Thursday, April 21, 2016
Alternative Medicine Finally Becoming More Mainstream
Proponents say integrative and holistic treatments such as acupuncture and diet are finally being recognized and accepted by the traditional medical world.
There was a time not so long ago when the term “alternative medicine” conjured up visions in many people’s minds of shamans, charlatans, and crackpots.
However, times are changing.
In the past few years, many doctors and conventional healthcare institutions in the United States have shown a new acceptance of treatments and philosophies that historically have not been part of mainstream medicine.
In fact, now the term “alternative medicine” is out, and “integrative medicine” is in.
Proponents explain that integrative medicine addresses the full range of a patient’s physical, emotional, spiritual, and environmental influences. It also deploys therapies that extend beyond the surgeries and drugs that have historically defined the American medical establishment.
Unlike some of the stalwart believers in alternative medicine, integrative medicine’s supporters do not reject conventional or allopathic medicine. They insist there is room at the table for all options.
Integrative medicine advocates tell Healthline that while pills and procedures still help millions of patients, the evidence is mounting that diet and nutrition, natural therapeutics such as supplements, vitamins, herbs, and acupuncture, along with lifestyle behaviors such as exercise and smoking cessation also have a direct impact on disease.
They say the more natural approach can even lead to reversals and cures.
Is this idea, which for decades has been ignored in America’s medical schools, really catching on?
Multiple healthcare executives, doctors, and patients interviewed for this story say yes. They say the driver of this trend is overwhelming patient demand.
Some are quick to add, however, that there’s still resistance in some conventional American medical circles as well as by insurers and pharmaceutical companies.
Proponents: The Time Has Come
In 1994, Dr. Andrew Weil, the Harvard-educated physician, author, lecturer, and internationally recognized pioneer of integrative and holistic health, founded the Program in Integrative Medicine at the University of Arizona.
This was years before most people had even heard of integrative medicine.
Weil told Healthline that today approximately half of America’s medical schools have signed on to an integrative medicine consortium.
“Patients are dissatisfied with the small amount of time they get with their doctors and with doctors who prescribe a pill for every ill,” Weil said. “The integrative medicine movement is not a rejection of conventional methods. But patients are saying that the conventional model is not working, that it’s broken. And they are right.
Weil said that many doctors, too, are unhappy with the current system and are beginning to embrace this new model to varying degrees.
“Pediatrics is very open to this as is family medicine,” Weil said. “Oncology is slower to embrace it. Oncologists are more defensive, perhaps because they know that their methods can cause harm to patients and are not always as effective as advertised.”
Doctor Bridges Gap
Dr. Gordon Saxe, director of research and a founding member of the Center for Integrative Medicine at the University of California, San Diego, broke the news to Healthline that a grant somewhere in the “$30 million range” from late philanthropist Andrew Krupp will establish an ambitious new research program at the university.
The program will formally study how diet, natural therapeutics, and lifestyle behaviors such as exercise can treat a variety of diseases, including cancer and heart disease.
Saxe described the research endowment as “far and away [the] largest for any center for integrative medicine that exists.”
He noted he had an epiphany about how food can treat and perhaps even reverse disease when his father was diagnosed with cancer.
“I discovered that there are studies that show how food can have an impact on cancer and other diseases,” said Saxe, who got his Ph.D. in nutrition, then decided to go to medical school and focus on oncology.
“These studies are in the medical literature. You just have to dig a little to find them,” said Saxe.
He said his father’s life was extended by more than a decade thanks in part to modifications in his diet.
Pain Treatment at the Forefront
One of the most significant shifts toward a more integrative approach to patient care can be seen in pain treatment.
This is in part because pain can be tricky for doctors to identify and treat, and in part because of the opioid painkiller addiction epidemic in the United States.
The Substance Abuse and Mental Health Services Administration’s 2012 National Survey on Drug Use and Health estimated that more than 2 million people in the United States who were prescribed opioid pain relievers such as Oxycodone and Vicodin in 2012 suffered from substance abuse.
Dr. Robert Bonakdar, director of pain management at Scripps Center for Integrative Medicine in La Jolla, California, said that over the past few years he has seen “two to three times more referrals” in which the patient or provider is asking for integrative therapies.
Bonakdar embraces many nonpharmaceutical options such as electrotherapy, tai chi, and mindfulness/meditation as well as diet and supplemental therapies such as the anti-inflammatory herbals ginger, curcumin, and boswellia.
"What they provide is that they may be a better fit for a patient than maybe a monotherapy prescription," he said. "For example, ginger may help that migraine patient with stomach symptoms and nausea. There is also some evidence that ginger may heal some of the gastritis that can come from increasing use of NSAIDS, which can happen as headaches worsen.”
Bonakdar added that there is emerging evidence that conditions such as osteoarthritis, even in those who are normal weight, have a metabolic component, especially glycemic control.
Bonakdar spends a lot of time talking to his patients about the importance of a low glycemic, anti-inflammatory diet with an increase in fresh foods.
“I saw a patient last week with severe arthritis of the neck, very clear on MRI. What was interesting is that for about two weeks prior to seeing me she was told by a cardiology fellow at our clinic to reduce her sugar intake by half based on their discussion,” he said. “She was amazed when she saw me that her neck pain was more than 50 percent relieved. I have seen this often enough that I no longer discount it to just chance. Even with specific areas of pathology or medical illness, we know that simple dietary shifting, such as reducing added sugars, can have a meaningful impact."
Bonakdar said there has been a dramatic increase in acceptance of his type of work from the conventional medical community, with one glaring exception.
