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Medical Refugees & Navigating Conventional & Alternative Health Care

October 10, 2010

Complementary and alternative medical (CAM) clinics are serving as the de facto refugee camps for people with health conditions that are not addressed by “conventional” medicine. CAM clinics are staffed by licensed Naturopathic Doctors (NDs) and Integrative Medical providers who blend conventional healthcare with  alternative diagnostic and therapeutic techniques. The 2007 National Health Interview Survey (NHIS), found that 38 percent of US adults use CAM. The boundaries between CAM and conventional medicine are not absolute, and over time specific CAM practices may become widely accepted.

When medical refugees turn to alternative medicine, there are advantages and disadvantages. In this article, I’ll present my perspective on the strengths and limitations of both conventional and alternative medical approaches, and offer my navigational advice. First, lets cover some important definitions.

Complementary & Alternative Medicine (CAM): A diverse group of medical systems, practices, and products that fall outside today’s conventional medicine. Examples of CAM practices include: naturopathy, chiropractic, acupuncture, herbalism, Ayurveda, meditation, yoga, biofeedback, homeopathy, and nutritional-based therapies.

Complementary Medicine: Using CAM along with conventional medicine, such as using acupuncture in addition to allopathic methods to treat pain. Most use of CAM by Americans is complementary.

Alternative Medicine: Using CAM in place of conventional medicine.

Integrative Medicine: Health care systems that combine conventional and science-based CAM approaches.

Functional Medicine: A specific movement within integrative medicine that guides allopathic practitioners to integrative thinking and methodology.

Allopathic Medicine: Using drugs and surgery to manage and mask the symptoms of disease without necessarily addressing the cause. Conventional or “Western” medicine is generally allopathic medicine.

Naturopathic Medicine: More than any particular technique or approach, naturopathic training is guided by six core principles (below). Naturopathic students are exposed to an array of diagnostic and treatment modalities which include standard allopathic methods (including conventional laboratory testing, drugs and minor surgery), innovative science-based approaches, natural therapies (herbs, nutritional supplements, and diet and lifestyle interventions) and energetic practices such as homeopathy and reiki. Naturopathic methods come with varying degrees of acceptance by the conventional medical community. Individual NDs tend to specialize in particular diagnostic and treatment methods and may be more or less conventional. There are six accredited naturopathic medical schools which qualify graduates to sit for board examinations and licensure. In states that do not have naturopathic licensing laws, anyone may call themselves a “naturopath” even without an accredited education.

Core Principals of Naturopathic Medicine: 1) First, do no harm and whenever possible avoid high force interventions; 2) Support the inherent healing power of nature; 3) Identify and treat the causes of disease, not just the symptoms; 4) Educate the patient and encourage self-responsibility for health; 5) Treat the whole person and personalize treatment to the individual; 6) Promote optimal health for the individual, community and the interdependant web of life respecting that the two are inseparable.

Conventional is Allopathic

Today what we ironically call “conventional” or “Western” medicine falls under the allopathic umbrella. Allopathic medicine is typically practiced by MDs, DOs and other allied health professionals (such as physical therapists, psychologists, physicians assistants, registered nurses, and dieticians).

Modern allopathic trauma care is outstanding, arguably heroic and unparalleled in effectiveness. Today’s surgical techniques are equally phenomenal. Allopathic surgeons routinely remove deadly tumors and can replace and restore joints and many vital organs.

The allopathic pharmaceutical industry has rammed an impressive arsenal of over 6000 drugs through the FDA. This array of pharmaceutical weaponry gives physicians and patients the option of blasting away the symptoms of acute and chronic health conditions without having to stray from the health-neglecting yet “conventional” modern diet and lifestyle pitfalls. Due to market forces and the porosity of FDA regulation, the often disastrous side effects of allopathic drugs are typically vastly under-reported if not blatantly hidden altogether. Equally treacherous and even less explored is the vast potential for drug interactions.

