UNIVERSITY OF CINCINNATI

Date:______

I, ______, hereby submit this work as part of the requirements for the degree of: in:

It is entitled:

This work and its defense approved by:

Chair: ______

A New Paradigm for Dynamic Wellness: Integrative Approaches to the Healing Arts

L. Macheret, M.D. Friday, December 14, 2005 2

Preface: On first blush it may seem odd that a thesis discussing alternative medicine would be presented to the department of Occupational and Environmental Medicine. However, it is quite logical to place alternative medicine in the context of occupational medicine, because it is a useful tool in getting people back to work, and staying at work, at a reasonable cost. Furthermore, people who through alternative or traditional medicine, become partners in improving their own health, will also take care of themselves at work, an at home avoiding injuries, and illnesses.

This thesis does not negate the value of traditional medicine, which is excellent at treating acute illness and injuries. Rather, this thesis attempts to create a new paradigm for wellness: the Healing Arts, which blends both traditional and Complementary Alternative Medicine (CAM). This new paradigm includes occupational and preventative medicine, by working with the whole patient using various methods to improve that patient’s well being. The end result is a patient that is healthier, more able to work, more aware of his or her health, and less in need of the radical, invasive, and expensive treatment that is traditional medicine’s strength. In turn, this healthier patient is a worker who is able to work more productively, is more involved in his or her own well being, and therefore less prone to accidents. For businesses this means financial savings in healthcare costs, overall costs, as well as expenses for injury, surgeries, and missed workdays. It means improved earnings from a more aware and a more able workforce.

Clearly, CAM is an integral part of the Healing Arts as is Occupational and Preventative Medicine. This thesis will examine this new paradigm for healing and well-being, and will offer various methods for improving the health of all patients, just as Occupational and Preventative medicine can be applied to the health and level of function of all patients.

3

The doctor of the future will give no medicine, but will interest his patient in the care of

the human frame, diet, and in the cause and prevention of disease.

Thomas Edison

Introduction

Debates over healthcare and the healthcare crisis are not exclusive to this country

or this time. However, the general consensus is that we are facing a crisis in healthcare.

There are three major factors in this crisis. The first factor is the public has perceived a limit on the value of traditional medicine--often finding doctors who do not listen, or do not provide guidance in becoming well, rather than addressing presented symptoms.

Second, the constraints of insurance payments and the skyrocketing costs of malpractice insurance are also limiting factors in the accessibility to care. Very often those who need long-term or specialized healthcare cannot get it. Finances, location, or simply knowledge may limit them. The third factor is the rising cost of healthcare, which financially cripples the uninsured, the underinsured, as well as those companies and individuals that bear the brunt of paying for insurance.

These three factors lead to the rising popularity of healthcare terms such as: non- conventional, alternative, and holistic. With these buzzwords comes a potentially dangerous assumption that something new, natural, and non-allopathic must be good.

Natural, however, does not always mean safe. Eating natural poisonous mushrooms can lead to death from natural causes. Lately, patients have also become aware of iatrogenic effects—those caused by doctors and/ or conventional medicine.

Frighteningly, about 10% of all hospitalizations are due to iatrogenic causes. 4

Properly delivered conventional treatment is the sixth leading cause of death in the world,

and the fourth leading cause in the U.S.A.

So patients are left seeking knowledge, safe and effective healthcare, and hopefully the best choices among all of the available options.

Perhaps that golden mean is informed by our own instincts. The innate instinct for health has a meaning in the animal kingdom. One can observe animals looking for particular herbs to eat depending on their sickness. The Darwinian concept of "Survival of the fittest" in the animal kingdom can be translated to the “flourishing of the

healthiest" in the human world. In modern Western cultures, rather than depending upon

our own innate knowledge of our body and its needs, we often depend on the perceived

quick cure—fast food for our hunger and a fast pill for our symptoms. These choices may

solve an immediate problem, but often lead to neither fitness nor flourishing. With a lost

sensitivity to our instincts, we must make choices: to diet, to exercise, or to take a medicine. More often we let someone else give us directions. On the other hand, it would be impossible to have perfect habits, plans, or even environment. It is impossible to be perfect humans, but good intentions point us in a better direction.

Terms

Complementary Alternative Medicine

In this thesis I will discuss Complementary Alternative Medicine (CAM) which

has already been defined as a field of medicine that now “encompasses a multitude of

different approaches and beliefs that are generally linked by their emphasis on so-called

natural modalities of healing and wellness.”i The AMA has researched some uses of 5

CAM and lists the top reasons for people using these modalities:

1) Frustration with conventional medical benefits.

2) Broken lines of communication between doctor and patient.

3) Increasing awareness of benefits of medical practices from different ethnic groups/cultures.

4) Increasing scientific evidence linking disease to nutrition, emotion, and lifestyle factors.

5) Desire and expectation of overall wellness, not just absence of disease.

6) Desire and expectation to have less medicine and less side effects.

7) Decrease personal health care costs.

8) Increasing support for alternative medicine/healing by prominent institutions, MDs, and celebrities.

9) Fragmentation of care. ii

Additionally, the list below shows the most common complaints and healing techniques that patients use:

Back pain - chiropractic, acupuncture, massage.

Allergies - lifestyle and diet modification, herbs, homeopathy.

Arthritis – chiropractic, relaxation, herbs, magnets.

Chronic sprain/strain - massage, acupuncture.

Insomnia - relaxation technique, guided imaginary.

Headaches - relaxation, chiropractic, homeopathy.

High Blood Pressure - relaxation. 6

Anxiety - relaxation technique, guided imagery, homeopathy.iii

All of these reasons for seeking CAM are viable, but they are also issues that could be addressed by more traditional doctors if they slightly changed their practices or broadened their knowledge to encompass more CAM modalities. One such practice is to focus on TTT-- all patients respond to more talk, touch, and time from their physicians.

Another potential practice shift is a focus on care of the patient rather than cure of present symptoms. One such example is the communication gap between patients and doctors. For example, a survey of cancer patients shows that 70% perceive their oncologist as a major source of support, but over 80% have trouble communicating with them. Twenty percent of oncologists rate their communication competence as low. This particular study as well as many others, emphasizes the inherent difficulty in communicating both curative care as well as supportive or palliative care. The transition

involved in shifting from one modality to another presents additional difficulties in

communication for both the physician and the patient. As medicine shifts to include

supportive care, these communication skills become more important and must become

part of a physician’s practice.

Healing Arts

I propose a shift in the paradigms of both traditional medicine and CAM practices. Rather than accept the current gap in both understanding and communication

in the field, we might begin to practice a broader medicine called Healing Arts. I am not

suggesting that all MDs add a full list of CAM modalities to their practices, just as I am

not suggesting that CAM practitioners must learn surgery or other more traditional forms of medicine. I do hold that they are all practitioners of the Healing Arts and need to 7

become aware of each other’s practices and the values therein. A communication will

then develop among various practitioners and with patients about different therapeutic

options.

Dynamic Pyramid Metaphor

I like to think about the body as a dynamic pyramid. I propose that the main goal

of the body is to survive. The body will make its own adjustments in order to survive in

spite of pain and loss of function. Our goal as health practitioners is to not only ensure

the body’s survival, but to also help that body function at optimal levels. Health is the

fluid relationship of processes in the body that are able to self adjust to internal and

external challenges. In the pyramid, the energy of the life force either produces stabilizing corrections to all of the challenges of the ever-changing life dynamics, or if the responses to the changes are detrimental, it may cause a slow deterioration. For example, termites effect on a house.

We can think about the body as combination of processes that include: structural, energetic, chemical, emotional, spiritual and mental aspects. All of these aspects work together so that there is interplay of processes. A change in one process will affect the others. A very useful way to think about health is to imagine a pyramid. Each side of the

pyramid is an aspect of the body’s composition-- energy, biochemistry and structure. In

optimum health, each side of the pyramid is equally long, strong, and smooth. On the

inside of the pyramid, from the point hangs a pendulum, which in optimum health swings evenly and freely around a center point on the floor. If there is a functional problem in one of these three processes, the body will compensate to ensure survival and cause the 8

pyramid to shift and therefore the shape, length or strength of one wall will change.

Consequently the pendulum will no longer swing freely in its original path. The body

and its processes then are not functioning properly. The body can survive when the

pendulum does not swing properly, but it will not flourish. The compensating

mechanisms, sore back, poor breathing etc, if not addressed, will continue to increase and

the body will deteriorate beyond where it can be brought back into balance.

The pyramid itself is one level of processes: energetic, structural, and chemical.

But those processes (aspects of health) are (inter)related to even more subsystems in the

body. The pendulum itself represents deeper systems in the body. The pendulum can

really be thought of as a conglomeration of systems. One way to imagine the pendulum

itself is to think of the executive toy that has a row of metal balls that swing from a

frame. Usually the balls swing together from their frame as if they are one pendulum.

However if two balls are swung from one end, the energy is transferred and two balls

swing out from the other end. Yet still, the pendulum has balance and continues moving.

If one leg of the toy is knocked or shortened, the balls no longer swing in harmony and

chaotic swings or no swinging occurs. The pendulum in the pyramid is like this. It is a combination of processes that are also always moving. The swing of the pendulum in the

pyramid is not only influenced by the larger structure of the pyramid, but also the smaller

processes in the pendulum itself. The structure and the pendulum are always self-

adjusting so that the pendulum swings.

