Integrative Medicine and Family Practice

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That's fine. I respect your experience as a FP physician.

I disagree on a number of things here. And I have to limit my time on responding as well.


But I will say this.
It is highly subjective and ridiculous to make this statement:

"And most Americans are idiots."

Wow. That's an amazing attitude and position to hold.
What is that based on scientifically speaking?

It's really just a tainted, personal, subjective attitude that you hold. As such, it would have been better not to have stated it. Even if it is a feeling you have, it tells me that within the realm of all possible reality, this is something worthy of re-exploration. That is my opinion, just as yours is that "Most Americans are idiots.”

But see, my opinion leaves the door open for growth, whereas, clearly, yours does not, if this is indeed a perspective you hold as some sort of truth.


Most Americans are not idiots. This is condescending, and since I presume you treat mostly American patients, this is a slap in their faces as well and takes away from the practitioner's ability to be more open to people-patients-clients as individuals. (Whatever you feel is a fair reference there—I like them all. Through time and growth, I’ve grown to respect the term client in the sense that it includes patients as partners in their OWN health and wellbeing—not merely as some peons that bow before the great alter of the “House of Gods.”)


Of course, I'm probably just another American idiot to you, but I have some things that could be viewed as more objective that say otherwise.

The truth is there are quacks in allopathic medicine as well as other forms of medicine.

The attitude that we must throw the baby out with the bathwater, is ludicrous when there are things that have been used with success for 100's of years or more--or treatments and other things that have shown success among groups of people, but the powerhouse pharm. industry can't make enough money in researching them.

The whole debate in TRUTH comes down to politico-economics.

Many Americans and others will continue to explore various therapies. It behooves practitioners to learn as much about them as they can. If they produce good results and show safety, physicians shouldn't simply close the door on them b/c of the own biases as they hide behind the name of science.

Everyone knows that medicine is NOT a pure science, and in reality it never really can be, for a good number of reasons. It USES science. I'm all for that. But medicine shouldn't hide away from growth and helping people by claiming the name of science.

Even science has its limitations in this imperfect world. We must grow and learn with science as much as possible; but there are places where it has limitations in terms of practice and meeting individual needs. And that's a huge piece of human medicine--addressing individual, human health needs as well as the health and wellness needs of groups of humans.

It's about giving people valid choices and also helping to empower people to take charge of their own health and wellness.

Now this is a scary thing for some. There is a control-authority dynamic going on and is quite tradition-based in medicine. On one hand, some physicians complain when patients are non-compliant and don't take responsibility for their own health and wellness. On the other hand, they are reticent about expanding their patients' ability to do so.

That's problematic in itself.

(And before you jump to conclusions about me, you might be very surprised at how I am not from some far left political persuasion---at all—not even close.)

Patients are people. And people should have choices and be partners in their healthcare and wellness. We shouldn’t be fostering unneeded dependency with people. We need to be open to a variety of potentially effective options, so long as they demonstrate a reasonable margin of safety--and that too should include patient education.

There again, how can you educate a patient about something in which you, as the practitioner, don't have balanced, unbiased knowledge?

Truth is, historically many physicians have not been as good as they could have been in terms of patient education even with the orthodox treatments.
Truth is, some physicians either don't have the time or simply don't care to do patient teaching and follow-up.

Some choose, however, to make the time. I've known physicians that limit their schedules or even pt-client-base so that they can do a better job at this very thing. My rheumatologist is an amazing example of this, and he still works like a dog. In fact b/c of this, he has markedly increased his reputation and patient-base. He still manages to balance his own life and practice wellness and take the necessary breaks that are needed to have a good life and to be with his family.

Now, he's no “quack”--and he is highly respected in and around the medical community--both within the Ivy League system where he is chief, and in the surrounding areas. Furthermore, he affirms many of the recommendations made by the reputable naturopath that others and I see.



OK, and Hmmm, certainly Dr's Oz and Roizen are not physician you consider quacks, are they? One is a reputable cardiothoracic surgeon and the other is a reputable anesthesiologist. Who cares what their individual politics and associate with Oprah are? What they are advocating is in the best interest of people’s health and wellness. I’m willing to bet that they don’t travel in the same political circles that I do. It doesn’t matter. What I’ve heard them advocate is reasonable and helpful to people.

And really it's unfair for some to try to paint Dr. Weil as a quack as well.

In fact, people should dump the use of the word quack, b/c it’s so out-an-out subjective and is just a tool to dismiss others without a rationale basis. Hmmm, it’s sort of like dismissing ‘most Americans as idiots.’ It's a bias alarm word —its use is for pure propaganda, period.
Using such words undermines any legitimacy of the person's particular position; b/c it reeks of bias. That position in and of itself is highly unscientificin nature.



As a side note, I'd be shocked if you have not considered the virtues of things like Co-enzyme Q-10 or quality Omega 3 and 6, or vitamin D3.
It is interesting to me how some of the doctors that are crying "foul" and "quackery" have themselves found the information on such supplements as compelling enough for their own use.

And then there are still physicians that don't eat right, don't exercise, don't care that their BMI is dangerous, and just don't subscript to the whole concept of "physician heal thyself."