Modern drug therapy permits symptomatic treatment without needing to explore the causes. Consider allopathic treatment of a headache. A particular headache could have any number of antecedents: dehydration, low blood sugar, stress, inadequate sleep, caffeine addiction, a chemical exposure. An allopathic solution to any of these individual headaches might be to match the symptom with a drug with a track record for making that symptom go away. It’s not a stretch to suggest that in an ideal allopathic world, there would be an inexpensive drug for every symptom with no side effects. That world does not exist, and it never will.

Health Care or Disease Management?

It’s easy to understand why people seek alternative. Although conventional, allopathic medicine has become an exorbitantly expensive and yet fundamentally ineffective system of “disease management.” Although the US spends more than any other industrialized nation on health care (>15% GDP), we ranked 37th in the world’s health systems (just behind Costa Rica and Dominica).

Few doubt that the allopathic medical system alone is adequate to protect and promote health. In its present form, allopathic medicine is often heralded the answer to trauma, symptom suppression, and chronic disease management. Disease management has become a fat-cat industry that is crushing the vitality out of the economy while largely turning a blind eye to promoting health. The current health care debate has turned into an argument about how best to force everyone to subscribe to private insurance which will then contentiously administer a compromised and broken system of allopathic disease management.

Let’s be clear, the drug-based allopathic disease management system is not only expensive and wasteful, it largely ignores disease prevention and promoting optimal health.

The Making of Medical Refugees

Within the allopathic system, when there is no approved drug to treat a particular condition, the patients often get marginalized. Those suffering from a “disease without a drug” might be given a prescription for a drug that does not work, a drug for something else (e.g. antidepressants) or they even be told that there is nothing wrong with them. Astonishing as this is medical injustice is, there is a growing list of conditions that fall through the cracks of allopathic medicine in this way. People with these conditions are the medical refugees of our time.

Ten Health Care Refugee Syndromes:

1. Fibromyalgia

2. Chronic Fatigue Syndrome

3. Multiple Chemical Sensitivity

4. Sub-Clinical Hypothyroidism

5. Adrenal Fatigue & Failure

6. Attention Deficit Disorder

7. Irritable Bowel Syndrome

8. Sick Building Syndrome

9. Gulf War Syndrome

10. Post Lyme Disease

With the focus on allopathic “disease management” using drugs as the primary therapy, very little attention is being given to proven, effective lifestyle measures known to prevent disease and promote optimal health. By my count, eight out of ten of the leading causes of disease-related deaths in the United States might have been prevented with healthy diet and lifestyle interventions.

Ten Leading Causes of Disease-related Death in the U.S.:

1. Heart Disease

2. Cancer

3. Pneumonia & Influenza

4. Stroke

5. Alzheimer’s disease

6. Diabetes

7. Kidney disease

8. Septicemia

9. Chronic liver disease

10. Essential hypertension

(We may well eventually learn that Alzheimer’s and essential hypertension are also largely preventable making 10/10 of the top killers possibly preventable.)

What happens now is that a portion of the medical refugees and those seeking to prevent disease and promote health find their way to CAM. CAM practitioners employ cutting-edge, theoretical, energetic or otherwise esoteric diagnostic and therapeutic techniques. The best alternative practitioners are in this area are “complementary” meaning that they use, or at least understand the value and limitations of the conventional and alternative approaches.

It’s important to understand the two major factors can make something alternative. One is that the diagnostic or therapeutic measure is experimental and has not earned the “evidence-based” seal of approval. A given technique is evidence-based only when it  has been shown to effectively diagnose, treat or prevent disease in large, double blinded, placebo-controlled clinical trials. The other factor that makes a particular medical technique alternative is a lack of patent-ability and profit potential. It’s very easy to patent drugs and genetic tests, but it’s very difficult to patent lifestyle techniques, like clean food/air/water and good sleep and exercise.

