Healthy Alternate to Health Care

A recent editorial in the New England Journal of Medicine attacking alternative medicine in general and herbal remedies in particular did little to restore confidence in practitioners of conventional medicine. No informed consumer would reject conventional medicine or replace it with unproved therapies. But more of us--a recent national survey conducted by Stanford University indicated as many as 70% of us--are using treatments other than standard drugs and surgery.

The reasons for the trend are obvious: Patients want physicians who do not push drugs and surgery as the only available therapies, are conversant with nutritional influences on health, can answer questions about dietary supplements, understand mind-body interactions, look at patients as more than physical bodies and will not ridicule them for wanting to try a Chinese herbal treatment or biofeedback or other alternative therapies. Those are reasonable demands, but our medical schools are not producing such physicians.

To start with, the term “alternative medicine” should be retired. What an increasing number of physicians like me want to do is to broaden the horizons of medical education, research and practice by integrating ideas and methods not currently taught in medical schools. “Integrative medicine” is a much better term for this movement.

The University of Arizona, where I now teach, has begun an integrative medicine program, and a number of other schools have recently announced similar initiatives, among them Duke University, Stanford, UC San Francisco and Jefferson Medical College in Philadelphia. These institutions are committed to scientific method and to evidence-based medicine as well as to bridging the gap that has grown between consumers of health care and conventionally trained doctors.

With regard to herbal medicine, the authors of the New England Journal’s editorial rightly questioned the quality of products sold in health food stores. Recent surveys show that most brands of St. John’s wort lack activity and that a quarter of Chinese patent “herbal” medicines may be adulterated with strong pharmaceutical drugs. This must change. Even if medical schools begin teaching the basics of botanical medicine, doctors are not going to use it until they have the same confidence in herbal products that they now do in pharmaceuticals. The Food and Drug Administration needs to create a new division of natural therapeutics to regulate herbs, vitamins, minerals and other dietary supplements.

But when medical bureaucrats say that herbal medicine per se is dangerous, they are on shaky ground. First, they use rare reports of toxicity to make their cases, just the sort of “anecdotal evidence” they deride proponents of alternative medicine for using. Second, they are throwing stones in a most vulnerable glass house; herbal toxicity pales into insignificance next to the everyday calamities caused by pharmaceutical drugs. As many as 100,000 deaths a year and 1.5 million injuries that are serious enough to require hospitalization are caused by prescription drugs.

Of all the assertions in the New England Journal’s editorial, the one I find most irritating is that alternative medicine “has not been scientifically tested and its advocates largely deny the need for such testing.” The problem is that medical scientists with money and facilities for research have not shown the least interest in natural products or mind-body interventions because they are trained in an educational system that taught them nothing about such things. Give those of us who support such methods the money and means to conduct research, and we will do it. In fact, at last, in response to consumer interest, some research funds are beginning to trickle into university medical centers to test unconventional therapies, but the necessary changes in medical education are barely being discussed.

Bureaucrats can grumble all they like, but medical schools are going to change, a new generation of broader minded-physicians is in the works and the sea change that has occurred in the public’s view of conventional medicine is not going to reverse itself.