Because of environmental stresses, such as: climate, change, food, and air borne

toxins, etc., the pyramid does not have a stable base. Rather it is useful to think of the

pyramid as floating at sea. At times the sea is calm and adjustments due to the 9

environment are only minor. At other times rough seas or storms cause the pyramid to

adapt more to maintain its structure and the swing of the pendulum. So now the body (as

pyramid) is always in motion. It is adjusting from internal and external changes large and

small. The healthy body can adjust to these changes and then return to a place of balance

where the pendulum continues to swing evenly around the center point in the foundation of the pyramid. However, if the body makes an adjustment to a functional change and does not adjust back, the body creates a habit. This habit, or compensation for a problem may cause pain or diminished functioning, but has ensured that the body (pyramid) does not collapse. Very often the functional challenge (poor diet, infections, injured muscle) subsides, but the compensation (sore back, poor breathing, indigestion) continues as a habit. When this occurs, a new pattern becomes normal for the body, which will lead to further deterioration unless the body is retrained.

Perhaps more concrete examples will help with understanding the working of the pyramid. If a patient has a problem with her shoulder, her hip may shift to compensate.

However, it is difficult to predict where this patient may feel pain, in the hip, the

shoulder, or another part of the body. This pain may then cause the spine to rotate, and

then the chest wall cannot expand as needed. To allow chest expansion, the contents of

the abdomen will shift causing the patient to present another symptom, which may or

may not be accessed by analytical training. In another instance, middle back pain could

come from a problem in the pancreas or liver. Muscle spasms in the back could cause

less full breaths. If this person is exposed to an airborne pathogen, she could get

pneumonia because there is not enough ventilation in the lungs. One final example;

when we address a prostate problem, low back pain may subside. 10

We have all heard stories of people who lived in extraordinary pain until a special

event like a child’s wedding or the birth of a grandchild. After the special event they quickly died. We have also heard of people showing extraordinary strength like lifting a truck to free a child or acts of bravery in times of war. These are moments when the body is controlled by sheer mental and emotional power. At these times the structure of the pyramid is support by force of a head above the pyramid. This head represents the mental, spiritual, and emotional aspects of the body. It is supported by the structure/ health of the pyramid but can also prevent the pyramid from collapse in extreme conditions.

The role of the physician is to develop the skills that will allow him/her to learn the difference between curing and healing. . By curing, a physician may address one symptom or problem, but healing works to support the entire pyramid. In healing the physician addresses the dynamic nature of the pyramid as well as the compensating mechanisms, which the body had created to prevent the falling of the pyramid. A physician can aid in healing by sharing knowledge with the patient and partnering with the patient to maintain optimal health.

Current Relationship Between Traditional and Alternative Medicine

To address this dynamic pyramid, the fields of the healing arts must be able to work together. This work must also be done in partnership with the patient. For the medical professional to make the shift to encompass the Healing Arts, there must be a shift in medical training. 11

History of both Fields of Medicine

Hahnemann, the father of homeopathy, first started to used the word Allopathy to

name the conventional medical approach. Allopathy comes from the Greek which means

unlike and suffering. Allopathy uses therapies that oppose the symptoms. Allopathic

medicine offers medical care provided by practitioners who undergo standardized

training and work in established/accepted locations. It is a physician-centered practice where the doctor is the authoritative expert and the patient is a receptive participant. The

Allopathic practitioners have confidence in technology and find safety in the status quo.

As members of an established field they do not embrace change. Because of the pressures and standardization of their field, Allopaths are seen as radical if they do embrace change. However, it is just that change that may lead to healing. In discussing medical practices, many Allopaths hold that theirs is the only true healing profession.

Allopathy’s strengths are in its ability to respond to acute illness and emergency situations. It is the best-funded field of medicine and therefore has excellent research and support. The allopathic medical system is also well prepared to handle to the poorest and sickest in our country. I would prefer that rather than see a combative pose between the practitioners of allopathic medicine and CAM, that allopathic medicine meld into the field of Healing Arts, however the histories of the two fields often leave them at odds.

We learned in medical school that Hippocrate’s writings are the foundation of traditional medicine. In the Second Century, the Greek physician Galen, wrote a book on anatomical procedures providing a simplistic mechanical approach which started to dominate medical thinking by focusing on visual and physical objectivity. In other words, physicians were taught to use all of their senses to describe an illness or an injury. 12

If those senses could not capture all aspects of an issue, those uncaptured aspects were ignored. In the 18th Century, during the Newtonian era, the emphasis was on an objective approach for observing any phenomenon. Medicine’s effectiveness was therefore measured by tangible tests. Events which could not be explained were questioned, and/or ignored. Current allopathic medicine is based on this same scientific method. Illnesses and their treatments can be tested and assessed. Putting too much emphasis on statistics could bring adverse outcomes. In the 1960’s/1970’s doctors began to loose their clinical skills because of the growing use of antibiotics. They were seen as a panacea and every month a new one was introduced. There were/are dangers. On

February 16, 2004 the seven o’clock NBC News, Tom Brokaw broke the news that women who took antibiotics for more than 500 days had an increased risk of breast cancer.

Allopathic medicine is based on the contralia principle. Illnesses can be treated with the substances that produce symptoms opposite of those of the illnesses.

Allopathic medicine has of course evolved into its current form, which will be discussed throughout this section of the thesis. Because traditional medicine is integrally linked with government funding and accreditation, it has a stronghold on the standards of practice in the US and other Western Countries. However some of the standardized practices, training, and methods of research which make it such a strong field and excellent in its own right, also limit the field and put limitations on non traditional fields, which do not (cannot) work under the same assumptions for training and standards of proof. 13

Standardized Training

Influenced by Flexner's research on medical education--which found a paucity in

scientific methods or standardization in medical teaching practices—the AMA in 1910

insisted on scientific basis for medical practice. This move by the AMA lead to

healthcare institutions where education, research, and practice were inseparable.iv

Medical schools’ curricula became standardized and accredited by oversight bodies.

Currently not only are medical schools standardized and attached to research hospitals,

but only one accreditation body credentials all. While the standardization of medical

teaching, practice, and accreditation helped to raise the quality of general healthcare in the early twentieth century, it also left very little room for non-traditional practices and

unpopular views to gain the slightest foothold in American healthcare institutions that

researched, taught, and practiced standardized medicine. This posed a problem for all

practitioners of the healing arts. CAM practitioners and researchers have great difficulty

finding funding or a place to research or teach their methods. Consequently practitioners

of traditional Western medicine are not given a broader view of the field of the Healing

Arts.

However, medical students want training in CAM modalities. It is interesting that

in an abstract in The Journal of American CAM, Vol. 9, No. 2, 2003, when medical

students were asked if they had knowledge of CAM, all questioned responded no. When

asked if CAM modalities were efficacious, more than 75% participants responded

positively, rating counseling #1, acupuncture #2, and bodywork #3v. Obviously medical

training is lagging behind efficacy and practice. 14

In 1937, Lord Horder saw this flaw in standard medical training and pointed out

that for General Practitioners "inevitably, the doctors' work in the future will be more and

more education and less curative, more and more will he deal with psychology and

physiology, less with pathology. He will spend this time keeping fit the fit rather than trying to make unfit fit." Still, formal medical education has to change in order to accommodate recent trends toward shorter hospital stays and more ambulatory training.

Lately this type of training is more prevalent in naturopathic medicines: Eastern

medicines, acupuncture, etc. The knowledge and treatment modalities in these forms of

CAM would greatly benefit both the patient and the doctor-- if only medical schools had a place for these studies.

However, these fields of the healing arts must be proven effective by the measures of traditional medicine before medical schools will teach them. The standard of proof used by traditional medical schools is part of the problem. The tools used in measuring the success of a treatment do not look at the late-occurring side effects of a treatment.

Instead, a success is based on a very narrow assumption that we (scientists and medical doctors) can identify a problem in a patient, find the cause of that problem, and fix it.

When the assumed cause of the problem is fixed, we can then measure the effectiveness of that fix. As an example, if a patient presents with a sore throat, a doctor may swab for a strep infection. After a course of antibiotics, the patient’s symptoms may have subsided and a swab tests negative for strep. However this test does not take into account the patient’s comfort, the side effects of a course of antibiotics, or what triggered the superficial infection—perhaps it was a deeper infection Modern Medicine has a very different measure of success and perspective on how to achieve success than CAM. 15

Standard of proof

One of the reasons that many CAM methods are not taught in medical schools is

that they cannot be proven effective by the scientific method with the measurements tools

that are currently available. Conventional medicine currently requires double blind proof even though many medical procedures that have become standard do not have it.

However these tests themselves are inherently limited, by definition. For example, the

scales for centimeters have limits of measurement; they cannot measure microns or kilometers. They can measure only what they have been calibrated to do based on past knowledge. The double blind proof is applicable only for acute short-lived situations— those where an obvious solution to a crisis can be proven in a measurable period of time.

These tests work well on measuring the effectiveness in treating a broken bone or a raging bacterial infection. However, these tests do not work in measuring a patient’s comfort or ability to fend off disease. Using double blind and randomized controlled studies, it is almost impossible to measure social, cultural, statistical, etc. forces that shape our perception of reality and our general health.

CAM knowledge is based in general on anecdotal (empirical) evidence, which is applied to a chronic condition. Some of this goes back as far as 3,000 to 5,000 years.

