Your patients see them as well as you, so know who's out there.
Your patients see them as well as you, so know who's out there.
Teri, a scientist in the Midwest, has multiple sclerosis, and like many MS patients she suffers from optic neuritis. When an attack begins, she imagines that the inflamed nerve is packed with cold mud. "The pain goes down immediately," she says.
Teri's under the care of a neurologist, but she learned the cold-mud technique from Rita Louise, a holistic healer in Dallas. A naturopath and a so-called medical intuitive, Louise advises Teri about managing her MS with dietary supplements and encourages her to go into her bedroom, shut the door, and meditate for 15 minutes whenever she is frazzled, since stress aggravates her condition.
According to Teri, Louise also can see inside her bodya hallmark claim of medical intuitivesand spot, say, an inflammation near her left ear without hearing about any symptoms beforehand. That's all the more curious because the two have never been in the same room togetherthey've only talked on the phone.
If you're not familiar with the work of medical intuitives, naturopaths, or other practitioners of "complementary and alternative medicine," you should be. They're treating your patients. In the US, 36 percent of adults use some sort of CAM, not counting prayer, according to a recent survey by the National Center for Health Statistics of the Centers for Disease Control and Prevention. Of these, 55 percent are like Terithey believe in combining CAM with conventional, or allopathic, medicine.
And the borders between CAM and conventional medicine are blurring. MDs and DOs have not only been learning about CAM in medical school lately, but they're also adopting many of the techniques or working side by side with CAM practitioners. Kaiser Permanente, a bellwether of medical trends, has opened CAM centers in Colorado. And, since 1998, the National Center for Complementary and Alternative Medicine, a branch of the National Institutes of Health, has been studying the efficacy of naturopathy, guided imagery, St. John's Wort, acupuncture, and other treatments often written off as bunk. "We're getting more and more data on what works and what doesn't," says New York City cardiologist Isadore Rosenfeld, author of Dr. Rosenfeld's Guide to Alternative Medicine: What Works, What Doesn't And What's Right for You.
Of course, if you remain skeptical, you're not alone. While Rosenfeld is impressed with acupuncture, he decries faddish therapies such as coffee enemas and colon hydrotherapy. "I see a lot of garbage out there," says Rosenfeld.
Whatever you think of CAM, it's important to know whether your patients are resorting to it. "I ask them what vitamins, herbs, and supplements they're taking," says Rosenfeld. "Alternative therapies can neutralize a prescription drug or interact with it to produce bad side effects." At the very least, you can gently steer patients away from unsafe treatments and toward those that either do no harm or provide a benefit, even if it's produced merely through the placebo effect.
You'll probably have to ask your patients whether they see a CAM practitioner, because like Teri, the scientist with MS, they're not inclined to volunteer that information for fear of an unsympathetic response. "There's the risk your physician will tell you to choose between him and the other healer," says Teri, who declined to be identified in this story.
It's easy, though, to sympathize with people like Teri and understand why they turn to CAM. Driven to the point of desperation by chronic pain or a debilitating terminal illness, they're seeking comfort as well as cures. Hence the appeal of CAM practitioners who in some fashion touch or manipulate a patient's body. And while medical intuitive Rita Louise can't touch anyone over the phone, her alleged assessment of Teri's energy field or "life force" points to a spiritual dimension that CAM patients often yearn for. In contrast, most conventional physicians strike Teri as cold and clinical. "To them, I'm a disease, not a person," she says.
CAM often amounts to self-care, but much of it is administered by a bewildering variety of practitioners. We've provided thumbnail sketches of some of the most common types. With a little study, you can better understand patients like Teri, who live in two different worlds of healthcare.
Acupuncturist. Acupuncture is an ancient Chinese treatment that's been Westernized, like so many other healing philosophies from Asia. The familiar metal needles inserted into a patient's body have been augmented by low-voltage current, laser beams, and sound waves. Likewise, the original Chinese concept that acupuncture manipulates the flow of a life force called "ch'i" (or qi) has given way to biochemical theoriesthat the needles trigger the release of pain-reducing opioid peptides, for example. The technique is used not only for managing pain, but treating everything from drug addiction to asthma.
More than 40 states license acupuncturists, awarding them initials such as L.Ac (licensed acupuncturists) or R.Ac (registered acupuncturists). The 18,000 licensed acupuncturists in the United States include conventional physicians, dentists, and Chinese medicine doctors.
Ayurvedic doctor. India has contributed this ancient medical art popularized by endocrinologist Deepak Chopra. Ayurveda is a complex set of beliefs in a life force called pranasimilar to ch'ias well as three physiological principles, or doshas. The mix of doshas we receive at birth dictates whether our bodies are lean, muscular, or heavy, and whether our personalities are lively, warm, or calm. Imbalanced doshas lead to disease, which Ayurvedic doctors treat with meditation, yoga, diet, herbal remedies, massage, and detoxification techniques such as therapeutic vomiting.
