The Best Alternative Medicine

Dr. Kenneth R. Pelletier

• Publisher: Touchstone
• Year: 2010
• ISBN:
  9781439128954
• Topic: Medicina
• Subtopic: Medicina alternativa y complementaria

The Best Alternative Medicine is the only book available today that both evaluates the major areas of alternative medicine and addresses how they can be used to treat specific conditions. Dr. Kenneth R. Pelletier explains such popular therapies as mind/body medicine, herbal and homeopathic remedies, spiritual healing, and traditional Chinese systems, discussing their effectiveness, the ailments each is most appropriate for, and how they can help prevent illness. In the second part of the book, which is organized alphabetically, he draws on the latest National Institute of Health (NIH)-sponsored research to present clear recommendations for the prevention and treatment of health concerns ranging from acne to menopause to ulcers.Combining valuable guidance about alternative treatments with definitive health advice, The Best Alternative Medicine will be the standard reference for the increasing number of people integrating alternative medicine into their personal and organizational heath-care programs.

PART I

MAJOR AREAS OF TREATMENT

CHAPTER 1

THINK HORSES, NOT ZEBRAS

Throughout recorded history, every culture has had its own alternative medicines, from tropical Tahiti, Eskimos in the Arctic, American Indians, Mayans, and Gypsies to groups and sects throughout the ancient and modern world. Scientists reported in 1998 that the “Ice Man” discovered in 1991 at the foot of a retreating glacier where he had been buried for 5,300 years had used natural remedies. Since he had been dried by Alpine winds and then encased in ice, his body and belongings had been remarkably well preserved. Examination of his intestines noted eggs of Trichuris trichiuria, or whipworm, which is a parasite that causes abdominal pain and anemia. Researchers are quite certain that the Ice Man used a botanical product to treat this infection, since among his belongings they found two walnut-sized lumps tied to leather thongs. Analysis revealed them to be the fruit of Piptoporous botulinis, a plant containing oils that are toxic to parasites, as well as very strong laxative compounds that would cause expulsion of the dead and dying parasites and their eggs. In addition, he had what appeared to be several “tattoos” on his body. These were made by cutting into the skin with a sharp object, filling the incisions with herbs, and then cauterizing the wounds. Further investigation indicated that most of the lesions were situated over joints that had been damaged by arthritis. In addition to herbal medicine, the investigator speculated that he might have used these tattoos as a form of localized therapy for relief of muscle and joint pain. Surely, many forms of alternative medicine have been extant for thousands of years.

It is a humbling experience to thoughtfully examine the complex array of medical systems that CAM comprises. Certainly, this matrix of cultures, philosophies, traditions, and techniques is as subtle and complex as a rainbow.

Today, every medical student is taught the old aphorism, “Think horses, not zebras.” It is an admonition to pay attention to what is evident about the patient, and to rule out obvious, common conditions before reaching a diagnosis of a rare condition.

This time-honored rule is profoundly valuable in evaluating the best possible treatments for the most common health problems that our society now faces.

Currently, the United States, and much of the rest of the world, is experiencing an epidemic of chronic and degenerative illnesses, such as cardiovascular disease, cancer, diabetes, arthritis, and depression. Very often, these illnesses are the result of obvious, common lifestyle risks, such as smoking, overeating, or being too sedentary. Frequently, such illnesses can be prevented, arrested, and even reversed when individuals stop making these lifestyle mistakes and rebuild their health with various conventional as well as alternative, complementary, or integrative therapies.

Research indicates that many forms of complementary and alternative medicine, or “CAM,” are exceptionally effective at preventing and quelling the widespread chronic diseases that now plague much of the world. However, effective CAM therapies are often so deceptively simple that they may be overlooked. In effect, medical researchers and clinicians are failing to “think horses, not zebras.” They are overlooking the obvious: Lifestyle factors cause a great many chronic diseases, and complementary and alternative medicine can have a powerfully positive impact upon those diseases.

