Story by Kimberley Paterson • Photos by Ann Haver-Allen
Download entire alternative healing article: 18-EO-Alternative_Healing.pdf
Urban Myth or Evidence-Based Medicine? It has now been three decades since “evidence-based medicine” or EBM, became formalized and taught as the correct way to practice medicine. But a paper published recently in the American Medical Association’s Archives of Internal Medicine shows just how uncertain the field remains.
Studies from 1991 estimated that only 15 percent of medical interventions practiced by doctors were supported by solid scientific evidence. More recently, it has been estimated that decisions made by doctors using such science ranges widely from 11 percent to 70 percen
“Hardly ringing endorsement of medicine as science,” said Dr. Wayne Jonas, author of the AMA’s paper “Scientific Evidence and Medical Practice.”
Even when EBM does exist, it often only applies to a narrow range of patients. A 1994 study claims that many, if not the majority, of procedures carried out under modern medicine have “little if any scientific basis” (Maynard). Rather, it turns out that doctors most commonly rely on “mindlines” when deciding what kind of treatment might best suit a patient—essentially their best guess based on previous experience coupled with what colleagues currently believe.
That’s why such a broad variety of different treatments may be offered to patients suffering the same aliments.One example cited in a study published in The Journal of The Royal Society for the Promotion of Health was on prostheses for hip replacements: 30 different types of cemented and 35 types of uncemented prostheses were used in English hospitals, most of which had not been investigated.
Other studies revealed striking variations in surgical interventions for prostatectomy, hysterectomy, tonsillectomy and carotid endarterectomy. “If orthodox medicine is practiced
on the basis of scientific evidence, as is claimed by its practitioners, such variations defy explanation,” wrote the study’s high-ranking nursing professor authors. “In view of such admissions, it seems incredible that medical practitioners have been trying to undermine the practice of complementary therapists because of their lack of an appropriate evidence base.”
This lack of EBM has been a criticism long levelled at holistic or natural health practitioners. Yet, just as it’s being revealed how little of modern medicine actually relies on solid science, the global popularity of holistic treatments is itself driving a body of evidence proving their effectiveness.
Just a few examples:
• Randomized controlled trials showing aromatherapy and massage can be effective in reducing physiological and psychological stress after cardiac surgery (Jackson, 1995)
• Homeopathy and acupuncture being effective treatments for psoriasis (Liao and Liao, 1992)
• Massage effectively reducing anxiety and tension (Wilkinson, 1996)
• Reflexology useful in managing premenstrual symptoms (Olsen and Flocco, 1993)
Interest in such natural based therapies has been growing exponentially—some estimates say at around 11 percent annually.
A 1991 U.K. study showed that the number of alternative practitioners was growing at a rate of five to six times that of medical doctors.
Certainly, people are visiting holistic therapists in increasing numbers. A 2007 National Health Interview Survey conducted by the U.S. Center for Disease Control and Prevention found that four out of 10 American adults had used such therapies in the past 12 months.
Other studies have shown around 90 percent of the population of the United Kingdom had used at least one form of complementary therapy or another.
In Europe, those figures ranged from 24 percent in Denmark to 49 percent in France. In Denmark, cost of complementary treatment is reimbursed by private and state health insurance.
A study conducted by the Harvard Medical School concluded that complementary and alternative medicine has become a permanent part of medicine. The report found that visits to practitioners of alternative therapies increased 47 percent since 1990.
The Journal of the American Medical Association reported that the number of Americans using alternative therapies rose from 60 million in 1990 to 83 million in 1997 and that number is expected to increase.
Among factors found to be driving this global natural health trend is the lack of side effects from such treatments; the fact that complementary and alternative medical health (CAM) practitioners look to treat the whole person rather than just the symptoms and that such therapies empower patients by encouraging them to participate and take control over their own health issues.
A 1997 U.K. study showed that the vast majority of users were happy with such holistic treatments: 90 percent felt their quality of life had improved as a result and 60 percent would use natural health practitioners again, despite the often considerable costs involved.
Perhaps even more telling is just how public support of CAM therapies is driving doctor behavior.
In New Zealand, a small Pacific nation considered to be a leading light in the natural health world, a 2002 Health Survey found 12 percent of adults visiting a complementary health practitioner that year had been referred by their own general practitioner.
In addition regional studies discovered:
• A 2003 study of Wanganui city general practitioners found 92 percent had referred patients to CAM practitioners and 80 percent had contact with at least one CAM practitioner. The doctors rated their confidence highest in acupuncture, chiropractic, hypnosis, aromatherapy and Rongoa Maori (traditional Maori medicine) treatments.
• In a study of 249 Auckland general practitioners, 171 (68.7 percent) referred patients for CAM treatments. The study found younger doctors were the most likely to refer patients to CAM practitioners. The Auckland study found that 30 percent of general practitioners surveyed practiced one or more form of CAM—most often used to treat musculoskeletal and chronic pain problems.
The most common reason given by New Zealand general practitioners for referral to CAM practitioners was “failure of conventional medicine.”
At the forefront of an evidence-based approach to natural health care in New Zealand is Phillip Cottingham, a 30-year veteran of the natural health industry and founder of the leading training institute, Wellpark College of Natural Therapies, which trains domestic and international students.
He said the oft-cited criticism that natural medicine lacks scientific evidence is “the biggest urban myth of our times.” A strong advocate of the “integrated medicine” approach—effective health treatments that integrate the best available from orthodox and natural medicine—Cottingham is the driver behind a new research unit in natural medicines being set up in New Zealand.
The unit, located on a stunning 19-acre bush-clad site in the heart of Albany is only 15 minuets from Auckland. A full-time research fellow will be collate and make evidence-based natural health information freely available to the international public via the Web site (www. wellpark.co.nz).
What is clear is that doctors around the world who are open minded enough to refer patients to CAM practitioners are happy with the outcome.
In Germany, 58 percent of accredited general practitioners polled in a 1993 study declared that they preferred complementary to orthodox medicine—and all but three of the practitioners sampled accepted the value of complementary medicine.
In 1981, despite a ruling by the British Medicine Association that clearly discouraged general practitioners from connection with practitioners of complementary therapies, 10 percent of patients visiting natural health therapies had been recommended to do so by their doctors.
According to the Journal of the Royal Society for the Promotion of Health survey “Complementary therapy: complement or threat to modern medicine?” nurses and midwives have lost no time in keeping up with public demand either and have been training in such natural therapies.
The survey found that more than half of the nursing practitioners surveyed used CAM therapies in their work: 80 percent of those using such therapies had undergone training and 92 percent who had not used such therapies were prepared to do so (Trevelyan, 1996).
“Despite constant criticism of complementary therapy by some medical practitioners, 65 percent of hospital doctors believe that such therapies have a place in the mainstream of medicine,” wrote the report authors.
By 1993, the British Medical Association had changed years of attacking and attempting to discredit complementary medicine by conceding that there is a place for it in health care—provided doctors retain overall control of treatments received by their patients.
More than two dozen medical schools in the United States now offer electives in alternative medicine.
At Memorial Sloan-Kettering Cancer Center, for example, alternative therapies enhance each patient’s quality of life through healing regimes that address the body, mind, and spirit. Complimentary therapies offered include various types of massage, acupuncture, hypnotherapy, meditation, visualization, music therapy and nutritional counseling. Patients are also offered classes in yoga, tai chi and chair aerobics.
Many of these therapies have been used for centuries, but they lost favor with the advent of conventional medicine. The resurgence in popularity is credited to mature, health-conscious baby boomers who tend to take an active role in their healthcare.
It’s a good match for holistic practitioners who teach patients how to take responsibility for their own health.