Is there such a thing as evidence-based alternative care? Yes, and it’s definitely the most interesting, challenging and rewarding area of medicine to be working in. In its best application, evidence based alternative medicine is the leading-edge of health care innovation, and, given time, even the allopathic ranks follow the alternative lead when the method becomes proven. Of course, by then, the allopaths may have conveniently forgotten that they largely derided the practice a decade earlier when the technique fell under the alternative banner.

Patients and health care practitioners would be wise to note the critical margin where popular alternative medical methods meet the rigor of being evidence-based. It’s important to understand the pressures involved. With patients, clinicians and medical corporations all seeking to benefit from using, offering, or selling the alternative methods, it’s tempting for everyone involved to lean too far into alternative and miss the importance of sound principles and approaches based on sound principles.

For many medical refugees and their health care providers, dipping deep into alternative feels like the best or even the only options. By so doing, the parties may get the help they need while they energize the evolution of alternative approaches—where those that really help gain support and move towards gathering more evidence, while those methods that don’t work get sidelined.

Alternative medicine is definitely an industry. As the number of people seeking alternative care grows, there are more and larger companies offering alternative diagnosis and therapies. Like the pharmaceutical industry that preceded it, the alternative medical industry is also imbued with an inherent profit-based survival instinct. As such, alternative medical companies are often rushing to market methods packaged in polished promises of delivering exactly what the medical refugees so desperately want: safe, effective care for their conditions.

Esoteric Laboratory Testing

I frequently get asked about alternative laboratory tests. There are many out there including: tests for food sensitivities, adrenal stress profiles, neurotransmitter metabolites, heavy metal challenge testing, organic acids, and many more. The science supporting the clinical utility many of these always looks promising, and is also still developing. For better or worse, the FDA has the job of assessing the clinical utility of these tests. Almost invariably, there are some useful bits and also some claims that don’t quite measure up to the evidence. The best alternative laboratories are involved in efforts to improve the consistency of results and to identify real clinical utility out of the field of promise.

Diagnostic Testing Guide:

1) Outside or routine screening tests, only order diagnostic testing to CONFIRM or rule-out a diagnosis suggested by a thorough health history and physical examination.

2) Don’t order a test UNLESS the results are going to affect the treatment plan.

A little known fact is that some alternative laboratory tests offer the providers a kickback whenever the test is ordered. I recommend that you ask about this conflict of interest directly. If the answer is yes, it’s not a good sign. The validity of a diagnostic test should stand for itself, and laboratories that bribe doctors into using the testing are usually at the bottom of the barrel.

On Supplements

A good multi-vitamin can help ensure that the average person will not be deficient in a particular nutrient, but in general I’d rather have my patients spending their money on fresh, whole & local nutrient-dense food than vitamins. High-quality vitamin supplements are available, but they can be expensive. There are lots of cheaper vitamins available, but there is little guarantee that they actually provide what the label suggests, and the quality of the ingredients may be questionable.

While random mega-doses vitamins can actually be harmful, a nutrient-dense diet is not. Looking for the answer in a pill bottle (whether it is filled with vitamins, herbs or drugs) is the product of our modern quest for convenience and a reluctance return to a natural (and sane!) lifestyle that provides our bodies with they require for optimal health.

When I do prescribe supplements, I do so sparingly. Many of my patients are pleasantly surprised when I tell them to stop taking many supplements and put the focus on their diet and lifestyle. I do not sell supplements out of my office, because I want to avoid the temptation to prescribe anything in order to make a profit for myself.

Foundations of Optimal Health:

1) Focus the diet on vegetables & fruits that are fresh, local & organic; animal products that are wild, free-range, organic, grass-fed (or fat free); whole hypoallergenic grains (like brown rice and quinoa); and drink plenty of clean water.

2) Take steps to support strong digestion and regular elimination, get adequate good-quality sleep, and find exercises you can safely enjoy in a clean environment every day and then gradually increase the duration.

