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As little as 30 years ago, it was called alternative therapies, and it was looked upon with little more trust than voodoo. The mere idea that meditation or yoga actually might affect physiological changes in the body was absurd. Aromatherapy was laughable. Hands-on healing, or even stranger — distance healing — was just so much hocus-pocus. Herbs were considered impotent witches’ brews that had little more benefit than a handful of grass.
Today, the world’s major medical centers offer complementary and alternative medicine (CAM) — or by its more current politically correct nomenclature — integrative medicine. Even the shifting names by which it’s known indicates a growing public, and perhaps more importantly, professional acceptance. The number of integrative medicine centers and departments in prestigious medical centers notwithstanding, the public has accepted and even enthusiastically embraced CAM therapies by readily paying out of pocket more than $14 billion annually. The medical profession, however, is a little slower to jump on the bandwagon.
"There is more and more of an attempt to bridge the gap between CAM and conventional medicine," says James Dillard, MD, assistant clinical professor of medicine at Columbia University College of Physicians and Surgeons in New York City. "We’re getting less giddy about this stuff," he explains. "It’s sort of like we’ve now had three dates and decided to start a relationship."
And those who aren’t willing to enter into this new relationship are likely to become the wallflowers of the medical world and eventually will become spinsters left to lonely and less-than-lucrative practices. "It’s a microcosm of world politics, and the question is: Can we get the warring factions to work together?’" he asks. In Dillard’s opinion, the answer has to be "yes." "We are being dragged [into CAM] kicking and screaming by our patients. They want it, and they’re going to have it. They’re better informed than ever before, and we need to be responsive to them," says Dillard.
There’s a day — probably not more than five years in the future — when insurers will wake up to the idea that for certain conditions, CAM may be appropriate. CAM therapies provide a simpler and less-invasive approach to many chronic problems, such as back pain, arthritis, and even heart disease, notes Dillard. "And here’s the kicker for the insurers: Many CAM therapies work at a far lower cost than conventional ones," says Dillard, who is also medical director of CAM at Oxford Health Plans in Trumbull, CT.
Dillard says CAM practitioners already are beginning to find their way into mainstream medical offices, hospital and even operating rooms. In coming years, that relationship will deepen, he predicts. Insurance and government reimbursement for complementary therapies also is likely to expand in the coming years, says Dillard. "Right now, chiropractic is included in many policies, and acupuncture and massage are becoming more accepted. I think integrated therapies are likely to become part of standard disease management models."
In fact, integrated care teams may provide primary care in the not-too-distant future, says Steven Sinatra, MD, a cardiologist in Westport, CT. "Conventional medicine has become highly specialized," he says. "The training of U.S. physicians is painstaking, rigorous, and difficult. Specializing is good in one sense; you want specialists who are well-grounded and meticulously trained."
While this type of specialization may be essential for acute care, it’s not working terribly well in chronic care, says Sinatra. "You become narrow-minded. I know; it’s happened to me. If I had a heart attack, I would want the best board-certified cardiologist to get me through it. Then I’d want to get to an ND [doctor of naturopathy], a DO [doctor of osteopathy], or a primary care MD who is open to other modalities of healing."
The real work of healing and keeping patients healthy is in the preventive arena, and it is a weak spot in conventional medicine. "Our system is a great lover of Band-Aid measures, but that’s not working anymore," says Sinatra. "The public now demands medical professionals to show them what to do to prevent disease and how to create their own wellness programs. That’s where the future lies."
Dillard and Sinatra agree that CAM has areas of weakness that must be addressed to overcome conventional medicine’s resistance. "There are thousands of charlatans out there," says Sinatra. "There are people who have gone to a weekend workshop and call themselves iridologists or who go to a marriage encounter and hang out a shingle offering couples’ counseling." That’s dangerous, he says, "because they offer false hope, and sometimes it works, and sometimes these ungrounded methodologies leave the patient unfulfilled and shake credibility for the [mainstream] medical community."
Efforts to standardize requirements, license CAM practitioners, and create a central referral system will go a long way toward creating the trust necessary to deepen the relationship between CAM and conventional medicine. "We need better regulation of nutritional supplements and herbs. A lot of us want either self- or federal policing," says Dillard.
According to Sinatra and Dillard, as well as many MDs who’ve already bridged the gap in their medical practices, the future of integrated medicine seems strong — more because it is what patients demand rather than on the basis of any particular acceptance from the medical community.
More complementary training for conventional physicians also will go a long way toward bridging the alternative-conventional gap, says Dillard. "Doctors tend to practice pretty much exactly as they were trained in residency," he explains. "And will the old dogs who gate all this stuff come around and become CAM-friendly? It ain’t gonna happen."
Dillard suggests that CAM acceptance among the old guard conventional medical practitioners will come "one funeral at a time." Sinatra suggests that a new generation of medical practitioners is far more open to complementary modalities and more likely to practice them personally and also refer patients to complementary practitioners.
In addition, Sinatra says economics may eventually be the shotgun in a marriage of complementary and conventional therapies, "because the patients want complementary therapies, and they will vote with their feet and leave a physician who isn’t open to them."
"The public will force these guys into becoming more rounded and more open. The future lies in physicians changing when the public demands it. The Achilles’ heel in the medical professions is our rigidity," says Sinatra, who is board-certified in five disciplines.
To be acceptable to patients of the future, he explains, existing physicians will have to take more training and spend more time keeping up with the literature in the field. An MD degree simply won’t be enough for a future in the healing professions, he says. "To be good enough in the future, the concept of practitioner and healer must be integrated."
Dillard notes the same caveats that hold true for physicians also are applicable to nurses and other health care professionals. "The whole medical profession is shifting in this direction," he says.
There are strong signs that CAM has a large foot in the door. Consider these statistics compiled by Healthlobby.com:
There’s also a dearth of compassion that concerns Sinatra, but could be addressed by the coming climactic shift in medical practice. While the doctor-as-God syndrome is fast fading in practice, "a lot more humility will come out for medical professionals when they see there’s more than one way to skin a cat."
Many new specialties are likely to appear in the coming years, says Sinatra, with an aging population demanding its health care needs be addressed. "Anti-aging is cutting edge right now with the baby-boom generation entering its mid-50s. Gender-specific medicine also will become more and more important because we are already realizing that men’s and women’s bodies simply do not work in the same ways."
Finally, complementary therapies aren’t likely to provide a cure for cancer or heart disease or diabetes, but they may offer more comfort for patients.
Growing bodies of research show the efficacy of chromium, coenzyme Q10 and vitamin E for patients with diabetes — and the value of antioxidants is becoming even more pronounced for patients with heart disease. In the coming years, cancer patients will discover herbs and supplements are increasingly useful in alleviating the effects of chemotherapy and radiation and even in providing pain relief, says Dillard.
"Integrative medicine is the wave of the future. It can do so much for our patients that only the tip of the iceberg has been explored," says Sinatra. "And I think we as medical professionals are slowly coming to understand, integrative medicine and CAM therapies can do a great deal for us, too."