From herbal remedies and yoga to acupuncturists and reflexologists -- more and more patients are looking beyond conventional Western medicine for answers when it comes to medical issues such as chronic pain, stress, high blood pressure and rheumatoid arthritis.
These days, it seems like everyone is seeking alternative treatment for what ails them. And if you're not, you probably know someone who is.
From herbal remedies and yoga to acupuncturists and reflexologists -- more and more patients are looking beyond conventional Western medicine for answers when it comes to medical issues such as chronic pain, stress, high blood pressure and rheumatoid arthritis. According to a nationwide survey by the Center for Disease Control, more than one third of American adults are incorporating some form of complementary and alternative medicine into their healthcare routines. Other studies estimate that number upwards of 50 percent.
The National Center for Complementary and Alternative Medicine -- the government's lead agency for scientific research on complementary and alternative medicine -- defines this form of therapy, known throughout the medical community as CAM, as a group of diverse medical and healthcare systems, practices and products that are not presently considered to be part of medicine as practiced by holders of M.D.(medical doctor) or D.O. (doctor of osteopathy) degrees. That definition can prove to be problematic, however, for a field that experts agree is somewhat of a moving target, especially as more and more CAM practices are being accepted into mainstream medicine.
"It gets a bit complicated," said Dr. Ian Coulter, director of clinical research for the Samueli Institute, a nonprofit health care research organization, and senior health policy analyst for RAND Corporation, a 60-year-old nonprofit think tank. "No one has actually come up with a definition of what CAM is."
Coulter explained that up until the 1970s, chiropractic -- the art of manipulating the spine to ease things like back and neck pain and headaches -- was considered "quackery" by biomedical practitioners. Nearly 40 years later, not only has this once strictly alternative therapy risen above its previous status, but it also now seems to straddle mainstream and alternative medicine. In 1997, according to the Journal of the American Medical Association, nearly 192 million visits to chiropractors were recorded in the United States. And with so many people visiting chiropractors, one might be hard-pressed to find patients who now put the practice on par with say, ingesting a dose of the herb feverfew to combat a migraine headache.
"That was a long political battle for them" Coulter said about chiropractors. "When you think about that as a change, that's phenomenal."
It's not hard to imagine then that other forms of CAM will follow suit, eventually. Acupuncture, for example, is gaining increasing acceptance into mainstream medicine. Last year, Tufts University School of Medicine began a joint program with the New England School of Acupuncture in which participating students learn both the Eastern and Western perspectives on pain management and receive degrees from both institutions.
But Tufts isn't the only academic institution recognizing the importance of schooling future generations of doctors in complementary and alternative medicine. In fact, many of the nation's accredited medical schools now offer its students some type of CAM program or series of classes.
"If you go down the list, it's the who's who of medical schools," said Coulter. Among them are Duke, Harvard, Stanford and Yale.
Another bright spot on CAM's horizon, one that indicates its increasing validity, is the proliferation of research being conducted to determine its effectiveness.
"We've seen an enormous increase in randomized control trials," said Dr. Brian Berman, professor of family medicine and director of the University of Maryland Center for Integrative Medicine, which he founded in 1991. "There's certainly more evidence coming on board, but there's certainly a long way to go."
Integrative medicine is defined by the Consortium of Academic Health Centers for Integrative Medicine -- an organization made up of 36 top academic institutions, all offering comprehensive programs -- as the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing.
In short, it is the marriage of the best of both worlds -- conventional medicine and complementary and alternative therapies. "It increases people's options that they have," said Berman, including providing patients with tools for disease prevention.
And integrative medicine is where some experts, including Berman, say the future lies.
"There are very few people who want to walk away from conventional medicine," said Dr. Victoria Maizes, associate professor of family medicine and public health, and executive director of the Program in Integrative Medicine at the University of Arizona.
For Maizes, her journey into integrative medicine was what she refers to as a "gradual evolution." She was always interested in helping people lead healthier lives and had been fascinated with people's stories -- the why's of their illnesses. When her patients began asking her questions about alternative therapies, Maizes said, "I learned right along with them."
Today, she is the executive director of one of the pioneering programs in the nation. The University of Arizona has graduated nearly 300 doctors from their Integrative Medicine Fellowship and in 2008, the school will also launch a pilot program, the Integrative Medicine in Residency program.
"I think teaching people how to live a healthier life is really, really important," said Maizes. "We'll train a new generation of doctors to think this way."
In the beginning, the rapid evolution of complementary and alternative medicine was largely patient driven.
"I would say about 10 years ago was when doctors started getting interested in this," said Maizes. "It used to be that health care professionals were in the closet if they did acupuncture."
That is changing. But despite all the developments in academia over the last decade, one of the issues still surrounding CAM is the lack of education current, practicing physicians have on the subject.
"Ideally they would see their medical doctor," said Berman about patients interested in learning more about alternative remedies. "The problem is that their medical doctor is not knowledgeable."
So many times patients are on their own when it comes to navigating the sea of information available on the Internet, some of it reliable, much of it not. Maizes' advice? Be a discerning consumer. "You do have to sort out where the information is coming from," she said.
Even still, if and when patients begin a complementary and alternative treatment for a medical issue, they often aren't telling their primary care physicians, leaving a gap in medical care that could potentially harm the patient in the end.
"If our patients aren't telling us about it, that is quite challenging," said Coulter.
And there are other barriers facing integrative medicine, which is not yet regulated by the government. Coulter said that while patients are integrating conventional and complementary and alternative medicine quite well, "it's the doctors that are having a time of it."
In conventional medicine, while there is oftentimes a primary care physician that manages a person's overall care, there is a division of labor amongst the dozens of specialists a patient must see to receive total care. A CAM provider, on the other hand, manages the total patient.
"There's a terrible cash between the paradigm," said Coulter.
There is also the issue of cost. Though the insurance companies may be covering more alternative treatments than they used to -- such as visits to the chiropractor -- many CAM services are not covered. Maizes points out that while a $20,000 bypass surgery is reimbursable, simply spending time with a patient to discuss options is not.
But even with all the hurdles CAM must still jump, Berman said it is prevalent and here to stay.
"It's a gradual process, but when you take a step back, there's been enormous progress in the last 10 years."
For more information on complementary, alternative and integrative medicine, visit the University of Maryland's Center for Integrative Medicine at www.compmed.umm.edu/; the University of Arizona's Program for Integrative Medicine at www.integrativemedicine.arizona.edu; the Samueli Institute at www.samueliinstitute.org and the Rand Corporation at www.rand.org.
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