Musings of an Allopath

Americans spent 18 billion dollars on alternative medicine in 1998! Every week articles appear on alternative therapies in newspapers and magazines. Herbs made the cover of Time magazine. Patients come to clinic with magnets in their shoes and copper bracelets on their wrists. My neighbors sell "nutraceuticals" - (food substances with pharmaceutical value) vitamin supplements.

What is an allopath? It is a term created by Samuel Hahnemann, founder of homeopathy. His basic premise was "by similar things is a disease produced by similar things will it be cured", or "let like be cured with like." He called himself a homeopath. Homeo-like, "pathos" - suffering. Conventional physicians were "allo" - different, "pathos" - suffering, since their treatments counteracted or suppressed symptoms.

As an allopath, I ask myself "What is the allure of alternative medicine?" There have been several theories proposed in the literature. The first is dissatisfaction with conventional care which is perceived as too impersonal, too technological, too costly, and associated with too many side effects. The second is that patients want more personal control over health care decisions. Conventional medicine is viewed as too authoritarian. Finally, alternative medicine may be more compatible with the person's philosophical or spiritual world view. Many people recognize that physical-emotional-spiritual aspects of their lives are interrelated and they want their health care providers to recognize this also.

In a recent poll, 79% of Americans believed that faith can help the course of an illness and 63% want their doctors to discuss spiritual issues with them. Physicians do not necessarily need to agree with their patients. Often, it is very helpful to explore the patient's belief system and its impact on the patient's life and their illness. In the right circumstances, I have found it helpful to pray with patients.

Another obvious reason to seek alternative care is that conventional therapies have been exhausted -- end-stage cancer or chronic pain syndromes where conventional therapies are not particularly effective -- Fibromyalgia, chronic fatigue.

I believe that there are two additional reasons that patients seek alternative care. In his book "Spontaneous Healing", Andrew Weil, MD, states that conventional physicians worship Aesclepius, the male god of medicine - the snake on the traditional medical symbol. He wages war on disease. Complementary providers worship Hygeia, the female goddess of healing. They teach that the body is self-healing. Their job is to strengthen the body from within so it can heal itself. These therapies offer the possibility of a cure. They do not promote just the absence of disease or symptoms, but instead promote wellness. This idea is appealing to people.

Secondly, alternative providers do not differentiate between "physical" illness and "psychosomatic" illness. Patients are often offended by the term "psychosomatic," feeling that physicians believe the illness is "All in my head," or that "I am crazy." Physicians are often frustrated by these conditions because we do not have effective treatment.

Complementary medicine may be better suited to deal with these conditions because it is holistic - the mind-body and spirit are viewed as interconnected. There is no differentiation. For instance, when a patient with chronic fatigue visits a homeopath he/she takes an extensive history with special attention to the patients subjective experience of illness. No diagnosis is made. There is no label. The homeopath simply says, "I have a remedy that closely matches your symptoms." The patient has been listened to and given a remedy. The clinician-patient encounter itself is healing.

Most people do not see alternative providers exclusively. In Astin's national survey described in the Journal of the American Medical Association, only 4.4% of patients did not have a conventional physician. Most patients used both forms of health care. Alternative care was used for chronic conditions especially chronic pain. In Eisenberg's two national surveys on the use of alternative medicine in America in 1993 and 1997, only 40% of patients told their physicians about their use of alternative practitioners or therapies. Twenty percent used prescription medications concurrently with herbs, supplements or megadose vitamins. So, it is important that we ask about these therapies and have some knowledge about efficacy and usefulness. Many alternative therapies have not been well studied. The Office of Alternative Medicine was recently upgraded to an independent center and renamed the "National Center for Complementary and Alternative Medicine," and given an increased budget of $50 million.

As further studies are done and therapies are found to be efficacious, both patients and conventional physicians will benefit. The recent fascination with alternative medicine can be a growing experience for us allopaths - causing us to examine what we do well, and what we don't do so well - and allowing us to learn from what complementary providers do well.

  Sources cited:

1. Weil A. 1995 Spontaneous Healing. Alfred A. Knopf, New York
2. Astin JA. 1998 Why Patients Use Alternative Medicine: Results of a National Study. Journal of the American Medical Association 279:1548-1553.
3. Eisenberg DM, Kessler RC, Foster C, et al. 1993 Unconventional Medicine in the United States: Prevalence, Costs, and Patterns of Use. New England Journal of Medicine 328:246-252.
4. Eisenberg DM, Davis RB, Ettner SL. 1998 Trends in Alternative Medicine Use in the United States, 1990-1997. Results of a Follow-Up National Survey. Journal of the American Medical Association 280:1569-1575.

"Reflections" is a collection of essays by the health professionals of the Medical College of Wisconsin.