This anecdotal evidence is truly a discussion of what works and what is practical. It shows the value of a treatment that may not be currently measurable. Anecdotal evidence does not find support from drug companies or drug-driven research. Unfortunately, most doctors get their continuing education through pharmaceutical company sponsored training sessions or journals so research that is not supported by drug companies is not easily available to busy doctors. To the credit of the traditional medical establishment, the 16

day-to-day practical side of anecdotal evidence is having a bit of a revival. Both Journal of Family Practice and American Family Physician are calling for research to find

material that is patient oriented evidence that matters (POEM). This is a new type of

thinking that is not necessarily supported by pharmaceutical companies. According to

American Family Physician, “POEMs have to meet three criteria: they address a question

that primary care physicians face in day-to-day practice; they measure outcomes important to physicians and patients, including symptoms, morbidity, quality of life, and mortality, and they have the potential to change the physician’s practice.”vi The

information offered in POEMS is driven by the practical needs of physicians, not the

profits of drug companies.

The most practical and successful fields for modern conventional medicine are

life threatening infections, treatment of physical traumas, and surgery. These treatments

usually assume a linear/cause effect after disease crosses a certain diagnostic threshold.

Different healing systems in the healing arts choose treatments that do not assume a linear approach. Instead they add interlocking treatment plans by looking at the same patient from additional dimensions. This creates a lace-like approach to healing that is also practical.

I like to work with the theories of Salutogenesis discussed by Antonovsky as one lace-like approach to unhealthy situations: ones that are neither acute nor life threatening-

- yet. His basic premise is that the body works to survive. Its first priority is to be the healthiest and the fittest. If the body encounters illness or injury, it has mechanisms that will keep it alive even if comfort and quality of life are sacrificed. From these compensating mechanisms that may have at one time been life sustaining, the body 17

creates new memories and new patterns even if the cause of illness dissipates. In and of

themselves, these compensating mechanisms do not heal the body. They only become

habits that may cause greater discomfort than the original injury or pathogen. The

physician’s job is first to prioritize the present needs of the body, whether to address the

primary issues or the secondary compensatory mechanisms. This takes learning different

clinical skills. As with an onion, sometimes it takes peeling many layers before reaching

the core. The final job of the physician is to put the body’s pendulum back into the

dynamic state which defines the patient’s fittest mode. The physician must encourage this shift while incurring the least damage to the body and its systems.

New research needs to take into account Antonovsky’s approach to the body’s

desire for equilibrium. This means that medical research needs to look at the long term

effects of treatment through a systemic lens. The researcher must find the tools to

measure and understand the impact on the body and its compensating mechanisms that

occur from not only illness but also treatment. Traditional scientific research does not

look at these systems as a whole and therefore cannot find a clean definition of either

success or of failure. For example, in some situations, a patient has stress hormones

coursing through his or her body, bringing the body to breaking point. That breaking

point is manifested through what we call stress-related disease symptoms, i.e. GI distress,

headaches, insomnia, etc. However, the cause of the stress hormones, and the result of

the body’s compensation mechanisms are not addressed by traditional treatments for

stress related disorders. The complexity of disease and the powerful healing capacity of

the body make it difficult to apply "clean science”—researched with the traditional

western scientific method-- to clinical medicine. Clean science may be seen as 18

succeeding, but that is because there is an 80% rule. With the right marketing and drug-

company driven research, new treatments usually bring about an 80% positive outcome.

Often, that positive outcome is limited and short lived.

Rather than looking toward clean medicine, we should look toward evidence- based medicine. The Goal of evidence-based medicine is the conscientious, explicit, and judicious use of the most current and the strongest evidence in making decisions about the care of individual patients. It is our duty to conscientiously present evidence so that our patients' decisions may be truly reflective of their own values. This involves translating evidence for patients in a way that is not unduly influenced by our own values, biases, and expectations. It is the major challenge of evidence-based medicine. If solid evidence-based medicine were readily available to answer every possible clinical question, medical practice would be straightforward. For now, we are faced with a wide array of medical practices and patient problems while we have a relative paucity of evidence. Thus we still depend on a belief in clean science.

One outcome of clean science is the pathophysiologic model of disease. When there is an obvious cause or even symptom of disease, there is a sub-specialist who can address that illness or symptom. The subspecialization of medicine lets doctors believe that there is an answer to any question as long as the right subspecialist is found.

However, sub-specialization has also broken down communication among physicians and turned the patient in to a collection of specific illnesses rather than a whole person/pyramid system with physical, chemical, and energetic problems. This single- minded focus, one that is purely mechanical, erodes patient-doctor relationships, adds to 19

medical insurance constraints, administrative costs, and further complicates the American legal system.

One way that doctors have chosen to avoid the constraints of sub-specialties and the red tape of insurance is to create a new sub-specialty-- the boutique doctor. The

patient of a boutique doctor often pays an annual or outside-of-insurance fee for

specialized care with one doctor. This care can include 24-hour access to the physician,

in home or after hour visits, same day appointments, and contact through fax and email.vii

These practices are often limited to 100 patients who can pay up to $20,000 a year in

membership fees, or retainers. While some retainer practices will charge less and accept

some insurance, critics say that these types of practices still make higher quality care and

very well trained physicians only available to those who can afford the retainer. This fee

creates three-tiered medical system: one for those who can afford the retainers, one for

those who are insured, and another for those who are under- or un- insured. Still, for those who can afford it, they are able to access doctors when they need them and to have the patient-doctor relationship that is so integral to creating wellness.

In general, the sub-specialties in traditional medicine separate knowledge among specialties and therefore keep new practices limited to those sub-specialties. One key difference in adopting new practices in conventional medicine versus the Healing Arts is that in conventional medicine, procedures are introduced by industries and/or professional bodies while new practices in non-conventional medicine are much more patient driven. When the public (patients) adopts new practices, they produce enough

pressure for drug industries or medical professionals to follow. The different relationship

to innovations in practice in conventional and non-conventional medicine has much to do 20

with the difference in structure and funding to the two fields. There needs to be

communication between conventional and non-conventional medicine so the both types

of innovation can be assessed and used by practitioners of all of the Healing Arts.

Unfortunately, that type of communication is rarely occurring in either direction.

New methods of treatment in CAM are at first ignored by traditional medicine. If the

governing bodies of traditional medicine do not ignore these practices, then those bodies

will try to undermine a new healing method with disciplinary actions. Under pressure

from medical practitioners and the public, some of these healing methods will be, or have

been, introduced into practice. This wave of suppressing and undermining new practices

continues. In my opinion, we were and are spending health resources and adding long-

term sustained benefits when they are not helping patient health and are bankrupting our

healthcare system. We need to bring back an old doctrine in medical education: the goal

of health care is to provide the most practical, economical, and feasible support for the

patient’s welfare. This may seem like common sense, but much of conventional

medicine, with its structure, funding by drug companies and use of “clean science”- and

all of its limitations-does not help our patients to be well. We must be concerned with our

patient’s welfare—not just the welfare of the patient’s back, or heart, but the patient’s

general well being. Why else do patients look for help outside of conventional medicine?

The Healing Arts are sought-out by patients for many reasons. First, is pragmatism. Conventional approaches to treating chronic diseases are, for the most part, unsatisfactory. Perhaps this is because conventional medicine views chronic illness as just that—chronic and incurable. Rather, non-conventional medicine may see the chronic illness as a clue, a symptom that points to body sensitivities—an imbalance in the 21

pyramid of health. Second, patients appreciate a people approach. They need to have the

time and attention that non-conventional practitioners are showing them. In my observations, people do not mind seeing psychiatrists who often increase medications,

but they do mind if their primary care doctor does not show a caring attitude. Third,

people appreciate the learning tools offered by Healing Arts practitioners that enable

them to modify their lifestyle and therefore greatly impact their lives and health.

By spending time with non-conventional doctors, patients learn skills that cover

more than one organ or bone. For example, patients learn different methods of stress

management. Spirituality becomes another healing tool where patients learn the value of

prayer in institutionalized and non-institutionalized settings; a church or a field will work.

A non-traditional doctor highlights the importance of nutritional changes such as

restricting alcohol, and reducing the intake of sugars and some fats, and increasing the

intake of vegetables. To ensure well being, patients learn the importance of exercise and

which type of exercise is best for them. A holistic practitioner can guide patients in many

subtle changes in habits, lifestyle and emotional responses. Most conventional medical

practitioners do not have the time or ability to teach these tools that greatly modify health.

Limitations of Traditional Medicine

The well-known doctor, P. Airola N.D., comments that we are a country with so many doctors, so many hospitals, the most advanced technology, and a wealth of resources, including food, herbs and medicine; but in relationship to our resources, we are a country of sick people. We need to use those resources to build health. We also need to be careful that those resources are not misused to cause worse problems than those 22

they cure. These problems can be highlighted by some commonly known medical

disasters. The Tuskegee syphilis experiment is one such example of poorly planned

research. The farmers, who had syphilis, as well as their families, were not given

treatment for their disease and were, in effect, prevented from getting life saving health-

care. The death and suffering to come out of these experiments is only the first level of

fall-out. An even more lasting outcome of the experiments is that now African-

Americans are wary of medical trials and are therefore under-represented in medical experiment for fear of a replay of the Tuskegee experiment.