Sure, individually some people honestly have an inherently greater struggle with weight control and other things, like cholesterol. But I am amazed when I see some obese physicians (And it doesn’t matter if they are morbidly obese or not.) that don't see what kind of horrible walking billboard they are for their patients and the medical community as a whole.

Some of these folks rationalize their own lack of commitment to wellness and sound health and wellness practices under the auspices of "Quack-Watch," and lack of "EBM," and dub everything as quackery without further exploration or standing up and addressing why some of the more naturally derived things are research-worthy.

In reality, more physicians should support efforts at raising monies for more research into naturopathic or CAM treatments and integrative treatments. But they go with the path of least resistance--the monopolizing pharm. companies--which I do not set forth as all bad. But their power and control is just too much, and it becomes too limiting. Thus what could be used SCIENTIFICALLY to advance wellness and health gets pushed to the back of the bus or labeled as mere "quackery."

As long as physicians are beholding to them, there will be this ongoing, close-minded bias against exploring other more natural or CAM-based treatment modalities. Again, it really is politico-economical. And again it may well include a lack of willingness to commit and be an example to sound wellness practices--starting with individual physicians embracing sound wellness practices in their own lives.

That's close-minded in itself.
That mentality limits science, it doesn't advance it.:thumbdown:


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It's called "hyperbole."


Sorry, but please don't hide behind that either. It is very telling--your so called use of hyberbole. Just think about it. I mean no disrespect, but it comes from somewhere.:nono:
 
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re: Integrative med & bio-identical hormones


Regarding bio-identical hormones:

Yes both carry risks, but not the same. I know the differences well, b/c I know my own body. It's wonderful how SLE managed the kick the crap out of my ovaries at a very young age-->POF. I have been through a lot, and I can most definitely tell you the difference in terms of SE's.

Now, such a statement is called subjective, b/c it is.

But all that is subjective is not without merit or constructive value.

And again, it's a major pain to get long term studies for a great number of more natural things that have, over time,, shown themselves to many individuals as healthier and as having less side effects.

So now we can't fairly debate this all b/c there is this glaring subjectivity factor. ????? :shrug:


But we could debate this on other levels, yet there are those people that are more closed to such things, so they will stick to whatever they can use to easily shut things down.

Here's what's worthy of consideration.

As far as blue's comments, it's not merely about beliefs. It is about people's experiences.

Yes, again that is subjective. When, however, you get large groups of people with similar experiences and patterns that are shown regularly and consistently, that is when you have to stop and give pause.

Even in the long well-funded studies, what the patients experience is subjective, but they group those subjective responses together.

*sigh* :bang:
 
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Sorry, but please don't hide behind that either. It is very telling--your so called use of hyberbole. Just think about it. I mean no disrespect, but it comes from somewhere.

Whatever, Sigmund. :rolleyes:

Sometimes a cigar is just a cigar.
 
Whatever, Sigmund. :rolleyes:

Sometimes a cigar is just a cigar.

Another trite statement one can use to hide behind.
And uh whatever to Blue Dog, huge proponent of rational thinking. :prof:
 
[The health zeitgeist is changing rapidly in this country, and many in the mainstream medial community have not noticed.

Health care has become expensive, it is not able to address many of the complaints that patients have, when it can, side effects can be serious. Most importantly, mainstream medicine can't explain why everyone in this country is so sick.

But the wellness movement can.

It has said that we are overfed and undernourished, over medicated and in poor health, and that we are toxic. That we don't need another pharmaceutical to fix the problem, we need to go back to the symbiotic relationship we had with the planet we grew up on, and only introduce hard core chemicals into our bodies when absolutely necessary.

And guess what... people everywhere are finding out that they are right! When they stop eating processed foods and drinking diet soda, when they go organic and non GMO, when they get rid of gluten and artificial sweeteners, and start taking vitamins, they feel better and can often go off pharmaceuticals on which they have been dependent.

And really, this is what Allopathic medicine has been telling us to do for years. To exercise and eat right and take responsibility for our own health.

But now that we are doing it, they are not so happy.

Because many of them don't like the conclusions that we come to when we really and truly take responsibility for our own health.

So unfortunately, instead of being excited that Americans are doing what they have always told us to do, and partnering with them to learn from the masses what the masses are learning and experiencing and thinking and believing and implementing in regards to keeping themselves out of doctors offices, they have chosen to actually mock them. ]
--read more:


http://stanford.wellsphere.com/auti...-itself-in-the-foot-by-attacking-oprah/702943
 
Brevity is the soul of wit. You should try it.

Seriously.


What kind of ninja suit are you wearing? You love to skirt things.


Beside, it's about BALANCE IN TRUTH, not brevity. Save that brevity stuff for Shakespeare. Oh wait, when I studied his works, they mostly weren't brief--including many sonnets.



But here you go: Look how relevant this is:

http://www.encognitive.com/files/Part%20I--Death%20by%20Medicine.pdf




Balance in truth is wonderful. Give that a whirl.

But if you don't want to read or discuss with substance and balance, simply bypass where you feel necessary. Either way, please, don't insult my intelligence or the intelligence of others by once again hiding and attempting to insult with sarcasm, jabs, and further avoidance techniques. It's beneath an educated person.
 
