Prescription For America 3- Prescription for America is Optional, After Whole Medicine
I am grateful for the encouragement and support of The Light Connection readers regarding Prescription for America, a comprehensive set of recommendations intended to end up in President Obama's hands. That book is nearly complete. As I prepared to write the introduction, an open letter to the President, something became clear to me. While conventional medicine has not had much good to say about alternative therapies, and has often opposed it, alternative practitioners generally don't have much good to say about conventional medicine.
In order to make practical recommendations for healthcare reform, I had to look at the big picture, and deeply acknowledge conventional medicine for the healing it brings. A paradigm shift in healing is not just about incorporating more alternative medicine. Whole Medicine needs to look at where conventional medicine excels (and where it does not) and where alternative medicine excels (and where it does not). I wrote the introduction to Prescription for America, with a clear intention to unite medicine.
Conventional medicine is best suited to treating emergencies of all sorts, which represents about 25% of all healthcare dollars. 75% of medical costs are for chronic illness, and conventional medicine simply does not do a good job at treating chronic illness. Alternative medicine does a much better job at not only alleviating chronic symptoms, but also in uncovering causes and curing chronic disease.
Conventional and alternative medicine have not yet come together in any significant way, although there are pioneers who bridge acute and chronic illness. Conventional medicine was forced to listen to patients talk about alternative therapies in the early 1990's based in part by a study by Harvard physician Daniel Eisenberg, M.D., who published a paper in 1993 that revealed that in 1990 Americans visited alternative practitioners 425 million times. The total number of visits to all primary care physicians was 388 million. The dollar difference forced conventional MD's to crack open the door, just a bit. While budging a bit, conventional doctors have not had too many kind words for alternative medicine.
Alternative practitioners, on the other hand, have, in general, not had much good to say about conventional medicine, deriding the various failings of medicine and medications, without providing their patients with a balanced view of the benefits and risks, the pros and cons of conventional and alternative medicine. It is time to bridge this gap.
The roots of this stormy present go back to the mid to late 1800's when a battle was raging about the cause of illness. Louis Pasteur is credited with being the father of the Germ Theory, the idea that an outside agent, a germ, invades an otherwise healthy person and makes him sick.
Physiologist, Dr. Claude Bernard, a contemporary of Pasteur held quite a different view. In front of a group of physicians and scientists, Bernard claimed, “The terrain is everything; the germ is nothing.” He then proceeded to drink a glass of water filled with cholera . . . without any adverse effects.
As he lay dying, Louis Pasteur, stated, “the terrain is more important than the germ.” He realized that the overall vitality and integrity of what I (Gersten) call “The Internal Healing Environment” was far more important than various external invaders. All of the various fields in alternative medicine focus on The Internal Healing Environment.
But Pasteur's germ theory won. For modern conventional medicine, the idea of a pill that works quickly and kills bacteria or pain is quite attractive. The idea of taking a pill for virtually everything lives in the American psyche. The path toward health and wholeness of the individual is indeed piled high with difficulty. Those of us in healthcare watching its collapse over the last 20 years have known that the day of its demise . . . and rebirth would come.
Healthcare emergencies (medical, surgical, and psychiatric), which represent about 25% of health costs in America, are best handled by conventional medicine. If you've just been in a car accident or are having a heart attack, you want a terrific ER doc, and not an herbalist or nutritional psychiatrist! If you require any kind of surgery, whether emergency or elective, you want treatment by a conventional medical doctor.
Conventional medicine, in addition to being the best approach for emergencies, has made significant headways in the treatment of cancer and AIDS.
Chronic illness represents about 75% of health costs and 75 – 80% of doctor visits; and it is best treated through a variety of alternative therapies. With very rare exceptions, conventional medicine has offered mainly symptomatic relief of chronic illness, while not getting to the heart of the matter. Pasteur's germ theory model does not help in understanding chronic illness, but it is still the main premise in conventional medicine in understanding all illness. With that said, alternative medicine is not better, and is not superior in the treatment of acute illness, including medical, surgical, and psychiatric emergencies.
Optimal healthcare is a merging of the best of all worlds. So, while my experience and research has shown that conventional medicine treats symptoms of chronic illness, but does not really cure chronic illness, the reality is a bit more complex. Let's say I'm evaluating someone with asthma, and she has had it for 30 years, has been in and out of ER's, nearly died a couple of times, and has had her life saved through emergency care, including medications.