"We continue to see a lot of unacceptable denial of evidence-based therapies such as biofeedback and acupuncture by insurers based on them being experimental or investigational," he said. "Hopefully with more spotlight on the evidence and how these therapies may actually reduce healthcare costs, this will also shift."
Acupuncture Broke the Ice
Probably the first and best example of something that was once considered alternative but has solidified its position in conventional medicine backed by scientific research is acupuncture.
Rooted in traditional Chinese medicine (TCM) and modern medical science, today’s acupuncture practices across the United States are a unique integration of the old and new.
“Thirty years ago MD’s were skeptical and often dismissive of acupuncture,” said Neal Miller, a nationally certified acupuncturist from Los Angeles and past president of the Acupuncture Integrated Medicine Specialists (AIMS
That initial skepticism changed to curiosity, Miller said, which evolved into acceptance based on clinical observations and research conducted by the National Institutes of Health (NIH) and other major medical institutions.
“In the past few years many hospitals have included TCM acupuncture to treat many conditions,” Miller told Healthline. “Cleveland Clinic, UCLA, and Kaiser to name a few.”
Miller, whose practice specializes in integrated orthopedics and internal medicine specialties focused on immune therapy, autoimmune diseases, cancer, and viral conditions. He said his patients used to come from word of mouth and most often as a last resort for pain relief.
“Today the referrals are often from MD’s and other healthcare providers and institutions,” he said. “Today more than half of my patients see me as their primary healthcare provider and all accept me as part of their healthcare team.”
Sometimes Patients Are Resistant to Change
Dr. Gary Small, a professor of psychiatry and director of the UCLA Longevity Center at the Semel Institute for Neuroscience & Human Behavior and author of several well-received books on aging, said he brings dietary and other holistic ideas about aging to his patients more often than they do to him.
“When patients come to my office, we sometimes deal with pushback on some of our ideas,” he told Healthline. “We suggest taking baby steps, try it out and see how you feel, make it fun and interesting. Once people get started they notice benefits right away. They start losing weight, they sleep better, they’re exercising, they feel better, and they incorporate it into the rest of their life.”
Shaw, who’s developed groundbreaking brain imaging technology that allows physicians to detect brain aging and Alzheimer's disease years before patients show symptoms, said he is less inclined to recommend medication that has side effects than to recommend a lifestyle strategy that prevents diabetes and other age-related issues.
“I don’t want to wait for a study. You just need to stop smoking,” he said. “It just makes good sense.”
The Lifestyle Medicine Movement
Dr. Marc Braman is a founding member and first executive director of the American College of Lifestyle Medicine (ACLM), the national medical specialty society for healthcare professionals committed to a lifestyle medicine-first treatment option.
He said that the scientific evidence that food and lifestyle can treat our ills is indisputable.
Among the evidence Braman points to is a European study of 3,759 colorectal cancer patients that concluded combined lifestyle factors, such as healthy weight, physical activity, no smoking, limited alcohol consumption, and a healthy diet, were associated with a lower incidence of colorectal cancer in European populations characterized by Western lifestyles.
Despite the integrative medicine trend, Braman said future doctors in the United States are still primarily taught to consider pharmaceutical options first and this will not change overnight.
“In American medical schools, pharma still runs the show,” Braman said. “But patients want all options on the table. Lifestyle medicine, which takes into account what the patient does on a day-to-bay basis, including nutrition, exercise, and much more, is the future of medicine, and personal responsibility and taking control of your own healthcare are important components to this.”
Susan Benigas, ALCM's current executive director, said the United States is in the midst of a seismic shift in healthcare, as we move from a fee-for-service to a value and outcome-based model.
“Diabetes alone is a looming global pandemic with incalculable consequences, yet it's a food-borne illness,” she said. “Fifty years ago, there were 2 million Americans with this chronic condition. Today, there are over 160 million who’ve already been diagnosed or are pre-diabetic. We cannot stand by and allow this and other chronic conditions to destroy lives, and even our nation's fiscal solvency, without doing all in our power to sound the wake-up call.”
Benigas said the optimal lifestyle recommendation of a predominantly whole food, plant-based diet is becoming more compelling to Americans.
“An allopathic-only approach to healthcare is unsustainable, not to mention not being in the best interest of patients,” she said.
Is Integrative Medicine “Inevitable” Medicine?
Dr. David Leopold, director of health and wellness at Scripps Center for Integrative Medicine, said the center is having “significant difficulty keeping up with [patient] demand, which unfortunately can result in long waiting times for our patients. The growth at our center is echoed on a national level as patients increasingly seek out integrative medical centers.”
Leopold cited the nutritional interventions and nonpharmacological approaches of integrative medicine as among “the best options to try to deal with some of the pressing issues and healthcare delivery.”
Saxe, who said his university is offering the Natural Healing and Cooking Program for doctors, medical students, and others interested in understanding the effects of dietary patterns on health and illness, likens the current boom in integrative medicine in the United State to China’s response to its current energy crisis.
“China is a growing economy that has to generate more energy but has hit the limits of what they can generate using fossil fuels,” Saxe said. “Cities in China are choking and dense with foul air. The need for cleaner, softer, renewable energy will continue to increase in the future. The situation in American medicine is analogous to that. I don’t see pharma disappearing at all, I just see the increasing demands that are being placed on the system. Baby boomers are aging, and the medical community faces years of chronic disease in that population. The increase in demand has to be met by integrative medicine. It’s inevitable.”
by Jamie Reno