Diaspora of Clinical Medicine Exploring the Rift Between Conventional and Alternative Health Care
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Practice Diaspora of clinical medicine Exploring the rift between conventional and alternative health care Stephen J. Genuis MD FRCSC DABOG DABEM We can’t solve our problems by using the same kind of Divide between conventional thinking we used when we created the problems. and alternative medicine Einstein A perspective from conventional medi- cine. Improvements in life expectancy during the growing phenomenon continues to fracture con- past few decades are often heralded as evidence of the temporary clinical medicine. We now have ortho- sufficiency and success of the conventional scientific A dox medicine, naturopathic medicine, ayurvedic medical model. With such achievement, physicians fre- medicine, environmental medicine, osteopathic medi- quently fail to regard alternative health providers as cine, complementary and alternative medicine, func- “real doctors,” sometimes perceiving them as pretend- tional medicine, restorative medicine, and so on. ers or charlatans who practise quackery with no sci- Mainstream physicians generally believe that conven- entific substantiation for their far-fetched interventions. tional medicine is scientific and that alternative med- Some physicians consistently disparage other health icine is unscientific1; alternative practitioners, on the care disciplines, highlighting the glaring paucity of clini- other hand, generally believe that conventional prac- cal trials and evidence-based science in many alter- titioners are ill equipped to facilitate health and heal- native interventions.1 In fact, the Canadian Medical ing. Although each group shares a common desire to Association recently summarized the view of many phy- help patients and sincerely believes it has answers sicians that a nonallopathic approach to health care for the health care challenges of today and tomorrow, has “minimal scientific validity and that recommend- the expanding divide between professional health dis- ing it to patients achieves no clinical purpose and may ciplines is confusing for patients and problematic for be unethical.”9 Responding to the mounting interest in those crafting health policies. It behooves medical orga- nizations to address the rift between conventional and Figure 1. Visits to health care providers alternative health care for the sake of patient well-being (United States, 1997) and the future of clinical medicine. Fractures and splits are often a barometer of the level of dysfunction within an institution—this is certainly 700 evident in contemporary health care with escalating rates of chronic disease,2,3 poor morale within the medical 600 community,4 health care systems in disarray,5 alarming 6 rates of medical errors, and so on. In this milieu, there are 500 countless suffering patients scrambling to find solutions for their health concerns, and recent evidence suggests 400 there are now more visits registered to nonallopathic practitioners in America than to conventional primary care physicians (Figure 1).7 In fact, the demand continues 300 to escalate, with current reports estimating that $5.6 billion, or about $166 per capita, is spent annually on 200 8 nonconventional health care in Canada. Physicians ANNUAL VISITS (MILLIONS) often feel slighted when patients seek help elsewhere, 100 yet the escalating demand for nonallopathic approaches frequently represents dissatisfaction with outcomes 0 obtained through conventional medicine. Rather than PRIMARY COMPLEMENTARY AND collaborating to optimize patient outcomes, however, CARE ALTERNATIVE MEDICINE disparate medical groups continue to allow tensions to PHYSICIANS PROVIDERS divide them. TYPE OF CARE PROVIDER This article has been peer reviewed. Data from Eisenberg et al.7 Can Fam Physician 2013;59:628-32 628 Canadian Family Physician • Le Médecin de famille canadien | VOL 59: JUNE • JUIN 2013 Practice unconventional interventions from some physicians, the guidelines detailing recommended practice algorithms British Columbia Medical Association recently warned of in conventional medicine are often developed by com- “ethical challenges that arise when physicians form pro- mittees whose members have substantial financial rela- fessional affiliations with alternative providers.”8 tions with industry.19-21 Conventional medical advocates have often alleged The most acerbic assertions against the conventional that the divisions within health care are destructive and medical model, however, highlight the widespread expressed the sentiment that until “people themselves medical blunders and complications within mainstream are better educated concerning the danger and iniquity medical practice.6,22-26 The oft-quoted statistic, originally of quackery, they must be