May 25, 2006

Making a Stand for the Future of Medicine

Martin Luther King Jr. said, "I have a dream." Well, I have a dream too: That one day traditional, naturopathic physicians and conventional, allopathic medical doctors can practice side by side such that patients can receive the right treatment or combination of treatments for their ills without feeling guilty but wanting that variety and believing that different techniques are effective for different ailments. After all, sometimes we truly need drugs or surgery that focus on isolated symptoms or conditions, whereas other times -- hopefully, most of the time -- we're better off optimizing our health through disciplines that use techniques and natural substances to leverage the body's own ability to heal. And, sometimes we need a combination.

As someone who visits practitioners on both sides of the fence, I can vouch for the fact that at present there is often uneasiness when it comes to sharing turf. My naturopathic doctor (ND),who is trained in allopathic as well as naturopathic medicine, tells me that he is open to making specialty referrals to MDs as necessary, though he is often quick to tut-tut the drug-focused medical advice of my general practitioner. On the other hand, when I talk with my MD about natural alternatives such as nutritional supplements, massage or acupuncture, I won't say he rolls his eyes, but he clearly thinks much of it is hooey.

MAKING THE CONNECTION

Traditional medicine generally focuses on enhancing wellness, while the strength of allopathic medicine lies in high-tech disease management. Chances are, as we navigate our lives, we'll need both -- traditional disciplines emphasizing elements such as lifestyle choices and supplementation to promote better health, along with high-tech disease management. When it comes to common chronic illnesses such as heart disease and diabetes, clearly earlier and more vigilant attention to factors such as diet, exercise and weight management can help prevent the later necessity of high-tech interventions.

Yet even though it's all part of the same package -- working to keep people well -- there's still an active disconnect between traditional and conventional disciplines that needs to be overcome. Fortunately, change is in the air. Consumers are taking more control of their health and health care. I spoke with Pamela Snider, ND, executive director of the Academic Consortium for Complementary and Alternative Health Care (ACCAHC), an organization dedicated to advancing access to diverse health-care systems and making sure that the systems truly collaborate.

She told me that with integrated health care, the goal is to foster collaboration between CAM (complementary and alternative medicine) and conventional allopathic medicine to ensure that people receive the best possible health care. (Note: CAM encompasses many health-care systems including naturopathic medicine, acupuncture and oriental medicine, midwifery, homeopathy, licensed massage therapy, chiropractic and whole-food nutrition.) There are a number of ways to go about reaching this goal, including beginning early.

COLLABORATIVE HEALTH-CARE TRAINING MUST BEGIN EARLY

All medical practitioners should be educated about different outlooks and health-care systems starting in their very first year of training, notes Dr. Snider. To effectively practice collaborative care, she points out that health-care professionals need to understand one another's skills in order to respect their abilities. There must be a kind of "connective tissue" among disciplines, and the earlier this is developed, the better.

Ideally, this should start at the medical school level with a broader and more formalized type of exchange program between training in traditional or CAM disciplines and that in conventional allopathic nursing and medical schools. At present, NDs are quite familiar with conventional care, because most are exposed to it in naturopathic medical school, observes Dr. Snider. However, although virtually all allopathic medical schools offer at least some introduction to traditional health-care systems, content varies widely and some schools are clearly more progressive than others.

NOT EVERYONE CAN DO IT

According to Daily Health News contributing editor Andrew L. Rubman, ND, an unfortunate by-product of the new openness to traditional disciplines is that MDs sometimes incorrectly believe that they can do it all. That is, some take a weekend course on acupuncture or bone up on supplements over the Internet, and then add these therapies to their treatment roster. This practice can backfire on patients, who are better off receiving such specialized care from licensed naturopathic physicians or acupuncturists who have devoted years to the study and practice of their own disciplines.

No matter how holistically inclined MDs may be, traditional medicine cannot simply be absorbed into conventional medicine, says Dr. Rubman. There is too much information and clinical expertise in traditional medicine -- it's not just about recommending this or that herb for arthritis or gastritis. Naturopathic physicians and other traditional health-care providers use a variety of health-care systems that are developed during years of training. In much the same way that a naturopath can't become a surgeon by only studying anatomy, an MD can't become a naturopath by studying a book of herbs.

COLLABORATIVE CARE IS A MUST

Team care is another huge issue... and not just in integrated health care, but in all health care, observes Dr. Snider. If you have high blood pressure you may see a cardiologist... arthritis might send you to an orthopedist, etc. But what are the odds of busy medical professionals -- especially those with differing philosophies and approaches -- picking up a phone and communicating directly with one another? Too slim at present. Dr. Snider emphasizes that this needs to change. We need better communication across the board, in both the traditional and conventional allopathic medical spheres.

THE BEST OF BOTH WORLDS

How can we create the best of both worlds? By insisting on it. Don't let yourself be intimidated by your practitioners. It is your life and your health. If you want to explore multiple disciplines, do the research and find the best practitioners. But don't hide the fact that you're doing it from your practitioners. Let them know that you have created this team and that it is important to you that they actively support you and participate on the team. If you can't get their participation, then perhaps you need different players.

We're seeing the medical world changing as a result of rising health-care costs and researchers increasingly proving the value of traditional treatment methods. But, change takes time. It is scary for even the smartest and most successful among us. Hopefully it won't take too long for practitioners to catch up to their patients. With integrated health care, the goal is to deliver to patients the best of both worlds. Well, we'll get there -- one step at a time.

Be well, Carole Jackson, Bottom Line's Daily Health News

Sources:

Making a Stand for the Future of Medicine

Pamela Snider, ND, executive director, Academic Consortium for Complementary and Alternative Health Care (ACCAHC), Seattle. To learn more about integrated health care, you can E-mail her at plsnider @ comcast.net.

Quick Test Can Save a Life ,,Gregory W. Albers, MD, professor of neurology and sciences, director of the Stanford University Stroke Center, Palo Alto, California.
American Stroke Association, www.strokeassociation.org
American Heart Association, www.americanheart.org