art by Sarah Burns
At the Crossroads of Tradition and Modernity
by Rajiv Reddy
“Why did the shaman claim to be able to cure the disease with his cane? He had a holy-stick approach to medicine!”
Although this joke, with its terrible pun and political incorrectness, wrongly stigmatizes traditional medical practice, it brings up an important point about these methods—they often do assume a holistic approach to treating patients. But what exactly does this mean?
According to the American Holistic Health Association, holistic medicine is “the art and science of healing that addresses the whole person—body, mind, and spirit.” I like to think of this definition as implying that medicine is an art form, the art of caring for all aspects of a patient’s well being, including the spiritual and mental. The individual is not just viewed as a body, but rather as a human being.
Traditional medical practice, now referred to as complementary and alternative medicine (CAM), thrives in capturing the essence of this holistic approach. Dating back thousands of years, healing systems like Traditional Chinese Medicine emphasize a unique treatment plan for patients based on their individualized mental and spiritual well-being in coordination with their physical ailment.
Take acupuncture, an ancient Chinese medical practice. In this form of treatment, needles are inserted into various precise points on the body, believed to balance disruptions in Qi (energy). Gaining international attention in the 1970s, acupuncture was the subject of numerous research studies, with the majority backing its medical efficacy. What makes this treatment so compelling is not only its ability to treat and prevent pain, but also its reported potential in relieving stress and anxiety, thus boosting a patient’s overall health.
Another healing system, Ayurveda (which literally means “the science of life”), is a natural and comprehensive approach developed in India that places equal emphasis on the body, mind and spirit, striving to restore the innate harmony of the individual. Some of the primary Ayurvedic treatments include meditation, herbs, massage and exposure to sunlight. The focus of this method is on the prevention of ailments through proper health management.
However, contemporary allopathic medicine seems to have shifted from this mindset, taking a reactive approach over a proactive one. According to Jeffrey Levi, PhD, associate professor of health policy at George Washington University, conventional medicine relies too heavily on reactionary treatments that wait until the problem is acute (and sometimes too late), instead of emphasizing changes in lifestyle that would support a preventative system and better health. Currently, our health care system is built upon this very premise, where a doctor prescribes medication that can “cure” your disease.
Dr. David Katz, the founding director of the Prevention Research Center at Yale University, argues that this mindset makes consumers feel powerless to take charge of their own health. He contests that the alarming rates of obesity, diabetes and cardiovascular disease in the United States are the result of such a health care system. The tendency of allopathic medicine to view the human body in terms of compartmentalized systems rather than a connected whole can lead to incomplete courses of treatment that do not target the root of the problem.
Although CAM and allopathic care differ in their philosophical approaches, they do share a number of common elements, which are crucial if we hope to find a happy medium between the two. Both systems are based on the belief that one’s body has the power to heal itself, marshaling multiple techniques and treatments that are individualized as well as dependent on the presenting symptoms. As it turns out, these two approaches are not mutually exclusive. But how can we integrate the best of both worlds, traditional and modern, into one system that will be the future of health care? The answer lies in integrative medicine.
Katz, in his paper “Preventive Medicine, Integrative Medicine & The Health of the Public,” writes, “The holistic approach of integrative medicine overcomes the traditional wall of silence between complementary and alternative medicine (CAM) and conventional practice, reducing the risk of adverse interactions or gaps in care. The goal of integrative medicine should be to make the widest array of appropriate options available to patients, ultimately blurring the boundaries between conventional care and CAM.”
Integrative medicine incorporates three preventative measures into the modern allopathic system. At the level of primary prevention, an array of modalities is used in health promotion, including lifestyle counseling, dietary guidance, stress mitigation techniques, interventions to improve sleep quality and use of nutriceuticals and herbal supplements. In terms of secondary prevention, stress management and nutritional supplementation can reduce risk factors for chronic disease. Finally, tertiary prevention offers the full range of alternative medical techniques that pertain to pain management, symptom control, stress relief, disease management and risk reduction.
Numerous studies have touted the efficacy of integrative medicine. As an example, in a recent review paper published in the Journal of Psychosomatic Research, investigators concluded that Mindfulness-Based Cognitive Therapy (MBCT), an approach that combines mindfulness meditation and interventions taken from cognitive therapy, is a useful technique for a broad range of chronic disorders and problems. According to literature on the topic, “Improvements were consistently seen across a spectrum of standardized mental health measures including psychological dimensions of quality of life scales, depression, anxiety, coping style and other active dimensions of disability. Likewise, similar benefits were also found for health parameters of physical well being such as medical symptoms, sensory pain, physical impairment, and functional quality-of-life estimates.” Yet another paper published in September 2004 in The Lancet, called the INTERHEART study, followed 30,000 men and women on six continents to find that improving lifestyle could prevent at least 90 percent of all heart disease.
In addition to its much-touted efficacy, integrative medicine also presents exciting progress in the realm of cost efficiency. Savings from integrative approaches are achieved through two main avenues—lower utilization of expensive medical interventions, such as pharmaceuticals and mental health visits, and the fact that many of these interventions, such as MBCT and mind-body skills training, are taught in groups, reducing per-patient provider time. At the end of the day, it is easier and cheaper to prevent the onset of disease than it is to treat once it has developed. According to the INTERHEART study, if only 10 percent of the coronary angioplasty procedures and coronary bypass operations were avoided by the utilization of lifestyle change programs, around $10 billion dollars would be saved annually.
Integrative medicine may be the key to the future of American health care. Whether or not a successful transition from modern allopathic techniques is feasible remains to be seen. However, current signs point to the transition being plausible.
Since their introduction to industrialized nations in the 1970s, alternative medical practices have slowly gained acceptance and are making their way to the forefront of health and wellness. According to surveys conducted by the Samueli Institute (a non-profit research organization), 38.3 percent of adults used some form of alternative therapy in 2010, a figure that has since increased. The institute also found that nearly 42 percent of hospitals in the U.S. provide at least one form of alternative treatment and nearly 43 percent of U.S. medical schools offer courses on alternative medicine. The momentum is in the right direction.
However, the recent growth of alternative modalities, such as dietary supplements, has brought increasing attention to the existence of both a knowledge and communication gap for health care professionals with respect to being able to properly counsel patients about these treatments. A lack of evidence-based information about efficacy, safety and drug interactions with CAM therapies, as well as a lack of formal training, is thought to be responsible for this deficit. These issues call for more research into the therapies themselves and a systematic training of health care professionals in alterative medical practices. Until we become more knowledgeable about these therapies and how to use them responsibly, integrative medicine cannot overtake modern allopathic practices.
The advancement of science in the 21st century is driving revolutionary progress in exciting and innovative directions. But contrary to expectation, rates of obesity, cardiovascular disease, diabetes and a host of other conditions are skyrocketing. There must be a reason for this paradox—many believe that we may be overlooking the essence of traditional medical practice, which is holistic care. Now more than ever, we need to shift our view of health care from reactive to proactive, from compartmentalized to holistic and from drug-based to lifestyle-based.
By no means will the transition be easy. It will require a change in mindset, further research on alternative techniques, proper communication between health care providers and patients, and a systematic training of future health care professionals. However, the novelty and appeal of integrative medicine that focuses on prevention and comprehensive management allows us to change our conceptions of medical care in a way that is both health-promoting and cost-preventive, leading us to build a sustainable health care system for the future. After all, as Renu Chaudary, a certified Ayurvedic practitioner, put it, “No medicine can compensate for un-healthy living.”