Coming from an Indian-American background, yoga and Ayurveda were a part of my life even before yoga pants and juice cleanses became popular. As a child, my parents had all kinds of alternative remedies for common childhood afflictions. Instead of taking Tums for an upset stomach, I drank a concoction of ginger, cumin and lemon to relieve my discomfort. And I still do. On trips to India, my parents would make sure to stock up on Ayurvedic medicines that weren’t available in the United States. This isn’t to say that my parents were ignorant or distrustful of modern medicine: on the contrary, my mother is a practicing doctor and both my parents believe in the efficacy of science-based medicine. Yet, despite their knowledge of Western medicine and easy access to modern health care, they still adhered to some traditional Indian medical practices. When I was younger, I simply wrote it off as a commitment to cultural heritage.
As I grew older, I encountered more instances of complementary and alternative medicine (CAM) in the mainstream. A 2012 survey by the Center for Disease Control found that among adults 18 and over, 33.2 percent used some form of CAM. Among the most popular practices were taking herbal supplements, deep breathing, yoga and meditation. Other practices that fall under the umbrella of alternative medicine include chiropractic care, Ayurveda, tai chi, qi gon and acupuncture. The popularity of many these therapies has been steadily increasing over the years as they become more commonplace in the health care and gain trust in the American consciousness.
However, I didn’t think much more about alternative medicine until medical school. We briefly touched on CAM and how to discuss it with our patients when we become practicing doctors. But why, I wondered, were people drawn to alternative medicine in the first place? Why, when Americans have access to scientifically backed treatments-would people try alternative therapies?
There seems to be three loosely defined groups of people drawn to CAM. The first group consists of immigrants that carry over traditional medical practices from their homelands. The second group seems to be composed of people that turn to CAM for treatments to diseases that modern medicine can’t successfully treat. For these adherents, CAM therapies can be a symbol of hope after exhausting all the conventional treatment options that clinical medicine provides. But there’s also a third group of people drawn to CAM who claim no cultural link to alternative therapies nor suffer from any incurable diseases.
Why exactly do these people gravitate to alternative therapies? I pondered this question as I waited for a hair appointment. The salon seemed “new age” inspired. There were incense sticks on the counter tops and the walls were painted a muted green. I chatted with the other women waiting for their appointments. Once they found out I was a medical student, the conversation inevitably turned towards health. One of the women began to discuss her 20-year journey with yoga and Ayurveda and how these practices had helped her maintain her strength and health throughout the years. She also told me about many sick individuals that she met who improved drastically with regular yoga practice. One story in particular involved a lady with Parkinson’s who, after years of yoga sessions, could now even do a headstand. I nodded along politely though I was more than skeptical about the Parkinson’s yogi.
On the way home from the salon, I couldn’t help but think about how pervasive complementary medicine had become in American society and what its pervasiveness meant. According to the CDC survey, the most frequent users of CAM tended to be female, educated and chronic pain sufferers. This indicated that CAM adherents weren’t necessarily choosing CAM therapies because they were uneducated or desperate. Instead, it seemed to signify a fundamental shift in how Americans were thinking about health care.
The success of Western, modern medicine lies in its ability to fight disease. We have medicines and therapies aimed at fixing specific problems but a limited emphasis on health as a whole. Historically, the trend makes sense. The 20th century saw a world plagued by small pox, polio, tuberculosis and other now preventable diseases. With the advent of science-based treatments, these once fatal diseases have basically been eradicated in the developed world through aggressive vaccination programs. The problems the medical world faces now might not be as frightening or fatal as the ones it faced in the 20th century, but they may require a shift in thinking of what providing good medical care entails.
The most common health problems in the United States today are chronic conditions such as diabetes, arthritis and heart disease. These conditions involve an interplay of genetic, environmental and lifestyle factors. It follows that management of these conditions should also be as multi-faceted as its causes. This is perhaps where CAM triumphs over modern medicine. CAM emphasizes a holistic, mind-body approach to these conditions. Holistic health care takes into account all aspects of health including the physical, mental, emotional and societal factors that can influence a person’s well-being. In providing care for a patient, CAM practitioners tend to focus on the person as a whole instead of treating just their immediate condition. In treating conditions like chronic pain, alternative therapies tend to take into account lifestyle factors, stress and emotional state as influencing factors.