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"Many physicians already know that grapefruit juice occupies the CYP3A4 enzyme, leading to slower-than-expected metabolism and, therefore, higher blood levels of a host of pharmaceuticals."-- http://www.kevinmd.com/blog/2010/02/alternative-herbal-medications-dangerous-side-effects.html

Yes, and so do pharmacists. That is why they put this information on the pill bottles.

Let's look at the numerous iatrogenic causes of death and disability that occur through medicine and hospitals. It's staggering.
 
http://www.srfmr.org/fellowship.php

This program is pretty new but the fact that you get paid to do a fellowship is wonderful. The CME allowance is very attractive, it may allow you to attend some of the conferences hosted by the Consortia of Academic Centers for IM or attend some workshops in Tucson, Az at UA.

One of the program directors, Dr. Wendy Kohatsu is an alumni of my IM fellowship. So if you decide to join, you're in good hands. I'm sure the didactics would be great.

The fact that the program is affiliated with UCSF and you actually get an appointment from UCSF is great. I guess during the fellowship you will also pick up some leadership and administrative skills.

I don't know how far Santa Rosa is from SF but you might be able to arrange some time away to see how the Osher Center functions at UCSF and what their IM attendings are doing as a fellow.

90 minutes for each patient encounter is excellent :thumbup: You will get ample amount of time to do whatever you would need to do with the patients.

Normally people think IM is available to the elitists because only they could afford it. It is wonderful to see that it is now available for the underserved as well.

That's about all I'm going to say.


This is great. Thanks for posting the link.

My naturopath is so booked, it's tough to get a routine appointment with her for months in advance. People come from all over the US and world to see her.:)
 
There are lots of ways to learn more about integrative medicine during residency besides going to only UofA and Santa Rosa. I highly recommend the IM rotation at UofA as a 4th year medical student or resident. Their fellowship is very pricey and they say that some people negotiate the cost into their salary when finding jobs after residency. It also is something people do many years after residency (when I rotated there they had an ex-fellow who is a CT surgeon doing research on laughter yoga). They also offer a really great conference and different online modules (which are free if you do the rotation). Some residencies are actually using their new online residency curriculum and you could talk to potential residencies about integrating it.

To bill yourself as exclusively an integrative medicine doctor in the future seems silly. Integrative medicine is exactly what says 'integrative'. As a family medicine resident, I am focusing on building a sound medical knowledge and incooperating integrative medicine into my body of knowledge and style of doctoring. But I would never advertise myself as an integrative medicine specialist because I want to provide care to a wide range of patients, not just wealthy well-insured patients which is what billing yourself as an Integrative Medicine practioner typically attracts.
 
There are lots of ways to learn more about integrative medicine during residency besides going to only UofA and Santa Rosa. I highly recommend the IM rotation at UofA as a 4th year medical student or resident. Their fellowship is very pricey and they say that some people negotiate the cost into their salary when finding jobs after residency. It also is something people do many years after residency (when I rotated there they had an ex-fellow who is a CT surgeon doing research on laughter yoga). They also offer a really great conference and different online modules (which are free if you do the rotation). Some residencies are actually using their new online residency curriculum and you could talk to potential residencies about integrating it.

To bill yourself as exclusively an integrative medicine doctor in the future seems silly. Integrative medicine is exactly what says 'integrative'. As a family medicine resident, I am focusing on building a sound medical knowledge and incooperating integrative medicine into my body of knowledge and style of doctoring. But I would never advertise myself as an integrative medicine specialist because I want to provide care to a wide range of patients, not just wealthy well-insured patients which is what billing yourself as an Integrative Medicine practioner typically attracts.

From the business end of things, can you incorporate an integrative-minded practice into a typical crunched-for-time family practice with all the reimbursement issues that come along with a family practice? It was my impression that most integrative practices stress more time with each patient, digging into the history, alloting more time for dietary counseling, etc. Can you afford to do all that if you aren't going to be adequately reimbursed (assuming by "wide range of patients" you meant those who can't or won't pay out of pocket for your services)?
 
There are lots of ways to learn more about integrative medicine during residency besides going to only UofA and Santa Rosa. I highly recommend the IM rotation at UofA as a 4th year medical student or resident. Their fellowship is very pricey and they say that some people negotiate the cost into their salary when finding jobs after residency. It also is something people do many years after residency (when I rotated there they had an ex-fellow who is a CT surgeon doing research on laughter yoga). They also offer a really great conference and different online modules (which are free if you do the rotation). Some residencies are actually using their new online residency curriculum and you could talk to potential residencies about integrating it.

To bill yourself as exclusively an integrative medicine doctor in the future seems silly. Integrative medicine is exactly what says 'integrative'. As a family medicine resident, I am focusing on building a sound medical knowledge and incooperating integrative medicine into my body of knowledge and style of doctoring. But I would never advertise myself as an integrative medicine specialist because I want to provide care to a wide range of patients, not just wealthy well-insured patients which is what billing yourself as an Integrative Medicine practioner typically attracts.


Yes. I did see where their fellowship was a lot. I thought I read where it was becoming quite popular.
 
From the business end of things, can you incorporate an integrative-minded practice into a typical crunched-for-time family practice with all the reimbursement issues that come along with a family practice? It was my impression that most integrative practices stress more time with each patient, digging into the history, alloting more time for dietary counseling, etc. Can you afford to do all that if you aren't going to be adequately reimbursed (assuming by "wide range of patients" you meant those who can't or won't pay out of pocket for your services)?

