Great Smokies Medical Center of Asheville

Archive for the ‘Alternative Medicine’ Category

Blinded By Double-Blind Scientific Studies

Monday, September 12th, 2005

Evidence-Based Medicine (EBM) is the latest buzzword used to describe an emerging model of healthcare that advocates applying data from scientific double-blind studies to "real" patients in clinical practice.
The double-blind study, the gold standard of scientific research, is a process by which two similar groups of people are studied. One group is given an actual treatment, while the other is given a placebo or "sugar pill." Neither participants nor researchers know which group is which until after the study is completed, hence the term "double-blind."
Proponents of EBM believe that applying research in practice will result in better treatment outcomes.
However, some physicians have concerns about applying scientific research data in their practices. They recognize the limitations of scientific research and thus don’t want to risk over-reliance on it, because doing so could expose their patients to both known and unknown risks.
What are some of the limitations of scientific research?
For starters, study participants may not be representative of people who will be likely to take the drug in real life. Study participants may be younger or healthier, and elderly or sick people do not respond to drugs in the same way their younger, healthier counterparts do.
Also, considering the potential for huge profits in drug sales, the pharmaceutical industry’s funding of research has been shown to buy biased results that, in the opinion of some, resemble paid advertising more than scientific research.
Additionally, even in the most scientifically-sound studies, group statistics do not apply to individuals, because people aren’t test subjects, but are complex and dynamic individuals.
Furthermore, contractual agreements between clinical researchers and drug companies can take away the scientific independence of researchers and tie their hands from freely reporting unfavorable data.
Also, the very treatment a patient needs may never be researched. For instance, natural substances cannot be patented and thus don’t have the potential to produce the huge profits necessary to recover research costs, which are routinely in excess of $300 million.
The reliability of scientific research is regularly questioned. Many drugs have passed rigorous scientific studies and clinical trials and gained FDA approval only to be taken off the market because of side effects that became apparent only when the drug was given to "real" patients. Indeed, there is less risk when taking "tried-and-true" drugs that have withstood the test of time than there is from taking newer drugs that have been in the marketplace for only a short time. According to a report released by the General Accounting Office of the U.S. government in 1990, of the 198 drugs that the FDA approved between 1976 and 1985, a staggering 52 percent proved to have “serious post-approval risks.”
Practicing doctors can end up being spoon-fed whitewashed research data, unwittingly becoming the third "blinded" group.
Historically, most major advances in medicine have not resulted from scientific research, but instead from reasoning of individual physicians’ basic observations of the patient and his disease.
Throughout history, the real movers and shakers in medicine have been free-thinking individuals who were unbound by the influence of research money and restrictive political-based regulations.
What’s a patient to do? Cautiously walk, don’t run, toward the latest research. Get second, and third, opinions when needed. Go to physicians who practice integrative medicine, who utilize treatments other than drugs, who get to know their patients as individuals, and who value both the science and the art of medicine.

Creating a Healing Environment

Monday, September 12th, 2005

Advances in physical sciences in the last 150 years have led to the human body being viewed as a collection of parts. That view has, in turn, led to medical specialization that treats only certain parts of the body (eye doctors, heart doctors, skin doctors, etc.) and the surgical removal or transplantation of parts. Though this mechanistic view plays a very important role in modern medical treatment, it came into existence only very recently in a long, rich history of healing arts and veers from ancient wisdom in which the body, mind, and spirit were all integral parts of healing.
As a result, nurturing the body, mind and spirit is more relevant now than ever for a person trying to heal from illness.
Paying attention to environments in which you feel good and want to linger can help you define environments that can help facilitate your healing. Symbols of nature are often present in healing environments in the form of sounds, breezes, sunshine, plants, flowers, stars, trees, and vistas. Humor, music, art, photography, and books can also nurture the mind and spirit, as can colors, lighting, and smells. Attention to what you eat and the physical and emotional environment in which you eat can all contribute to healing. Cleanliness, tidiness, and an environment free of chemical exposures all contribute to making a home conducive to the practice of spiritual practices including prayer, contemplation, or meditation.
Internal dialogue and emotions can either contribute to or detract from a healing internal environment. Scientific research of the body’s physiological changes has shown powerful correlations between thoughts, emotions and the physical body. This research has blurred any perceived barriers between body, mind and spirit. As such, awareness of your negative self-talk and feelings and changing them, if need be, toward a more supportive, positive tone can contribute to your healing.
Even seemingly small changes in your internal or external environments can facilitate healing in surprisingly profound ways as they tap into your inherent ability to heal.

