Two medical schools in my home state have established integrative medicine divisions. One named me adjunct clinical professor, despite the fact that I do not reside in that city. While colleagues of mine were actually teaching classes at that school, I was given this title for reasons unknown to me; presumably because I am senior to practically everyone in the practice of alternative medicine, and partly (I imagine) to secure me for some future duties.
Recently, however, the medical school in my own community has begun knocking on my door regularly. I have been asked a number of times to attend meetings of their integrative medicine division, and their department of family medicine has been sending students to my clinic on a regular basis, in spite of the fact that I am not on their faculty. I do this as a courtesy, and am happy to introduce young students with still-open minds to my methods.
The school's program for integrative medicine invites members of the community to attend their meetings and tell what alternative services they have used and their results. They publicize this inquiry with posters, and offer $20 to anyone who participates in this "study." As a professional who attended and gave them some of the statistics they wanted, I wasn't even offered the $20 given to laypersons. Perhaps they thought it would be insulting.
What I did think was mildly insulting, though, was the questionnaire I was given to fill out for inclusion in a local provider directory. When listing your "alternative medicine services," the form asks you to "send us a business card, if you have one" (emphasis added). Wouldn't one assume that a medical professional, of any type, would have a business card, unless one wasn't assuming much of a professional standing from those included in the list? I thought it odd, but realized that it may be revealing an attitude on their part. Also appearing on the same page was the instruction to list "your age (in years)." How they thought I would list my age otherwise is beyond me.
These meetings are interesting. Various unorthodox health care providers have been asked to come for round-table discussions and are quizzed on topics relating to the use of their services by the public. These meetings are tape-recorded. I was asked to sign a release and a confidentiality agreement. Apparently, members of the department of family medicine, and possibly other departments, are listening to these discussions with invited practitioners from the community.
The practitioners insist on using the term "complementary" medicine and frown upon the use of the word "alternative." This is the trend within orthodox medicine, and it clearly reveals the appearance they wish to create: that this is not an "either/or" proposition - orthodox vs. and "alternative" medicine. This is "complementary" - two different fields working together for the good of the public. So far, so good ... at least, theoretically.
The first problem that arises from this situation is that while there is much of value to the patient in both camps, the underlying assumption on the part of the orthodoxy is that since they have the big institutions, high-tech equipment, and a near monopoly on life-saving procedures, they are the senior partners in this collaboration. They see themselves as doing "real" medicine, and see everyone else as a useful add-on. It seems clear to me that the "fishing" expedition they have been conducting in my community (and perhaps yours) is to evaluate the marketplace, not to establish relations with other providers to whom they can refer. With the tremendous resources they have for community outreach, the presumed superiority of a facility with all phases of medical care under one roof, and - here's the biggest hook of all - complete insurance coverage, they can force the independent provider out of the marketplace. Remember, that means you.
I have heard positive remarks about the "open-mindedness" of local allopathic doctors who are adopting some natural remedies in their practices. In their literature, the local hospital's program for integrative medicine talks about "effective approaches to health care from a variety of traditions to supplement that of conventional (allopathic) medicine."
Think for a moment. Can you imagine how outraged they would be if we were to say, "We will be offering Pap smears, mammograms and intravenous medication to supplement our alternative methods"? Why are we not outraged that they are now trying to provide our services as an adjunct to theirs?
To illustrate the different standard used for alternative providers, I will point out that I have never heard internists or emergency medicine doctors make disparaging comments about dermatologists because dermatologists don't treat many life-threatening diseases, yet I have heard countless times the ridiculous comment, "If I was hit by a truck, I wouldn't go to a homeopath!" I also do not hear complaints made about psychiatry never having been "proven" by double-blind studies (which it hasn't). Yet this is always the first objection you face from a skeptical MD who dismisses anything he thinks is "alternative" without investigating it.
Within the medical fraternity, one's own fellow members are beyond reproach. However, outside that private club, practitioners have always been expected to prove themselves. Now that there exists substantial proof of the validity of many unorthodox approaches, the allopaths are begrudgingly accepting these methods. However, the acceptance does not necessarily extend to the practitioners.
I feel this is partially due to the grouping together of various techniques under the umbrella of "complementary" or "alternative." Combining fragmented techniques such as yoga; vegetarianism; reflexology; aromatherapy; crystal healing; spiritual healing; massage; and meditation under the same blanket term with such well-organized systems as chiropractic, naturopathic medicine and Oriental medicine is confusing and misleading.
These last two medical systems, for example, both contain such varied modalities as dietary adjustments; yoga-like postures, exercises and breathing techniques; contemplative and meditative techniques for psychotherapeutic use; as well as herbal medicine; point stimulation; manual manipulative techniques; and a host of diagnostic procedures. All of these modalities are used (as they should be) in a fully orchestrated way of practicing comprehensive medicine, not as fragmented parts misconstrued to be an entire system of medicine.
While experts in dietetics or medicinal herbs may certainly be valuable for consultation, unless they are fully trained in medicine, they will not be recognized as full-fledged practitioners, so orthodox medicine's attitude in this regard is understandable. If they are introduced to unorthodox medicine with the initial (mis)understanding that aromatherapy, for example, is a system of medicine, and they find it being practiced by individuals with no training in physiology or pathology, they are apt to reject it at the outset.
But this does not excuse MDs for not treating NDs, OMDs, DCs, etc. as different but equal practitioners. And while doctorate-level training has not yet been established (and may never be) for aromatherapy, therapeutic touch, polarity therapy and other systems of this type, it has long bee established for naturopathic medicine and is finally beginning to be settled for Oriental medicine. Chiropractic does not consider itself a medical system, bit its doctorate and educational standards have long been established, and I should point out that chiropractors take more class hours in most subjects than medical doctors, so I think they have to need to apologize to the medical establishment.
This is why some long-time practitioners such as myself bristle a bit at being grouped with other therapies that are still in their infancy. I have no doubt as to the efficacy of a technique like aromatherapy, although I do not use it myself. But the lumping together of various "wellness" lifestyle methods, such as diet and exercise systems, with organized schools of natural medicine is misleading. I believe that it is a deliberate attempt to downplay the potential of orthodox medicine's most powerful competing systems. If the pubic equates naturopathy with massage, or Oriental medicine with crystals and spiritual healing, they will be less likely to rely on these systems as primary sources of health care. Oriental medicine in particular has been at a disadvantage for years because we emphasized acupuncture to the exclusion of other modalities and became known as "acupuncturists." I chuckle to think of allopathic doctors being called "hypodermicists."
So-called voices for a new, integrated medicine like Andrew Weil, MD, compound the confusion when they represent "alternatives," as Dr. Weil did on the cover of Life magazine by taking a mud bath and clutching a sprig of leafy herb. This is alternative medicine? I cannot say too strongly or loudly that Andrew Weil covered in mud does not represent what I do professionally! The impact on alternative medicine from one image like this, seen by millions, can do incalculable harm. Maybe the cherubic and likable Dr. Weil did not do any real damage to unconventional medicine, and maybe I could take a leaf (so to speak) from one of his books and lighten up a little. But I cannot shake the ominous feeling I get from observing orthodox medicine making fun of alternatives on the one hand, then getting involved with alternatives on the other. I believe there are early signs of trouble for our profession, which I will address in the next two installments of this series.
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