I believe this is possible more for those patients that would be willing to pay for this approach out-of-pocket.

Physicians around here seem to be doing a number of different things.

And this seems doable. I know a highly respected ENT around here that takes insurance, but for those that he has some trouble with, he offers a discount to patients that were willing to pay out of pocket. Of course I do not think this applied to certain procedures.
 
A Short History of Medicine

2000 B.C. - Here, eat this root.
1000 A.D. - That root is heathen. Here, say this prayer.
1850 A.D. - That prayer is superstition. Here, drink this potion.
1940 A.D. - That potion is snake oil. Here, swallow this pill.
1985 A.D. - That pill is ineffective. Here, take this antibiotic.
2000 A.D. - That antibiotic is artificial. Here, eat this root.

;)
:banana::laugh:
 
Interesting article in the New Scientist. NHS is going to stop funding any treatments with and studies on homeopathy.


Look around. Everything is getting tighter and tighter financially. Taxes are going up a lot. What's going on? You cut where you think there will be the least amount of return on the dollar.

It's economics. It's kind of like how institutions first cut education benefits when things get tight. One way or another, it's about money.

But people will still look towards whatever will help them sustain wellness without having to go hog wild into drug and tx costs.

Of course with unemployment and people getting beaten down by taxes and government monopolizations, people will end up having less money for both.
 
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I don't really understand all the excitement about this stuff. It's mostly snake oil, and at a minimum should be reserved for the most resistant patients. So many people think there is some big conspiracy with the FDA and big pharma to keep these great natural cures away from the public. I don't at all get that. These companies are profit driven to the core. If there were treatments out there that actually worked, why wouldn't they try to package them up and sell them? Oh wait, they did that with Lovaza... and Niaspan... and even Digoxin.

As evidenced by this thread, there are people out there who are very passionate about this stuff. And I'm sure some symtoms are improved by these treatments, but generally they don't work any better than placebo (which I will admit is suprisingly effective). There are also complications THEY don't want you to know about. I've personally seen three deaths directly attributable to "natural" treatments.

I'm not saying alternative treatments shouldn't be explored, but they should be held to some sort of evidence based standard and safety based standard.

By the way, that big lump in your mid-section is fat. Your colon doesn't need cleansing.
 
I've personally seen three deaths directly attributable to "natural" treatments.

As a learning opportunity, can you describe a little bit about these cases?
 
The worst case was a Chinese American high school student. He was a distance runner with no known medical problems. He was given a mushroom by an herbalist that was supposed help with athletic performance. (Cordyceps??) It was never really determined wether he actually took the intended mushroom, or if it was a look alike. Either way he died of hepatorenal failure after a prolonged ICU stay.

Second was a GI bleed in a 37 year old woman. H pylori negative. No NSAID's, ETOH, or tobacco. Was taking several herbs including ginko, ginseng, and wu wei.
 
This is more reason why education must increase.

Hmmm, in the late 1950's and very early 60's, who'd of thought that thalidomide would have some worthwhile medical value?

An either/or, closedminded approach is NOT the way to go here.

But as usual, that which has the greatest political and economical power behind it will determine what will be actively researched and found to be of value.
 
I'll admit the last case was not solely attributable to alt med and I don't think there was any sort of advice given to start the St John's. The patient was sick in the beginning. I don't remember the exact age of the patient, but he was in his fifties. Hx of hepatocellular carcinoma s/p transplant on cyclosporine. Started taking St John's Wort for depression because he didn't want to be on any more "medicines." Fairly rapid rejection of the organ progressing to death after a period of doing well.
 
I'll admit the last case was not solely attributable to alt med and I don't think there was any sort of advice given to start the St John's. The patient was sick in the beginning. I don't remember the exact age of the patient, but he was in his fifties. Hx of hepatocellular carcinoma s/p transplant on cyclosporine. Started taking St John's Wort for depression because he didn't want to be on any more "medicines." Fairly rapid rejection of the organ progressing to death after a period of doing well.


I've worked in cardiac and lung transplantation with kids. They are on a plethora of medications and their whole lives change down to the tiniest detail.

Call me nuts, but it seems like common sense that these patients not be on anything without the full awareness and approval of their physicians.

Of course our teens were often brought back in d/t to complications from lack of medication and lab compliance--a fair amount of it was development in nature. The parents needed tons of education and counseling as well.

So somewhere along the line, the pt you speak of had a gap in his education or he was incredibly stubborn and foolish in not getting his physician's perspective. If there are any patients that have to be ultra careful and strict with their medications, their regimens, and what they are exposed to it's the transplant pts.
 
As a learning opportunity, can you describe a little bit about these cases?


We had one recently. A man attempted an at home colonic, perforated his colon, became septic and died shortly thereafter.
 
Colonic perforation with sepsis and death may be rare, but complications arising from alternative therapies are not. I freely admit there are lots of conditions that allopathic medicine does not treat well. There are complications from what we do. I also agree that some non-mainstream treatments have the potential to provide benefit to patients. However, so many people just want to throw science out the window when talking about this stuff. If these treatments can stand up to investigation, then they are not alternative or complementary. My big problem with this stuff is that the great potential for harm is so often ignored and the potential for benefit is so often exaggerated. There have been several comments in this thread mentioning money, but this is already a multi-billion dollar industry. There's so much money to be made with practically no accountability or regulation; it's the perfect environment for charlatans.
 
