ULSE PTHE MEDICAL STUDENT SECTION OF JAMA THE PROMISE AND DIFFICULTY OF INTEGRATING DIFFERENT HEALING TRADITIONS Downloaded From: https://jamanetwork.com/ on 09/24/2021 EDITOR’S NOTE PPUULSELSE Evaluating the Alternatives Editors in Chief Jonathan H. Lin, Columbia University College of Physicians and Surgeons Jonathan H. Lin, MA Columbia University College of Physicians and Surgeons The term alternative medicine has been leagues state in their report, engaging Ivan Oransky used interchangeably with comple- in yoga subsequent to open heart sur- New York University mentary medicine, integrative medi- gery can be dangerous. By working to- School of Medicine cine, and unconventional medicine. gether, surgeons and yoga instructors While these names encompass many have modified these exercises to allevi- Senior Editor healing practices outside the realm of ate pressure on the thoracic cavity. Ac- Li-Yu Huang, MHS allopathic medicine, they are not nec- knowledging the prevalence of alterna- Texas A&M University Health Science Center essarily equivalent and are often inac- tive therapies might allow physicians to College of Medicine curate in describing the practice and incorporate those that are beneficial in use of alternative medicine in the the regimen toward complete recovery. Associate Editors United States. Can alternative therapies be inte- Bryan K. Chan For example, not all alternative grated with allopathic practices to pro- Stanford University therapies complement allopathic duce improved patient outcomes? School of Medicine medicine. As Megan Johnson illus- Without rigorous research, it is impos- Scott Gottlieb trates in her essay, homeopaths might sible to identify those therapies that Mount Sinai School of Medicine treat a runny nose by prescribing reproducibly benefit patients’ health. of the City University of New York herbs that enhance the nasal dis- Fortunately, the Office of Alternative Jason A. Konner charge, while allopathic physicians Medicine at the National Institutes of Stanford University School of Medicine would probably provide medications Health is tackling these problems. Af- Heather R. Schroeder-Mullen to suppress the symptoms. Combining ter careful study, some alternative Case Western Reserve University both approaches to restoring health practices may prove to be useful. In- School of Medicine may not work synergistically, and it is deed, experimental evidence already Ronald J. Willy unclear to what degree treatment suggests that surprising benefits can Brown University compatibility exists. Physicians must be found for certain alternative thera- School of Medicine identify the parameters within which pies. For example, gingko biloba ex- Sue Sun Yom, MA alternative practices can be best used. tract has recently been documented to University of Pennsylvania Another term that inadequately slow the progression of dementia in School of Medicine describes alternative medicine is un- some patients.2 The possible benefits JAMA Staff conventional . While most allopathic should be justification enough for physicians may not recommend the continued rational evaluation. Charlene Breedlove Managing Editor use of energy healing to their ill pa- If an accurate, comprehensive defi- Juliana M. Walker tients, they might recommend other nition of alternative medicine remains Assistant Editor practices, such as the use of vitamins. elusive, perhaps a more restrictive Alternative practices may even be es- definition can be applied. From the AMA-MSS Governing Council sential for the total health of the indi- perspective of medical students, alter- Michael W. Bigelow, PhD, Chairperson vidual, given that the training of allo- native medicine consists of those tradi- Cesar Aristeiguieta, Vice Chairperson pathic physicians has traditionally fo- tions and practices of healing not Francine Wiest, Delegate cused on intervention. Perhaps the taught in medical schools.1 Given the Natalie Groce, Alternate Delegate Kristin Cooper, At-Large Officer prevention or palliation of certain prevalence and potential of these Steven Stack, Speaker chronic conditions are areas where practices, it is the responsibility of Jeffrey Towson, Vice Speaker alternative medicine could provide medical students to rectify this situa- Christopher R. Cogle, MD, Past Chairperson effects that are synergistic with allo- tion and educate themselves about the Pulse is prepared by the Pulse editors and JAMA pathic interventions. field. staff and is published monthly from September If alternative practices are not en- References through May. It provides a forum for the ideas, tirely complementary or unconven- opinions, and news that affect medical students 1 1. Eisenberg DM, Kessler RC, Foster C, Norlock FE, and showcases