A colleague recently received the following statement, as part of a follow-up report from a board-certified specialist to whom she had referred a case. The pet received a number of alternative medical therapies as well as conventional treatment for its condition.
“Integrative medicine can increase the variety of many different treatment plans and has the opportunity to reach a more successful health plateau for your patient. Invariably, integrative medicine acts as a adjunct protocol and offers more than a healthy body. Integrative medicine also provides a healthy sense of well being. As we progress towards newer and more extensive technology we lose the art of the basic touch and hands on treatment. In this day and age with our society relying heavily on technology and invasive sciences we must not look to holistic care as an alternative but as a way back to our soul.”
There are a number of elements to both the concepts and the logic of this statement which I find disturbing, especially coming from a specialty center to which I sometimes refer patients, and in which I must have confidence in order to keep doing so. It also illustrates one of the biggest problem in defending science-based medicine: overcoming the conflation of unproven or ineffective CAM treatments with a warm and caring therapeutic relationship.
1. “Integrative medicine can increase the variety of many different treatment plans”
This seems a variety of the bogus “health care choice” argument. Yes, adding unproven or implausible therapies to what we do gives us more things to do, but if these interventions aren’t shown to have a benefit, and might even be harmful, then so what? Variety is not itself a good thing, especially if it only serves our psychological need to do something without truly benefitting our patients.
2. “has the opportunity to reach a more successful health plateau for your patient”
This statement is meaningless without evidence to show it is true. CAM proponents freely claim better health through their methods, but shampoo makers freely claim their product is “New and Improved” every few months too. Should we believe it just because they say so?
3. “Invariably, integrative medicine acts as a adjunct protocol and offers more than a healthy body.”
Same problem. The assumption is made that adding this stuff helps, but I expect any doctor, especially a second-tier specialist, to have more than anecdote and faith to back up their claim that their treatments can help my patient. This statement suggests any and all CAM interventions added to conventional therapy will “invariably” bring benefit. No side effects? No interference with conventional therapies? No possibility of failure? If it sounds too good to be true that’s because it is.
4. “Integrative medicine also provides a healthy sense of well being”
Here we begin to get into the underlying philosophical position that will fully emerge later. These added interventions aren’t really about making the patient better in terms of their disease but about making them feel better. Of course, since we can’t access our pets inner feelings in any detail (well, except for pet psychics, of course), we have to decide if they get a sense of “well being” from CAM therapies. And given that both as doctors and owners we desperately want them to be and feel better, there is great risk of our projecting our needs and feelings onto them. CAM placebo effects certainly have an impact of people’s perceptions of their own disease, and they have an impact on their perceptions of how their animals feel (as the recent guest post illustrated), but I have yet to see anything more convincing than testimonial to show that they really affect our pets’ feelings as this statement presumes they do.
5. “As we progress towards newer and more extensive technology we lose the art of the basic touch and hands on treatment.”
Ah, we begin to see the cliché New Age notion that modern medicine is all about technology and that in the mythical Golden Age medicine was about caring and healing the whole person. There is no question the dramatic proliferation of knowledge and the subsequent necessary division of doctors into ever narrower specialties has affected the patient/client-doctor relationship, and this is part of why people are driven to the often warmer and more personal ethos of CAM. Scientific medicine must address this problem to protect our patients from turning to physically ineffective but more psychologically appealing methods.
However, the fact remains we live longer, suffer less, lose fewer of our children, and overall enjoy a far better quality of life and health than any humans who have ever lived, largely thanks to technology. We now have the luxury to indulge our search for meaning and fulfillment because most of us aren’t always battling to feed ourselves or struggling with an endless stream of physical ailments. I for one see no reason we can’t enjoy the opportunity for “self-actualization” technology has provided, and improve on the gains we’ve made, without jettisoning the very technology that has given us the opportunity to do so. I would love to have a close, supportive relationship with my health care provider. But I see no reason why that should require I also accept a host of implausible, vitalistic, and ultimately often ineffective therapeutic interventions too.
Finally, one must ask again if we are projecting our needs onto our pets. I believe I am as gentle, caring, and empathetic as any vet, and I generally have good success interacting with my patients. But frankly, many of my patients don’t appear to take comfort from being handled, however caringly, by strangers. The acupuncture and chiropractic sessions I’ve seen often involve a great deal of supportive, caring treatment of the client, who then feels their pet must enjoy the relationship as much as they do. However, judging from the behavior of the animals themselves, I remain unconvinced. They generally seem no more nor less distressed when receiving chiropractic or acupuncture than they do during my physical examination or vaccination procedures. Yet somehow, everyone involved believes the animals share their owners’ feelings the “spiritual” aspects of these encounters.
6. “In this day and age with our society relying heavily on technology and invasive sciences we must not look to holistic care as an alternative but as a way back to our soul.”
It isn’t entirely clear from the passage (especially given the awkwardness of some of the language which suggests to me it might have been written by someone not a native speaker of English) whether or not the use of “soul” here is intended literally or is just a way of referring emphatically to feelings and emotions. It wouldn’t surprise me if it is meant literally since the notion that disease is fundamentally a spiritual rather than physical phenomenon is widespread in alternative medicine. Either way, however, the sentence echoes the theme of the statement as a whole, which seems to be that scientific medicine is cold and machinelike and that we need some “old-fashioned” psychological support from our doctors.
There is an element of truth to this, certainly for humans, though I think it is sometimes debatable whether what our pets need or desire in terms of a therapeutic relationship is the same as what we think they want. However, once again there is no reason this needs to be connected to alternative, unconventional medical treatments. The answer to a more supporting, warmer health care environment and better human relationships between health care providers and patients/clients isn’t to give up scientific medical therapies that work, or even to add unproven therapies to them. It is to change the economics and structure of the health care system to provide both the highest quality, most effective physical care and meet the emotional needs of patients/clients. This won’t be easy, and it will likely be more expensive, but turning to CAM isn’t the answer.
Linking CAM to the perception that modern medicine is cold and uncaring is a marketing triumph, but it doesn’t make the specific methods any more likely to be effective. This is why so much CAM is used by people with complex, chronic diseases, often for which scientific medicine has not yet found effective treatment. When choosing care for discrete, acute, critical illnesses few people choose CAM methods of questionable effectiveness. People want medicine that works, and though they want to feel cared for also, they shouldn’t have to accept bogus treatments along with emotional support.