Colonic perforation with sepsis and death may be rare, but complications arising from alternative therapies are not. I freely admit there are lots of conditions that allopathic medicine does not treat well. There are complications from what we do. I also agree that some non-mainstream treatments have the potential to provide benefit to patients. However, so many people just want to throw science out the window when talking about this stuff. If these treatments can stand up to investigation, then they are not alternative or complementary. My big problem with this stuff is that the great potential for harm is so often ignored and the potential for benefit is so often exaggerated. There have been several comments in this thread mentioning money, but this is already a multi-billion dollar industry. There's so much money to be made with practically no accountability or regulation; it's the perfect environment for charlatans.

But funding for many supplements, for example, is simply not there because the process is cost prohibitive. When there isn't a patentable product with potential for billions in sales at the end of the process, who is going to make that investment? The government, perhaps, and it is doing so to some degree. While the CAM market overall runs in the billions, you can't make parallel comparisons to pharmaceutical products because of the cost issue. I'm not saying there shouldn't be accountability, though.
 
Colonic perforation with sepsis and death may be rare, but complications arising from alternative therapies are not. I freely admit there are lots of conditions that allopathic medicine does not treat well. There are complications from what we do. I also agree that some non-mainstream treatments have the potential to provide benefit to patients. However, so many people just want to throw science out the window when talking about this stuff. If these treatments can stand up to investigation, then they are not alternative or complementary. My big problem with this stuff is that the great potential for harm is so often ignored and the potential for benefit is so often exaggerated. There have been several comments in this thread mentioning money, but this is already a multi-billion dollar industry. There's so much money to be made with practically no accountability or regulation; it's the perfect environment for charlatans.


Yet are they not less rare than mortality and morbidity from iatrogenic causes of western/allopathic medicine, for which such iatrogenic complications and troubles we have tomes of information? Yes there is always moderating benefits vs. risks. But indeed there are two sides here, and surely no one denies the complications and deaths from "modern" medicine. Balance in reasoning is essential, else everyone loses out.
 
Yet are they not less rare than mortality and morbidity from iatrogenic causes of western/allopathic medicine, for which such iatrogenic complications and troubles we have tomes of information?


OK... show me some of data. I'm just not sure that's true. I know there are complications with allopathic medicine.... but I know there is benefit as well. I know there are complications with "alternative" medicine, but I'm not so sure about the benefit.
 
OK... show me some of data. I'm just not sure that's true. I know there are complications with allopathic medicine.... but I know there is benefit as well. I know there are complications with "alternative" medicine, but I'm not so sure about the benefit.

I believe alternative medicine represents a lifestyle judgement that you do not agree with and thus can't accept. Many countries with a greater amount of "alternative" medicine are much healthier than we are as a nation. To imply that the influence of your culture which (during your lifetime) has allowed and the most profitable industry in the world (with 50% of their profit being exclusively from America) to so greatly impact the government as well as the medical field overall has not affect your ability to look at this issue unbiased is ludacris.

The positive effects of meditation have been extensively explored and supported by studies, and involves the additional positives of improved mood and overall psych health. I'm sure you are aware that a patients belief in their treatment significantly influences their response to treatment, his is basis of extensive neuroscience research into the mind body connection. So as long as the medicine is effective (and the best way for that to become possible is for proper training), who cares if it is only because someone believes it, why would you take that away just because you don't agree? Everyone has helath "beliefs" that affect their treatment just like religious beliefs, saying they aren't relevant only alienates patients.

I took this from a paper i wrote about helath beliefs while studying tibetan medicine in india:
The World Health Organization (WHO) defines health as, "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." Despite obvious attempt of the WHO constitution to make the definition universally applicable, each individual has their own unique characterization of it. .Every person has a "health belief" system in which they categorize health and illness, have explanations for illness, and define a scope for the practice of healers .(Bury, 1997)... This system is largely influenced by a person's society and personal experience such that, "the coherence of lay health beliefs…has to be set against their loosely organized and fluid character (Bury, 1997)." These beliefs are reflective of the influence that each persons' background has had, which results in people placing different emphasis on the medical, social, economic, spiritual, and other uncategorizable or unspecified components of health.
. The dynamic impacts of peoples' cultures on their views of health have been extensively researched. Health and illness are very personal experiences, yet each is molded and affected by the context in which they are experienced. While the symptoms and problems associated with illnesses remains essentially constant across cultures, the content of their expression is "influenced" or "shaped" by such culturally specific features as the prevailing explanatory models of illness, the experience of self and the organization of the health-care system (Radley, 1993). The evidence of this influence has been recognized by the Kleinman, Eisenberg, and Good's research, which describes illness as shaped, "..by cultural factors governing perception, labeling,..explanation, and valuation of the discomforting ..experience,..processes embedded in a complex ..family, social, and cultural nexus (1978)." ..Additionally, ..how we communicate about our health problems,..the manner in which we present our symptoms,..when and to whom we go for care, and how we evaluate that care are ..all affected by cultural beliefs (Petrie and Weinman, 1997). .