Functional Symptoms vs. Organic Disease

Monday, September 12th, 2005

Many, if not most, health complaints are termed functional, meaning that no known associated organic or pathological tissue changes can be found by the physician investigating possible causes of the symptoms. Functional symptoms can include headaches, fatigue, insomnia, irritability, abdominal pain, indigestion, low back pain, or simply not feeling well.
Organic or pathological disease are terms used to describe more advanced stages of disease that are accompanied by physical, cellular changes that can be identified by diagnostic testing. Examples of organic diseases include cancer, arthritis, heart disease, gastric ulcers, and emphysema.
Too often, diseases are diagnosed when they are more advanced, end-stage organic diseases. On the other hand, functional complaints can be too easily brushed aside by busy doctors who have an ever increasing number of drugs available to them that suppress functional symptoms—an approach that has been likened to covering up a car’s "check engine" light. People with functional complaints may feel frustrated when their doctor tells them that all their tests are normal. Doctors who are unable to establish physical evidence of organic disease may determine, rightly or wrongly, that the symptoms have psychological origins.
Holistically-oriented doctors find a patient’s reporting of functional symptoms, particularly when woven into the fabric of that patient’s life story, to be an opportunity to shed light on the earliest origins of disease.
Understanding the root causes of functional symptoms rather than suppressing them with drug therapies is one of the foundations of preventive healthcare.
When functional symptoms are understood by physicians who have a working knowledge of health in addition to knowledge of disease, a customized strategy for disease prevention can be developed.

Prevention Strategies in Mainstream and Alternative Medicine

Monday, September 12th, 2005

Is the time-tested adage "An ounce of prevention is worth a pound of cure" relevant in the discussion of disease prevention? The answer is a loud and clear "Yes!"
Prevention in a mainstream medicine model includes accident prevention (e. g. wearing seat belts, preventing falls), screening elevated blood pressure and blood sugar, weight normalization, smoking cessation, regular exercise, vaccinations, avoiding excess alcohol, cancer screening (breast exams, mammograms, PAP smears, prostate exams, PSA tests, colonoscopies, skin checks), diabetes screening, avoiding excessive sun exposure and using sunscreens.
The word prevention is often used in the mainstream medical model when the term early intervention would be more accurate. For instance, mammograms do not prevent breast cancer and PSA tests do not prevent prostate cancer. Regardless, early diagnosis and intervention are critical to tip the odds toward successful treatment outcomes.
The discriminating consumer of healthcare is advised to keep an eye to the horizon for changes in these recommendations that may accomplish even earlier identification of disease more effectively and with less risk. For example, radiation exposure to the breast from annual mammograms can be greatly reduced by utilizing thermograms for breast cancer screening with occasional mammograms when indicated.
In contrast to the mainstream medical approach that uses knowledge of disease, holistically-oriented physicians use their knowledge of how the body naturally attains and maintains health (homeostasis) to develop health maintenance strategies that help promote the body’s optimal function as a means to prevent or delay the onset of disease.
What are the causes of disease from a natural, holistic viewpoint?
Any situation that results in abnormal function of the body’s cells has the potential, over time, to result in organic disease. Some of these causes cannot be modified, including certain genetic diseases such as Huntington’s Disease, Achondroplasia (dwarfism), Sickle Cell Anemia, etc. However, most genetic contributors to disease, though less well-known than these dramatic conditions, are genetic glitches that require environmental triggers to manifest health problems including heart disease, osteoporosis, and immune system-related problems. The risk from these glitches can be modified by targeted nutrient therapies.
Environmental, biological and metabolic triggers of disease include infections, infestations, malnutrition, toxins, emotional shock, injury, and stress.
In addition to using the mainstream medical model, prevention in a holistic medical model also includes assessment of: digestion (Are hydrochloric acid, digestive enzymes, and friendly gut bacteria deficient?), nutrient adequacy (Are nutrient deficiencies perpetuating symptoms?), toxic influences on health (Are chemicals and heavy metals interfering with optimal functioning?), detoxification capacity (Are environmental toxins interfering with normal function?), diet (Is the diet nutrient-dense or nutrient-sparse?), effects of chronic low-grade infections and infestations on immune health, hormonal deficiencies and imbalances, dental interferences to general health (Are dental material incompatibilities, cavitations or mercury amalgams obstructing health?), and the health consequences of trauma, emotions, and stress (Is your autonomic nervous system functioning on tilt?).
Disease prevention is best accomplished by defining and addressing contributors to disease, often accomplished through common-sense lifestyle and diet changes.

