I used to think of it as "the underground health economy." For those of us who have been involved in complementary/ alternative medicine (CAM) for ten or more years, there was little surprise in David Eisenberg's findings, published in the January 1993 New England Journal of Medicine, that a sizable portion of the public was using these therapies. The surprise was in just how large a portion this was - one in three, or 33% of the population -- and the amount of money this group spent out-of-pocket: more than 10 billion dollars, exceeding what was spent on all hospital visits throughout the country.

Eisenberg's paper unleashed a torrent of reaction. This was one large market! The alternative side beamed and glowed - and grew. Mainstream health professionals and physicians who had long been in the alternative closet came out in droves, now that there seemed to be a demand. "Alternative Medicine" conferences were organized, and journals were born, such as Alternative Therapies in Health and Medicine, spearheaded by Larry Dossey, a physician who had been paying attention to these issues and writing books on them since at least the early ‘80s.

Meanwhile, the shocked, conservative side of modern medicine reacted as well. New York Times reporter Gina Kolata, never a friend of what she calls "untested therapies" on the "fringes of healthcare," wrote a critical article in 1996 about the growth of the field. She quoted Stephen Barrett, a self-styled "quackbuster," as saying "quackery isn't necessarily about selling products and services -- it's about selling misbeliefs." Barrett assumed a lack of judgment in consumers of alternative therapies: "If you can convince someone that the Government is not going to give you accurate information on any health matters, that doctors and researchers cannot be trusted, then that person will be damaged."

Is this really true? Are we faced with an ever-growing army of snake-oil salesmen who prey on the gullible and separate them from their money? Are the consumers/ clients/ patients of alternative practitioners nothing but ignorant dupes, lured away from tried-and-true medical treatments -- and therefore in danger? Quite the opposite seems to be the case.

John Astin, a postdoctoral fellow at the Stanford University School of Medicine, set out to find an answer to the question "Why do patients use alternative medicine?" There were some surprising results. Only 4.4% of those surveyed said they used alternative therapies exclusively; the rest used them as complements to mainstream medicine. Confirming earlier studies, Astin found that alternative medicine users are more highly educated than the population at large; they have a wholistic orientation to health; they have had a transformational experience that changed their world view; and they could be classified as being in "a cultural group identifiable by their commitment to environmentalism, feminism, and interest in spirituality and personal growth psychology."

Interestingly, Dr. Astin found that the best predictor that someone uses alternative medicine was not dissatisfaction with the mainstream medical system nor mistrust of government, but rather his or her feeling that "these healthcare alternatives (are) more congruent with their own values, beliefs, and philosophical orientations towards health and life." An article in the Annals of Internal Medicine confirmed those findings: "The attraction of alternative medicine," say authors Eisenberg and Kaptchuk, "is related to the power of its underlying shared beliefs and cultural assumptions." Its basic premises, which include advocacy of nature, vitalism, and spirituality, offer patients a "participatory experience of empowerment, authenticity, and enlarged self-identity when illness threatens their sense of intactness and connection to the world."

Between 1990 and 1997, the percentage of the population using alternative therapies grew from 33% to 42%. Total out-of-pocket expenditures for alternative therapies is currently estimated to exceed 27 billion dollars, comparable to the figure projected for all out-of-pocket costs for U.S. physician services. It's clear that "alternative medicine" is here to stay, since it is being sought out by close to a hundred million people.

Does this mean that alternative therapies are the answer to all of our healthcare problems? Not necessarily. No one system is always effective or always the solution for everybody. Many systems are now available, which increases the variety our options and the likelihood of finding help for our complaints.

We are fortunate to live in a time "when all occult knowledge is brought into the light." From this viewpoint, medical knowledge is no longer the domain of a small elite; it is available to the public -- in libraries, in books, and on the Internet. We now also have the luxury of choice, but it comes with a price: the need to educate ourselves in order to make informed choices. Fortunately, many books and teachers provide us with that opportunity. One of the best new offerings is Radical Healing: Integrating the World's Great Therapeutic Traditions to Create a New Transformative Medicine, by Rudolph Ballentine, MD (Harmony Books, NY, 1999).

Many enlightened physicians have set up "integrated healthcare" offices or clinics where they offer, along with conventional medicine, a series of additional healing modalities for their patients. The most common of the alternative therapies, according to Astin, are chiropractic, acupuncture, homeopathy, lifestyle diets, megavitamin therapy, spiritual healing, relaxation, massage, folk medicine, exercise, psychotherapy, and art/music therapy. In other words, people feel better with bodywork, stress reduction, non-drug remedies. They feel better with diets higher in fruits, vegetables, and whole grains, and lower in sugar and processed foods. And they respond well when attention is paid to their psyche and spirit. In our high-stress, technological, often impersonal society -- where people live by the clock and the computer, and subsist on refined, packaged, colored, flavored, and microwaved food - this trend is hardly surprising.

The emerging paradigm of healthcare returns to the ancient view of the human being as a whole, complex system, where not only the foot bone is connected to the ankle bone, but everything else connects to everything else. As Candace Pert discovered, neurotransmitters (those "molecules of emotion") are found not only in the brain but also in the gut, the endocrine system, and the nervous system throughout the body. That is the clearest proof -- if you need proof -- that the mind and the body are one. Our modern-day knowledge of body mechanics and structure, as amassed by conventional medicine, can now be harmonized with ancient knowledge of body/mind conenctions, as well as of the effect of herbs, home remedies, bodywork, and spiritual pursuits. Soon we will also have a scientific understanding of empirically tested techniques such as homeopathy and acupuncture.

When faced with a client with vague complaints, the new health practitioner will not just ask about symptoms and blood pressure, then order expensive tests. Focusing only on test results should no longer be viewed as sufficient. The most crucial questions to ask might be: Are you feeling stressed? What have you been eating? How much coffee are you drinking? How are things at home and at work? Have you had a massage lately?

This is the dawn of integrative medicine, and it opens up a real possibility for effective healing at all of our levels.

References

Eisenberg, D, et al, "Unconventional Therapies in the United States: prevalence, costs, and patterns of use." New England Journal of Medicine, 1993 Jan 28;328(4):246-52.

Kolata, Gina, "On the Fringes of Health Care, Alternative Therapies Thrive." The New York Times, June 17, 1996.

Astin, JA, "Why patients use alternative medicine: results of a national study." Journal of the American Medical Association, 1998 May 20;279(19):1548-53.

Cassileth, B; Lusk, EJ; Strouse, TB, Bodenheimer, BA, "Contemporary unorthodox treatments in cancer medicine: a study of patients, treatments, and practitioners." Annals of Internal Medicine, 101:105-12, 1984.

Kaptchuk, T; Eisenberg, D, "The persuasive appeal of alternative medicine.’ Annals of Internal Medicine, 1998 Dec. 15;129(12):1068-70.

Eisenberg, DM; Davis, RB; Ettner, SL; et al, "Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey." Journal of the American Medical Association, 1998 Nov. 11;280(19):1569-75.

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