The following article, written by Michael Ash BSc DO ND Dip ION mIOD, of Nutri-Link Ltd., explains why natural approaches to healthcare, and especially so-called 'integrative' medicine, may be the way forward in an era of chronic disease. The article is a longer version of a brief response to a recent British Medical Journal article on the College of Medicine.

Integrative and alternative therapies (CAM) are most effective on patients with chronic illness.  Despite the periodic efforts to compare homeopathy with acute medicine interventions, emergency medicine is not the ground on which the allegedly unsubstantiated and evidence-deficient therapies predominately operate and deliver most benefit.

Mainstream medicine development

Mainstream medicine, dominated by drugs and surgery, has in the main continued to evolve through reliance on its early 20th century model and its success in treating infectious diseases, rather than chronic, complex diseases. This strategy has been remarkably successful, and we have much to be thankful for. However, mainstream medicine’s typical ‘seek and destroy’ mentality may be contributing to the current evolutionary drift toward now-common illnesses, such as allergy, autoimmunity, diabetes and cardiovascular disease.[1]

Helping people change is no mystery

It is no mystery to medics that lavishing attention on patients motivates them to make the lifestyle changes that are apparently so crucial for lowering the risk of serious disease and managing chronic illness. That means longer, more frequent visits; more focus on what’s going on in their lives; more effort spent ameliorating anxieties, instilling healthy and positive attitudes, getting patients to take responsibility and engaging in their well-being; and concerted attempts to provide hope.[2] Our current understanding of chronic disease origins is that they emerge from a complex interaction between the genetic uniqueness of the individual and his/her lifestyle and environment.[3] Modifying gene expression and lifestyle changes requires an increasingly personalised approach to lifestyle and nutritional inputs that are likely to exceed recommendations delivered by public healthcare providers.[4]

A New England Journal of Medicine article by A.L. Barabasi suggests that the future of medicine lies in the systems approach, which views disease as arising from complex alterations in our pliable physiological network, drawing connections from genetic inheritance, expression, environment and social factors.[5]

Skeptics – what do they add to our future health needs?

We are all aware of the almost rabid attacks on alternative strategies and practitioners by some self- appointed skeptic experts. We also know that patients are frequently challenged by their general practitioners (GPs) or consultants when they cite marked improvement in their health that they relate to a particular approach by an ‘alternative’ healthcare practitioner. Instead of passively or actively supporting these polarised positions, doctors and researchers might wish to keep their minds open and show tolerance or even praise for the alternative approach, for these practitioners mostly fill the gaping holes present in modern medicine. Patients do not care about mechanisms, they want and desire a route to improved health.

The Holy Trinity of patient-centred outcomes – satisfaction, functionality and cost – are well met by alternative/integrated medicine practitioners. What else do patients care about? 

Regular posturing occurs by a small group of well-recognised and vocal skeptics. A fair spread of the main players would include: Professor David Colquhoun, a respected researcher but not a physician; Professor Edzard Ernst, a recently retired professor of complementary medicine who is long since removed from daily clinical practice; Dr Steven Novella, a neurologist with disproportionate levels of blogging time; and Dr David Gorski, a surgical oncologist with a highly caffeinated writing style. If, however, we were to seek support from all the physicians and researcher–physicians who remain open-minded and actually employ or tolerate ‘alternative medicine’ because they see and experience patient benefits, this page would need a new server to run it.

Proven benefits of integrative approaches

A popular target for the skeptics and mainstream medics, Dr Dean Ornish MD, has repeatedly demonstrated that integrative medicine approaches may stop or even reverse the progression of coronary heart disease, diabetes, hypertension, obesity, hypercholesterolemia and other chronic conditions.[6] Many of these are recognised to be the leading causes of morbidity and mortality in the Western, and increasingly the Eastern, world and are essentially diet- and lifestyle-related illnesses.[7]

For skeptics, randomised, controlled clinical trials (RCTs) are the only approved method for demonstrating efficacy, often assumed to be the same as real-world effectiveness. Iit comes as a surprise to many, therefore, to learn that RCTs published in the New England Journal of Medicine[8] and elsewhere have shown that angioplasties and stents, common surgical procedures used to treat heart disease, do not prolong life or even prevent heart attacks in stable patients, i.e. at least 95% of those who receive them. And coronary bypass surgery prolongs life in less than 2% of patients who receive it. If RCT analysis or a cost/benefit ratio analysis was applied to these procedures, then they may also be declared ineffective.