.The relevance of the differences found in people's health beliefs is unmistakably relevant to the delivering better health care. Based on studying healthcare in a variety of different cultures, In Cultural Diversity in Heath and Illness, Dr. Spector was able to conclude that health care providers can improve the quality of care they supply by being sensitive to the differing medical beliefs which result in health and illness norms that are often in conflict (1999). This was confirmed in a study about health care delivery which found that, "Physicians and patients often hold discrepant models of health and illness that may affect the effectiveness of communication during the clinical visit (Pachter, 1994)." By understanding what these differences are doctors and other health care provides may be able to tailor their treatment to each patient's health belief system and provide them with care that is not only more comfortable but more effective..

. Largely intrinsic in peoples' cultural concept are their religious and/or spiritual beliefs. As a result, religion has a significant impact on peoples' ideas about health, and thus their interactions with the medical system. Religion has been widely accepted as well as proven to help people understand the meaning of events, especially those which are painful, troubling or unexpected, as health problems tend to be; this can lead to using religious script to make sense of symptoms (Bearon and Koenig, 1990). Within the Judeo-Christian tradition of western culture, extremely prevalent in the United States, there is a prominent tendency to view death and illness as adventitious because of the tradition's definition of life as a "gift from God" to be cherished (Radley, 1993). Therefore it understandably follows that good health is interpreted as a blessing (Bury, 1997). .
.
...a national survey, which found that t..he majority of alternative medicine users pursue it not as a result of being dissatisfied with conventional medicine but largely because they.. found the health care alternatives to be more congruent with their own values, beliefs, and philosophical orientations toward health and life.. (Astin, 1998). ..Understanding these kinds of subtleties between groups is imperative to providing adequate care. ..The importance of respect for a person's beliefs was confirmed ..in a study of different ethnic groups in Sweden; Hjelm found that cultural and religious awareness are essential for understanding self-care practice and care-seeking behavior (2003)..

.Despite the multitudes of research supporting the idea that the belief of a patient affects health care's efficacy it is unclear and difficult to ascertain to what extent the average doctor accepts or is even familiar with the concept. ..Despite the lack of emphasis placed one belief there has been extensive research in the West of late exploring the significance of the mind/body connection...The most extensively researched example of the efficacy of belief in Western health care is the "placebo effect". Multiple studies have found that patients have a more positive or negative effect to the same treatment based purely on innocuous labeling or description of it (Branthwaite and Cooper 1981; Egbert, et al., 1964; Desharnais, et al., 1993). For example in a study conducted in China, people being treated for a variety of ailments died at higher rates when they believed in traditional Chinese medical theory's negative prognosis based on their birth dates. The death rate directly correlated with the amount of belief in the traditional system as measured by a survey (Phillips, Ruth, and Wagner, 1993). These and many other analogous studies imply a strong mind/body connection that has the potential to both improve and impair recovery and treatment..

Just an ignorant pre-med here but I know that IM will be a part of my practice in the future, but not (exclusively) for the reasons I gave above. I trust thousands of years of r&d over the ridiculously partial research we have today. I want to help people using all available information.

Edit: Lemme know if you want my sources.
 
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I believe alternative medicine represents a lifestyle judgement that you do not agree with and thus can't accept. Many countries with a greater amount of "alternative" medicine are much healthier than we are as a nation.


Well.... Communication is an extremely important part of the practice of Family Medicine. Cultural and religious literacy is integral to that communication.

If being sensitive to my patient's beliefs and recommending a balanced low calorie diet with exercise to my patients makes me an integrative physician, then I'm already there.

I'm even a fan of meditation. It's definitely safe and tolerable. The price is right. There's even some evidence that it's effective. Good luck getting your patients to buy in though.

I agree with a few of your points, but your post doesn't at all address the statement you quoted.

I want evidence that these alternative treatments have a risk to benefit ratio that is better than allopathic medicine. I have personally seen some of the harm caused, but I have not seen the benefit.

A powerful placebo affect does exist. But when that is taken away by a blinded study, most of these things don't show much of a benefit.

It's been stated several times during this thread that not enough research dollars have been devoted to alternative therapies. That may be true, but there is still a suprising amount of research out there. It generally is not supportive. In the cases that it does support the "alternative" therapy, it is no longer alternative. I write a script for niacin or fish oil at least daily.

Again, I'm not saying all alternative therapies are bad. It's just that you have to wade through so much crap. The Ming the Merciless looking guy that claims all illness is caused by forty pounds of toxins in the colon and the Al Sharpton guy that claims barley will cure "the cancer" (I will admit that beer does usually make things better) are prime examples. When you show me evidence that ground walrus penis is safer and more effective than viagra for treatment of ED, I'll start recommending it to my patients.

As far a thousand years of R+D... remember to document informed consent before you bleed the evil humors from your septic patients.
 
No question that there are a massive number of alternative medicine "therapies" that are just junk. However, there are plenty of promising non-drug treatments that have been studied, but most need further research to become mainstream. Of course, much of what allopathic medicine ignores or gets wrong is on the prevention side, which is another issue entirely.