What is Alternative Medicine?

Monday, August 22nd, 2005

by Dr. John L. Wilson, Jr.

Alternative medicine is best defined by understanding some of the principles that guide it. In contrast to “conventional” medicine, which is based on the knowledge of disease and specializes in the use of drugs and surgery to treat disease, “alternative” medicine focuses on identifying factors that promote health, removing obstacles to health, and recognizing the ability of the body to heal itself, given the proper environment to do so. Conventional medicine shines in the treatment of trauma. Alternative medicine advocates prevention and early intervention, and may include nutrition, herbs, lifestyle modification, homeopathy, and a variety of other treatments intended to optimize function.

Alternative doctors encourage patients to be informed and involved in their own health care, knowing treatment outcomes are improved by doing so. Alternative doctors see a person holistically. As such, an alternative doctor may find that arthritis is caused by a diseased tooth, fatigue is caused by heavy metal toxicity, or a rash is caused by malnutrition. The impact of emotional states on health is also recognized. Every thought or emotion has a bio-chemical consequence in the physical body, and if an individual’s thoughts are habitually worrisome or angry the body can suffer.

Knowing that the complexity of a person cannot be fully understood in scientific double-blinded studies, alternative doctors also give credibility to knowledge gained by observation . . . so-called empirical or anecdotal evidence. Common sense and intuition can complement knowledge gained from scientific research. For example, Africans knew the relationship between mosquitoes and malaria for centuries, while the English believed malaria was caused by “bad air.” Observation and experience provide valid, useful information and are an essential part of a good medical practice.

Drugs represent hope for many and are used in most alternative doctors’ practices, but seldom as a first choice for a chronic health problem, or as a tactic to suppress symptoms if other approaches can correct the underlying problem. Many diseases are termed “idiopathic,” meaning the cause has not been determined. Alternative doctors presume that everything is caused by something, and strive to identify the causes of symptoms. Symptoms are the language spoken by our bodies, and striving to interpret what symptoms mean, rather than hiding them with drugs, is essential. If the causes of illness can be understood and addressed, symptoms diminish and drugs may be unnecessary.

Disease is like a polluted river. You float along, oblivious to the pollution until the first symptoms of disease occur years, even decades, after the disease process has silently started. By the time you are thrown a lifeline or crawl ashore, your health may be severely compromised. By being aware of what is going on in your body, you can identify subtle symptoms that are “early warning signs.”

Just as each person is unique, alternative medicine approaches are individualized. Understanding both inherited and acquired disease risks of an individual is important in determining the best approach for them. One size does not fit all. Depending on the condition, roughly 20 to 40 percent of disease risk is genetic . . . the lion’s share is due to the impact of the environment and lifestyle. Alternative doctors look closely at a person’s environment and understand the role it plays in disease. Lifestyle choices are the overriding influence on health and on disease.

Ultimately, alternative medicine attempts to evoke a healing response using the least invasive and safest approach possible.

A Brief Political History of Modern Medical Practice

Monday, August 22nd, 2005

by John L. Wilson, Jr., M. D.

Modern healthcare in the United States has come a long way since its homespun origins in the 18th century. The evolution of our healthcare system has been strongly influenced by not only scientific advances, but also by many non-medical historical and political events. Because healthcare is among the most regulated industries in the world, politics and medicine will continue to be strange bedfellows in the foreseeable future.

The history of the influences that define medical practice involves the usual players: money, power, and politics. Understanding some of the political influences may help shed light on the good, the bad, and the ugly of our present-day healthcare system and the prevailing attitudes that many physicians and consumers have developed toward alternative health practices.

I would like to take a look at the intended and unintended impact that the following events have had on our healthcare system:

    • The formation of the American Medical Association in 1847
    • The release of the Flexner report in 1909
    • The discovery of penicillin in 1928 and sulfa drugs in 1935
    • The regulation of healthcare by the government and professional boards
    • The passing of the Kefauver Harris Amendment in 1962
    • The establishment of Medicare under the Social Security Act in 1965
    • The increasing dominance of the pharmaceutical industry in healthcare

    The present-day outcomes of these events could not have been anticipated and, not surprisingly, resulted in coming full circle and rediscovering the values inherent in our medical roots.

