Because I Said So

There is a perception that docs who believe in integrative forms of medicine must be flawed in some manner, that they’ve been taken hostage by “conversion phenomenon.” And because William T. Jarvis, Ph.D. said so, it must be true. What’s worse; this misinformed article is being waved in the air as the great defender to those who decry the evils of alternative medicine. These medical professionals have suffered nervous breakdowns, have low self-esteem, are paranoid, going through a divorce, or are in the midst of a mid-life crisis. I find this every bit as comical as I do pathetic. Why, for the love of all that’s sacred, would anyone refer to a ten-year-old article where the most recent references are from 1987? This is supposed to be compelling? I’ve heard those very same reasons as to why democrats exist. The article is pure bunk.

When I think back to 1998, I remember the medical world laughing hysterically at biofeedback and guided imagery as something the Birkenstock and tie-dye-wearing community would embrace. Certainly not respected doctors. Flash forward to 2008. Now we’re hearing that biofeedback, hypnotherapy, and guided imagery are not only acceptable, but they’re no longer “alternative medicine.” Huh? Don’t get me wrong, I’m thrilled at the acceptance of these modalities. What surprised me is that they are now being called mainstream. As defined by NIH:

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Complementary and alternative medicine (CAM) is the term for medical products and practices that are not part of standard care. Standard care is what medical doctors, doctors of osteopathy and allied health professionals, such as registered nurses and physical therapists, practice. Alternative medicine means treatments that you use instead of standard ones. Complementary medicine means nonstandard treatments that you use along with standard ones.

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Obviously many things have changed in the ten years since Dr. Jarvis penned his fantasy. Not unexpected because medicine changes at an alarming rate, as does professional opinion. But I’d like to know if this transformation from alternative/complementary to standard care happens by agreement. If so, who is the governing body? How many make a quorum? What is the litmus test? How did they come to this agreement? Who votes?

Admittedly, I’m confused. On one hand, I have docs telling me about the dreaded “conversion phenomenon,” and that no sentient doctor would be so taken in by this lunacy. On the other hand, I see what was once “alternative” is now standard care, such as hypnotherapy, biofeedback, guided imagery. What’s worrisome is that there is a vocal community within medicine who don’t agree and there are a lot of darts being lobbed back and forth. This is fine if that’s what floats their boats. But you know what, this ultimately affects patient care. Where some docs may prescribe a drug, another may prescribe biofeedback. Who’s the winner of this scenario?

Response

I get comments on my blog. Since there was so much to address with this particular one, I decided to turn it into a separate post.

“This post should be titled, "Attack of the Straw Men."
No, I prefer it the way as is. What I don’t think the world needs more of is condescending platitudes.

“…you're mixing apples and elephants. Hypnotherapy, guided visualization and biofeedback (essentially relaxation therapy) are qualitatively different from Reiki, acupuncture and chiropractic (magical thinking in lieu of any plausible scientific basis.) Lumping them all together is a "Trojan Horse" strategy, per Orac, via Dr. RW (see comments section from this post for the full quote)”
Not sure who put Dr. RW in charge of all convening opinions, but according to Panda and others, this is an all or none proposition. It’s either science based medicine or it’s hooey – there is no in between. Now I’m being told that some alternatives are now suddenly deemed “okay” by the medical community – going so far as to question why they were even called “alternative” in the first place? I don’t believe this for a minute. Acceptance from the medical community comes in degrees, and it’s based solely on the fact that some methods are easier to swallow than others.

You’re now giving Biofeedback its due? Why? It’s mind/body medicine, after all.

Biofeedback as taken from the Mayo Clinic:
Biofeedback is a type of complementary and alternative medicine called mind-body therapy. It's designed to enable you — in mind-over-matter fashion — to use your thoughts and will to control your body. Biofeedback is based on the idea, confirmed by scientific studies, that people have the innate potential to influence with their minds many of the automatic, involuntary functions of their bodies.

Guided Imagery (visualization), as defined by Web MD:
Guided imagery is a program of directed thoughts and suggestions that guide your imagination toward a relaxed, focused state. You can use an instructor, tapes, or scripts to help you through this process. Guided imagery is based on the concept that your body and mind are connected. Using all of your senses, your body seems to respond as though what you are imagining is real.

