The Suit Magazine

An integrative approach could solve the U.S. healthcare dilemma. But is alternative medicine part of the answer?

On the verge of attending medical school, Alan Christianson decided that he was disillusioned with the U.S. healthcare system.

He’d aspired to a medical career since childhood, when lifestyle changes helped him beat both epilepsy and obesity. But the more he learned, the more he hesitated. “Spending more time with doctors, I learned that there are very rigid standards of practice,” he said. “You’ve got guidelines you must adhere to that are dictated by insurance companies and medical boards.”

So Christianson opted for an education in naturopathy, and is now a physician with an independent practice. It’s cash-based, so it isn’t beholden to the demands of insurance companies—and business is booming. “The naturopathic profession allowed me to be a regular physician and still do the appropriate conventional things when they were needed, but have greater leeway,” he said. “And the term that a lot of us have adopted now is ‘integrative.’”

Christianson is not alone. Integrative healthcare is a growing movement. This is in large part thanks to organizations like the Bravewell Collaborative, an organization spearheaded by president and co-founder Christy Mack to promote a more holistic approach to medicine. “Bravewell is promoting patient-centered care, focused on prevention through behavior change,” she explained. Her vision involves a network of health coaches: trained individuals who help people by listening to their problems, understanding their backgrounds, and teaching them how to maintain wellness for life. Compared to the way we do business now, this would be “much less costly, and certainly health beneficial. That’s a win-win situation.”

Bravewell’s efforts in research and public education are paying off. Due partly to their input during a summit on Capitol Hill in 2009, the Patient Protection and Affordable Care Act of 2010 includes an allotment of $15 million for preventative healthcare awareness and education.

Despite progress, there are many issues in the way of implementation, including resistance from the pharmaceutical industry and the deep entrenchment of existing healthcare bureaucracies. But one of the biggest lightening rods in the conversation has to do with integrative medicine’s openness to ‘natural’ and ‘alternative’ forms of treatment, and whether these represent a world of opportunity or a dangerous drain on resources.

Both Mack and Christianson emphasize that integrative healthcare and conventional medicine are not mutually exclusive. “We’re not saying no allopathic medicine,” Mack said. “Definitely not… it’s about a marriage.” Alternative medicine is just one component of the integrative movement—but it sparks some fierce debates. Exactly how much potential does it have in solving our health care dilemma?

The very definition of the word ‘alternative’ varies from one source to another, and the range of treatments is too broad to speak in generalities. Some unconventional remedies, including meditation and many chiropractic practices, have been at least partly validated by scientific studies. Others remain dubious, like acupuncture and herbal weight-loss pills.

Critics of alternative medicine argue that too many of its methods are substantiated only by anecdotal evidence, and haven’t been validated by research. Mack disagrees. “There is a lot of evidence out there,” she said. “It’s just a matter of who wants to look at it. It’s there. And that’s one thing that Bravewell is trying to do, along with other facilities across the country that are working to prove the efficacy of things like acupuncture.”

The National Center for Complementary and Alternative Medicine is one such facility. Operating as a governmental organization under the National Institutes of Health, they’ve funded hundreds of clinical trials on alternative practices, summaries of which are linked to their website. Interested visitors can peruse a history of experiments—the results, however, are hard to find. That’s because most of these clinical trials have not led to findings worthy of publication.

NCCAM stresses the importance of scientific evidence. Their mission:  “To define, through rigorous scientific investigation, the usefulness and safety of complementary and alternative medicine interventions and their roles in improving health and health care.”

But some skeptics take issue with statements like that, and Dr. Stephen Barrett is one of them. “They focus on ‘determining the usefulness,’” he notes. “But who says it’s useful?”  Barrett is the founder of QuackWatch, a website that spreads information to fight healthcare quackery. A former psychiatrist, he took an early interest in medical fraud; in 1993, he closed the doors of his practice to devote all his time to exposing it.

He argues that there is no such thing as ‘alternative’ health care. Any treatment that can be scientifically proven to work is legitimate—anything that can’t is quackery. He believes that allocating funds to clinical trials for dubious cures is a colossal waste of money. “NCCAM’s criteria for giving out research funds are very poor because they don’t take into account implausibility,” he said, adding that the United States is in no position to be spending taxpayer dollars on useless experiments. “And to my knowledge, they have never said that any [treatment] they’ve looked at doesn’t make sense.”

His concerns are not only fiscal. For some patients, unproven methods can be risky or even fatal. “There are a few treatments that are dangerous outright, but for many the danger depends on what you need,” he said. For instance, delaying conventional treatment in order to try an unproven remedy may give diseases time to worsen past the point of no return.

As an example, Barrett points to one of his most pressing concerns: chelation therapy. It’s a highly controversial treatment in which chelating agents are introduced into the bloodstream; they bond to toxins, enabling the body to flush them out. Chelation has been approved by the FDA, but only for the treatment of heavy metal poisoning. Still, some practitioners use the therapy to treat other symptoms, most notably heart disease and autism.  Both the Federal Trade Commission and the American Heart Association have rejected chelation as a legitimate solution for heart disease. The therapy has no proven effect on autism either, and in a few cases, incorrectly dosed chelation treatments have led to the death of autistic children. Currently, NCCAM and the National Heart, Lung and Blood Institute are conducting the first large-scale clinical trial to assess the treatment as a remedy for heart disease. A final report was originally predicted for 2008, but has since been postponed until 2012.

Many practitioners currently offer chelation therapy, and Christianson is one of them. “The main indications that we use it for are environmental toxins,” he explained, “and that would include things like, most commonly, mercury and lead. And these medicines are well-documented to make those types of toxins water-soluble and eliminate them.” In the case of autism, he affirms that chelation is not a valid option for treatment. “That’s an example of medicine gone wrong, which can happen to natural medicine as well as conventional. But there is a legitimate place for certain symptoms: screening for the presence of toxins and then, if they are unusual, treating them until they’re eliminated from the body.”

Christianson is aware of the debate surrounding this remedy, but he maintains chelation therapy as one of many available tools to help him find the best treatments to suit each patient’s needs. For him, it’s all about finding a balance.

“There are a lot of things in natural medicine that, frankly, are just hokey and not effective, and there are some [practitioners] who do openly embrace those. But part of the integrative model is that we are still adhering to the rules of scientific discourse and evidence,” he said.

Christianson’s practice has grown steadily since its foundation in 1997, lending legitimacy to his vision of patient-centered medicine. But the movement toward integrative health care is still nebulous in concept, and the practitioners who fall under this umbrella vary wildly in their methodologies. What binds them is an underlying philosophy of holistic care. Mack explains, “What we do in today’s system is respond to crises. We’re not managing health; we’re managing disease. We need to turn that around.” Ideas like these have great potential to transform the U.S. healthcare system—more research will reveal whether alternative medicine can play a role in that recovery.

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