In 1959, Professor Dr. Debois at Rockefeller University in New York highlighted another reason for the public to express fear. He noted "medical progress did not make

Americans healthier. In early 1960, [the] thalidomide tragedy struck. [A] senate

committee under Sen. Kefauver criticized the medical profession for . . . over prescribing,

mis-prescribing, [and an] inability to discipline its members." Suddenly the public

realized that no matter how rigorously test procedures are done, there is no way to foresee

serious side effects of a medication—which may not be seen until the third generation. In

1965 R. Dubois remarked upon an increase in the popularity of what has been called

fringe medicine. Whether or not it has therapeutic validity, he argued, was irrelevant. "Its

popularity points to the failure of the present biomedical science to satisfy large human

needs.” Those needs are for overall wellness.

That need for overall wellness is highlighted today by another widespread misuse

of medication. Hormone Replacement Therapy (HRT), a combination of estrogen and

progestin was seen as a sort of fountain of youth for post-menopausal women. It was

promised to strengthen bones and the heart while maintaining a high level of brain 23

function. However two recent studies have proven just how dangerous this panacea may

be. The first was a landmark American study that ended early because the treatment was

found to be dangerous for the women taking HRT. In a British study involving 1 million

women, HRT was found to increase a woman’s risk of developing breast cancer by 66%

and of dying from it by 22%.viii The U.S. study found danger associated with HRT for

even short-term use. The British study showed that while the risk of breast cancer

increased with the length of HRT therapy, there was minimal or no increase in the first

few years after treatment was stopped. The true costs, not only financially but also in

lives, families, and emotions can hardly be calculated. The fall-out of the HRT studies is

that both doctors and patients must feel wary of further treatments as well as powerless.

Not only is there dissatisfaction among patients, but there is also a common

dissatisfaction among physicians as well. I believe that this dissatisfaction among

physicians is brought about not only from the healing limitations of medicine as

described above, but also from the loss of mutually satisfying relationship with the

patient as well as a loss in autonomy in the practice. Perhaps a blending of traditional

medicine and CAM can help alleviate this dissatisfaction. While some discount CAM practices like yoga or tai chi because their practitioners still may suffer from terminal

diseases, I believe that their values are not yet realized. I propose, combining the

technology of the present for screening, i.e. colonoscopy, etc., with yoga and other

ancient healing system to support and maintain quality of life in any circumstances.

This proposal is not new. Many conventional doctors became discouraged 200

years ago by prevailing medical techniques of blood letting, blistering, using toxic doses

of mercury, etc. Currently we see doctors with the same problem. They can use modern 24

technologies to diagnose disease, chemical and structural problems in the body, but they

often feel unable to help people living with chronic disease. The problem is that doctors

are now taught to remove (chemically or surgically) the symptom and to later find out the

cause of the illness as well as the side effects of the treatment. This is why some doctors

lately are taking classes and gearing up to incorporate in their practices unorthodox

approaches. Practitioners of traditional medicine are joining forces with practitioners of

CAM to practice healing arts.

Out of a popular desire from both patients and doctors, there is a common push for complimentary medicine in hospitals. One of the first hospitals to use complimentary medicine is a holistic center in Germany. One of the strengths of its program is that it has

developed a system for profiling medical care providers on the basis of quality of care – a

practice that is rapidly becoming widely used in health care policy and research.

Profiling is defined as a process of comparing quality of care, user services, and costs

with normative and community standards. It helps to gather data for efficacy of the

"therapeutic cocktail" instead of one simple treatment for one symptom.

With the understanding that there is a need among patients and physicians for a

more healing and more holistic approach to well being, I will further discuss CAM- its

definitions and modalities.

Alternative Medicines, CAM, and different Modalities

Contrary to popular beliefs or fears, alternative medicine does not mean any exotic

approach. Actually, many practices that are commonly used as self-care are part of

alternative medical practices. People of all ages use self -massage for sore muscles, 25

stretching to prevent muscle stiffness, and soaking in a Jacuzzi after hard day. Even

cracking joints and icing a sprain can fall into this category. Simple changes in diet or

getting flowers or a new scented soap are also part of alternative medicine. The list goes

on, but often those actions that we instinctually know will make us feel better will fall

under the umbrella of alternative medicine. They just may be more beneficial under the

guidance of a professional who understands how to combine and strengthen these

practices.

It is difficult, actually impossible, to provide strict divisions between different

healing techniques; most of them overlap. The choice of treatment depends on the

patient's condition during evaluation as well as the skills, experience, and cultural

background of the practitioner and patient. For example, asking a vegetarian from India

to add meat to the diet would be counter to that person’s culture and religion. Sensitivity

to the patient’s educational background and experiences will give the practitioner a gauge

of what types of changes and treatments the patient may be willing to try as well as how

the practitioner can explain that treatment. The variety of practitioners and practices are

great. I cannot here cover all practices or practitioners. This section of my paper serves

as an introduction to complimentary alternative medicine and its practices. To that end

when I am describing CAM, I intend for definitions to remain flexible, allowing for

change in practices and protocols with the end goal of promoting the health of individual patients.

It remains very difficult to put rigid definition on what is alternative and what is

not medical treatment. Potentially, medical treatment could be considered an alternative

to surgery. Even what we call alternative medicine could include surgery. Alternative 26

medicine, then, is a misnomer. Rather than attempt to make a rigid definition, or create a new term for alternative medicine, I will discuss alternative medicine as part of

Complimentary Alternative Medicine. This way we can think of many types of healing as interrelated as parts of the healing arts. When we talk about complementary medicine it is important to remember that most healing modalities are complementary such as: diet, exercise and counseling. By considering these treatments as complementary we create a cumulative effect of adding additional therapeutic modalities- allowing for a nexus of possible treatment combinations suited for different patients and their needs through time.

In the context of CAM, alternative simply means using an approach or technique that is not part of the accepted practice of traditional medicine. Alternative becomes the practice of using different approaches that are most of time in opposition to the majority of accepted practice. These practices do remain in the field of medical treatment. They are part of the healing arts.

Very often CAM has been called integrative medicine. Integrative healers

"practice medicine in a way that selectively incorporates elements of complementary and alternative medicine into comprehensive treatment plans alongside solidly orthodox methods of diagnosis and treatment."ix Integrative medicine’s goal is to be flexible. It combines traditional healing with alternative modalities in order to create long-term benefits with minimum side effects. The flexibility in this practice allows the practitioner to choose which healing modality is most important for the patient’s health and which other modalities will support that goal. Integrative medicine must be contrasted with pluralistic health care in which different healing modalities may be chosen by unqualified professionals or patients. This may be quite dangerous. Even though a treatment is 27

alternative, it still requires training for safe and effective use.

Integrative medicine remains a patient-driven approach to health care that

combines synergistically effective medicine under supervision of a chosen doctor. This

field of medicine involves understanding several factors in a patient’s well being. First it

involves the integration of individuals in a stream of life. If life is like a stream, then

moving in with the flow is ideal. However, stress, illness, and environmental toxins may

leave one stuck in an eddy unable to fully participate in life. Second, a patient’s religious and spiritual values are taken into account when creating a plan to regain or maintain health. This field of medicine acknowledges the mind/body connections and the independent role of the conscious mind. Lastly but equally as important, the physician first must do no harm. This concept of harm extends to the physical, spiritual, and emotional aspects of the patient.

In treatment the physician makes an effort to use a whole substance thus allowing for the healing synergy of all of the properties of an herb, food, or treatment rather than traditional medicine that often isolates one chemical for use in treatment. The aim of these treatments then becomes balance and harmony. This includes balance and harmony in the energetic processes of the patient. The main goal in integrative medicine is healing versus curing. Curing often pertains to ridding the body of a specific infection or,

mechanically repairing an injury while healing takes into account the well being of the entire patient, physically, emotionally, and energetically. This is as the French call it,

Medicine Douce, mild medicine.

The CAM physician uses holism by looking at the patient as a whole as well as looking at the effects of treatments on the whole patient. "Holism" from the Greek holis 28

simply means whole. The synthesis of parts into a whole changes those parts so that they

no longer function as they would be in isolation. By addressing the entire body we address a different entity compared to addressing only parts of this body. However,

orthodox medicine insists that holistic treatments could defer "real treatment" that could

cure people.

Generosity with time and personal attention is often the reason patients choose

unconventional doctors. The comedienne Gilda Radner repeatedly expressed a preference

for unconventional doctors not because conventional therapy was more effective, but

because, as she said, they were "taking me seriously", and were "paying attention to me."

This personal time and attention is essential when treating patients in CAM--whether the

treatment is called alternative, integrative or holistic. It is only by viewing the patient as

a person, rather than an illness, that healing, rather than curing, can occur.

Funding and Government Support

We are optimistic that a wide range of approaches to healing will operate in

conjunction with allopathic medicine on a basis of equality and mutual respect. To that end, more research needs to be funded. However, in my opinion there is a problem with

that funding. It is not reaching the people in useful ways. In 1991, the appropriation committee of the US Senate instructed the NIH to appoint a panel for development of research to evaluate the effectiveness and the costs of promising alternative therapies. In

2001, the Senate appropriated $89 million to be divided between major medical

institutions and small centers to be distributed by the Center for CAMx.