Bodyworker. Although bodywork is sometimes used to describe esoteric branches of CAM such as reflexology, it also encompasses more straightforward forms of massage, body manipulation, and movement therapy. "Rolfers," for example, go after connective tissue with deep, sometimes uncomfortable massaging to bring the body into correct alignment. You'll supposedly come away standing up straighter, moving more freely, and feeling more relaxed. Practitioners of Trager or Tragerwork treat patients to gentle rocking, bouncing, and cradling to achieve similar results. Other schools of bodywork include Feldenkrais, Hellerwork, Swedish massage, and the Alexander technique.
Chiropractor. Although the public doesn't ordinarily associate chiropractors with CAM, the NCCAM puts them in this category. And they're the most widely consulted kind of CAM practitionernearly 20 percent of Americans have seen a chiropractor at least once. Many chiropractors go beyond manually manipulating joints to embrace virtually every kind of CAM school, including ayurveda, acupuncture, homeopathy, craniosacral therapy, and magnetic therapy.
Craniosacral therapist. To craniosacral therapists, cerebrospinal fluid is a river of health. They say that by softly touching your head or back, they can detect and correct disturbances in this fluid that cause problems in all parts of the body. Accordingly, craniosacral therapists treat such diverse disorders as depression, infertility, asthma, colic, and sinusitis. Borrowing from Eastern philosophies, they even speak of dissolving pain-producing "energy cysts" brought on by past emotional trauma.
Craniosacral therapy was developed by osteopath William Sutherland some 100 years ago. Today, it's taught in some osteopathic colleges, but practitioners also include massage therapists, physical therapists, and dentists.
Homeopath. At the heart of homeopathy is a 19th century theory that "like cures like," or, put another way, "what kills also cures." Homeopaths believe that they can treat disease with highly diluted quantities of substances that, in more concentrated doses, would produce symptoms. For example, ipecac induces vomiting, but homeopaths administer diluted doses to stop it. Research on the efficacy on homeopathy is mixed, with positive effects "not readily explained in scientific terms," according to the NCCAM.
About 100 years ago, 8 percent of physicians were homeopaths. There were 22 homeopathic medical schools, but these either shut down or converted to allopathic schools in the wake of the historic Flexner Report on medical education. The profession waned but has since revived: Almost 4 percent of adults report having seen a homeopath. Most homeopaths are licensed as some other kind of healthcare practitioner such as an MD or naturopath, but their number also includes lay healers.
Medical intuitive. Conventional doctors frequently pinpoint disease with blood tests and X-rays. A medical intuitive relies on a kind of clairvoyance to diagnose problems, specifically, by reading a person's energy fieldch'i or pranaand locating disturbances. The medical intuitive then resorts to any number of CAM therapies, ranging from naturopathy to energy healing (see Reiki below), to treat the disorder.
If you think medical intuitives resemble old-fashioned psychics, you're on the right trackRita Louise in Dallas and others advertise themselves as such. Some even promise to help you communicate with dead relatives. Despite its air of hucksterism, however, medical intuition has gained adherents among physicians such as neurosurgeon C. Norman Shealy, who teaches it at his Holos University Graduate Seminary in Springfield, MO.
Naturopath. Naturopaths are generalists who embrace homeopathy, acupuncture, herbal medicine, clinical nutrition, therapeutic fasting, Chinese medicine, various forms of bodywork, hydrotherapy, and counseling. Minor surgery and diagnostic imaging also are in their realm. What clearly marks them as CAM practitioners is their belief in a life force that, if subject to the right conditions, will help the body heal itself.
Naturopaths also are among the most extensively trained in the world of CAM. Licensed in 13 states, naturopaths study their science for four years. There are five naturopathic colleges in North America accredited by the profession.
Reflexologist. Employed at hospitals, spas, and cruise ships, reflexologists massage your feet, but the goal is more than relaxation. Reflexologists believe that the foot is like a medical control panel, with different sections corresponding to different organs. Manipulate the little toe the right way, and you can relieve sinus congestion.
A form of both bodywork and energy healing that resembles acupuncture, this therapy has its roots in ancient China and Egypt. Modern practitioners claim that by restoring the body to a state of balance, they can help you with everything from cataracts to hypertension. Some say they also can diagnose these problems through foot manipulation.
Reiki master. Reiki is a Japanese word meaning "universal life force" (shades of ch'i and prana). Reiki masters purport to channel this force as they put their hands on or near a patient's body, relieving pain and helping the body heal itself. Advanced practitioners allegedly can transmit reiki over long distances and even apply it to food and automobiles.
This art, founded by a Japanese Buddhist monk, is passed down from master to student through a spiritual ceremony called attunement. Students can attain master status through weekend courses (although Judith Conroy, a Reiki master in the United Kingdom, says you can do it within 48 hours"24 hours if you're really in a hurry"with a $67 book that she markets on the Internet).
The National Center for Complementary and Alternative Medicine, part of the National Institutes of Health, maintains a Web site (www.nccam.nih.gov) where you can read up on CAM therapies and learn about the clinical trials its conducting. Youll find a less sympathetic but well-researched view of CAM at Quackwatch (www.quackwatch.org), an organization run by retired psychiatrist Stephen Barrett in Allentown, PA, (see "Stephen Barrett on unconventional therapies") with the help of a volunteer network of scientific and technical advisers.
Robert Lowes. A field guide to alternative healers. Medical Economics Sep. 17, 2004;81:21.,/font>