The Most Fundamental Difference Between Traditional and Complementary and Alternative Practitioners
As most of you know, I have been practicing CAM exclusively for a long time. I
switched after just 4 years in a traditional (drug pushing) practice of psychiatry in 1980, and have never looked back. Over the years I have often been asked to discuss the differences between the two paradigms in medicine, and have given several talks on this subject. Since many of my readers are patients who are with me because they know and have experienced first hand those differences, and one or more of them accounted for their switch to my practice, I will not go into great detail, but I will review briefly my perspective on the differences. Then I'm going to tell you about an insight about this that I had recently that seems to possibly be the most fundamental difference. Read on.
Please note that although I started using the term Integrative for my practice for a short time, I have now dropped it. I will explain why in my next newsletter. I am back to describing my practice as complementary and alternative medicine (CAM for short).I am going to put this in a table format (TM stands for traditioanl medicine):
Compared --TM-- -- CAM--
Drugs only non surgical intervention use minimized
Naturally occuring
substances ignored major interest
role in therapeutics
Physician role dictator member of the team
Dr/Patient relationship relates to the “case”, the chart, relates to the
and the test results person
Open mindedness little or none more
to other safer and less
expensive approaches
Base of practice hospital community
Media bias pro con
Political power mighty minimal
Problems with State
Licensing Boards rare common
Trust in the FDA complete minimal
Interest in “anecdotal” reports minimal yes
Interest in true causes of disease minimal major
Believe Diet is Important No Yes
There certainly are other characteristics that I could discuss here, but let's move on. What is not on this list that may be the difference underlying most if not all of the other differences? It just came into my mind the other day, and it clicked. Hippocrates said FIRST DO NO HARM, and traditional physicians pay minor lip service to this guiding ethical principle. Yet I saw clearly that in order to maintain the attitudes and philosophy of medical practice reflected in the column under “ traditional medicine” above, the standard physician must have abandoned completely or dropped in priority the importance of first not harming the patient. Why do I say this? Here's a quote for you to consider (iatrogenic means caused by physician treatment or intervention):
Gary Null PhD, Caroly Dean MD ND, Martin Feldman MD, Debora Rasio MD and Dorothy Smith PhD in their recent paper Death by Medicine - October 2003, released by the Nutrition Institute of America.
"A definitive review and close reading of medical peer-review journals, and government health statistics shows that American medicine frequently causes more harm than good. The number of people having in-hospital, adverse drug reactions (ADR) to prescribed medicine is 2.2 million. Dr. Richard Besser, of the CDC, in 1995, said the number of unnecessary antibiotics prescribed annually for viral infections was 20 million. Dr. Besser, in 2003, now refers to tens of millions of unnecessary antibiotics. The number of unnecessary medical and surgical procedures performed annually is 7.5 million. The number of people exposed to unnecessary hospitalization annually is 8.9 million. The total number of iatrogenic deaths shown in the following table is 783,936. It is evident that the American medical system is the leading cause of death and injury in the United States. The 2001 heart disease annual death rate is 699,697; the annual cancer death rate, 553,251.
It is astounding, but true, The American system of medicine (errors and complications of often unnecesaary high tech interventions) has become the number one leading cause of death in America. High tech, late disease intervention, and unnecessary procedures put people at grave risk of premature death, and disability. Does the average doctor care? No. Does the AMA care? No. Does the FDA, NIH, or the government as a whole care? No. But let's keep our focus on the the DOCTORS. IF a doctor really believes that his first duty in considering treatment for his patient is to do no harm, then here's what he would do:
He'd use naturally occurring substances like herbs and vitamins more, and dangerous drugs less. He'd listen to anecdotal reports of favorable outcomes with less invasive therapies, and these would impact the type and rate of surgical interventions. Because he cared more for helping the patient and avoiding hurting him, he would have a different kind of relationship with the patient, one where he listened and respected the patient more. He would suddenly become very interested in treatments safer than the ones he had been using, and in earlier addressing the true causes of disease. They would become acutely interested in PREVENTIVE medicine, and not wait until disease is well established to intervene. They would want to learn about safer less expensive therapies. The State Boards would not harass physicians thinking and practicing outside the box. In other words, if traditional physicians valued and practiced the dictum of “first do no harm”, they would become more like the CAM practitioners!
Here's how I put it all together. The system is controlled by people with money and with power who want more of both. It has rigidified in such a way that all those who have found their place in the “system” like the way it works, and don't want anything to change. It is about the money, about the business. It is more profitable to go high tech and pharmaceutical based, and no one wants their income reduced. As a result, a major compromise of ethics is required to sustain such a system. The first principle that had to be dropped was “First Do No Harm”. Why do you think there's a conveyor belt system that leads innocent people to have dangerous interventional cardiac procedures, induced by fear and intimidation, every single day? Why do orthopedists continue to operate on knees and low backs and shoulders when prolotherapy could bring natural healing to probably over half of their cases. Why does it so clearly seem that getting into the system means you enter a maze of higher and higher cost and risk interventions that rarely solve the real problem? Sorry to say the answer is that it because it's about the money and not about the patient. If you were to ask the average surgeon or oncologist why they harm so many of their patients, they would tell you that it is an unavoidable result of the difficult risky work that they do. If you got further in to the discussion with them, what you would find is yes their work is risky and dangerous to the patient, but they are making no intellectual effort at all to find better and safer ways that would allow them to treat their patients patient without harming so many of them.
I hope this article will help you evaluate and identify the kind of attitudes you would like to see in the doctors that care for you and those you love.
Robert C Filice, MD