Hypnotherapy as defined by University of Maryland Medical Center:
Hypnotherapists typically use exercises that bring about deep relaxation and an altered state of consciousness, also known as a trance. Many people routinely experience a trance-like state while they are watching television or sitting at a red light. A person in a trance or deeply focused state is unusually responsive to an idea or image, but this does not mean that a hypnotist can control his or her mind and free will. On the contrary, hypnosis can actually teach people how to master their own states of awareness. By doing so they can affect their own bodily functions and psychological responses.

This is mind/body medicine, folks, alternative medicine. And this is okay with you? I find the irony staggering. There is no more “science” to these alternative healing methods than there is with acupuncture, reiki, and chiropractics. The only way to determine the level of healing is asking the patient how he feels. By all admissions, this isn’t acceptable.

I’m confused as to how guided imagery can be easier to accept than Reiki, acupuncture, or chiro. At least with chiropractics, you have the benefit of x-rays. It’s pretty easy to see if a disk or hip is back in place after the course of treatment.

The truth of the matter is that the fraction of docs who don’t believe alternatives have any place in medicine have never done the research. They go to the sites and literature that only support their bias. How can I make such an inflammatory statement? Because of the many docs I researched who do use integrative medicine in their practices. I’ve been told time and time again that the literature is out there. It’s just that the docs aren’t listening. Or they’re being selective.

A key issue is that when looked at scientifically, the data you speak of for CAM are far from compelling.
Then why and how is it that biofeedback, hypnotherapy, and guided imagery get a pass, according to Orac and Dr. RW. They’re alternative medicine, no matter how one tries to justify it. You simply cannot rewrite the rules to fit your needs, and that’s exactly what it sounds like you’re doing.

The "respectability" of those promulgating it is irrelevant.
Are you kidding me? First I’m told that “some” alternatives are okay. Now you’re telling me that the opinions from respected and renowned docs who utilize integrative medicine in their practices are irrelevant. Why are their opinions irrelevant? They earned their reputations because they were recognized as being superior at what they do. This appears to be a case of, “I don’t like what I’m hearing on this particular issue, so I’m going to dismiss it, regardless of who said it. But, boyo, his opinions on heart valve surgery is bang on.” This is talking out both sides of your mouth.

Basically this comes down the fact that many docs will never see eye to eye on the integrative issue. The methods of dismissal are akin to politics – if one talks it up or down enough, it becomes real “because I say so.” That’s not reality, and thankfully, there are many, many docs who disagree with you because they’ve had success with alternatives and use any number of those methods in their practices - including Reiki, acupuncture, and stuff I've never even heard of. The face of medicine is changing to include other forms of healing.

As I've said a million times, I would never proscribe anyone turning their backs on their docs. But I don't believe that docs know everything there is about how the mind and body integrate in healing. Some things are, indeed, seemingly magical because there's no science that can back it up. But that doesn't make it irrelevant. It makes it compelling.

Is It Real?

Yesterday’s paper had a long article about fibromyalgia and the controversy over whether it’s a made-up affliction or real, which begs the question as to how the medical community defines disease. Can disease only be defined by the ability to measure it with medical testing, or are the symptoms enough to give it disease status? For a non-medical person like me, this question falls under the classification of, “if a tree falls and no one is there to hear it, is there noise?”

On one hand there seems to be an agreement among the medical community that if a consistent set of symptoms exists in a high enough populace, then a “disease” or “syndrome” is added to the books – regardless of whether there is a test to measure its existence. I’m good with that. I believe we can have afflictions that science has no means of measuring yet.

But what happens when science changes their mind and decides that a disease isn’t a disease after all – as with fibromyalgia? Frederick Wolfe, the lead author of the 1990 paper that defined how to diagnose fibromyalgia, now believes that fibro is a physical reaction brought on by stress, depression, and economic and social anxiety. Yikes. What was real for 18 years is now bunk. Just like that.

This article made me think about other afflictions that are void of scientific testing, and the only barometer is a populace suffering from the same symptoms. Attention Deficit Disorder is a big ticket item. And what about that real heart breaker – Restless Leg Syndrome? (I can’t help but wonder if Big Pharma came up with that one on their own – the idea of it is just too silly to contemplate)

What’s interesting about these syndromes and disorders is that the drugs invented to ease patient suffering are as enigmatic as the disease itself. According to the medical articles I’ve read, no one seems to know how or why Lyrica or Ritalin, or Concerta work. The general acceptance of these drugs seems logical in a convoluted way because there are no medical tests to diagnose the problem in the first place. But the drugs are, nonetheless, prescribed by a community that normally says, “it must be scientifically proven.”