However, proponents and practitioners of CAM frequently make an equally egregious intellectual error. They often tend to believe that virtually any form of CAM is superior to any form of conventional medicine. Some advocates of alternative medicine seem to adopt CAM as a veritable religion, and fail to see that CAM, like conventional medicine, has many limitations, and can also be reductionistic, as well as harmful, if used improperly.

This book challenges the polarized, dogmatic thinking that often surrounds the conflict between conventional medicine and CAM. Both of these medical traditions need to be evaluated objectively, using the best research available. Perhaps surprisingly, many conventional medical practices lack any real scientific basis. A 1990 report from the United States Office of Technology Assessment of the United States Congress concluded that upwards of 80 percent of conventional medicine lacked an adequate basis in research. During 1991, Dr. Richard Smith, editor of the British Medical Journal, examined twenty-one common medical practices and concluded that the evidence for seventeen out of twenty-one was “poor to none” in an editorial commentary on the necessity of research-based medicine. Most recently a review by Jeanette Ezzo and Dr. Brian M. Berman of the University of Maryland was undertaken under the auspices of the international Cochrane Collaboration that focuses on “evidence-based medicine” for both conventional and alternative medicine. Based on 159 reviews of conventional medical practices, the reviewers found that only 20.8 percent evidenced a positive effect on the treated group over the control group. For the vast majority of the conventional medical practices, the evidence ranged from 6.9 percent demonstrating harm to 24.5 percent resulting in no effect at all.

To avoid a double standard, all therapeutic interventions should be held to the same rigorous standards of evidence-based medicine. Essentially, the purpose of the book will be to rigorously evaluate the most common forms of CAM, based on the best scientific research, and to shed light upon: (1) What works; (2) What doesn’t work; and (3) What is “in the works.” It is very important to underscore that negative findings on “what does not work” will be very limited, out of necessity. This is due to the fact that negative research findings are not frequently published. Emphasis throughout will be predominantly on what CAM therapies work for which conditions, and for whom, based on the best available research evidence today.

Groucho Marx once quipped, “Be open-minded, but not so open-minded that your brains fall out.” In the evaluation of complementary and alternative medicine, it often seems as if some clinicians’ and researchers’ brains have “fallen out.” No other area of medical research generates such acrimonious and often unenlightening debate as does the area of complementary and alternative medicine. Debate over this subject is highly polarized, and highly politicized. In fact, both advocates and critics of CAM may decry this book’s attempt to hold to a middle ground, and to sort fact from fiction. On every controversial issue, we hear accusations from one side or the other that the sky is falling. These extreme positions create mass confusion on vital issues, such as chemical and pesticide hazards, food additives, cancer therapy, silicone breast implants, and even on issues as mundane as the value of high-roughage cereals. There is a shortage of fact and a plethora of opinion.

As the debate rages on, however, we remain in the midst of an epidemic of inadequately treated chronic illness. Heart disease remains the major cause of disability and death, despite decades of major advances in treatment. Sixty million Americans have hypertension, forty million suffer from arthritis, and twenty-three million have chronic migraine headaches. A million Americans each year are diagnosed with cancer. Almost 40 percent, or nearly every other person you know, will eventually develop this terrifying disease. On the increase is the prevalence of asthma, multiple sclerosis, chronic fatigue, immune deficiency syndrome, HIV, and a host of other debilitating conditions. Compounding this dire litany is the fact that more than forty million Americans—the total population of thirteen states—have no medical insurance!

Nevertheless, treatments do exist that are extremely effective at preventing and ameliorating these maladies. Many of these therapies are deceptively simple.

For a moment, reflect on a “breakthrough” intervention now being supported by decades of research from the National Institutes of Health. This breakthrough has been acknowledged by the American Medical Association and the United States Surgeon General. It has the documented effect of reducing virtually all forms of illness. It helps patients prevent or recover from high blood pressure, diabetes, osteoporosis, breast cancer, arthritis, and chronic pain. It improves mental function, sleep, weight loss, and muscle mass, and extends life expectancy. Miracle drug? New product of advanced genetic engineering? Discovered in an arcane Chinese medical text? None of the above. It is … exercise! Exercise is more important for health than most of the more exotic forms of CAM, and a great many forms of conventional medicine. Think horses, not zebras.