There is a tremendous bias against non-mainstream therapies. For example, everyone probably hears in medical school or elsewhere that there is no strong evidence for therapeutic benefits from vitamin C, and that megadoses mostly end up in the urine (the implication being you are wasting your money for nothing). First of all, any drug that is excreted renally likewise could be said to "just give you expensive urine." This ignores the fact that a 3g dose of vit C does in fact lead to a higher plasma concentration than a 500mg dose. The fact that a greater proportion of the 3g dose will end up in your urine is immaterial, especially given how cheap vitamin C is. Could even have the "side effect" of preventing UTIs.

I don't agree with wild claims that vit C is a panacea, but I think we should be more open to its potential medical uses. There have been several extremely promising studies (including a couple in PNAS recently) that showed that IV ascorbate was selectively toxic to cancer cells in vitro and in vivo. Unlike most chemotherapeutic agents, however, ascorbate is utterly harmless to normal cells. Despite the great potential for cancer therapy, there hasn't been much action on clinical trials. Why? Vitamins are not patentable, thus private funding is hard to come by. It's just sad.

To extend my example to the issue of safety, vitamin C (as all vitamins) is extremely safe. Even vitamin A, the vitamin with the greatest risk of toxicity, is much safer than most drugs. Recent data shows there were no deaths attributable to vitamins or minerals, which is remarkable considering over half of Americans use supplements.

I am 100% in agreement that any therapy put into practice needs to have a strong foundation in science, and evidence to support its clinical use. But to write off all "alternatives" to mainstream medicine is foolish. Keep in mind that lack of evidence of benefit is very different from evidence of no benefit. We can't say that any treatment that is not supported by loads of RCTs is worthless—to do so is to ignore everything upstream that determines which treatments get researched and put into use. And that comes down to money.

The bottom line is we need more government funding of objective research on non-drug therapies! The pharmaceutical industry is one of the most profitable industries in America, with 20% of revenue as profit. That is obscene, given the health care crisis in this country. We can't let such a powerful, profit-driven industry dictate what is good medicine.
 
No question that there are a massive number of alternative medicine "therapies" that are just junk. However, there are plenty of promising non-drug treatments that have been studied, but most need further research to become mainstream. Of course, much of what allopathic medicine ignores or gets wrong is on the prevention side, which is another issue entirely.

There is a tremendous bias against non-mainstream therapies. For example, everyone probably hears in medical school or elsewhere that there is no strong evidence for therapeutic benefits from vitamin C, and that megadoses mostly end up in the urine (the implication being you are wasting your money for nothing). First of all, any drug that is excreted renally likewise could be said to "just give you expensive urine." This ignores the fact that a 3g dose of vit C does in fact lead to a higher plasma concentration than a 500mg dose. The fact that a greater proportion of the 3g dose will end up in your urine is immaterial, especially given how cheap vitamin C is. Could even have the "side effect" of preventing UTIs.

I don't agree with wild claims that vit C is a panacea, but I think we should be more open to its potential medical uses. There have been several extremely promising studies (including a couple in PNAS recently) that showed that IV ascorbate was selectively toxic to cancer cells in vitro and in vivo. Unlike most chemotherapeutic agents, however, ascorbate is utterly harmless to normal cells. Despite the great potential for cancer therapy, there hasn't been much action on clinical trials. Why? Vitamins are not patentable, thus private funding is hard to come by. It's just sad.

To extend my example to the issue of safety, vitamin C (as all vitamins) is extremely safe. Even vitamin A, the vitamin with the greatest risk of toxicity, is much safer than most drugs. Recent data shows there were no deaths attributable to vitamins or minerals, which is remarkable considering over half of Americans use supplements.

Tell that to John McCain, who has that kooky legislative proposal to restrict supplements. I think we as a country have a few more pressing issues than limiting nutritional supplements.

I am 100% in agreement that any therapy put into practice needs to have a strong foundation in science, and evidence to support its clinical use. But to write off all "alternatives" to mainstream medicine is foolish. Keep in mind that lack of evidence of benefit is very different from evidence of no benefit. We can't say that any treatment that is not supported by loads of RCTs is worthless—to do so is to ignore everything upstream that determines which treatments get researched and put into use. And that comes down to money.

The bottom line is we need more government funding of objective research on non-drug therapies! The pharmaceutical industry is one of the most profitable industries in America, with 20% of revenue as profit. That is obscene, given the health care crisis in this country. We can't let such a powerful, profit-driven industry dictate what is good medicine.

And yet it does and will continue to do so. At the end of the day, money talks. I have no confidence that this will ever change.
 
Money will always talk, but it's not the only voice. One would hope that as science advances onward, truth will win out over self-interest of those in power, slowly but surely. Better education, easier access to information, and greater transparency can go a long way toward this goal. I'm encouraged by recent efforts to limit the pharmaceutical industry's reach, which are raising awareness at the very least.
 
Again and again you guys mention this conspiracy by the pharmaceutical industry.... Sure, they've done lots of dirty things. Neurontin is a great example. It was developed as a seizure drug, but it didn't work all that well. The pharma company then basically marketed it off label as a treatment for everything else. However, no one is willing to admit that there is just as much of a conspiracy in the alternative medicine industry. The natural cures guy is a convicted felon. The majority of claims range from gross exaggerations to flat out lies.
 
The bottom line is we need more government funding of objective research on non-drug therapies!

Why should the government fund it? They don't fund pharmaceutical research.

The burden of proof is with the manufacturer.
 
Why should the government fund it? They don't fund pharmaceutical research.