But what has me really puzzled is that the medical community is willing to accept an affliction as being real even though there is nothing to prove its existence other than collected data by respected scientists. They’re also willing to accept its pharmaceutical magic bullet, yet they turn their noses up at integrative healing methods – something that has no side effects. I can’t help but see a double standard at play. Hypnotherapy, Reiki, guided visualization, biofeedback, acupuncture, and chiropractic is reviled as a group of snake charmers who are out to fleece granny out of her last dime – even when its advocates are respected docs who have provided equally compelling data. Puzzling.

The Chicken and the Road

Since I have the tendency to wander south of Esoteria, it’s no small wonder that I would finally ask, “Why did the chicken cross the road?” I took my question to a number of folks for their feedback. Their answers:

DR. PHIL:
The problem we have here is that this chicken won't realize that he must first deal with the problem on 'THIS' side of the road before it goes after the problem on the 'OTHER SIDE' of the road. What we need to do is help him realize how stupid he's acting by not taking on his 'CURRENT' problems before adding 'NEW' problems.

OPRAH:
Well, I understand that the chicken is having problems, which is why he wants to cross this road so bad. So instead of having the chicken learn from his mistakes and take falls, which is a part of life, I'm going to give this chicken a car so that he can just drive across the road and not live his life like the rest of the chickens.

GEORGE W. BUSH:
We don't really care why the chicken crossed the road. We just want to know if the chicken is on our side of the road, or not. The chicken is either against us, or for us. There is no middle ground here.

COLIN POWELL:
Now to the left of the screen, you can clearly see the satellite image of the chicken crossing the road...

ANDERSON COOPER - CNN:
We have reason to believe there is a chicken, but we have not yet been allowed to have access to the other side of the road.

JOHN KERRY:
Although I voted to let the chicken cross the road, I am now against it! It was the wrong road to cross, and I was misled about the chicken's intentions. I am not for it now, and will remain against it.

NANCY GRACE:
That chicken crossed the road because he's GUILTY! You can see it in his eyes and the way he walks.

PAT BUCHANAN:
To steal the job of a decent, hardworking American.

MARTHA STEWART:
No one called me to warn me which way that chicken was going. I had a standing order at the Farmer's Market to sell my eggs when the price dropped to a certain level. No little bird gave me any insider information.

DR SEUSS:
Did the chicken cross the road? Did he cross it with a toad? Yes, the chicken crossed the road, but why it crossed I've not been told.

ERNEST HEMINGWAY:
To die in the rain. Alone.

JERRY FALWELL:
Because the chicken was gay! Can't you people see the plain truth? That's why they call it the 'other side.' Yes, my friends, that chicken is gay. And if you eat that chicken, you will become gay too. I say we boycott all chickens until we sort out this abomination that

the liberal media white washes with seemingly harmless phrases like 'the other side. That chicken should not be crossing the road. It's as plain and as simple as that.

GRANDPA:
In my day we didn't ask why the chicken crossed the road. Somebody told us the chicken crossed the road, and that was good enough.

BARBARA WALTERS:
Isn't that interesting? In a few moments, we will be listening to the chicken tell, for the first time, the heart warming story of how it experienced a serious case of molting, and went on to accomplish its life long dream of crossing the road.

JOHN LENNON:
Imagine all the chickens in the! world crossing roads together, in peace.

ARISTOTLE:
It is the nature of chickens to cross the road.

BILL GATES:
I have just released eChicken2007, which will not only cross roads, but will lay eggs, file your important documents, and balance your check book. Internet Explorer is an integral part of eChicken. This new platform is much more stable and will never cra...#@&&^(C% ..! ..... reboot.

ALBERT EINSTEIN:
Did the chicken really cross the road, or did the road move beneath the chicken?

BILL CLINTON:
I did not cross the road with THAT chicken. What is your definition of chicken?

AL GORE:
I invented the chicken!

COLONEL SANDERS:
Crap, I missed one?

DICK CHENEY:
Where's my gun?

Reading the bathroom walls

As seen on the stall wall in a particularly grungy gas station bathroom in Barstow where mold and grime have replaced paint:

For a good time, read M.D.O.D.

See guys? You’re moving up in the world.

