, the author of “Complementary and Alternative Medicine:

Foundations, Ethics, and Law, the rapid growth of Complementary and Alternative Medicine

(CAM) is forcing change in the way we view the health care system. Eventually, there will be a

single health care system that encompasses the integration of a variety of health care modalities,

however still based in science. Keeping the foundation of science, the system would reach

beyond scientific based medicine and include a multitude of treatment and therapy options that

are considered more of a complement to conventional medicine. In his paper, he includes a point

of view from a highly educated medical professional that speaks of an integrated system that is

working.

Ruiping Fan is a Hong Kong scholar and has extensive experience in the study of

Chinese medicine and modern scientific medicine. He reviews the dual diagnosis system in

China where a patient is evaluated and diagnosed in the traditional Chinese method and the

conventional medicine method that is widely used in the United States. He says they "cannot be

evaluated by the same standards". With dual diagnosis, a patient is given two different diagnoses

and is treated in two different ways. This is also known as "double therapy" and what has seemed

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to occur, is that scientific medicine "plays the major role and traditional Chinese medicine plays

a minor, complementary role". Fan points out that the reason this has happened in China is that

even though the two originate "from different health care standards, the health care standard in

China is a single standard, that of scientific medicine" (Sade).

Fan explains the major difference in science verses traditional Chinese medicine.

"Scientific medicine sees illness as anatomic pathological, while traditional Chinese medicine

sees it as symptom-complex of the whole body". The medical definition of anatomic

pathological is, “The study of the structural and compositional changes that occur in organs and

tissues as a result of disease.” (Medical Dictionary - The Free) Fan talks about the major

differences in disease and "illness origins (disease entities vs. unbalanced climate and emotional

factors); differences in the "diagnostic process (advanced laboratory investigations vs. physical

examination); clinical focus (pathological anatomy and function vs. the patient’s complaint and

experience of illness)..." He argues that the only way a health care system can "truly integrate

traditional Chinese medicine standards with scientific medicine standards", is if the system

moves from a single standard to a dual standard that can respectively integrate together. The

example of how it is working in China shows that the integration of CAM and scientific

medicine in the U.S. can be achieved (Sade).

The scientific foundation of medicine is an integral part of fighting illness and developing

cures for diseases. Research is important when weighing the options for a treatment since

everyone has individual physiological differences. A drug that may work for one person may not

be the right drug for another. There are limits to science and the way we conduct our lives is not

always based on facts and objective evidence. When reviewing scientific research, it becomes

clear that the results can only go so far, and variables are dependent on the individuals who are

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conducting the research. It is important to examine the whole picture, not just the scientific but

the intuitive. The intuitive part involves energy which is more metaphysical and cannot be

examined with a microscope

Many challenging events occur in one’s life, and dealing with a debilitating disease,

whether it is a chronic or acute illness, is among the more stressful situations a person can be

faced with. In the case that an ailment occurs, it would be comforting to know that the medical

system can provide the support, resources, and therapeutic treatments that can be tailored to the

individual. Integrating a holistic partnership into an established science-based medical system

that is lacking in an imperative area of patient care would be of the upmost benefit in fighting

invading agents all the while, nourishing the spirit.

The need to nourish the spirit and create a sense of connectedness resides within every

one of us. When it comes to healthcare and wellness, a humans’ need to feel they are being

taken care of should be priority. They need to feel a trust and a bond with the network that

surrounds them through an integration of systems that work to support the body, mind, and spirit.

This is necessary for a healthy human development in all stages of life. Coping strategies and

therapeutic decisions ultimately depend on the individual and the choices one makes. They are

also in direct relation to belief systems, personalities, social networks such as work, family,

friends and acquaintances, cultural influences, and variations in physical functions.

There are endless possibilities for continuing research in this area. I would like to see

more studies on ways to implement the education of complementary and alternative therapies in

medical schools and how a balance of knowledge within the two systems could play a role in a

doctor’s practice. What does the medical education system need to do to make sure physicians

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are creating dialogue with their patients on the type of treatments they may be using outside of

the doctor’s office? More importantly, how can the medical system support and create

communication and a connection between the numerous healthcare practitioners that are

involved in the patient’s treatment plan?

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Works Cited

Balneaves, Lynda G, et al. “Bridging the Gap: Decision-Making Processes of Women with

Breast Cancer Using Complementary and Alternative Medicine (CAM).” Supportive

Care in Cancer 15.8 (2007): 973-83. ProQuest Nursing & Allied Health Source. Web. 19

Mar. 2012. <http://168.156.198.98:2048/?url=http://168.156.198.98:2065/ ?url=http://

168.156.198.98:2065// ?accountid=1553>.

Best Health. BMJ Publishing Group in assn. with Clinical Evidence, 2011. Web. 20 Mar. 2012.

<http://besthealth.bmj.com/// /support.html>.

Best Health. BMJ Publishing Group in assn. with Clinical Evidence, 2011. Web. 20 Mar. 2012.

<http://besthealth.bmj.com/// /support.html>.

Briggs, Josephine P., M.D., dir. National Center for Complementary and Alternative Medicine.

National Inst. of Health, n.d. Web. 19 Mar. 2012. <http://nccam.nih.gov/>.

Dupree, Kendall, and Adrian S Dobs. “The Status of Complementary and Alternative Medicine

in the United States.” Asia Pacific Biotech News. World Scientific Publishing, 2004.

Web. 19 Feb. 2012. <http://www.worldscinet.com// / /.html>.

Medical Dictionary - The Free Dictionary. Farlex, Inc, 2012. Web. 20 Mar. 2012.

Navarra, Tova. “Naturopathy (History and Evolution).” Health Reference Center. Facts on File,

Inc, n.d. Web. 16 Mar. 2012. <http://www.fofweb.com/.asp?

ItemID=WE48&SID=5&iPin=ECAM0256&SingleRecord=True>.

Randall, Gayle Madeleine. Interview. Wordjourneys.com. N.p., 2008. Web. 20 Mar. 2012.

<http://wordjourneys.com///_inter.htm>.

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Sade, Robert M. “Complementary and Alternative Medicine: Foundations, Ethics, and Law.”

Journal of Law, Medicine and Ethics 31.2 (2003): 183-190. ProQuest 5000. Web. 7 Mar.

2012. <http://168.156.198.98:2048/?url=http://168.156.198.98:2065/ ?url=http://

168.156.198.98:2065// ?accountid=1553>.

Straus, Stephen E, M.D. Director. A statement about Integrative Medicine. National Center for

Complemenatary and Alternative Medicine. National Inst.of Health (NIH), 28 Mar. 2000.

Web. 9 Mar. 2012. <http://nccam.nih.gov///// .htm>.

Thornton, Deirdre, and Jeff Daniels. “Big Sky Physician Embraces ‘The Other Side’ Lauds

Benefits of Enzymes and Probiotics.” Natural Life News and Directory [Livingston]

Nov.-Dec. 2011: 31-32. Print.