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.”
Jamie
Reno
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