The New Holistic Medicine:
For quite some time providers of Alternative, or Holistic Medicine, have been exposed to all kinds of ridicule and efforts to discredit their practice as quackery, witchcraft, heresy, and black magic resulting in the execution of thousands of people. Times are changing and the scope of this post is to put the recent reemergence and popularity of Holistic Medicine (CAM) into facts and figures and establish a connection between these and the increasing involvement of the government to scientifically research, give credibility to the holistic modalities, and hopefully protect and educate the American public through various programs. An exercise which turns out to be very sobering for Conventional Medicine and very encouraging for the field of Complementary and Alternative Medicine (CAM).
If the numbers indicate anything, then it is that there is a movement back in time, when people consulted, the then conventional medicine, which included, herbs, laying on hands, getting in touch with their emotions by either consulting with the spirits, a priest, shaman or through meditation, massage and so forth. There is an opportunity here which does not present itself very often, and this opportunity is to create an new kind of accepted medical practice, which would include a merging of Alternative Medicine and Conventional Medicine to a new kind of Integrated Medicine, in which again, the person and her longterm health become the sole focus. Using this approach we could be eliminating a host of chronic diseases caused by stress and unhealthy life styles because of the newly adapted approach to health. By treating the person with the best possible regimen, from all possible modalities, specific to that persons condition, we could rewrite history. When the day comes that a person's health is discussed in morning meetings by M.Ds., herbalists, chiropractors, massage therapists, acupuncturists etc., all sitting at the same table, then we are making the patient's health truly our priority.
But first we need to find a way to merge “Old” with “New” and the U.S. Government, also trailing European nations, has taken the first important steps by creating the Office of Alternative Medicine (OAM) in 1991 which eventually lead to the creation of NCCAM (National Center for Complementary and Alternative Medicine) in 1999. Let's take a look at the numbers and the corresponding time line leading to the creation of this office.
Results from a nationally representative survey of prevelance, cost, and patterns of use of CAM suggest that in 1990 Americans made an estimated 425 million visits to providers of CAM care. This number exceeded the number of visits to U.S. primary care physicians, 388 million, and was associated with a cost of approximately $13.7 billion, three quarters of which ($10.3 billion) were paid out of pocket. This amount was comparable to the $12.8 billion spent out of pocket annually for all hospitalizations in the U.S.
In a follow up study between 1990 and 1997(1) the following discovery was made, the prevalence of CAM use increased 25 percent from 33.8 percent in 1990 to 42.1 percent in 1997, herbal remedies increased 380 percent, high dose vitamin use increased by 130 percent, visits to CAM providers increased by 47 percent from 425 million in 1990 to 629 million in 1997(2). The total visits to CAM providers exceeded the total number of visits to all primary care physicians (386 million) in 1997. Estimated expenditures for CAM professional services increased by 45 percent, exclusive of inflation. In 1997 such expenditures were estimated to be $21.2 billion.(3)
Given these developments the U.S. Congress could not stand by and in October 1991 passed legislation (P.L.102-170) that provided $2 million in funding for fiscal year 1992 to establish an office within the National Institutes of Health (NIH) to investigate and evaluate promising unconventional medical practices. The Office of Alternative Medicine (OAM). This eventually leads to the creation of NCCAM (National Center for Complementary and Alternative Medicine) by congressional mandate under provisions of the Omnibus Appropriations Bill (P.L. 105-277). This bill amends Title IV of the Public Health Service Act and elevates the status of the OAM to an NIH Center. In February 1999 a charter creating NCCAM and making it the 25th independent component of the NIH is signed. This law gives the NCCAM Director control of the Center's day-to-day financial and administrative management, as well as broad decision-making authority, fiscal, and review responsibility for grants and contracts. In June 1999 a Special Emphasis Panel is chartered to enable NCCAM to conduct peer review of mission-specific CAM applications. In July 1999 the Cancer Advisory Panel for Complementary and Alternative Medicine (CAPCAM) is created to assess preliminary clinical data related to treatment of cancer submitted by CAM practitioners. In September 1999 NCCAM awards two multicenter research studies, on ginkgo biloba for dementia, co-funded with the National Institute on Aging, and on glucosamine/chondroitin sulfate for knee osteoarthritis, co-funded with the National Institute of Arthritis and Musculoskeletal and Skin Diseases.
In September 2000 NCCAM's first strategic plan is published, Expanding Horizons of Healthcare: Five-Year Strategic Plan 2001-2005. "The Science of the Placebo: Toward an Interdisciplinary Research Agenda," a workshop examining the many aspects of the placebo effect, is organized and sponsored by NCCAM, in conjunction with a group of other NIH Institutes and Centers and Department of Health and Human Services agencies. In February 2001 CAM on PubMed, a comprehensive Internet source of research-based information on CAM, is launched by NCCAM and the National Library of Medicine. In June 2001 The Office of Scientific Review is established.
