April 9, 2012
How do you feel about naturopathic medicine? I’ll be the first to admit, as an allopathic MD, I haven’t had any training in this sort of thing. Some feel we should be reaching out and incorporating CAM (Complementary and alternative medicine) and others think it is on the fringe for a reason: it doesn’t do anything. To quote Paul Offit from a recent article in the January 2012 edition of Infectious Diseases in Children, ‘one could argue there’s no such thing as alternative medicine. If a medicine works, it’s not an alternative. And if it doesn’t work, it’s not an alternative.’
Natural supplements with purported benefits need to stand up in blinded trials. If there is a clear benefit, these should be adopted into our overall approach. As the argument goes, it isn’t alternative anymore but real medicine at that point.
Many people who seek out CAM are doing so because the pills and therapies we provided didn’t seem to work; people still have joint pain or high blood pressure. They still feel symptoms of depression or are still getting debilitating migraines. Despite treatment, the cancer is back. Their toddler still has a runny nose and won’t eat his dinner. From the mildest to the most serious issues, we don’t always have the solutions people want.
Some medications have smaller effects than we would like to believe and we often use them incorrectly. I wonder how many Z-paks are given each year for the common cold. 60 minutes recently ran a story on the placebo effect, pointing out the limited efficacy of SSRI’s in mild to moderate depression. We know this and yet we still write these scripts. How many of the FDA approved scripts that we write each year have good efficacy and how many are, well, placebos?
The healers of the past relied on the limited power of certain medicinal plants, and the power of ritual. Evidence based medicine has moved us beyond this, but in many ways only to point out how limited our therapies can be. People will still come looking for an answer or a pill. We are doing our best to provide them but I wonder at the purity of our traditional medicine when I see elephants and stretchers and now even bathrobes following people around on TV commercials.
When it comes to preventative medicine, maybe it is time to consider a less invasive, more ‘naturopathic’ approach. It would be far better if many of the disease states we are trying to re-calibrate never occurred in the first place. Naturopathic providers may do a much better job with this message than I can do in my busy practice.
The human body really can heal itself. Many alternative medical providers tap into this, as healers have for centuries: exercise, meditation, and healthy diet all have profound effects. There are limits to this healing power. Naturopathy will never catch or cure leukemia. It cannot stop MRSA but it may be a great help with hypertension, diabetes, sleep disorders, behavioral disorders and on and on. It may be a great help with things that are influenced by diet, lifestyle and mood. In the same way that our therapies, drugs and antibiotics are sometimes used in less than optimal ways, naturopathic care can easily go astray and venture in dangerous directions. When I hear some naturopaths espouse the benefits of NOT vaccinating a child, I see blindness to the evidence. Anything, including the healing power of healthy living, can be taken too far, to conclusions that are unsupportable by evidence.
If we can stick to the evidence, we see there is great power in both forms of medicine as well as potential for abuse. With a looming healthcare crisis of cost, regardless of which direction the political winds blow, we will need to be creative about getting our population healthy. A pill may not always be the cheapest or even the most efficacious therapy.
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