The political agenda of those on the committee to distribute funds caused the

money to be poorly used. I see that a lot of money has been spent to prove common 29

sense issues. For example, chicken soup is being studied for its benefits in fighting a cold.

Another example is the usefulness of aspirin. Even though the panel was comprised of scientifically oriented professionals, the money was not spent on projects that would have a greater benefit than simply proving common knowledge. Rather than seeing if chicken soup or zinc is beneficial for colds, we must use that research money to train doctors to investigate empirical evidence, such as home remedies. Instead of proving that extracts of certain chemicals work, I would rather spend money on researching the usefulness of

combinations of herbs. This funding should also go to the training of different modalities

of CAM in medical schools. Contrary to the assumed need for the scientific method,

some aspects of CAM would be more beneficial and cost effective if they were taught

rather than proven. These may include: diet, exercise, spirituality and lifestyle changes.

A doctor could suggest remedies that are part of the patient’s culture or are simply

cultural and ethnic family remedies like: chicken soup, hot foot-baths, poultices, and teas.

Another skill is food combining. Doctors could teach their patients the nutritional

synergies in food and how they may enhance their quality of life and performance

through the foods they eat. Most importantly, through learning CAM, doctors can learn to

address symptoms as symptoms and not the illness that needs to be addressed.

The change must come from training doctors and from doctors training their

patients. The Latin root for doctor is docere, to teach. Rather than see doctors as gods, or

in the least high priests, whose education protects their patients from illness, it may be

more useful to return to the idea of the doctor as teacher. The roots of Indian, Iranian,

Oriental, African, American Indian, healing traditions show that role of

healers/physicians is to instruct people (community) to live harmoniously with 30

themselves, other people, and environment. The following practices in CAM can be

taught by various practitioners to achieve wellness and harmony.

Physicians and those in the field of medicine assume that an education serves to

vaccinate people against making bad medical decisions or following an "unscientific

healing approach", but in reality, a number of studies have shown that clients of

alternative practitioners have, for the most part, an above average education and

economic status. Recently, an editorial in The Journal of American Medical Association

stated: "there is no alternative medicine; there is only scientifically proven medicine

supported by solid data, or unproven medicine for which scientific medicine is lacking."

The false assumption here is that we must find scientifically supported data for so-called

alternative methods in order for those methods to be seen as useful. However, the tools of

the scientific method are often flawed and are not the only tools for finding solid data.

Rather, solid, alternative practices are supported by empirical data collected over time and generations.

In February 1995, the counsel for Kings County in Washington State unanimously approved the establishment of a clinic to provide the county's low income population with naturopathy, chiropractic, massage, acupuncture and other alternative services in addition to more orthodox treatments. The state legislature on January 1, 1996, passed a

law requiring every health plan in Washington to cover claims for services provided by

all licensed practitioners, including chiropractors, naturopaths, acupuncturists, and

massage therapists. In 1999, nearly two thirds of nations HMOs offered coverage of at least one alternative method. 31

What follows is a more specific discussion of various forms of CAM. The reader may notice that many practice have methods or approaches in common. A trained practitioner can pick and choose among these methods in order to best treat a patient.

Forms of CAM

Osteopathic medicine

A.T. Still founded the field of Osteopathic medicine in the late 1800s . Soon thereafter the Kirksville School of Osteopathy was founded in Missouri. The field is concerned with the establishment and maintenance of the normal structural integrity of the body. The practice of Osteopathy is based upon this principle: “that man is a machine, and when diseased, an expert in mechanical engineering is needed to adjust its machinery." Thus, many non-specific symptoms could be adjusted by manipulating the autonomic nervous system through moving the head around the center-point of the spine.

This adjusts the entire body. Animals and children practice this engineering naturally.

They stretch and yawn and cough to self adjust. Osteopathy abides by the rule of the artery, which states that Osteopathic physician should remove the obstruction, or lesion, to let nature’s remedy - arterial blood - be the doctor.

There are two kinds of Osteopathic lesions. Lesions in the spine represent an imbalance of normal tensions among muscles, ligaments, and bones to the extent that information reaching the spinal cord from the deep muscles of the spine makes the body confused and contradictory. The second type of lesion is in the nerves where a particular part of the spinal cord becomes oversensitive and passes the irritability further to the joints, ligaments, muscles etc. The irritability affects the arterial and venous circulation to 32

organs and tissues whose nerve supply originates in the spinal cord. Currently, instead of using the word lesion, many practitioners are explaining the issue as dysfunction. It was

the Osteopathic lesion that could be aided through Osteopathic Manipulation Techniques

(OMT).

Research continued even after the death of Still in order to prove that skeletal

misalignment will lead to an obstruction or lesion in the body. In these experiments mild

skeletal displacements were performed on anesthetized laboratory animals, then later,

when animals were sacrificed the nerves showed congestion and inflammation at the site

of the lesion, and the organs they supplied gave evidence of congestion, inflammation,

and disordered functions. These findings reinforced the premise in Osteopathic medicine

that the blood can cure, and, moreover, that allowing the free flow of blood can heal

while obstructing the flow of blood can cause illness.

There are three main groups in Osteopathic medicine. Classical Osteopaths have

skills in healing manipulation. Conventional Osteopaths continue their postgraduate

training in traditional medical residence programs eventually becoming in practice as a

conventionally trained medical doctor. The third group incorporates skills of

manipulation and knowledge of the whole body approach and regular medical training in

order to provide the best medical care.

Chiropractic Medicine

Chiropractic medicine is based on the belief that a break-down between structure

(primary spine) and function (autonomic nervous system) is the cause of disease. The field was established by D.D. Palmer who began using magnetic forces for healing but 33

switched to manipulation of the spine. In 1896, with the help of the Reverend S. Weeds,

Palmer named his new healing method chiropractic which means done by hand.

According to D. D. Palmer: Innate intelligence continued to care for and direct the functions of the body as long as the soul holds body and spirit together. However, the governance of this innate intelligence can be disrupted by subluxation, a misaligned or poorly working joint, and with further subluxation, illness would result. In 1905 Palmer founded the American Chiropractic Association, which soon spread internationally. His son, B.J. Palmer, continued his father’s work, but not without an amount of resistance

from the traditional medical establishment.

In 1963, the AMA established a committee on quackery with the goal of

controlling and eliminating chiropractic medicine. It sent out in 1986 warnings against

Chiropractic to all physicians, libraries, and medical establishments in the country. The

Chiropractic Association sued the American Medical Association for violation of

Sherman Antitrust. In 1987, the North District of Illinois decided against organized medicinexi. An appeal was refused by US Supreme Court in 1990. Consequently, the

AMA had to send an apology letter to everybody in the country who received previous

letters of warning.

In the time since the first letter of warning from the AMA much has changed. In

1970, Chiropractors regularly referred patients to MDs but only five percent of MDs

referred their patients to Chiropractors. By the mid 1980’s, however, up to sixty percent

of MDs referred their patients to Chiropractors. The growing popularity of Chiropractic

Medicine is by no means limited only to the US. In 1978, the Governor General of New

Zealand appointed a panel to evaluate the benefits of Chiropractic coverage as a part of 34

Social Security. The panel members started with the impression that Chiropractic

Medicine was an unscientific cult. However, upon completion of the study, the panel found itself irresistibly and unanimously drawn to the conclusion that modern

Chiropractic Medicine is soundly based and a valuable branch of health care in a specialized area neglected by the medical profession.

Modern Chiropractic Medicine has various forms of treatment. One form is

Spinal Manipulation Therapy for misaligned and poorly working joins. Treatments vary between high speed with low amplitude, or low speed with high amplitude. So small movements can be made quickly while large adjustments must be made slowly.

Chiropractic also uses Applied Kinesiology which improves the flow of the body’s own energy with supplements, technological tools, and exercises as well as massage.

Oriental Medicine

Oriental Medicine embraces Chinese, Japanese, Korean, South Eastern Asian, and other healing methods from the Far East. An old Chinese proverb states: "When you have a disease, do not try to cure it. Find your chi and you will be healed."

One of the most popular oriental medicines, the Chinese system of healing, is based on the book The Yellow Emperors Classic of Internal Medicine. This book emphasized the need to balance Yin and Yang, the opposite but inseparable energies of the universe. A practitioner needs to learn the 365 vital Acupuncture points. Diagnoses are based on being close to the patient, listening, questioning and examining. This book also records the importance of different physiological changes based on the pulse, tongue, etc. These ideas are still carried out in Chinese medicine today. 35

According to the translation by Dr. W. Bensky, During the Ming Dynasty in

China, about 1500 years ago, anyone who wanted to call himself a physician had to go

through national test to prove that he knew what he was doing and to be known as a

credible doctor by emperor. And then had to report all patient interaction to empirical government. Government had thousands of people who sat around and did nothing but

tabulate this data. If physician cured less than 68% of his patients, then he was called

physician of chance. This type of cure rate is not required of traditional Western doctors

and yet, Western doctors often cite Oriental medicine as unproven.

Traditional Chinese Medicine, TCM is the term designated by the

Communist Chinese government in 1958 to describe the standards and training

for Chinese healing methods. TCM involves use of Acupuncture—insertion of

needles in certain points in the body to produce healing/balancing results.

Moxibutism, the burning of mixed medicinal herbs is also part of standardized

TCM. Practitioners of TCM are very skillful in diagnosing by evaluating the pulse, tongue, eyes, skin, hair, nails, etc. For the best results, the patient must be able to speak mandarin Chinese.