“Inties” vs “Alties” – thar be a difference

Alternative and traditional medical care combine to heal middle-age figure skater. This article is a prime example of why I find integrative medicine so powerful. Alternative medicine is invariably exclusive from medicine, while Integrative medicine believes in playing alongside traditional medicine in order to obtain the best of both worlds. What's not to love?

“I did some digging to find a solution. After much research, I turned to the Susan Samueli Center for Integrative Medicine at UCI… because of what it stands for: "Wellness through knowledge." This is the basis on which they work with their patients.

Their medical practitioners follow research-based techniques to get at the core issues of an illness or injury – not just mask symptoms with drugs (a remedy other doctors had tried with me in the past). My practitioner explained that the center strives to provide care which allows the body to heal itself — a natural approach that I liked and felt good about.

The center is "integrative" because it combines the efforts of traditional western medicine with alternative or integrative approaches— a combination that proved to be a winning formula for me!”

Obecalp – the new wonder drug?

I love reading medical blogs – it’s how I spend my early, early mornings before my day job kicks me in the lower forty and tells me to quit being a slacker. One such blog led me to read a frightening article about how a Gulf War veteran was given “Obecalp” as part of his treatment. When the veteran didn’t find any relief, he got to checking things out. Obecalp is placebo spelled backwards. To say the least, I’m amazed that anyone would do this to a patient.

The veteran was duped. No matter what kind of treatment a patient receives, he’s gotta be told. Full disclosure, ethics, and all that. To do anything less is fraud, in my opinion. After all, it’s not like this vet was taking part in a clinical trial.

The article goes on to say that regular docs have been found to prescribe placebos in place of medicine. I can understand docs’ temptations to do this, say in cases where a patient wants antibiotics for something viral just to shut them up. I had no idea this practice actually went on. I know that every one of my doc friends would be disgusted that a colleague would destroy the doc-patient trust.

Ironically enough, I’m informed by docs on a near-daily basis that integrative healing options are nothing more than placebos, so I do see the paradox of my outrage. However, the difference is that the patient knows exactly what’s going on in a professional setting. Well, okay, there was that time I fried my father-in-law’s synapses with a rousing Reiki session that he knew nothing about. In my defense, I don’t hang out a shingle that says, “Reiki Master” and get paid for my services. This was more a drive-by shot of Reiki which produced some incredible results that puzzled the gas out of his doc. But that’s for another post.

I’m wondering if my doc prescribes Obecalp for me if it’s okay to let the air out of his tires. After all, I really like the guy. Maybe I’ll just Reiki his cat as payback.

(Thanks for the links, Sid)

Universal health care...I'm scared

This article in this morning’s paper says it all regarding universal health insurance. What really galls me is something we already know: health care will be rationed, the docs will be overwhelmed, and their reimbursements will dwindle. To that end, I was oh so pleased to see that my insurance company actually cut a check to my doc for $0.67. In their defense, they also cut him a check for the princely sum of $30 for my doc visit.

Just to stick my foot in a pool of hungry sharks, this begs the question of how this type of overburdened and rationed health care will drive up the integrative care business.

Balance

“Number 4 Spawn,” my mother said not too long ago, “always make sure that you keep a sense of balance in your life.”

Thinking she was alluding to the fact that I’d single-handedly eaten all the fudge she’d made for the holidays, I went into mega remorse mode. “Look, Ma, I’ll make more fudge for everyone. It was an accident. You always put nuts in the fudge, and, well, I hate the nuts. But this was pure fudge – as God intended it – and…”

“Forget the fudge,” she said. “It’s your life I’m talking about.”

Mom is good at handing out sage tomes of wisdom that make me think. What’s uncanny is that she does this at the times when I need to hear it the most. This time was no different because I’ve been experiencing a crisis of faith. No, not the dogma kind – I believe in the Cosmic Muffin and all that – but the foundations of where I stand with integrative healing. It’s kind of like when Mary Katherine Albaugh kept telling me I had bird legs when we were freshmen in high school. I heard it so much that I began to believe I really did have bird legs.

I love medblogs and read them religiously because I respect the docs who author these blogs. They have great senses of humor and make my morning cuppa a joy. Until talk turns to integrative medicine. Then my cyber heroes turn into people that shake me to the core. It’s not that I don’t believe that we all aren’t entitled to our opinions. And it’s not like I don’t share some of their same concerns. It’s the vehemence and absolutes in which they attack something I love. With them, there is no gray area, or “let me consider the possibilities.” It’s a case of “anyone who believes in integrative healing options is full of shit.” I know it’s not personal – at least I’m pretty sure it isn’t. Well, okay, there was that one blog that got really ugly, and I don’t go there anymore.