    Doctors didn’t have any licensure requirements mandated by the government or professional boards at the start of the 19th century, a time when a person who had a calling to be a doctor received his medical education largely through apprenticeship. Doctors often worked in their communities in other capacities, such as judges or merchants, stopping to perform surgery or other riskier interventions when the treatments available through the primary healthcare of the day, midwifery or herbalism, failed to solve the problem at hand.

    Medical societies formed in the early 19th century, and the dues-paying members eventually proclaimed themselves able to pass judgment on the competence of others in and out of the societies. The American Medical Association (AMA) was founded in 1847. By 1900, most states had licensing boards. These boards were, at that time, generally inclusive and tolerant of all types and methods of medical practice – – homeopathy, herbal medicine, midwifery, surgery, etc.

    Then came the Flexner Report. Abraham Flexner was a high school principal hired in 1909 by the Carnegie Foundation to do a study of American medical education. Rumor had it that he had never set foot in a medical school prior to visiting 69 medical schools in 90 days to gather data. Many felt that the resulting Flexner Report was permeated by unfair bias from the influence of its underwriters: the American Medical Association, the Carnegie Foundation, and the Rockefeller General Education Board.

    Regardless, the Flexner Report became a roadmap for the future of American healthcare, and several changes occurred as a direct result. Larger, moneyed institutions became the preferred source of medical education, replacing apprenticeship (at a time in history when people lived in rural areas and seldom traveled). States’ authority through licensure and the establishment of medical boards grew to have more influence. The centuries old healing modalities of homeopathy and herbalism were nearly eliminated through funding that favored their allopathic counterpart, a move that implied (to the public) an “official” lack of approval of the former and sanction of the latter. Seven minority (black and women) medical colleges of the day closed within three years of the release of the Flexner Report. A cottage industry style of healthcare became a corporate style dominated by white males.

    In recent decades, medical education is coming full circle to rediscover value in its rural roots. Apprenticeship, now renamed preceptorship, has helped to attract and keep physicians in rural communities that routinely suffer from physician shortages. Once again it is considered worthwhile to become educated in the art and science of medicine at the side of an experienced physician. In addition, gender bias in selecting medical school applicants has decreased, reflected by the fact that in 1999-2000, 46 percent of entrants in US medical schools were women.

    Throughout history, bacterial infections have plagued civilization. For millennia, people lacked scientific understanding of the cause and method of transmission of infectious illnesses and, as a result, superstitious explanations surfaced in an attempt to understand why some people got sick and died and others didn’t.

    Two scientific discoveries in the early 1900s that resulted in treatments for infections greatly affected the future of healthcare. The hope felt as a result of the discovery of penicillin in 1928 by Alexander Fleming, a British bacteriologist, and the discovery of sulfa drugs in 1935 by Gerhard Domagk, a German physician, strongly influenced the practice of medicine. Indeed, many lives that were previously doomed to end prematurely from bacterial infections were spared.

    However, nobody anticipated the ability of bacteria to develop resistance to antibiotics. As the limitations of antibiotics have become apparent in recent decades, healthcare practitioners who are aware of nutrition’s ability to enhance the body’s natural resistance to infections are using strategies that are reminiscent of the way our farm-based predecessors ate: organic, fresh, seasonal, whole foods. Diet and its modern counterpart, supplemental nutritional therapy, are again being used as a strategy to improve people’s ability to resist infections.

    During the late nineteenth and twentieth centuries, scientific advances quickly prevailed over the art of medicine. But, patients, and some physicians, still know that well-indicated treatments delivered artfully in a context of understanding, hope, and encouragement are more effective than treatments delivered in a more technical style characteristic of a research scientist. A good bedside manner goes a long way toward creating a context that enhances the likelihood of healing.

    State medical boards were formed with the intention of using uniformity in medical practice to ensure quality, not considering the possibility that uniformity would lead to conformity, which ultimately risks ensuring the status quo. The regulation of medical practice has important benefits, including helping to assure consistency of medical education and competency of practitioners. However, the authority given to regulatory agencies, like any authority, has the potential to be misused. State medical boards are charged with protecting the citizenry from charlatans, hucksters, and various sellers of snake oil. But, a narrow, biased, or uninformed interpretation of charlatanism by state medical boards can increase the risk that intelligent, proactive citizens will be denied access to the kind of healthcare they desire. Regulatory oppression of ideas that oppose prevailing medical customs has resulted in the limitation of access to treatment, a difficult pill to swallow for a person who values the freedom to choose his own healthcare options.