TCM principles are based on a Confucian-Taoist theory that everything in universe must be in balance, from the smallest atom to the universe itself. The human being and human society influence larger and smaller ecosystems constantly, and both are constantly influenced by them. The Tao is a way of life, which is in harmony with oneself and entire universe. Harmony is also needed in the relationship between Yin and

Yang. They are opposite, inseparable powers which regulate everything. A TCM practitioner has to choose to tonify yin (weakness) and/or dispurse yang (strength in order 36

to restore harmony). To learn these skills takes at least 15 years. It is very difficult to

find the skills to support the balance of a person’s health. It is also difficult to help

him/her be responsible for his/ her own health.

In the west, Worseley established the first school for TCM. He studied TCM and

translated the information into English. He describes the five elements that are the

cornerstone of TCM as being fire, earth, metal, water, and wood. Yin and yang are a

nonseparable part of each element.

Also in the west, Dr. W. Osler, positively introduced acupuncture in his classic

textbook practice of medicine in 1857. He was not sure why, inserting thin nails in

certain places in gluteus muscles helped people with low back pain.

Acupuncture practitioners rebalance chi (life energy) disturbance in the body.

The acupuncturist uses tiny needles pinpointing specific points along meridians subdermally. Usually, occasional bleeding could be stopped by pressure. As long as usual antiseptic techniques are followed, infection was never a problem. Japanese

Acupuncture provides a more gentle technique. With the belief that the ear is connected

to and mirrors the organs of the body, Auricular Acupuncture is based on needle

positions on the ear. A third style of Acupuncture is the French/Helms style. Most of the

MDs/Dos in the US train in this system. It is basically a blend of different approaches. A variation of Acupuncture, which balances Chi through the use of specifically placed needles, is Acupressure, which uses pressure points that are activated with fingers or other objects. Shiatsu is the Japanese version of Acupressure. Electromagnetic acupuncture uses weak electrical current to the same effect. . Multiple studies have shown benefits of combining auricular acupuncture, electrical acupuncture, etc. with 37

conventional programs for addiction with more than 80% success ratio. Additionally the

National Institute of Health (NIH) issued a consensus statement in 1998 "acknowledging

the effectiveness of acupuncture in relief for postoperative pain; nausea and vomiting induced by chemotherapy."

Another aspect of Oriental medicine is the use of Chinese medicinal blends or

mixes. These mixes are comprised of minerals as well as plant and animal matter. The

blends are available in different forms, raw/ bulk, as a pill, tincture, or extract. xiiDiet and nutrition as well as exercise, stress reduction and lifestyle counseling are all part of

Traditional Chinese Medicine. Massage also plays a role. The Chinese version is TuiNa - acupressure combined with tapping, vibration, rubbing, and kneading. An-Mo (An Mo,

Amma) is the Japanese version of TuiNa, which combines treatment of body motion and spirit including diet, supplements, and herbs. Jin Shin Do is a form of body-mind

Acupressure developed by a psychotherapist. Acupressure is used longer and deeper to resolve tension, maintain balance and support feelings and emotions. Jin Shin Jyutsu, the practitioner gauges effects of treatment by checking pulse, using 2 or 3 points from 26 most common points. All of these healing forms are part of the key goal of prevention medicine. To that end there is a concentration on strengthening and maintaining the immune system. A patient/ follower of Chinese medicine must watch and make lifestyle adjustments in response to changes in the climate such as hot, cold, dry or windy. The focus is on overall balance, not just one or two different symptoms. In this healing art the patient and practitioner are partners. Perfect harmony means perfect health. There is a difference between learning the skills of TCM and the instincts and art behind TCM. 38

Naturopathy

B. Lust, a German immigrant, started the American School of Naturopathy in

Manhattan in 1902. B. Lust, after being diagnosed with terminal tuberculosis said, "my death warrant was made out by the doctors in my presence." Then the doctors stated that they were powerless. He went back to Germany and claimed he had a full recovery after changing his habits, plus using modified hygeiotherapy (hydrotherapy). After his recovery and with his new found knowledge he returned to the United States to teach

naturopathy.

The focus of naturopathy is to introduce the patient and the body to a more

naturally intended lifestyle. This friendly introduction of a natural lifestyle enables the

body to rid itself of impurities developed as a result of unnatural (read unhealthy) habits.

Lust defined the system of "Pathological monism in therapeutic universalism." This

theory claims that there is only one disease, the inhibitions of the body’s natural power,

and virtually an infinite number of healing agents—all part of nature’s force.

Naturopathy is a philosophy of harmony between a person and nature. The role

of the naturopath is to aid the body’s innate healing powers. There are six central

principles in the field of Naturopathy. The first is: VIS medicatrix nature, or the healing

power of nature. For example, when a patient has a high temperature, instead of lowering

the body’s temperature chemically or mechanically, use the fever as a friend. It may be

that the body is using temperature as one way to address an infection. 39

The second principle is: Tolle Causam, find the cause. Every illness has an underlying cause other than that which is identified on the conventional tests: blood, radiology, etc. The cause is not the symptom.

Thirdly, a naturopath must practice Premium non-nocere, do not harm. This means that treatments may not have long-term detrimental side effects. The principle object of naturopathy is to reestablish the union of man's body, brain, heart, and all body function with nature. To that end, naturopathy must use complete botanical extracts instead of those that are chemically altered, or drugs synthesized in pharmaceutical laboratories.

Fourth, a naturopath must be holistic and address the whole body, not just a part, or a symptom. Fifth, a doctor should be a teacher of healing, not priest of magic or a scientist looking at a simple system. Finally, prevention is the best cure. The doctor can teach preventative practices based on improved lifestyles and habits.

In Everybody's Guide to Nature’s Cure, 1936, H. Benjamin outlined three principles of disease that come from a patient’s habits. All forms of disease are due to the same cause, the accumulation in the system of waste materials (the body’s refuse)— often caused or worsened by unhealthful/unnatural habits. In spite of the accumulated waste, the body is always striving for the ultimate good of the individual. The body contains within itself the power to bring about a return to a condition of well-being, or health, provided the right methods are employed to enable it to do so. The right methods include: fasting, scientific dieting, hydrotherapy, hygenic body-building principles, and psychotherapy. 40

To teach the methods of healing and cleansing the body, in 1956 John Bastyr

opened a College of Natural Medicine, Bastyr University in Seattle, Washington. The

late president of John Bastyr University, J. Pizzorno, emphasized that the school

“concentrate more on the scientifically verifiable aspects of natural medicine and less on

the relatively anecdotal cure aspects." This approach made room for naturopathy to

work alongside traditional medicine. Now the primary objective of naturopathic

treatment is detoxification using different technologies such as colon cleansing, special

diets, etc. More and more MD's, DDS's, PA's, RN's are taking courses and getting very

proficient in this field.

Ayurveda

Some historians insist that Oriental medicine came from India and therefore is

related to Ayurveda. In Sanskrit, Ayurveda means science of life. More than 5000 years

old, it is a mind-body medicine technique teaching system narrated by Rishis (Sages).

The school Auy-Ved was founded by the Maharishis Mahesh, a yogi who emphasized

Transcendental Meditation as a key to healing. TM has been shown to someone 67 years

old who now, does not eat or drink water and meditates almost 20 hours per day.

Some use supplements in healing as well. Maharishi Mahesh added concentrated food supplements to augment the healing response. Practitioners are usually Indian trained healing professionals. The best known is Deepak Chopra.

The philosophy of Ayurveda views the universe as a Microcosm. In microcosm situations all problems can be answered in a linear analytical way, but that microscom is part of a large system-- a macrocosm, which is related to laws of energy and balance.

This is the difference between mechanical physics on the level of the microcsm and 41

quantum physics on the level of the macrocosm. The smallest living organism can affect

the biggest and vice versa. The life force in this system is known as prana. In the body

there are various collections centers for prana known as Chakras. The flow of prana is

regulated through breathing and yoga. Yoga is both a physical and spiritual practice. The

body, mind, and spirit are inseparable for the healing approach. This healing approach

must also take into account an awareness of the balance in the body internal and external.

A follower, practitioner of Ayurvedic medicine must take personal responsibility for

one’s action in society, the planet, and the universe.

According to Ayurvedic theory, all nature consists of five elements, ether, air, fire, water, and earth. Each of the elements governs the five senses and is manifested in

main organs in the body. For example air is in the lungs, and fire is in GI tract. The five

elements separately combine to form three doshas—basic forces. Ether plus air combine to create vata, fire plus water create pita and earth plus water create kapha. Each person has all three doshas but depending on which dosha dominates, the person is labeled vata, pita, kapha, or a combination thereof. To determine a person’s dosha, a healer will look for characteristic traits. Vatas are enthusiastic, anxious, thin, prone to have poor sleep and GI disorders. Pitas are intense, patient, muscular, and are prone to heartburn,

gallbladder disease and a sluggish liver. Kaphas are tranquil, indecisive, and are prone to

respiratory and GI allergies. They require more sleep and warmth than the other types.

