Alternative medicine becomes the mainstream

8 January 2002

Published in The Age

As the result of a seachange in health practices over the last generation, more Americans now visit holistic practitioners than GPs. To many - 30 percent in one survey - holistic care does not supplement mainstream medicine, but replaces it. Indeed the trend is so marked that the majority of US doctors now prescribe alternative treatments.

With the public voting with its feet, the health infrastructure is scrambling to keep up. The majority of US health insurers support one or more alternative therapies; virtually every US medical course now embodies some training in holistic approaches.

In 1998 the US Government established the National Center for Complementary and Alternative Medicine at the prestigious National Institutes of Health, to support quality research into alternative therapies.

Whilst the US is the world leader in this new model of health care, large changes are underway in Australia too. Doctors are retraining in holistic or alternative therapies: universities are teaching them, health insurers are underwriting them, and consumers are flocking to them. (Before long, even the media will catch on.)

Given the vast changes underway, what new professional paradigm will emerge over the next 40 years?

Will we see a degree course in the holistic arts, with specialisations - Chinese Medicine, herbalism, et al - after that? Will holistic healers be called doctors, and get Medicare funding?

Or might we see a re-design of the medical degree: the retention of biology, anatomy and surgery, but a scaling down of (say) pharmaceutical medicine, "miracle" technology and transplants? And the incorporation, in their place, of a range of scientifically proven holistic practices?

Will what we call "Medicine" even survive?

"Of course Medicine will survive," says Dr Edward Campion, deputy editor of America's best-known medical journal - The New England Journal of Medicine. "Assuming that civilized societies survive. I cannot predict the future, but Medicine and alternative medicine meet quite different needs."

But in reality, the two are moving closer. Medicine embraces more training in nutrition and patient skills, and practitioners are increasingly broadening their repertoires to include acupuncture, herbs, homeopathy and the like. On the other hand the mind-body principles of holistic healers are being validated by the new science of psycho-neuro-immunology; and "alternative" research in general is increasingly science-based. Its notorious flakiness is on the wane.

So will the two schools one day merge?

"They are  merging," says John Weeks, Principal of the Collaboration for Healthcare Renewal - a non-profit US body which works towards integration, from both sides of the fence. "The question is whether or not the mainstream will be influenced by both the individual therapies and the patient-centred paradigm which 'alternative medicine' originally represented."

This "patient-centred paradigm" has, perhaps, been holistic medicine's greatest drawcard. Medicine has undoubtedly lost many clients to "alternatives" because of the inferior patient rapport of doctors. That's changing fast.

"Medical training was seen to be out of touch," concedes Agnes Dodds, senior lecturer in medical education at Melbourne University. "The old style of doing three years of basic science followed by three years in the hospital - it was felt that the students didn't get introduced early enough to doctoring. Being in touch with patients - finding out really that it's a profession that's about people. From day one now in the modern course, it's made very clear to students that they're going to spend their working lives dealing with people. They need to be able to talk to people at their own level, in words they can understand. If the profession learns that lesson, then thirty years down the track hopefully it will be more respected as a profession."

Holistic ideas are influencing Medicine's "content" too, with a Melbourne University curriculum working group presently looking at ways of introducing students to alternative therapies.

John Weeks observes the same trend in the US, though in a more advanced form:

"Mainstream care is already responding, at many levels, to the consumer. The most significant US developments are new integrative educational initiatives in medical schools, such as that at Georgetown led by Dr Aviad Haramati, which aims to create a 'new kind of physician'. We'll see MDs [GPs] in a kind of European model, including various CAM [complementary and alternative medicine] modalities in their routine care."

In 1999 the Director of the National Center for Complementary and Alternative Medicine in the US, Dr Stephen Strauss, predicted the changes he thought would occur in alternative medicine by 2020:

“As a result of rigorous scientific investigation, several...[alternative] modalities will have proven effective. Therefore, by 2020, these interventions will have been incorporated into conventional medical education and practice, and the term 'complementary and alternative medicine' will be superseded by the concept of 'integrative medicine'.

“Other modalities will have proven unsafe or ineffective, and an informed public will have rejected them.”

Whilst doctors have learned from the patient skills of holistic healers, holistic medicine in turn is taking onboard mainstream medicine’s greatest strength: the rigorous testing of its theories.

This is significant - not only for rescuing alternative medicine's scientific credentials, but because some traditional therapies simply don't work. The new “empirical” approach has found, for instance, that chiropractic manipulation is ineffective against periodic tension headaches, and that iridology is a comprehensive failure at diagnosing kidney disease.

Weeding out its duds will be as important to holistic healing’s journey into the mainstream as substantiating its successes.

A recent two-year research project by the US Institute for Alternative Futures concluded that, by 2010, holistic modalities such as chiropractic and oriental medicine will be used by two-thirds of Americans.

The Institute forecasts that America's largest CAM therapy, chiropractic, will double its practitoner numbers - to 103,000 - in just ten years. Oriental medicine is expected to grow even faster.

And once a mechanism is discovered to explain homeopathy's effectiveness, the Institute predicts, it will gain greatly in credibility: particularly as "it can be integrated relatively easily into the protocols of managed care", and tends to be far cheaper than mainstream pharmaceutical approaches.

[2013 update: Homeopathy has since been debunked. It is now fading in popularity.]

The Institute concludes that CAM approaches will - in future - "displace some portion of conventional medicine"; "will become major tools for health promotion and prevention"; and will be increasingly embraced by conventional doctors. CAM practitoners are even thought likely to gain the "competitive advantage" over doctors in the medium-term.

John Weeks feels that "the shift appears to be less 'away' from conventional medicine than toward a broader paradigm of care in which mainstream medicine is still used, but is viewed as part of a picture, with strengths and weaknesses."

Some of the most interesting commentaries on the "new paradigm" are coming from (of all places) medical journals. On November 11, 1998, the Journal of the American Medical Association editorialised:

“There is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data, or unproven medicine, for which scientific evidence is lacking. Whether a therapeutic practice is 'Eastern' or 'Western', is unconventional or mainstream, or involves mind-body techniques or molecular genetics, is largely irrelevant except for historical purposes and cultural interest.”

Thus in one short statement did the official organ of the US medical profession do away with its age-old hostility to alternative approaches. The statement also underlines the scientific validation so crucial to those "alternatives" entering - and perhaps becoming - the mainstream.