Dear critics of Integrative Medicine,
This letter is in response to An open letter to Alternative Medicine published in Healthy Debate. I have a message of my own.
I am going to ask that critics of alternative/integrative medicine take a pause. Kindly take a break and think about your message and what it says to people with chronic disease. It is all too easy to forget that at the centre of this debate are patients. Patients have turned to integrative medicine because they have been forgotten, ignored and patronized by conventional medicine, a doctrine you so vehemently defend.
Granted, you acknowledge our broken and fragmented health-care system, which is appreciated since it is that very system that drives people away. Like you, there are many of us who acknowledge that there are severe issues with “alternative medicine”: sales-driven tactics and slick charlatans who have little regard for patient safety and are only interested in lining their pockets. We want rid of them and want them to stop as much as you do. It looks like we may have more in common than we thought.
But here I ask you to pause, self-examine and ask yourself, is your strategy of painting all practitioners of integrative medicine with the same brush productive? Many integrative medicine practitioners are board-certified medical doctors who have acknowledged the failings of our current way of delivering “health care” – and I use the term “health care” very loosely. Current modalities in conventional medicine seem to skew heavily toward treatment and symptom suppression rather than curiosity in discovering underlying causes of chronic diseases and disease prevention. Many symptom suppression treatments are life-long and have undesirable side effects. The burgeoning statistics on chronic illness and the number of prescriptions dispensed should be a battle cry for better ways of doing things.
Now, conventional medicine related to acute care is irrefutably superior. People are living longer, but are they living better? The vast majority of health-care providers are doing their best. However, systemic issues and pressures often create an environment that is not conducive to optimizing the patient experience. Another point we agree on. These are enormous problems, and indeed are a big reason people seek additional care from integrative medicine practitioners.
Regarding your concerns with integrative medicine, we acknowledge that some of your beliefs have merit, and we support you in calling those out, too. What we do not support is your use of broad-brush tactics to demonize an evolving field of health-care delivery that has the potential to significantly improve patient outcomes, especially for those with chronic disease.
Many chronic disease patients see improvement in quality of life when treated by an integrative provider. Additionally, esteemed medical faculties of education such as the University of Toronto, McGill University, the University of Alberta and Duke University have incorporated integrative medicine elements into their curricula.
Science is constantly changing and evolving. New strategies and ways of thinking are frequently investigated. Several integrative therapies do have evidence to support efficacy. The tactic of admonishing an entire field may discourage someone who may benefit from a safer, more holistic strategy from even considering it. For example, if given a choice between prescription painkillers or comparatively effective acupuncture or therapeutic massage treatment, which would you want to try? Many patients are not given a choice but only a prescription. Broad-brush approaches disempower patients and take away their choices.
You ask if we want a health-care system that embraces deception and magical thinking. No, we do not. You ask if we’re going to encourage an approach that invites people to ignore science and use less critical thinking? No, we do not. Is enabling a vast wellness industry built around placebo theatre a sustainable health-care policy? Absolutely not.
We want a health-care system that focuses on both health and care. We want a system that encourages more critical thinking and uses relevant science to guide but not dictate health care. Patients with chronic disease need new and innovative strategies to manage their condition.
We need strong voices to call for more science to research which integrative therapies are effective and how effective therapies may be incorporated into treatment plans. But we fear that will never happen if the developing field of integrative medicine is stunted before it has a chance to grow. We suggest that the heightened focus on science has been a significant contributor to over-diagnosis and over-medication. We also suggest that less critical thinking has contributed to steering people away from focusing on health and care, on prevention and recovery, and on efforts to retain/regain health. We respect the art of medicine, and we respect the practitioners that are doing their best with the training and experience they have accumulated.
Many patients that work with integrative medicine practitioners are seeing their health improve. Many are reducing their dependence on prescription drugs. Many are feeling happier and healthier. If their health is improving “as part of an elaborate placebo theatre,” so be it. If, more likely, patient health is improving because patients are under the care of compassionate, empathic health-care practitioners who motivate them to embrace lifestyle changes, which is helping them more than being interrupted after 11 seconds, dismissed after 10 minutes, with a no-hope diagnosis beyond a lifetime of an Rx cocktail, then maybe there’s something to be learned from this approach.
Yes, some of the treatments do work. Discrediting an evolving branch of medicine is of no benefit to anyone and a missed opportunity. Remember, psychiatry was once called “pseudoscience,” and many conventional medical treatments that were once considered standard of care are no longer used. Things change.
There are problems throughout medicine that need to be addressed, and there are also good and bad practitioners in all types of medicine.
As chronic disease patients, we can assure you that until you are diagnosed with a condition that seems to have spontaneously started, has a detrimental impact on the daily quality of your life, likely did not exist 50 years ago and are told the only way to manage it is with drugs that will also make you sick, we assure you that you do not get it nor do you understand.
So at the very least, you could use your influential voice to demand better. Better research, better treatment and better care. We know there are issues. And the constant badgering of practitioners that are helping so many patients improve their health is driving an enormous wedge between patients, physicians and academics. Your focus is misguided; step back and look at what the massive problems are. If we solve the massive problems, these lesser problems will take care of themselves. Adjust your lens.
So, please, critics of integrative/alternative medicine, stop using a broad-brush approach to discredit these types of offerings. Not only are your arguments disingenuous, but they are also dismissive. You can’t fix the conventional system’s problems by ignoring them and deflecting your anger toward other areas.
We need common sense, critical thinking, sound science and compassion everywhere, especially in patient care.
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Thank you Ken for bringing Health and Care to light. Appreciate your incite.
So very, very true Ken!!
Nice work, Ken! Thank you for sharing your wisdom.
Sound science which includes evidence-based medicine as most would see it albeit EBM takes it’s mantra from the legal field in many respects. But integrative medicine requires EBM methodology just as in other areas of healthcare and medicine. For example, this Cochrane review concerning “Psychosocial interventions for conversion and dissociative disorders in adults”, is a good example assuming that psychosocial interventions would be regarded as integrative medicine.
“It’s always been felt that infections are underlying triggers for autoimmune diseases. Sadly, the development of expensive drugs to mask symptoms has overshadowed efforts to identify root cause of autoimmune disease.” Duke University Oncologist, Dr. Neil Spector. Shareholders decided that antibiotics and cures are not profitable. Studies that show that RA and MS patients improve with antibiotics have been ignored or attributed to their anti-inflammatory effects when they don’t come close to ibuprofen. There is far less science in medicine than one would expect. It is basically authoritarian based where decisions are made without transparency behind closed doors.
Physicians and the public hold the CDC in high regard and expect impartial unbiased leadership, but this may have to be reassessed. The CDC accepts funding from industry lobby groups, which raises some serious conflict-of–interest concerns. Marcia Angell, former editor-in-chief of the New England Journal of Medicine, told The BMJ “The CDC has enormous credibility with physicians, in no small part because the agency is generally thought to be free of industry bias. Financial dealings with biopharmaceutical companies threaten that reputation.”
According to the BMJ article by Jeanne Lenzer published in May 2015: “The CDC does receive millions of dollars in industry gifts and funding, both directly and indirectly, and several recent CDC actions and recommendations have raised questions about the science it cites, the clinical guidelines it promotes, and the money it is taking.” Allowing corporations, institutions and medical organizations to help fund the CDC Foundation could in large part have led to the current problems with chronic disease management in North America and globally, including its diagnosis and treatment.
This is absolutely bang on! Thank you for writing this, Ken.