My work will involve a comprehensive took at her entire life, and lab work to detect 1) Primary Causes like parasites and food allergies, 2) the body's response to primary causes, which is inflammation and the stress response, and 3) metabolic chaos.
She is not coming to me so that she can throw out her asthma inhaler, but she is hoping to improve. Through our work, I am expecting improvement. Depending on a variety of factors, she may improve dramatically, maybe just a little, or, on rare occasions, not at all. From the very start, I will want to make sure that she is not intending to throw out her inhaler and her injectible epinephrine, a shot she can give herself if she suddenly develops a severe asthmatic attack. I am well aware that she has a chronic illness that periodically can become an acute illness, a medical emergency.
When I lay out my recommendations for her, I will make it clear that I understand that we are working to heal the deep causes of her asthma. I also understand that she has a condition that could kill her, and she has an illness that, when it becomes acute, my tools of alternative medicine are not the main treatments. She does not need to stop the various nutritional supplements, and possibly medications I'll recommend, but I am not providing the expectation that I have an alternative magic bullet she can take during an asthmatic attack. She does have a magic bullet and it's her inhaler and the epinephrine injection, which I do not prescribe. Her internist or pulmonary specialist prescribes her asthma medications.
From Acute to Chronic
In the beginning, at the onset of her first asthma attack, she had an acute illness, best treated by medication managed by an M.D. specializing in asthma. Over time, her condition became chronic, so by the time I met her, she may have had a chronic condition for decades. While treating her chronic condition, I am quite aware that the asthma can suddenly become acute again. She can start wheezing, have trouble breathing, and need to use her inhaler or an injection.
My point is that there is not a clear dividing line between acute emergency care and chronic care. With acute care, conventional medicine is in charge and there may be some alternative therapies that can complement the conventional therapies. When she reaches the point where she is coming to an alternative practitioner who might have science and experience to get down to root causes, the alternative therapy may become the main focus and treatment. In this case, the conventional approach is now playing a “supporting role.” I am aware that chronic illness waxes and wanes, gets better, and then flares up.
I have no emotional attachment to one kind of treatment or another. I'm a pragmatist. Some alternative practitioners look down on medication and conventional medicine and convey that disdain to their patients, as if the “alternative way” is better. It's not better! In the right hands, with a good balance of head and heart, science and art, alternative medicine, by looking at the entire person, by looking at every aspect of a person's life, is often able to cure or significantly improve the patient's health.
Conventional medicine is not working with a Health Map or any map that provides a cause-and-effect understanding of chronic illness, but do not come to me for your acute asthma management or your heart attack. I am treating a chronic condition with the hope and belief that we'll be able to cut down the use of medication, and perhaps eliminate it. In the case of asthma, even if my patient were symptom free for a year, I would still want her carrying her inhaler, having her injectible epinephrine handy just as a backup. With this Integrative approach healthcare is understood as a balance between acute and chronic.
You might ask, “Why would someone want to try to get off medications that keep her alive?”
1. Some medications, like steroids for asthma, have potentially very serious long-term side effects, so if I can help her improve to the point where she no longer requires Prednisone, that is fabulous.
2. Many medications that we don't think have side effects, in fact, do. Tylenol (acetaminophen), for example, that you might take for pain or fever, strains the liver. In particular, Tylenol depletes the liver and cells throughout the body of glutathione, our body's natural detoxifier, and a cofactor that is vital to the functioning of the Kreb's Cycle, the biochemistry that produces ATP, the molecule of energy.
3. We want to look beneath the tip of the iceberg, the symptom, the wheezing, examining the rest of that gigantic iceberg, to see if we can truly improve her health and not just keep her alive.
Illness Vs. Disease
Traditional medicine looks at symptoms of disease, the tip of the iceberg of health and illness. Most alternative treatments look at illness. What's the difference? Illness involves the biological event, the psychological stresses and reactions to the illness and the social factors. Conventional medicine is hoping to find one main cause for each disease (perhaps a bacterium or virus) and then hopefully find a magic bullet or two to treat it. Alternative medicine is holistic and sees illness in a much broader context. Thus, if we look at alternative medicine from the perspective of traditional medicine, we will be looking at acupuncture, for example in terms of a disease model rather than an illness model. We will be using a microscope when a wide-angled lens is the more appropriate tool of examination.