In fact, many CAM modalities, including various forms of exercise, stress reduction, and optimal nutrition, have been embraced by conventional medicine in recent years.

Despite this growing collaboration, the atmosphere of the debate surrounding CAM is still often strident, shrill, and short of fact. In Choices in Unconventional Cancer Therapies, Dr. Michael Lerner states, “Critics have characteristically dismissed the alternative therapies as quackery … and have worked systematically and often effectively to … disbar or ‘defrock’ physicians, researchers and attorneys. Practitioners have faced legal prosecution, lengthy trials with high legal expenses, suspension or loss of their licenses to practice medicine, and sometimes jail terms…. Opposing the Quack Busters is a coalition of proponents of alternative cancer therapies…. While some members of the coalition are moderate in tone, others use harsh language and tactics. Opponents of alternative therapies have been seriously compared to Nazis. Conventional therapies such as surgery, radiotherapy, and chemotherapy are denounced as ‘cut, burn, and poison….’ While for many years the Quack Buster coalition held the advantage in this vociferous conflict, a significant shift in the balance of societal forces has occurred in the last 10 years, so that conditions are now somewhat more favorable to the proponents of alternative therapies.” Between the strident and polarized opinions is a vast middle ground where the issue of what does and does not work needs to be addressed by scientific research and clinical judgment, not by uninformed diatribes from both extremes.

One result of this vitriolic polarization is that patients, starkly aware that many conventional doctors disapprove of complementary and alternative medicine, often hide their use of CAM interventions from their conventional physicians. In the classic 1993 study of alternative medicine by Dr. David Eisenberg of the Harvard Medical School, less than 40 percent of patients who used alternative medicine told their doctors. In certain instances, this can have disastrous results, since some CAM modalities, such as use of certain herbal supplements, may interact negatively with medications.

What is needed in the ongoing debate over complementary and alternative medicine are more constructive yet critical voices similar to that of Dr. Wallace Sampson of the National Council for Reliable Health Information. Recently, Dr. Sampson founded a new journal entitled The Scientific Review of Alternative Medicine, which interjects a healthy note of skepticism into the alternative medicine debate. Through the NCRHI, such publications provide an invaluable service by sorting fact from fantasy through rigorous science and evidence-based medicine.

This book is intended to build such an evidence-based foundation.

WHAT IS CAM?

According to Dr. David Eisenberg of the Harvard Medical School, a widespread, accepted definition of CAM, which was used in his 1993 and 1997 studies, is “Those practices explicitly used for medical intervention, health promotion, or disease prevention which are not routinely taught at United States medical schools, nor routinely underwritten by third party payers within the existing United States health care system.” Because medical schools and insurance companies are gradually accepting various CAM modalities, the practices included in this definition are constantly being revised.

In March of 1997, the National Center for Complementary and Alternative Medicine (NCCAM) formulated another definition: “CAM includes those medical systems, interventions, applications, theories or claims that are currently not part of the dominant (conventional) biomedical system. Classification of a practice as CAM may change, depending upon changing attitudes, scientific data, and experience.” Given the rapidly evolving nature of CAM, this operational definition will be used throughout this book.

For this book, we will examine the following CAM modalities: Mind-Body medicine; dietary supplements, phyto- or plant-based nutrients, and hormones; traditional Chinese medicine; acupuncture; European herbals; naturopathy; homeopathy; chiropractic; Ayurvedic medicine; as well as spirituality and healing. These are currently the most predominant forms of CAM used by the largest number of people in the United States and abroad, according to several national and international surveys.

Many areas of alternative medicine are not addressed in this book, which predominantly focuses on those that are most common, according to national surveys. Bear in mind that the Office of Alternative Medicine has identified over six hundred specific terms describing an array of CAM practices. It is simply impossible in the confines of this book to address them all, including areas such as chelation, aromatherapy, multitudinous varieties of meditation, applications of bioelectromagnetic fields, and other promising areas of research and clinical practice. No matter what area is addressed, the right approach by a clinician or individual is one of well-informed, cautious involvement.

