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by Judy Gerstel
We're on the brink of going back to the
future in medicine.
Stem cells, genes and transplants are
getting the headlines, but the bigger story may be that medicine
is advancing beyond the biomedical model and embracing medical
pluralism.
The overwhelming trend is the
integration of orthodox medicine, defined by its
pharmaceuticals and invasive techniques, with other ancient,
old-fashioned and unconventional healing practices.
The future
of medicine, it seems, is not
only in the high-tech laboratory and the surgical suite but
also on the NST and massage tables, at the herbalists and
the health food store, behind the therapist's closed door,
but most especially in the cerebral hemisphere ã the
mind.
This week's edition of Annals Of Internal
Medicine, the August journal of the conservative American
College of Physicians-American Society of Internal Medicine,
kicks off an unprecedented series on complementary and alternative
medicine.
And they take the subject seriously, referring
to "postmodern medical diversity." It's probably
the first time that Haitian "vodun", hair analysis,
crystals, magnets and charismatic healing have all been mentioned
without derision in the pages of Annals.
Authored by David Eisenberg, MD, and Ted
Kaptchuk, OMD (Doctor of Oriental Medicine) of Harvard Medical
School and its division of complementary and integrative medical
therapies, the series considers everything from acupuncture
to iridology to chicken soup to Reiki to vitamins to "ethno-medicine."
"The alternative medicine `boom'
is not new," Kaptchuk says. "What's new is that
orthodox medicine has abandoned
the crusade against alternative medicine and is
trying to accommodate widespread patient belief and acceptance
of these practices."
MDs are unlikely to suddenly start recommending
copper bracelets to combat arthritis or stopping a nosebleed
by placing a a red string around the neck, but they are acknowledging
that a patient's belief
in healing properties may be just as powerful in
many medical situations as the interventions of the physician.
In this week's issue of the journal Science,
there's stunning testimony from University of British Columbia
researchers about how the
mind can heal the body. Their study suggests that the
placebo effect in Parkinson's disease produces the same neurological
outcome as active drugs used to treat Parkinson's: an increase
in dopamine release by neurons impaired by the disease.
The placebo effect occurs when individuals
take an inactive substance, rather than an active drug, and
experience beneficial effects only
because they believe they're receiving beneficial
treatment.
"The magnitude of the placebo effect
was surprising," admits UBC researcher Ral de la Fuente-Ferny¥ndez.
"The greater the expectation, the greater the effect
of the mind's healing power."
He adds, "This paper shows that there
must be a bridge between traditional medicine and natural
medicine."
In studies of the impact of psychological
therapies on longevity in patients with metastatic cancers,
Ontario Cancer Institute senior scientist Alastair Cunningham
found an association between intense spiritual work and longer
survival.
"The psychological dimension offers
promise for the treatment of many physical diseases,"
writes Cunningham in the forthcoming issue of Advances In
Mind-Body Medicine, an innovative, peer-reviewed scholarly
journal published in the U.S.
"Modern medicine is conservative,"
says Cunningham. "My approach is to try to play on the
medical playing field and give evidence."
Scientific, evidence-based proof of the
placebo effect and the psychological dimension is only one
reason for the dramatic shift right now toward inclusiveness
and away from the historical antagonism to alternative practices
by the medical establishment, say the Annals authors.
"People generally adopt multiple
healing practices, even when biomedicine is generally available,"
note the Annals authors.
This sheer force of numbers comes at the
same time as a trend toward consumer-oriented medicine and
away from "doctor knows best."
More and more, the increasingly sophisticated
patient is an educated partner
in medical decisions. Knowledgeable health consumers
are letting the medical profession know they want inclusive
medicine.
The medical profession is responding for
two reasons. First, there's money to be made from patients,
since most alternative services must be paid for privately.
But with the US leading the way, there's
also more funding for alternative and complementary medicine.
American researchers vie for grants from the prestigious National
Institutes of Health's Office of Alternative Medicine. And
insurance providers such as HMOs in the US are beginning to
realize that alternative practices can be just as effective
and a lot cheaper than expensive high-tech interventions.
But what may appear to be new and cutting-edge
is only a change in perception and attitude by orthodox medicine,
maintains Harvard's Kaptchuk, co-author of the Annals article.
"I'm so bored with people being hypocritical
and pretending that all this is new, rather than saying that
they've changed standards," he says. "That's a kind
of distortion, not looking at the reality of the phenomena.
It's the response that's different. What is new is that conventional
medicine has to redefine its relationship to this phenomena."
Kaptchuk claims that orthodox medicine's
nascent inclusiveness of complementary and alternative medicine
is "a breathless attempt to co-opt it."
"It's market-driven," he says,
with distaste. His cynicism is understandable.
"In 1970 I was arrested in Cambridge
(Mass.) for practicing medicine without a license," Kaptchuk
says. "Now I'm a professor at Harvard Medical School."
The Star.com
August 10, 2001
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