    Once again, in recent decades, we seem to be coming full circle. Consumer interest in alternative medicine harkens back to practitioner-based healthcare in contrast to our present-day corporate-based healthcare. Grass root legislation has mandated that several state medical boards protect the access of their citizens to alternative medical therapies. This interest in alternative therapies is driven, in large part, by increased awareness of the dangers of a predominantly drug-based and increasingly invasive healthcare system.

    A medical tragedy occurred in Europe in the 1950s that spawned legislation that would forever change the practice of medicine in the United States. The drug thalidomide, used to treat nausea of women in the first trimester of pregnancy, resulted in severe birth defects, typically absent or malformed limbs, in the exposed fetuses. In 1962, in an effort to prevent another similar disaster in the wake of the thalidomide disaster, the U. S. Congress passed the Kefauver Harris Amendment that required pre-market approval for drugs.

    The dominance of drugs as a first line approach for health problems has increased the possibility of a patient being harmed by healthcare. Medical doctors today are expected to keep up with a rapidly changing and growing body of scientific information. Continuing medical education of doctors is largely accomplished through attending seminars that are sponsored by pharmaceutical companies in exchange for the opportunity to expose attendees to their latest miracle drug. Professional medical journals are full of pricey, glossy, multi-page advertisements designed to sell drugs. Television advertisements penetrate targeted healthcare consumer groups in carefully choreographed sales pitches that rapidly blur over significant side effects of the drug being promoted. Such advertising has the potential to over-expose physicians and healthcare consumers to new drugs whose safety has not yet been established.

    In 2000, Prilosec was the world’s top selling medication with annual sales of $4.6 billion. Lipitor, a cholesterol-lowering drug, was the second best seller at $4.1 billion. All cholesterol-lowering drugs combined accounted for more than $12 billion dollars in annual sales. Can you say, “overdose?”

    The prestigious British journal, The Lancet, in January of 2003 found pharmaceutical advertising to be “misleading.” If you need a drug, you may well be safer with an older one with a proven track record.

    In 1965, another event strongly influenced the delivery of healthcare in the United States: the signing of Medicare into law. It was the culmination of 20 years of debate started by President Harry S. Truman who recognized the need for recipients of Social Security to have access to affordable healthcare during their retirement years. Since then, the federal legislature has enacted several Medicare laws, including authorizing Medicare payments to HMOs in 1972, authorizing routine mammogram reimbursement by Medicare in 1988 (an economic advantage for radiologists), and establishing a fee schedule, implemented in 1992, that limited Medicare reimbursement paid to physicians.

    Fee schedules require any participating physicians who treat Medicare enrollees to accept federal reimbursement even if it is below their actual cost of providing the service and to agree not to bill the patient for the difference. As a result, many physicians have had to limit the services they offer to Medicare patients, or work within the system by seeing an increased volume of patients for shorter and shorter periods of time to make up for their inability to bill appropriately. As a result, many patients feel that they are but cows in a system of cattle chutes. Removing free enterprise from doctors (or plumbers, merchants, mechanics, or any trade) removes incentive. A lack of incentive in a service-based profession translates to consumer and provider dissatisfaction.

    The bottom line of the cumulative effect of these political events is that many physicians and consumers are concerned about the resulting medical-pharmaceutical-industrial-insurance complex that is part and parcel of healthcare in the United States.

    How do we go about coming full circle once again and reclaiming our legacy of practitioner-based healthcare?

    Patients and physicians can become informed about the strengths and liabilities of our present healthcare system. Understanding the limitations of drugs to satisfactorily address our nation’s chronic health problems, the effects of regulation on the erosion of healthcare choices, the inability of the federal government to meet all the healthcare needs of its enrollees, and the impact of stripping free enterprise from healthcare providers, are philosophical stepping stones along the path of change.

    What can a concerned healthcare consumer do? Seek out physicians who can think outside of the box (just in case the solution they need isn’t in the box), who are interested in finding the cause of symptoms, who do not use drugs as a first line approach, who are educated in the treatment of health problems in methods that avoid or minimize drug use, and who are self-empowered to make healthcare decisions independent of politically-based expedience to best serve their patients.

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