The doshas also control body functions-- vata controls movement, pita controls

metabolism, and kapha controls the structure. Health is achieved through harmony of the

doshas. 42

Assessment is done by the practitioner using pulse, tongue, nails, eyes, face and other parts of the body including lifestyle habits as well as examining questionnaires

filled out by the patients. Then patient gets individualized plans (rasayna) that include

herbs, yoga postures (asanas), breathing exercises, and meditations. Marma therapy

stimulates the bodies almost 107 junctions (marmas) and through those points, balance

could be achieved. The imbalance of energy is the main cause of disease.

Another important aspect of Ayurvedic practice is Yoga. Yoga, in Sanskrit means

Union. It is a physical and spiritual practice. The various body postures and movements are called Asanas. The breathing that accompanies Yoga is known as Pranayama. There are different styles of yoga. These include: Astanga, integral, lyengar, kripali, kundalini, power yoga, sivananda, viniyoga.

Homeopathy

Homeopathy is based on the principle of “similia similibus curantur,” likes cure likes. Originally the statement was translated as let likes be cured by likes. So, an herb,

mineral, or force that causes the symptom a patient is experiencing (a like) will heal the

patient of those symptoms when the smallest possible dose is used. At the center of

homeopathy doctrine is the concept of vital force every substance has its own vital force,

which could be transferred with potency of the subject (herb) without side effects of

original substance. The essence of an herb is used rather than a large dose of the herb

itself. Homeopathy was developed as empirical science, in the same way as allopathic

medicine. Proving from German Prufung (test, trial) testing "drug materials" on

relatively healthy symptom free people in control environment to discover the effects of

use. Potentiation is process of repeated dilution with succussion (shaking), and again the 43

diluted material is tested. The higher the potency of homeopathic preparation, the smaller the amount of medicinal substance is present in the diluted solution.

Hahnemann, the father of Homeopathy, believes every man has his own disease.

While illnesses may have common traits, the constellation of symptoms is particular to the individual. That attention to the individual is one standard of Homeopathic medicine which approaches the whole person. To cure is not under the power of the doctor. Rather, the cure is found in the healing force of nature (vis medicatrix naturae).

Homotoxicology

Homotoxicology, founded by Dr, H.H. Reckveg, is a marriage of Allopathic knowledge and testing standard with Homeopathic principles. This field claims that illness occurs as a biologically useful mechanism against exogenous and endogenous hemotoxins (human poisons.). Therefore, health is "freedom" from hemotoxins. Quite a few illnesses, called indispositions, will disappear with treatment if external causative factors are removed.

Musculoskeletal Therapies

Massage

Massage is the systemic manipulation of soft tissue of the body. It involves a combination of rubbing, kneading, slapping, tapping, rolling, pressing, jostling, providing pleasurable sensations physically and mentally. This therapy mimics passive and active exercises to relax muscles, stimulate circulation, increase ROM, etc. There are various forms of Massage. Swedish includes basically five different strokes: Long stroke 44

(effleurage), kneading (petrissage), friction, vibration, and percussion/tapping

(tapotement). Deep tissue massage aims at deeper layers of the muscle, focusing on more

specific areas of the body. Esalen/Swedish massage is usually done with music and often with aromatherapy. It uses slow, rhythmic, hypnotic strokes, combined with gentle rocking and stretching movements. Manual lymphatic drainage massage focuses on providing continuity of lymphatic circulation by doing light rhythmic strokes. In myofascial release, the therapist uses gentle, prolonged, pressure on the fascia

(connective tissue).

Rolfing/ Structural Integration

Ida Rolf founded and developed this system, based on the belief that fascia

(connective tissue envelope) hold everything in balance. Change in one area affects the

rest of the body.

Naprapathy

Naprapathy also uses manipulation and energy to help the body to keep skeletal and muscular systems in perfect alignment by relieving muscle tightness and congestion.

While Chiropractic works on the skeletal system, Naprapathy works on ligaments and

connective tissues usually along the spine and sometimes other joints. Naprapathy,

however, does not move joints. The basic philosophy of Naprapathy is that imbalance

and illness comes from strained ligaments.

Feldenkrais 45

The Feldenkrais system focuses on increased flexibility, coordination, range of

motion, etc. It starts with a program of ATM - Awareness of Movement. It then moves

to more advanced (FI) Functional Integration.

Alexander Techniques

The Alexander Technique involves relearning basic movements in order to release

stress-related musculoskeletal imbalance. Then one must learn to balance healthy

movements with emotional/mental images.

Exercise

The Body is like a hinge on the door. If it is not swung and lubricated, it will rust

-- Oriental saying. Regular exercise rewards a person with multiple benefits directly and indirectly, not only physically, but also psychologically. Exercise is any prolonged physical activity that if it is customized and prescribed, helps people to cope to with the challenges of civilization. In the primitive world we exercised for survival, now we do so for optimal health.

Pilates

Pilates is a method of exercise which increase the body’s strength, flexibility, and balance. These exercises involve controlled motions that focus on strengthening the core of the body either without machines i.e. mat work, or on specially designed machines such as the reformer, the trap table, the barrel and the chair, etc.

Joseph Pilates designed these exercises while he was interned with other German nationals in England during WWI. As a boxer and an athlete he tried to help those whose physical conditions were only deteriorating because of life in the camp. From many years of self study that included yoga and different oriental methods, etc., he devised a system 46

of exercises, mat work, that he called “contrology.” When he was transferred to another

camp, he acted as nurse. He used the available beds and bedsprings to create exercises

that offered resistance, movement, and support to those patients who were bedridden.

After returning to Germany and training dancers and police forces, Pilates moved to the

US. With his wife, Clara, he set up a studio in New York City. Pilates is available in classes with instructors, in individual sessions, and even on home video. Pilates is now available in studios and homes throughout this country as well as many countries in the world.

There a various methods of certification available, that include, the Physical Mind and

Pilates Method as well as others.

Energy Work

Biofeedback

Biofeedback is a technology to train or control the autonomic nervous system.

Therapeutic touch

Founder of nursing, F. Nightingale, in 1859 wrote "What nursing has to do is to

put the patient in the best condition for nature to act upon him." Therapeutic touch does

just that. Developed by the Professor of Nursing at NYU, D. Krieger, therapeutic touch

usins the spiritual and emotional energy of patient and healer to allow nature to do its

work. In order for this method to succeed, the operator (healer) must concentrate on

helping the patient to heal. Also, the patient must have sincere intent to heal. In 1990,

The North American Nursing Association accepted the diagnosis of "energy field

disturbance,” which can be addressed through these methods or laying on hand with the

addition of visualization. In this system of healing there is no apparent difference 47

between whether there is actual touch or not. Lately, around 100,000 RNs have been

taught this technology. Many testimonials as well as some studies have been printed

claiming that Therapeutic Touch has helped alleviate many reoccurring and difficult to

treat complaints.

While Allopathic medicine is superb in dealing with acute conditions, it basically eliminates patient involvement. Therapeutic touch involves the patient’s intent and energy. It has been promoted by radiation oncologist Dr. Simonton, and Surgeon B.

Siegel, among others. In1998 R. Byrd looked into the effects of prayer on hospitalized cardiac patients in a double blind study and found that with prayer, less complications occurred and fewer interventions were needed. The study also found that there were faster recoveries in those patients who received energy through prayer. Importantly, it did not make a difference what type of religion was used compared to the control group.

American Medical Schools are now offering courses on spirituality and health.

National conferences on Aging, Health, and Religion also include discussions of

Therapeutic Touch. Dr. L. Dorsey published a book describing a new age of medicine where a central theme is non-local manifestations of consciousness—the basic premise of

Therapeutic Touch.

Polarity Therapy

Polarity Therapy was developed by R. Stone, M.D. D.S, N.D. This technology involves multiple different methods to balance a patient’s energy field so that the patient feels invigorated in body, mind, and spirit. Different methods could be found in TCM,

Acupressure, Reflexology, Polarity Verbal Guidance, Diet, Hydrotherapy, Supplements,

Massage, Etc. 48

Music Therapy

Music Therapy is the use of music to therapeutically address physical,

psychological, cognitive and/or social function for patients of all ages. Besides its use in

different diseases, disabilities, etc, it is effective in the healthy individual. It can lead to decreased stress. It is useful in supporting physical health. Music therapy can also lend assistance in labor and delivery.

Many old philosophers, i.e. Plato, Aristotle, made remarks about music’s healing influence. It was customary in wartime for musicians to visit and perform in hospitals for wounded people. Research has demonstrated that music aids in the regulation of the adrenal function, i.e. reducing catecholamines. It improves communication skills as well as learning, and behavior disorders. Thus it is a quite a useful tool in treating developmental disabilities, etc. Is also improves the quality of life to patients with chronic and terminal diseases. Currently certifications and credentials are available from the Board of Music Therapy.

Hypnosis

Hypnosis is used for many disorders which have significant emotional and/or psychological aspects. After awhile, patients learn self-hypnosis. Documented success was found in asthmatics, different pain conditions, addiction, weight loss, etc.

Psychoneuroimmunology

Knowledge of Psychoneuroimmunology is rapidly growing. It is the understanding that the body’s chemicals in combination with emotions create health. It is 49

the study of the very complex relationship between the psyche and the immune system.

With a greater awareness of how our mental attitude affects body function, more practitioners are finding the value in stress relief and prayers.

Reiki

Reiki (Rei - universal; ki - energy; life force) is a system, which uses the " life

force" to heal the body, mind, and spirit. Reiki therapy, facilitated by light touch, is

believed to balance the biofield and strengthen the body's ability to heal itself. Full

treatment typically includes placing hands on 12 positions on the head, front, and back of

the torso. The practice of Reiki is primarily passive, embodying the Asian philosophy of

non-action.