But in reading these blogs that deride integrative healing with tsunami force, I found myself questioning my own beliefs. Since derogatory vitriol was all I heard, my perspective became skewed. Not every doctor feels this way, and I needed to remind myself of this fact. Salvation came from the strangest place – a submission. A well-respected neurosurgeon submitted an enticing manuscript about his journey to integrating alternative healing options into his surgical career. We’ve exchanged a number of emails, and I found it refreshing to hear a doc whose world is steeped in science let words like “spirit” and “karma” slip off his tongue with ease. Within a day, I felt a cosmic sigh leap from my lungs. I felt grounded and more at peace with my writing and my direction.

Mom was right. My world had been out of balance, and I allowed my empathy for docs’ concerns to override the amazing stuff I’ve seen over the years. Thanks, Mom.

And, Mary Katherine? Just so you know – I have great legs.

Where I Stand on the Issues of Integrative Forms of Healing

After writing my book and going out on the discussion circuit, I received a small, but not unexpected backlash from docs regarding its premise of selected integrative healing options being mainstreamed into the hospitals. I took great pains to not make this an agenda book because I see where there are legit concerns surrounding integrative medicine. Much needs to be said regarding this issue, and I felt my book opened the door to getting the pros and cons out there.

I became acquainted with Reiki during the research phase of my book. Reiki, initially, was a mere footnote in the book until it made a huge impact on my own health. No one was more dubious and skeptical than I. Healing energy that pours through one’s hands? Give me a break. It wasn’t until my docs had to take me off my meds for reasons they couldn’t identify that I realized something big had happened to me, and that maybe we don’t know everything there is to know about healing. I felt it an intriguing (and controversial) premise for my book.

There’s a line from my main character in my second book that sums it up: “For a profession where knowledge is power and new discoveries await us at every turn, we doctors certainly are a close-minded lot.” Those words came from my imagination before my first book came out. I had yet to discover how prophetic those words would be as I encountered over-generalized bias.

Most comments I’ve encountered run along the same lines; integrative medicine preys upon the ignorant, gullible, and desperate who stupidly shell out thousands for fake cures. There is truth to this comment, and this is something I play up in my book. For every honest alternative healing option, there are dozens of fake ones. I understand docs’ anger over this because people are dying or getting sick from curable diseases.

But rather than denigrating the uses of alternatives, the crux of the debate should center on the need for patients to always go to their docs. Integrative /alternatives/ CAM, whatever label you use, is not a replacement for medical care. It’s an addition, and patients need to always communicate with their docs about what forms of alternatives they’re using.

But docs shoot themselves in the foot by lashing out. How forthcoming is a patient going to be if they’re laughed at or told they’re stupid? When my doc and I came to the conclusion that I could no longer tolerate my meds - we scratched our heads until I realized the only change in my treatment was Reiki. If I had felt for one minute that I was going to be subjected to humiliation, I would have kept my mouth shut. A doctor's reaction/ belief system is very influential to the doctor-patient relationship, and I worry about about eroding communication to the point of silence.

Why do I say this? I researched many people who use various forms of alternatives, and most reasons given for shunning their doctors was that their doctors had at one time or another made them feel like fools for using Reiki or a chiro, or acupuncture, etc. I recommended they find new docs. They shook their heads and said they were in far better hands. Now that scares the shit out of me.

I’m not saying that Reiki, chiropractic, or acupuncture will cure all disease for everyone because no one can guarantee that. Because of this, I see why many docs are skeptical. But as long as patients continue to be under a doctor’s care, I see no reason why alternative healing options can’t be considered viable. And I see no reason why docs shouldn’t expand their horizons to do some unbiased research. There is plenty of solid information out there, many from well-respected mainstream docs and surgeons.

So that’s where I stand. I believe in integrating alternative healing options into science-based medicine to create a united front against disease. I believe in being cared for by my docs. I believe integrative/ mind-body medicine isn’t going away because there's too much out there that supports its use. I believe docs can either close their minds to the notion that they don’t know absolutely everything about how the body heals and how the mind contributes to wellness, or they can hold fast to their beliefs and risk losing open communication with their patients.