Research indicates that these various forms of CAM are now extremely popular in America, accounting for approximately 425 million visits to providers in 1990. It is important to note that this number exceeded the total number of visits to all United States primary care physicians for the same year, at only 330 million office contacts. Repeating his classic 1990 survey, Dr. David M. Eisenberg and his colleagues at the Harvard Medical School found that this number of visits increased by 47 percent from 1990 to 1997 for a total of 629 million visits. This 47 percent increase is in striking contrast to a much smaller increase in the number of primary care visits in 1997, to only 386 million. Generally, patients seek out CAM therapies mostly for prevention, and second for chronic, ongoing conditions, rather than life-threatening illnesses.

A 1998 national survey by Dr. John A. Astin of the Stanford University School of Medicine determined the general type of individual who uses CAM. Compared to the general population, CAM patients are better educated, have more health problems, have a greater belief in the healing power of the mind and spirit, had a “transformational experience” that changed their worldview, and participate more in environmentalism, feminism, esoteric spiritualism, and personal growth psychology. CAM patients tend most often to have the following health problems: back pain, obesity, anxiety, depression, insomnia, and chronic pain. They report that their primary reason for using CAM is that it relieves their symptoms better than conventional medicine. Most significant, the patients who use CAM do not express any greater dissatisfaction with conventional care than patients who do not use CAM! Only 5 percent of them rely primarily upon CAM. It was only this 5 percent that expressed greater dissatisfaction with conventional care.

Satisfaction of CAM patients with conventional care strongly suggests that there is, indeed, a fertile middle ground for patients and practitioners who wish to use both CAM and conventional care.

AN EXPLOSION OF INTEREST IN CAM

Amid the heated debate over CAM, one fact is certain: Consumers are not waiting for scientific experts to tell them that it is acceptable to use CAM. Pharmacies throughout the United States are experiencing a huge surge in the demand for alternative remedies. This is now the fastest growing segment of the over-the-counter market. From 1991 to 1996, this market doubled, to over $3.77 billion. It is projected to reach more than $6.5 billion by 2001, for an average growth rate of 12.5 percent.

Furthermore, in a 1996 study by Landmark Healthcare, over 70 percent of HMOs reported an increased request for CAM by their enrollees. Modalities most in demand were acupuncture (requested by 56 percent of patients), chiropractic (45 percent), massage (25 percent), acupressure and biofeedback (21 percent each), hypnotherapy (8 percent), and reflexology (4 percent). Perhaps even more telling is that 38 percent of the HMOs believed that offering alternative medicine would increase their enrollment.

A central reason that CAM is vaulting in popularity is simply that the general public demands the benefits of such CAM therapies. One of the most important and insightful articles in this regard was published in the Journal of the American Medical Association by Dr. J. Michael McGinnis, former director of the U.S. Office of Health Promotion and Disease Prevention, and Dr. William H. Foege, director of the Centers for Disease Control in Atlanta. Their 1993 article cited the usual “Ten Leading Causes of Death” in 1990, ranging from heart disease and cancer at the top to chronic liver disease and HIV infections at the bottom. These mortality statistics and supposed causes are so ubiquitously cited that they belie a more fundamental issue.

Upon closer examination, McGinnis and Foege contend that this familiar dire litany of mortality consists not of the actual causes of death but of the terminal diseases cited in a pathologist’s report or autopsy. In fact, the actual “causes” from most impact to least are: tobacco (which caused approximately 400,000 deaths in 1990), diet and inactivity patterns, alcohol, certain infections, toxic agents, firearms, sexual behavior, motor vehicles, and finally, drug use, which was responsible for 20,000 deaths in 1990. This listing of the ten actual causes contributed to 1,060,000 deaths, or ...

Table of contents

• Cover Page
• Title Page
• Acknowledgments
• Contents
• Introduction
• Part I: Major Areas of Treatment
• Part II: CAM Therapies for Specific Conditions
• Selected Bibliography
• Index