Mrs. Hawayo Takata (1900-1980), a first generation American, came to Hayashi's

(Japanese) clinic in 1936 suffering from respiratory and abdominal illnesses and

apparently was cured. She learned the technique and returned home to Hawaii in 1937.

Chujiro Hayashi (1878-1940), retired naval officer, developed the therapeutic aspects of

the system separate from the stringent meditative practices.

A core of training empowerments or attunements connects the student to the

primordial consciousness, an intelligence that permeates creation maintaining life-

sustaining functions and directing complex cellular processes. Students are taught how to

learn Reiki. Initiation at each level marks the beginning of study at that level. The

training of traditional healers requires subjective realms of awareness, a skill developed

through meditative techniques and disciplined spiritual practice. Although there are

several professional organizations for Reiki masters, the Reiki Alliance adheres most

consistently to the standards set by Takata. 50

The National Institute of Health’s Center for Complementary and Alternative

Medicine (NCCAM) has classified energy medicine therapies into 2 basic categories: biofield therapies and bioelectromagnetic-based therapies. Biofield Modalities are defined as those therapies intended to affect energy fields that purportedly surround and interpenetrate the human body. Reiki, Qigong, and Therapeutic Touch, involve touch or placement of the hands in or through biofields, the existence of which have not yet been scientifically proven. Bioelectromagnetic-based therapies involve the use or manipulation of electromagnetic fields (EMFs), invisible lines of electrical force or currents.

Conclusion

The WHO’s definition of health is "a state of complete physical, mental, and social well-being . . .”. It is our job as doctors to partner with our patients in order to bring about this type of health. I am referring here to healing, not curing. When we heal we take into account the dynamic pyramid of health in all its aspects. We work with the patient so that they may support and stabilize their own pyramid of health. Curing, on the other hand, is simply addressing a present, often acute, condition. However, once that condition is treated the side effects and the compensations of the pyramid must also be taken into account or the patient will soon have another acute condition. Rather, we must become practitioners of the Healings Arts using various approaches to help our patient maintain a full swing of the pendulum, a vibrant active life, for as long as they live.

To do this, I believe we should embrace all healing modalities. For this to happen, doctors must be trained in these methods or at least be exposed to these ideas so that they have openness to alternatives. For best patient care, and if a doctor has the best 51

interest of the patient in mind, the doctor must be open minded to find many tools to help

the patient heal. This includes an open mindedness to other professionals. An openness

includes using evidence-based healing modalities. This evidence is not always that

which is represented in standardized medical tests. Rather it can be evidence based in

folk remedies, and empirical evidence. An open minded doctor will also work in

partnership with the patient as both teacher in techniques of healing and a listener to the

patients needs and values.

To create this partnership a doctor must follow a few guidelines. First the doctor

must maintain open communication with the patient and other medical professionals.

Doctor and patient must have mutual respect. The patient must be valued for his/her

knowledge and work in healing. Both the patient and doctor need to speak up if anything

brings about negative feelings, energy, etc. Because we are social beings who live and

act in a matrix of relationship, those relationships should be respected and included in the

healing process. A patient should not hesitate to bring friends and family members to

visits. Patients need to be sure of what makes them unique as patients. One way for the

patient to do this is to bring a list of questions. Another way to nurture the partnership

between doctor and patient is for each to respect the time and culture of the other.xiii

Patients should be ready to ask for a reference for a second opinion and doctors must be able and willing to offer these references.

Partnering with patients does not make healing easier. Often it is more challenging to look at a whole person rather than an illness. For example it takes much more time to pay attention to and truly listen to the patient. Attending to the whole patient means understand the role that thoughts and feelings have in health and illness. 52

However, some well-meaning doctors believe that doctors who hold thoughts and

feelings as part of illness are judgmental and paternalistic.

Many educated people are no longer willing to accept just taking two pills, never

mind what it is or what it does. People are getting more and more curious about rationale for prevention and desiring long term healing approaches. This means that they are becoming more active in seeking out alternative methods of healing. This also means

that there will be a shift in the healthcare field. As new generations mature, the tradition

of trusting the medical establishment is melting away. These new generations will

challenge the establishment to incorporate many types of healing methods.

One such challenge will include the use of supplements and home remedies,

something that I support, but which also has a caveat. When patients choose to get

supplements on their own, they need to be taught the need to take care. Always read the

label. It must list all of the ingredients. Avoid impulse purchases. Slowly try only one

remedy at a time to understand the role that these purchases have in maintaining health.

Watch out for rip-off promotions. Avoid products that sound too good to be true—The

Arthritis Cure.

Patients who frequently return to our offices for seemingly insufficient reasons

are a constant challenge as we seek to provide care that is both effective and efficient.

Simple linear disease models often do not work well with frequent-visit patients. Caring

for frequent-visit patients places extraordinary demands on the wisdom and character of

the physicians who care for them. Admittedly, some physicians are better suited to caring

for frequent-visit patients and are more comfortable dealing in the shades of gray that is

often required. We must walk the line between diagnosis and judgment. Being too kind 53

and indulgent with these patients reinforces their immaturity and supports unnecessary

"disability." Telling the truth is part of who we are as caring professionals. Acting in the

patient's best interest thus calls for sometimes telling only part of the truth, but not overtly lying. There must be accommodation between what a patient wants and what is in his or her best interest in the long term.

Looking at human behavior is becoming less relevant because we now understand more of the chemistry of neural function and can modify it with drugs. However, little hard quantitative science is available to guide physicians in managing the human side of health care. Finally, there can be major conflict between your professional self-interest

and doing what's right.

Our goal as practitioners of the Healing Arts is first to strive for balance, bringing

together the best of all worlds--developing a truly holistic approach. Secondly, we must find the middle ground in providing accessibility and services at a reasonable cost for all

parties. Finally, we need to promote the patient as partner in wellness, determining together the goals of prevention and treatment. Then, hopefully the patient will be motivated to follow through with his/her choices while we act as providers of guidance

and support. Together we can affectively build a strong pyramid of health.

54

Special References i Doss AS, Ashar BH: Complementary and Alternative Medicine. ii Eisenberg DM, Davis RB, Ettner S, et al.: Trends in alternative medicine use in the United States 1990- 1997: results of a follow-up national survey. JAMA 1998; 280: 1569-1575 iii ibid iv Flexner A.: Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching, New York, NY; Carnegie Foundation; 1910 v American Family Physician. Volume 68, number 5, September 1, 2003; 952 vi Wagner L. “Boutique Practices Grow Amid Debate.” Physicians Financial News. Vol xxi NO 11 September 15,2003 vii Family Practice Recertification pg 12? viii BMJ, Vol 322, Jan, 2001 The Journal of American CM Journal, Vol 9, No. 2, 2003 ix In 1998, the title of the government’s Office of alternative Medicine switched to Natural Center for Complementary and Alternative Medicine. x The Medicare reimbursement system, adopted in 1965 for MDs and Dos, only included Chiropractors in 1974. xi In 1990 The Additional Pharmacopoeia of the People of Republic of China described 506 single drugs, 275 complex preparations xii Tong, Micheala Hyunjoo MD and Loren A. Crown, MD “Understanding a Korean Family’s Concepts of Care,” Family Practice vol 26 no2 February 2004

General References: ______

Charman, Robert A.. Complementary Therapies for Physical Therapists. United Kingdom. Butterworth- Heinemann. 2002. Goldberg, Burton. Alternative Medicine. U.S.A. Celestial Arts. 2002. Levin, Jonas. Essentials of Complementary and Alternative Medicine. Canada. Lippincott Williams and Wilkins. 1999. Pressman, Alan, D.C., Ph.D., D.A.C.B.N., C.C.N, and Donna Shelley, M.D., M.P.H. Integrative Medicine. New York. St. Martin’s Press. 2000. Spencer, John W., PhD and Jacobs, Joseph J., MD, MBA. Complementary and Alternative Medicine: An Evidence-Based Approach. Missouri. Mosby, Inc. 1999. Shealy, Norman C., M.D. Ph.D. The Complete Family Guide to Alternative Medicine. New York. Barnes and Noble. 1996. Stanway, Dr. Andrew . Alternative Medicine: A Guide to Natural Therapies. London. Penguin Books. 1992. Whorton , James C.. Nature Cures. United Kingdom.Oxford University Press. 2002.

Website References: ------www.healthwwweb.com. Health WWWeb: Integrative Medicine, Natural Health and Alternative Therapies. www.Altmed.od.nih.gov. NIH Office of Alternative Medicine(OAM). www.who.org/pll/dsa/cat95/trad5.htm. World Health Organization (WHO). www.nlm.nih.gov/databases/freemedl.html. The National Library of Medicine (NLM). 55

www.-commons.dcrt.nih.gov. CRISP System. www.hsl.mcmaste.ca/tomflem/altmed.html. Altenative Medicine--- Health Care Information Resources. www.spanit.com/Health.html. SPAN IT Health & Medicine. www.yahoo.com/Health/Alternative_Medicine. Yahoo! Home: Alternative Medicine. www.healthwwweb.com/LinksIndex.html. Internet Medical and Health Care Resources. http://www.dummies.com.The Dummies Web Site.