protected from the forces that published in JAMA, is the sobering detail that after prey.”10 Some suggest that perhaps discourse in science deaths from heart disease and cancer, iatrogenic illness and medicine should be constrained in order to avoid from conventional medicine is now “the third leading confusion for health consumers and to preclude loss cause of death in the United States,”27 with more deaths of trust in conventional approaches and institutions. than occur from strokes, chronic respiratory diseases, Recognizing that the scientific literature defines a “dis- Alzheimer disease, diabetes, accidents, or various others cipline’s objects of study, methodologies, and discursive causes. In Canada, a landmark 2004 study by Baker et al conventions,”11 some seek to influence the policies of found that there were 9250 to 23 750 preventable deaths scientific journals in order to control the production of in Canadian hospitals each year,28 and the American knowledge in a given field by requiring authors to stick Healthgrades report disclosed that the incidence of to “dominant discursive conventions”11 in order to get medical harm is estimated to be many thousands of published. Within this mindset, journals might disre- harmful or lethal errors daily,29 with a spike of fatal gard or reject submissions considered unconventional medication errors occurring in July owing, in part, to and limit what information can be categorized as cred- the arrival of new medical residents.30 Despite vigorous ible knowledge, thus determining who has the power to efforts of late to address the calamity of pervasive speak about a given field of study. iatrogenic illness, the New England Journal of Medicine In addition, some of the ongoing fodder for anti- reports that rates of harm persist unabated with little alternative sentiment is provided through websites and evidence of widespread improvement.31 Some critics publications originating from individuals with scientific contend that such outcomes reflect clinical practices training who customarily disparage unconventional atti- that are much more problematic than any form of tudes and therapies in health care.12-14 Allegedly acting alleged alternative quackery and consider it ironic as sentinels to expose contemporary health fraud and that conventional health providers deem themselves “quackery,” their message is often vitriolic toward physi- principal members of “the scientific community.”8 cians who incorporate nonconventional approaches, all Detractors of conventional health care point out that the while exhorting consumers to pursue conventional statistical improvements in life expectancy data, rather health care.12,13 Using scientific vernacular, such dia- than validating contemporary health care, primarily tribes are effective in manufacturing doubt15 and main- reflect steep declines in infant mortality resulting from taining unreceptive attitudes toward alternative care. innovative neonatal care, combined with advanced interventions for trauma, cardiac events, and infectious Rebuttal from advocates of alternative disease; such acute care is widely esteemed. Overall, approaches. Alternative health practitioners, on the however, “the neglected epidemic of chronic disease,”32 other hand, sometimes regard physicians as dupes who rampant iatrogenic illness,27 and inattention to are deluded about their own prowess and deceived by prevention33,34 have led critics to assert that mainstream the seductive charms of the pharmaceutical industry. medicine is failing as a results-oriented profession, and Detractors of conventional medicine often cite studies that integration of alternative approaches is required. confirming swelling rates of chronic illness,3 especially Finally, alternative medical practitioners assert in children,2 in the face of unprecedented health care that the vocal rancour from conventional medicine is expenditures as evidence that mainstream approaches disingenuous, self-serving, and unoriginal. In fact, a are failing. They frequently reference publications, such frequently referenced publication in JAMA highlights a as the BMJ, that report that most therapies in conven- 1987 US federal court judgment against the American tional medicine lack solid scientific evidence16 and that Medical Association and other medical groups for many have never been adequately assessed.16,17 Recent seeking to establish a health care monopoly, citing research, for example, confirms that two-thirds of clini- systematic defamation, and publishing and distribution cal practice recommendations put forth by the American of propaganda specifically intended to ruin other College of Obstetricians and Gynecologists lack good or health care professionals’ reputations.35 The American consistent scientific evidence.18 Further, the Institute of Medical Association was also