3) Avoid unnecessary chemical exposures in the diet and environment. This includes: processed foods, refined sweeteners, artificial ingredients, alcohol, and caffeine. When symptoms of poor health do appear, do everything possible to identify and treat the causes rather than turning to symptom-suppressing OTC or prescription drugs—which usually have side effects and exacerbate health problems while burdening the body’s critical detoxification systems.

4) Focus attention, speech and thinking on being well and strategies and successes toward getting there. This means consciously avoiding victim-based thinking, excessive commiseration, negative language & thought patterns. Along with applying a positive attitude, it is important to communicate one’s health history, along with any improvements and setbacks to the health care provider.

With these four suggestions, many patients (including the medical refugees), often see dramatic health improvement or complete resolution of their conditions.

The Limits of Compassion

I do feel strongly that we would all do well to be aware that there is a distinct limit to the benefits of getting attention and other positive feedback for being sick. This goes for patients, practitioners, support group leaders, friends & family alike. At issue is that we all tend to go (or stay) where we put our focus, and if that focus is on telling ourselves and everyone who will listen about how terrible we feel, then there is a very real danger of getting attached to that reward-pattern and thereby slowing our progress toward health.

Likewise, a good attitude can be taken too far. I would never suggest a patients stay with a doctor that encouraged them to ignore symptoms completely and only think good thoughts. There’s room for balance. Sadly, there are alternative medical practitioners that have committed to selling narrow ways of diagnosing and treating the medical-refugee conditions.

Medical Tunnel Vision

If any health care provider only has only a few tools to use, they may have fallen into the trap of overly simplistic thinking. The unfortunate “symptom-to-drug-matching game” that many allopathic providers use is one example.

On the other side are doctors like an MD I recently heard about that went “alternative” with little training and who now uses some very flimsy muscle testing to “diagnose” ~90% of his patients with candida overgrowth. Either one of these types of provider is unlikely to care a lot about what the particulars of a case is. They are in the unfortunately lucrative business of hitting different nails with the single hammer they have in their hand. Buyer beware of this type of practitioner.

Personalized Treatment Plans

My four basic recommendations (above) are just the foundation of my treatment plans. They are based on what is called the “determinants of health” and “removing the obstacles to cure.” Every one of my patients also gets a highly personalized treatment plan that is built on upon this foundation. Nutritional and herbal supplements, conventional and alternative lab tests, and even drugs all have their place, but they should never be considered the foundation of your care.

Grandiose promises from alternative health care practitioners and laboratory and supplement companies abound. These messages can be inspiring, and they might well indicate a great new therapy or diagnostic method. They may also be a hallmark of someone who has strayed too far into the wide galaxy of alternative methods and who is (knowingly or not) capitalizing on the desperate needs of medical refugees providing little benefit other than fleeting hope.

My fundamental advice: make sure that your care is being guided by a qualified and unprejudiced health care professional who understands and judges the values and limitations of both conventional and alternative methods. A good provider will take the time to understand their patient’s history, select appropriate diagnostics, and form a therapeutic partnership with the patient in the drivers seat of a personalized treatment plan based on realistic dietary and lifestyle interventions designed to promote optimal health.

May we all be well!

trmorrisnd headshotDr. T.R. Morris is a licensed naturopathic medical doctor (ND). He is currently serving as faculty and consultant to the Institute for Functional Medicine (IFM). The IFM mission is to revolutionize medicine by teaching the latest genetic, nutritional, hormonal and other biochemically-based integrative medicine techniques to MDs and other practitioners looking for new tools to prevent and treat chronic disease. In the past, T.R. served as the medical director of a large integrative clinic and taught (genetics, physiology, biochemistry, microbiology, cellular & molecular biology) for 10 years for various medical programs in the Puget Sound. He sees patients in person (or long-distance via Skype consultations) from his home office in Seattle.
Contact Dr. Morris

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