Wednesday, January 31, 2007

Your Doctor and You – Looking for Answers Outside of Traditional Medicine, Thirteen in a Series, The Great Debate, Fraudulent Practitioners, A Realist

The Great Debate

In 1999, the alternative vs. traditional medicine debate reached a defining moment when the doctor hero of the alternative movement, Andrew Weil, MD, debated Arnold Relman, MD, staunch defender of scientific medicine.

Dan Rutz, Senior medical correspondent at CNN refereed the debate, which was held at the University of Arizona medical center. The debater’s credentials were presented to the audience.

In one corner was Andrew Weil, MD, an international authority on integrative medicine and director of the University of Arizona Program in Integrative Medicine. He was author of many scientific and popular articles and seven books. Named by Time magazine as one of the nation's most influential people of 1997, Dr. Weil was a recognized expert on alternative medicine, medicinal plants, and reforming medical education. He was a member of the American Academy of Achievement and earned degrees in botany and medicine at Harvard University.

In the other corner was, Arnold Relman M.D., outspoken critic of integrative medicine (New Republic cover story, Dec. 14, 1998). He had served as editor-in-chief emeritus of the New England Journal of Medicine and professor emeritus of medicine at Harvard Medical School. Dr. Relman was a Fellow of the American Academy of Arts and Sciences, and a former president of the American Federation for Clinical Research, the American Society of Clinical Investigation and the Association of American Physicians.

To give you the flavor of the debate, here were Relman’s and Weil’s opening remarks.
Doctor Relman: “Integrating alternative medicine with mainstream medicine, as things stand now, would not be an advance, but a return to the past, an interruption of the remarkable progress achieved by science-based medicine over the past century.”

“I can't see how such integration, even if it were possible, would improve medical care or further the cause of human health. Most alternative systems of treatment are based on irrational or fanciful thinking, and false or unproven factual claims.”

“Their theories often violate basic scientific principles and are at odds, not only with each other, but with modern knowledge of the structure and function of the human body as now taught in our medical schools.”

“It could not be woven into the fabric of the medical curriculum without confusion, contradiction, and an undermining of the scientific foundation upon which modern medicine rests.”

Doctor Weil: “In this country and throughout the world, patients in unprecedented numbers are going outside of conventional medicine to look for help.”

“Why are people doing this? Clearly, there is dissatisfaction with conventional medicine. There is a large and growing gulf in this country between what patients expect of doctors and what medical schools are training them to do.”

“Patients want physicians who can take the time to sit down with them and listen and explain to them, in language they can understand, the nature of their problem; who are aware of nutritional influences on health; who will not push just drugs and surgery as the only approach to treating illness; who can answer intelligently questions about dietary supplements; who are sensitive to mind-body interactions; who will not laugh in your face if you ask questions about Chinese medicine; who are willing to look at you as more than just a physical body. I think those are very reasonable requests.“

Who Won?

Among the scientific community, Relman won the debate. The alternative community and the public felt Weil won hands down. Both sides remained unconvinced of the other’s position.

As time has passed, Relman’s position has been largely validated by government-sponsored double-blind, controlled scientific studies, which show most alternative products have no scientific value in relieving symptoms or curing disease.

On the other hand, Weil’s stature has gained widespread legitimacy in the public’s eyes and among some academic centers and mainstream practitioners, who know reality of alternative medicine’s popularity when they see it.

Beware of Fraudulent Alternative Practitioners

Unfortunately with legitimacy has come a rise in unprofessional, fraudulent practitioners (“Life and Death on Fringes of Medicine, Los Angeles Times, February 5, 2006).

Using the Internet and word-of-mouth promotion, peddlers of unproven cures offer hope to desperately sick people in imaginative new ways.

I had a friend with terminal pancreatic cancer who paid $10,000 for caffeine enemas and massive doses of multivitamins to treat his disease. Another friend, with advanced congestive heart failure, was told by a health food clerk that she had 20 proven remedies to treat heart failure. To doctors, thoughts of health food personnel dispensing medical advice can endanger and mislead patients.

The Case of Coretta Scott King

Some fatally ill patients forgo traditional care; others burn through their savings. Diagnosed with ovarian cancer, Coretta Scott King recently sought care at a Mexico clinic, Santa Monica Health Institute, known for its fringe medical treatments. She died there, and it was shut down by Mexican health authorities. Many patients merge conventional care with alternative practices without telling their doctors, risking dangerous side effects or drug interactions.

A Realistic Approach to Alternative Medicine by Doctors

For doctors, what is a reasonable approach to patients who are true believers in alternative medicine but whose health may be endangered through drug interactions or avoidance of proven traditional medicine?

As the editor of a monthly newsletter, Physician Practice Options, which reaches 100,000 practicing physicians, I endorse the approach of Doctor Neil Baum, a well-known urologist and medical marketing expert.

Baum advises doctors to learn from the effective humanistic techniques of alternative practitioners, ask patients about alternative drugs that may interact with prescribed drugs, show neutrality and understanding, and form relationships and develop referral relationships with legitimate alternative practitioners (“Clinicians Can Learn from Alternative Practitioners,” Physician Practice Options, October, 2004).”

In other words, don’t denounce alternative medicine practitioners, learn from them. When necessary protect your patients from potentially harmful products, but show understanding.

Wrapping Up

Alternative and complementary medicine is here to stay. Recognizing this, the National Institute of Health is studying it; academic medical centers and hospital systems are setting up programs and accepting patients. The America public continues to embrace alternative practitioners’ hands-on, naturalistic, spiritual, and compassionate approaches. But on its fringes, danger lurks in thee form of untoward drug interactions, worthless and costly procedures engendering false hopes, and fraudulent practitioner.

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