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.