Sometimes the choice to make a shift from conventional medical treatment to alternative is based on a healthy decision-making style. For others, the decision to move entirely into alternative healthcare can be motivated by denial or “doctor shopping.” It is quite common for patients, who see me for the first time, to do a fair amount of bashing of the conventional doctors they have seen. I believe that sometimes their assessment of poor diagnosis and treatment and poor interpersonal connection is correct. I do not flatter myself that they have chosen me! I am just as subject as a conventional doctor to low-compliance patients. I am immediately encouraged by a new patient who tells me about the “regular doc” they've been seeing, who they love and who has helped them a lot . . . but they feel it is now time for a new approach. (Evidence of gratitude tells me a great deal about who this person is.)
One of the fundamental aspects of the paradigm shift is a recognition of the unity of mind and body — the recognition that the mind and body are not neatly divided into separate compartments. Mind/body technologies, whose scientific underpinning is the field of psychoneuroimmunology, work on the premise, and the data, that the mind influences the body. From the simplest standpoint we know that stress produces and exacerbates pain syndromes. We also know that a host of illnesses have to do with mind-set and lifestyle: heart disease, ulcer, diabetes, chronic pain, and lung disease to name a few.
Techniques like meditation and guided imagery tap the mind/body connection. Techniques like acupuncture go the other direction. They recognize the mind/body connection and use a physical technique, acupuncture needles, to affect a change in the body and the mind.
Chronic illnesses, like asthma, heart disease, stroke, kidney disease, chronic mental illness, chronic fatigue syndrome and related disorders — are complex and require a Health Map to understand the territory, and a healthy respect for stress and other psychosocial factors that perpetuate illness. None of the illnesses listed above are cured by traditional medicine. These chronic illnesses absolutely require a paradigm shift in thinking and in treatment and that new approach is provided by alternative medicine.
When the patient is the healthcare system itself, we need to treat it with compassion and understanding. Most of you have received conventional, allopathic medical treatment that helped you enormously. Maybe it was surgery, emergency treatment for a car accident, or a very deep and dark depression — and a conventional doctor, using the tools of his trade, either saved your life or helped you enormously.
A medical doctor offers something people are not aware of. After the rigors of medical school, in which a medical student treats patients under the supervision of a chief resident and attending physician, the point comes where a doctors knows that, “The buck stops here. I am fully responsible for the treatment of my patient.” He knows that life and death decisions are his responsibility, and he takes that responsibility to heart.
American healthcare is coming apart at the seams. A major paradigm shift is required to “heal healthcare.” All of us must participate and be honest about treatments that helped, both alternative and conventional, and be grateful. I have written about the excesses, failures, and misconceptions of conventional medicine, but have not provided a profoundly unified outlook. In making recommendations for a Whole Medicine, it is time for conventional and alternative medicine to unite.
David Gersten, M.D. practices nutritional medicine and integrative psychiatry out of his Encinitas office and can be reached at 760-633-3063. Please feel free to access 1,000 on-lines pages about amino acid therapy at www.aminoacidpower.com.
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Trouble Keeping Resolutions?
Are you having trouble keeping your New Year's Resolutions?
For many, February finds you slinking back to old habits. You hate and berate yourself for being ‘weak willed' but can't find a way to resist temptation. The problem, typically, is not that you're weak willed, but rather that you haven't found a way to use your will skillfully.
Here's the tip. First, check if the habit you're trying to change is the one you're really ready to change. Be sure you're focused on the right one for you in this moment (not your partner, parent, or friend's pick.) Next, list why it's really important, to shift this particular pattern.
You'll need to have your values front and center whenever you attempt the hard work of deleting old and installing new behaviors.
Third, make another list of how pleasure in life will increase if you let go of this pattern. This is crucial because pleasure will not be denied. You'll need to see specifically how this change will bring you more pleasure.
Fourth, make this change easier — exercise with loved ones, stock your fridge with healthy, tasty treats, plan for comforting activities (baths, funny movies), find soothing shoulders and empathetic ears to help cope with the inevitable separation pain of dropping unhealthy crutches. Join a group designed to support recovery.
Finally, consider any relapse an opportunity to re-up and strengthen your resolve. Be gentle. Loving yourself is the most important skill of all.
Penelope Young Andrade, LCSW www.penelopetalk.com Call: 858-481-5752 fax: 858- 484-8374 email: firstname.lastname@example.org
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