Western medicine, on the other hand, is still prone to the cut-and-medicate route. In less technical terms, Western medicine doesn’t “feel good.” No one likes getting surgery or taking chronic medications. Alternative therapies such as meditation and acupuncture on the other hand, tend to emphasize whole well-being. And this feels good. For many people fed up with overly targeted treatments, alternative therapies are attractive because they focus on feelings of overall happiness more strongly.
Despite CAM’s popularity, not everyone is so quick to jump on the alternative healing bandwagon. Some doctors are skeptical about the supposed benefits of some of these therapies because they offer murky evidence of their efficacy. Instead, they tend to dismiss these treatments as elaborate placebos at best and harmful at worst. But this begs the question, should the positive outcomes of these treatments be ignored because they don’t follow the standard clinical treatment model?
For people who have been relying on CAM for pain management, the key to a good treatment doesn’t rely necessarily on whether the doctor uses CAM or Western medicine, but how the doctor interacts with the patient. Because of the holistic nature of many alternative medicine practices, doctor-patient interactions in these settings are more likely to be slow, relaxed and more involved. This in turn, tends to make patients feel more cared for as a whole human being. In sharp contrast, the average doctor visit to a Western clinic feels rushed, hectic and at times startlingly impersonal. While writing this article, I thought back to my own doctor visits and my aversion to getting my annual physical. What was it about the clinic and the doctors that made me drag my feet? As I thought about it more, I realized it was the whole atmosphere of the clinic. It often felt sterile and indifferent, with drab wallpaper and boring magazines. Sometime these feelings were reinforced by the doctors themselves. As a patient, I could tell when doctors were pressed for time and not completely engaged with the visit.
But this isn’t completely the fault of doctors. It’s the fault of a system that has lost its focus on patient-centered care. The insurance reimbursement system is set up so that doctors are incentivized to see as many patients as possible, not necessarily spend more time with each patient. This approach to health care leaves physicians dissatisfied and patients frustrated. For many patients, CAM therapies provide what they believe is sorely missing in the doctor’s clinic: a healing touch. And Western medicine has started to notice. However, just offering these treatments might not be enough if the attitude of alternative medicine is lost along the way. If patients are indeed drawn to CAM in part because of the doctor-patient interaction, then simply doing acupuncture instead of surgery might not make a difference if the holistic approach isn’t carried through.
This is where integrative medicine comes into the picture. Defined as a practice that draws on both evidence based medicine and alternative therapies, integrative medicine is becoming increasingly popular in both the research and clinical spheres. The National Center for Complementary and Integrative Health (NCCIH), a government organization, is dedicated to studying and integrating alternative therapies into mainstream medical practice. Many medical institutions now have centers for integrative medicine research and even offer these therapies alongside traditional treatments. Some of the most prominent include the centers for integrative medicine at the University of Maryland, University of Arizona and Duke. Proponents of integrative medicine claim that it emphasizes a whole person approach to medicine and focuses on cultivating the doctor-patient relationship. It also makes use of a wide variety of both traditional and alternative therapies and takes into account lifestyle factors to develop a robust treatment model that heals the whole person. Some doctors are critical of integrative medicine’s expanding presence in hospitals and schools. They argue that integrative medicine dilutes the efficacy of evidence based medicine with alternative therapies that might have exaggerated benefits.
Nevertheless, the growing acceptance of integrative medicine by the larger medical community might be indicative of a shift in what both doctors and patients perceive the role of medicine to be. Dissatisfied with some aspects of traditional medical care, with patients feeling neglected and doctors feeling rushed, both groups are turning to integrative medicine as a framework that might address these underlying issues. With its emphasis on the doctor-patient relationship and a holistic model of health, integrative medicine is pushing traditional medicine back towards its humanist roots. It is also perhaps opening up the door for a health care system that values metrics of overall patient well-being and happiness in assessing the effectiveness of clinical care.
In the coming years it’ll be hard to tell how exactly CAM will evolve within the current medical care system, but it’s apparent that alternative medicine in American health care is here to stay. As future doctors, whether we are in support of alternative treatments or skeptical about their scientific efficacy, perhaps what we can learn from CAM goes beyond herbs and dizzying yoga poses. Perhaps it lies in the reason we all decided to become doctors in the first place: to connect with our patients, to treat them with dignity and respect, and above all, to acknowledge their humanity.