The burden of proof is with the manufacturer.
Pharmaceutical companies benefit from the discoveries of government funded research.
 
Again and again you guys mention this conspiracy by the pharmaceutical industry.... Sure, they've done lots of dirty things. Neurontin is a great example. It was developed as a seizure drug, but it didn't work all that well. The pharma company then basically marketed it off label as a treatment for everything else. However, no one is willing to admit that there is just as much of a conspiracy in the alternative medicine industry. The natural cures guy is a convicted felon. The majority of claims range from gross exaggerations to flat out lies.

The natural cures guy? So one scumbag tarnishes all of CAM/integrative medicine? I don't think so.
 
Pharmaceutical companies benefit from the discoveries of government funded research.
It's true, pharm companies fund a lot less of the R&D than they'd like you to think. Blue Dog, my point is that the government should fund all of this research, including drug and non-drug therapies, simply because we can't trust profit-driven groups to put out unbiased research. Study after study has shown that there is a significant bias in research that is funded by industry. If we're interested in improving our patients' health, we need research we can trust.

Excellent book on the topic by the former editor in chief of NEJM.

EdibleEgg said:
Again and again you guys mention this conspiracy by the pharmaceutical industry.... Sure, they've done lots of dirty things. Neurontin is a great example. It was developed as a seizure drug, but it didn't work all that well. The pharma company then basically marketed it off label as a treatment for everything else. However, no one is willing to admit that there is just as much of a conspiracy in the alternative medicine industry.
I didn't mention a conspiracy. I don't think the CEO of Pfizer sits down and says, "let's see, how can we defraud the medical community and the public today?" There is no person or group at the helm of grand scheme. Instead, it's the result of a combination of insidious factors that have developed over the past several decades. As the system works now, it rewards exaggeration of drug benefits, minimization of side effects, and obfuscation of the real goals to improve health. For example, ezetimibe (Zetia) has never been shown to improve any outcome except cholesterol reduction, which is merely a secondary endpoint. The drug does not decrease mortality or coronary events, but that is exactly how it is marketed. The FDA should not have allowed it to be released without evidence of clinically meaningful benefit.

As stated previously, I agree that many alternative treatments are completely bogus and rip off people who don't know better. What I'm calling for is a central, independent source of funding for health sciences research that we can trust. It already exists (NIH) but its role needs to increase, and we need well-conducted, objective research to explore non-conventional treatments—and conclusively reject those that don't work.
 
I didn't mention a conspiracy. I don't think the CEO of Pfizer sits down and says, "let's see, how can we defraud the medical community and the public today?" There is no person or group at the helm of grand scheme. Instead, it's the result of a combination of insidious factors that have developed over the past several decades. As the system works now, it rewards exaggeration of drug benefits, minimization of side effects, and obfuscation of the real goals to improve health. For example, ezetimibe (Zetia) has never been shown to improve any outcome except cholesterol reduction, which is merely a secondary endpoint. The drug does not decrease mortality or coronary events, but that is exactly how it is marketed. The FDA should not have allowed it to be released without evidence of clinically meaningful benefit.

As stated previously, I agree that many alternative treatments are completely bogus and rip off people who don't know better. What I'm calling for is a central, independent source of funding for health sciences research that we can trust. It already exists (NIH) but its role needs to increase, and we need well-conducted, objective research to explore non-conventional treatments—and conclusively reject those that don't work.

Its funny you should mention Zetia. I just went onto that website and had a look around. Nowhere on the main page does it mention any cardiovascular benefits. In fact, on the "Cholesterol Basics" page I found the following in large bold print, "Unlike some statins, ZETIA has not been shown to prevent heart disease or heart attacks."

The FDA allowed it to be released because it does exactly what it says it does, lower LDL.
 
Its funny you should mention Zetia. I just went onto that website and had a look around. Nowhere on the main page does it mention any cardiovascular benefits. In fact, on the "Cholesterol Basics" page I found the following in large bold print, "Unlike some statins, ZETIA has not been shown to prevent heart disease or heart attacks."

The FDA allowed it to be released because it does exactly what it says it does, lower LDL.

That's the point, Pharma has also convinced us to buy things they don't need. Has our mental health really improved with all the drugs we've been giving our kids and ourselves? In fact they haven't even been provig that what they are doing isn't causing more harm in many cases. It is all very irresponsible and the medial community and govt are eating it up.
 
Its funny you should mention Zetia. I just went onto that website and had a look around. Nowhere on the main page does it mention any cardiovascular benefits. In fact, on the "Cholesterol Basics" page I found the following in large bold print, "Unlike some statins, ZETIA has not been shown to prevent heart disease or heart attacks."
Obviously the website has a statement after the controversy that erupted in the last two years. If you watch the original Zetia ads, they do not mention that inconvenient fact.

The FDA allowed it to be released because it does exactly what it says it does, lower LDL.
You missed my point. Why should I spend a lot of money (on a relatively new drug with unknown long-term safety) to lower my LDL if the drug hasn't been shown to actually improve my health? LDL is just a lab value. If I get an MI, who cares what my LDL was?

A 2009 trial published in NEJM compared ezetimibe + statin to extended-release niacin + statin. Both lowered LDL. Niacin reduced artery wall thickness, but ezetimibe increased artery wall thickness. Bad news.
 
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