Lifestyle changes have profound effects on people’s health, and yes, those of a skeptical persuasion will argue that all medical professionals advocate eating well, exercising regularly and reducing daily stresses. However, the reality is that they have little time or motivation to manage what are very difficult changes to sell to the patient, especially when both patient and clinician have bought into the long-sold and over-simplistic ‘a-pill-for-an-ill’ drug solution.

Time – no luxury; essential clinical care

Integrative practitioners commit to spending more time and more energy assisting this change, and benefits are seen in terms of transitions to positive, healthier lifestyles. The route to conversion away from self-destructive, industry-driven behaviours can be complex and riven with emotional, physical and economic constraints that far exceed the time and skills of many ‘mainstream’ medics.

Humans, being what they are, find their route to this solution through numerous portals; some may find a GP or private doctor with the time and motivation to counsel them accordingly, but most do not. Coming into contact with a caring healthcare practitioner – an alternative, functional or integrative practitioner, who spends time and engages with the individual to reach mutually agreed decisions – can have profound effects on that person’s current and future health status.

Unfortunately, RCTs continue to throw up spectacular failures and few successes when applied to separated aspects of the alternative armoury, rather than the collective experience. But to deny patients the entire option of alternative healthcare is to deny the powerful effects that this interaction and mutual care generates on mood and personal belief.  These benefits are dismissed as placebo by the skeptics, yet the same placebo-esque strategies are employed by their colleagues on a daily basis, where time and intellect demand fast and often abrupt communications. Medicine is not simply the delivery of technique; it also requires the art of support and development through a cooperative relationship between the participants. Employing different disciplines adds substantive healing benefit to the recipient. These benefits should be harnessed and employed as part of the therapeutic toolkit.

Functional medicine – a future care model

Snyderman and Hood’s proposal is that medicine – they refer to it as prospective medicine – should become focussed on improving the functional health of the individual. To achieve this, it requires practitioners to employ the following four criteria:

• personalised
• predictive
• preventive
• participatory

This new medicine is then focused on systems biology, rather than disease. By altering this approach, it redefines chronic disease as a functional alteration in the physiological network that, in turn, requires a systems approach to clinical intervention to improve both safety and effectiveness of therapy.[9],[10],[11]

Many mainstream medical colleges and scientific journals are exploring facets of alternative medicine previously, and in some cases currently, dismissed as quackery, and finding evidence of measurable effect.[12]  The prestigious Nature Immunology[13] journal earlier this year included a review article that included the following text:

“Rather than developing new anti-inflammatory drugs, it might be more cost-effective to devote more effort to new approaches, such as monitoring the human intestinal microbiota and manipulating it if required through the use of probiotics and/or prebiotics (nondigestible food ingredients that stimulate the growth and/or activity of bacteria).”

Chronic inflammation, at least at the molecular level, is an essential part of most chronic diseases.  Strategies outside of conventional dietetics and drugs are making promising inroads into the management and resolution of these conditions, often effectively employing principles and naturally derived agents derided by the skeptics.[14]

Inevitably, polarisation of opinions will reflect character, experience and education.  All sides can, at times, feel they have won a battle but lost the war, while in most cases, stridency is rarely appreciated except by the converted.  The incontrovertible truth is that both public and professions are voting with their feet, are happy to wait for the evidence that satisfies the critics, and employ the techniques and treatments that satisfy them now.[15]

The role of the new College of Medicine

The College of Medicine, if I am not mistaken, recognises this movement and seeks to harness the shift in such a way as to encourage interaction between caregiver and receiver to enhance outcomes – however they may be measured.

Inevitably, there will be protests and dissent, some alternative practitioners will feel their more philosophical/controversial interpretations will be derided and RCT enthusiasts will see glaring errors in all projects.

Where will we be in 10 years time?  My guess is that we’ll be financially driven to look to lifestyle medicine interventions over drugs and surgery.  We will also be politely replying to the retired skeptics who will be experiencing the complexities of chronic ailments for which alternative interventions have solutions, but which the recipients have no wish to experience because of their heavily self-imposed ideological barriers.