student writing, research, and art- tional, they are undeniably popular. Calkins DR, Delbanco TL. Unconventional medi- work. The articles and viewpoints in Pulse are not Despite their common use, physicians cine in the United States—prevalence, costs, and necessarily the policy of the AMA or JAMA. All patterns of use. N Engl J Med. 1993;328:246-252. submissions must be the original unpublished are often uninformed regarding alter- 2. LeBars PL, Katz MM, Berman N, Itil TM, Freed- work of the author. Work submitted to Pulse is native techniques. In the absence of man AM, Schatzberg AF. A placebo-controlled, subject to review and editing. double-blind, randomized trial of an extract of organized oversight lies the potential gingko biloba for dementia. JAMA. 1997;278: Address submissions and inquiries to for harm. As Mehmet Oz and col- 1327-1332. Pulse Coeditor in Chief Ivan Oransky, 545 First Ave, Apt 1R, New York, NY 10016; phone (212) 696-5553; Cover: Untitled acrylic painting by Patricia Wong, Stanford University School of Medicine e-mail: [email protected] 706 JAMA, March 4, 1998—Vol 279, No. 9 MS/JAMA ©1998 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/24/2021 PULSE ESSAY Homeopathy: Another Tool in the Bag Megan A. Johnson, George Washington University School of Medicine One popular form of alternative medicine is homeopathy, a system of medicine that attempts to stimulate the body to Common Homeopathic Remedies heal itself. Homeopathy is based on two main principles.1 Adapted from Healing With Homeopathy1 The first is that “like cures like”: one should administer therapies that will produce symptoms similar to those the • Hypericum (St John’s wort) patient is already experiencing.2 According to this principle, Suggested uses: Mild to moderate depression, symptoms are seen as the body’s attempt to restore itself to sharp nerve pain resulting from nerve injuries, health. Enhancing these symptoms would then aid the asthma that is worse in damp weather, toothache, body’s normal healing process. For example, one homeo- late menstruation, and headache pathic remedy for a patient with a runny nose is the red on- Notes: A popular remedy that has long been ion extract, called allium, that enhances the runny nose by used as a treatment for depression stimulating the tear glands and mucous membranes of the • Arnica montana (leopard’s bane) upper respiratory tract.1 In contrast, allopathic medications Suggested uses: After traumatic injuries, soreness such as antihistamines would suppress the runniness. and bruises, or when feeling hypersensitive and The second principle of homeopathy is that of “mini- nervous mum dilution”: one should use the lowest concentration of Notes: Often used after labor and delivery, after a substance that still provokes a response.2 This principle is a fall or blow, or for bruising essential to homeopathy’s viability, since some compounds • Arsenicum (arsenic) used in homeopathy can be toxic at high concentrations.1 Suggested uses: Restlessness, chilliness, Homeopathic medications have beneficial effects only at weakness, thirst, burning pains, nervousness, lower dilutions, although how this occurs is unclear. Pub- anxiety lished guidelines state the prescribed concentration for Notes: Often used for colds, flu, pinkeye, vaginal homeopaths to follow when creating remedies.2 infections, gastroenteritis Many factors contribute to the popularity of homeopa- thy, among which may be allopathic medicine’s ineffective- ness in treating the chronic health complaints of many pa- A second difficulty is the inconsistency in homeopathic tients. This may be especially true for more systemic condi- training. While many programs are offered in the United tions such as backaches, the “blues,” and general malaise. States, no state licenses the practice of homeopathy without In these cases, homeopathic remedies may be useful, since a medical degree. they do not require a specific diagnosis but are based on A third barrier is that most insurance companies do not the symptoms presented by the patient. Rather than sorting reimburse for alternative medical practices, because they out conditions that may not match a specific diagnosis, ho- lack sufficient scientific proof of efficacy. Nonetheless, ho- meopaths seek to enhance all symptoms through their meopathic remedies are easily purchased over-the-counter therapies. In this sense, part of homeopathy’s popularity and are also relatively affordable. may be due to this patient-centered view of illness, where Despite these obstacles, homeopathic and alternative the key to resolving health issues lies in understanding and medicines present a “significant public health challenge treating all symptoms, not just those that fit the textbook