Part 2: How is Complementary Medicine Different?

The Evolution of Complementary and Alternative Medicine

Where Has CAM Come From?

Beginning in the mid twentieth century, Americans were being introduced to treatments and ideas from other countries that dated back for centuries. Some of these “new” ideas were that food and supplements could be used to treat illness, a holistic approach was beginning to be embrace, making healthy lifestyle choices could help a person stay well, and the use of chiropractors, yoga, tai chi and massage could also improve health. (White House Commission on Complementary and Alternative Medicine Policy)

What is CAM like Today?

CAM is growing, and more traditional health providers are showing interest. According to the article, “5 Rising Trends in Health Care”, “The trend toward integrative medicine -- the combining of conventional Western medicine with alternative treatments -- is growing in popularity in the U.S…"I call it the best of both worlds. My principle is you do whatever is needed to help the patient, using the most recent research of both science and alternative medicine," said Dr. J. Ying Williams, a Harrisburg doctor who integrates Chinese medicine into her practice.” (Staff) In fact at the Kotsanis Institute, an integrative medical facility, Dr. Kotsanis is always looking for the latest technologies; he attends numerous conferences and visits clinics in other countries to learn about what other scientists and doctors are doing. He also networks with other thought leaders on the Internet – exchanging research, questions, and answers – to explore specific questions that arise in unusual cases. He welcomes information from patients on new treatments they may have tried or would like to know more about. It is his passion for practice that keeps him at the forefront of innovation.

Using data from the 2007 NHIS, we estimate that U.S. adults spent about $33.9 billion out of pocket on visits to CAM practitioners and on purchases of CAM products, classes, and materials.

Along with more doctors, like Dr. Kotsanis, integrating CAM into their practices, many people are using CAM. According to a study by the National Institute of Health, in 2007 “38.3% of adults (83 million persons) and 11.8% of children (8.5 million children under age 18 years.)” (Barnes, Bloom and Nahin) have used CAM. According to the National Center for Complementary and Alternative Medicine, “people with cancer, chronic back pain, and chronic pain use CAM the most. Other studies have documented that people with painful chronic conditions, including arthritis and headache, and psychological problems (insomnia, depression, and anxiety) are frequent users of CAM therapies, particularly massage, chiropractic, and acupuncture.13,45” (White House Commission on Complementary and Alternative Medicine Policy)

A number of surveys have been conducted on the use of CAM. Shown below are a few of them with the results.

CAM Usage Surveys	Results
“Survey that assessed both the prevalence and predictors of CAM use in a comprehensive cancer center population where all were using conventional therapies	63% had used at least one CAM approach other than a spiritual practice” (White House Commission on Complementary and Alternative Medicine Policy)
“Survey of almost 2,000 tumor registry patients selected at random	75% had used at least one CAM modality.38” (White House Commission on Complementary and Alternative Medicine Policy)
“A recent national survey by Astin17 found that back problems were the most common medical condition for which people reported using CAM treatments. In this survey, neck problems also were associated with frequent use of CAM.	24 % used CAM” (White House Commission on Complementary and Alternative Medicine Policy)
Chiropractors	· “1/3 of all patients suffering from back pain choose chiropractors over physicians to treat them· provided 40% of primary care for back pain.41,42· retained a greater proportion of their patients (92%) for subsequent episodes of back pain care than did other providers.” (White House Commission on Complementary and Alternative Medicine Policy)
“Krauss and colleagues43 found that CAM practitioners and products were chosen more often than conventional physicians and therapies by those persons with chronic pain	(52 versus 34 %) and headaches (51 versus 19 %), as well as by persons suffering from other associated maladies, including depression (34 versus 25 %), anxiety (42 versus 13 %), and insomnia (32 versus 16 %).” (White House Commission on Complementary and Alternative Medicine Policy)
“Surveys of rheumatology patients have found similarly high CAM utilization rates	Ranging between 19 and 63 %, depending on the type and severity of their condition.44” (White House Commission on Complementary and Alternative Medicine Policy)
“The majority of cancer patients enrolled in clinical trials at the National Institutes of Health used at least one CAM therapy, with an average use of two therapies per person.39	This same study found that the most frequently utilized therapies were spiritual approaches, relaxation, imagery, exercise, lifestyle, diet (e.g., macrobiotic, vegetarian), and nutritional supplementation therapies.” (White House Commission on Complementary and Alternative Medicine Policy)
“A similar pattern of CAM usage has been found among men with prostate cancer	42 % of those surveyed used vitamins, prayer or religious practices, and herbs to treat their condition.40” (White House Commission on Complementary and Alternative Medicine Policy)

The surveys show that a majority of these patients chose at least one form of CAM for treatment. Also, Craig Lambert said in his 2002 article, “The New Ancient Trend in Medicine”, “In 1992, the National Institutes of Health (NIH) created an Office of Alternative Medicine with a $2-million budget; in 1998 the office became the National Center for Complementary and Alternative Medicine, and today its research budget has increased fifty-fold, to $100 million. Furthermore, with 70 percent of their generation routinely using CAM therapies, today’s medical students increasingly demand education in this area.…the NIH recently awarded the new Harvard Medical School division a $2-million grant to build the first clinical model of integrative care within an academic teaching hospital—a model that could eventually be replicated throughout the United States.” (Lambert)

How Has The Doctor –Patient Relationship Changed in Traditional Medicine and how is CAM Different?