What is the purpose of NCCAM? Its mission is to dedicate itself to exploring complementary and alternative healing practices in the context of rigorous science, training complementary and alternative medicine (CAM) researchers, and disseminating authoritative information to the public and professionals.
Its vision is to advance research to yield insights and tools derived from complementary and alternative medicine practices to benefit the health and well being of the public, while enabling and informed public to reject ineffective or unsafe practices. The four primary areas of focus of NCCAM are:
1. Research consisting of clinical and basic science research projects in CAM by awarding grants across the country and around the world; it also designs, study, and analyze clinical and laboratory-based studies on the NIH CAMpus in Bethesda, Maryland.
2. Research training and career development by awarding grants that provide training and career development opportunities for predoctoral, postdoctoral, and career researchers.
3. Outreach by sponsoring conferences, educational programs, and exhibits; operating an information clearinghouse to answer inquiries and requests for information; providing a Web site and printed publications; and hold town meetings at selected locations in the United States.
4. Integration of scientifically proven CAM practices into conventional medicine. NCCAM announces published research results; studies ways to integrate evidence-based CAM practices into conventional medical practice; and supports programs to develop models for incorporating CAM into the curriculum of medical, dental, and nursing schools.
A more specific list of areas of focus includes Mind-Body Medicine and amongst others to discover means of enhancing and accelerating the healing process beyond the effects provided by conventional medicine. Biologically Based Practices and one of its goals to establish the efficacy of selected biologically based practices to maintain health, prevent disease, and treat conditions of public health importance. Manipulative and Body-Based Practices and one of its goals to determine the disorders and states of wellness for which selected manipulative and body-based practices may offer meaningful benefits and specify the optimal circumstances under which the chosen manipulative and body-based practices are performed.
Energy Medicine and the application in studies of energy medicine to the same standards used in designing experiments in physics, chemistry, and other scientific disciplines. Whole Medical Systems and to acquire a richer understanding of CAM whole medical systems and how they operate within their indigenous and dispersed settings. International Health Research and advance understanding of traditional/indigenous medical systems through international collaborative studies.
Health Services Research to determine how CAM services affect the health care marketplace and ethical, legal, and social implications of CAM. Research and Integrated Medicine to encourage the creation of integrated research environments and practice communities and to define and address ethical and legal issues related to the conduct of CAM clinical trials.
Training CAM Investigators. NCCAM has succeeded in attracting many conventional investigators to CAM research but not enough CAM-trained professionals. The Center is completing an external evaluation of its research training and career development programs to suggest new, more effective approaches for enlisting CAM professionals in research endeavors. The development of mutually beneficial partnerships between CAM and conventional training institutions is one strategy that is showing promise and finally, Expanding Outreach. NCCAM recognized the importance of communicating CAM research findings to the public and practitioners to help them make better-informed choices. The Center operates an information clearinghouse, partners with the National Library of Medicine to maintain and update CAM on PubMed (www.nlm.nih.gov/nccam/camonpubmed.html), and provides an award-winning Web site (www.nccam.nih.gov), rich in information and resources to serve the public, health care providers, and investigators.(4)
The field of study, Alternative Medicine, and its different modalities, even though evolved over thousands of years, is from a scientific perspective still in its infancy. From this paper, several conclusions can be made.
1. That there is a need for CAM trained researchers to contribute in the understanding of their specific practice.
2. That there is a wide spread confusion and misinformation of what might work and actually works.
3. Further down the road we could see some meaningful licensing for CAM providers, as to sort out the true hacks, which give CAM a bad reputation.
4. Modern Medicine will have to change and adapt in order to be most efficient in helping people heal.
5. One needs to be careful of the government's involvement, no matter how positive at this point, if the only purpose of the creation of this office was to proof modalities right or wrong. This would be missing the point of CAM which is, that we should do for a patient whatever necessary, to either heal, alleviate pain, comfort, or even help a person die gracefully and with dignity. At this point there is no mention of how we can assist a person in the transition from life to death. Death, and the avoidance of it is after all a major goal of all medicine. Conventional, or CAM.
Maybe we can adopt a new guiding principle for our motivation to alleviate pain and suffering when looking at the resulting Integrative Medicine after we combine “Old” with “New”. Maybe we, as humans, can mature enough to “pledge the cause”:
As the first, cultivate love.
Secondly, cultivate compassion.
As the third, cultivate joy.
At the end of it all, impartiality.(5)
Beste Gesundheit,
Werner
1. Eisenberg et al. 1998
2. Authors Note: An actual decrease by 2 million visits over the same time period to primary care physician
3. Complementary and Alternative Medicine in the United States. (2005)page34, (www.nap.edu/books/0309092701/html/34.html) (last accessed, April 4, 2006)
4. All data, unless otherwise noted from NCCAM's website: (www.nccam.nih.gov) (last accessed, April 4, 2006)
5. The Light of Wisdom, Padmasambhava, Shambala Boston-London. (1995) page119