Patient Trust

As healthcare evolved from family doctors to managed care, the doctor-patient relationship also changed. Managed care made insurers’ responsible for patient management and the physician responsible for patient treatment which consequently reduced the patient trust. The patient felt that care was limited because managed care plans focused on making profits rather than making the patient better. “Grumbach in 1999 (5) noted that 25% of patients had been forced to change primary care physicians in the previous 2 years because of changes in their medical insurance plan.² and Kenagy et al (4) point out that the U.S. health care system is the world’s largest service industry, and it excels in its capacity for treatment of serious illness. Despite this, however, physician satisfaction, respect for physicians, and trust in our health care system are declining. Polls conducted in 1994 (9,10) reveal that 75% of Americans felt that our health system requires fundamental change, and 84% said that there was a crisis in health care. The crisis relates to the lack of availability of health insurance, accelerating costs, and quality of care and service from managed care providers.”^{3 (Friedenberg)}Patients see primary care doctors less and specialist more with managed care. It was also noted by Friedenberg that “A major element necessary for patient trust is continuity of care with an individual physician. A major factor stressed by Sherger (6), which managed care providers do not seem to appreciate, is that diseases do not come for treatment, people do. Patient care is fundamentally based on human interaction, and healing requires such relationships. He stresses that patients do not care how much a physician knows until they know how much the physician cares. Trust in the physician is formed from patient-doctor encounters. The level of trust is used by the patient to judge the physician’s knowledge or skill (7).” (Friedenberg) Interestingly, Susan Dorr Gold pointed out that “actual time spent together is less critical than the perception by patients that they are the focus of the time and that they are accurately heard. Other aspects important to the relationship include eliciting patients' own explanations of their illness, giving patients information and involving patients in developing a treatment plan.” (Gold and Lipkin) And that the doctor-patient relationship can be compromised by “Standardization of practice”. They said, “Standardization is often touted as promoting fairness by treating like individuals in like manner…. The danger to the doctor–patient relationship in these movements is that individual patients with their individual needs and preferences may be considered secondary to following practice guidelines.” (Gold and Lipkin)

The elements fundamental to a good patient-doctor relationship such as those listed above, are becoming harder to find in managed care organizations, however, they are priorities in CAM practices. The Kotsanis Institute believes that helping a patient is more than just writing prescriptions. Getting to know the patient as an individual and involving the patient in their care is critical to its success. CAM and integrated medical facilities like the Kotsanis Institute want to ensure that the patient’s physical and emotional needs are being met, and they make themselves available as much as possible to their patients. They have also found that including patients in developing their own treatment plans saves money. At the Kotsanis Institute, it is understood that every patient has a unique set of symptoms, conditions, circumstances and needs. After listening to a patient’s goals, Dr. Kotsanis will investigate his/her complete history, do a physical examination, and will perform a series of diagnostic tests to determine what the patient’s specific needs are. After the reviewing the results, a highly customized treatment plan will be designed to help the patient reach specific goals.

Doctors Leaving Private Practice

Another issue changing the doctor-patient relationship is the trend for more doctors to be giving up private practice. A New York Times article reported that, “As recently as 2005, more than two-thirds of medical practices were physician-owned — a share that had been relatively constant for many years, the Medical Group Management Association says. But within three years, that share dropped below 50 percent, and analysts say the slide has continued…Ideally, bigger health care organizations can provide better, more coordinated care. But the intimacy of longstanding doctor-patient relationships may be going the way of the house call.” (Harris) Again the CAM offers patients a personal experience and a foundation of care through a strong doctor-patient relationship.

A Doctor Shortage

One last issue threatening the doctor-patient relationship is the doctor shortage. The article, “Doctor Shortage Likely to Worsen With Health Law”, reports that “The Association of American Medical Colleges estimates that in 2015 the country will have 62,900 fewer doctors than needed. And that number will more than double by 2025, as the expansion of insurance coverage and the aging of baby boomers drive up demand for care. Even without the health care law, the shortfall of doctors in 2025 would still exceed 100,000. Health experts, including many who support the law, say there is little that the government or the medical profession will be able to do to close the gap by 2014, when the law begins extending coverage to about 30 million Americans… Experts describe a doctor shortage as an “invisible problem.” Patients still get care, but the process is often slow and difficult.” (Lowrey and Pear) It is not hard to predict that with a shortage of doctors that the use of CAM to treat people will increase greatly.

Sources:

“Holistic practice emphasized an attention to the whole person, including the physical, spiritual, psychological, and ecological dimensions of healing. Holistic health care incorporates practices and concepts of Eastern philosophy and diverse cultural traditions, including acupuncture and the use of herbs, massage, and relaxation techniques as well as conventional medical practices.²⁶
http://www.whccamp.hhs.gov/fr2.html
http://www.pennlive.com/bodyandmind/index.ssf/2011/02/5_rising_trends_in_health_care.html
http://www.cdc.gov/nchs/data/nhsr/nhsr012.pdf
http://www.whccamp.hhs.gov/fr2.html
“Patients unanimously believed that these CAM treatments helped to improve their quality of life by helping them cope more effectively with stress, decreasing their discomforts related to treatment and the illness itself, and giving them a better sense of control” (White House Commission on Complementary and Alternative Medicine Policy)
http://harvardmagazine.com/2002/03/the-new-ancient-trend-in.html
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1496871/,
http://www.nytimes.com/2010/03/26/health/policy/26docs.html
http://www.nytimes.com/2012/07/29/health/policy/too-few-doctors-in-many-us-communities.html?_r=1&

Complementary & Integrative Healthcare - Part 2