By Manoj Jain
Special to The Washington Post
Tuesday, March 17, 2009
Our conference was being held over lunch, but Pat, a middle-aged health-care consultant, did not touch a bite of her food. When I asked if something was wrong, she revealed her lifelong battle with Crohn's disease, an inflammation of the bowels that causes diarrhea and abdominal pain.
I asked what her doctor advised. With some hesitation, she told me she was chiefly being treated by someone she called her "teacher," who helped her use her use qi gong, a Chinese system of breathing and energy exercise, to manage her illness.
She also sees a conventional doctor. But I was struck that this woman, whose job involves ensuring that hospital practices are supported by scientific evidence, had chosen to consult a provider of alternative medicine.
"My teacher looks at me as a whole person," she explained. "He looks at my emotional state, not just my diseased state. . . . He empowers me on how to care for myself. . . . My doctor looks at me just as a disease."
As an MD with two decades of experience, I felt a sense of rebuke. Personally, I am not averse to alternative medicine. Though I was raised and educated in America, I was born in India, where treatments such as ayurveda and yoga originated and where they are perceived as an equivalent method of healing many illnesses. And I use meditation and massage as aids to relaxation.
I also recognized some truth in Pat's words.
In a critically ill patient, we conventional doctors figuratively dissect the body. The cardiologist manages the heart, the pulmonologist manages the lungs, the nephrologist manages the kidneys, and each treats the diseases inflicting our respective organs. When the organ is no longer diseased, we sign off the chart.
When there is time, I try to step back and address my patients as a whole and try to listen to their concerns, but I admit I've been known to refer to a patient as "the pneumonia in Room 5133" or to describe an emotional patient as "a bit squirrelly."
But I have no patience with alternative providers when they reach beyond their expertise or when they allow themselves to be misunderstood by the patient. I am too aware of the potential for disaster. A physician's assistant recently told me about a woman in her 30s with a prosthetic heart valve who had done well for years on blood-thinning medicine -- until her preacher/faith healer told her she was "cured." She discontinued her lifesaving medication. Within weeks, the PA said, a blood clot formed near her heart valve, shutting it down. She died in the operating room.Tempting Advice
I've shared my skepticism with my parents, who are retired and spend the winters in India and summers in Boston. They both see conventional doctors and are proud of my career. But my mother is also an instructor of reiki, a practice based on the idea of healing energy. She tells me she has used it on her grandchildren to improve their SAT scores and on my father to help him prepare for medical procedures, and has employed it to treat her own headaches. She swears reiki is effective, though I remind her that randomized controlled trials don't support that conclusion.
My father, who takes blood pressure medicine, aspirin and lipid-lowering drugs, is learning about ayurveda and nudges me at every opportunity to do the same.
"Your health will benefit from drinking two glasses of lukewarm water each morning," he insists. "It will flush out your toxins." He offers this evidence: "Your grandfather does it every morning" -- and as I know, my grandfather is 90. It is tempting to take advice offered with passion by those you trust.
I think of alternative-medicine providers as good used car salesmen -- that is, with little scientific proof for their treatments, they find many willing customers.
But I don't mean that as an insult. On the contrary, the alternative providers offer a useful lesson in the doctor-patient relationship for conventional doctors like me. A good provider is a teacher, a coach, a friend and a fan; many alternative practitioners manage to play those roles, with the result that their patients trust them and have faith in their treatments. Within the constraints of the conventional health-care system -- with its 15-minute office visits, recurrent insurance denials and unnecessary diagnostic tests to avert malpractice suits -- I find it hard to perform all those important interpersonal tasks.
In addition, alternative providers have mastered the art of maximizing the power of the placebo. As R. Barker Bausell, author of the book "Snake Oil Science," writes, alternative therapies don't do much if any better than placebo treatments.
But placebos can be effective tools: For certain conditions, they have definitely been shown to cure or reduce symptoms. By listening carefully to patients and convincing them that they have the power to manage their illnesses, alternative therapists make the most of the mind's ability to help heal the body.
Pat, the health-care consultant, is far from alone in seeing alternative practitioners to complement or augment medical care. More than a third of American adults use alternative therapies, with some of the most popular being meditation, acupunture, chiropractic and the use of natural products such as glucosamine and echinacea. Almost all of those patients also see conventional doctors. Judy, a former intensive-care-unit nurse who works in my administrative office, is another example. For most of her life, Judy battled low back pain caused by scoliosis. As an adult she sought help at a respected orthopedic clinic. There, a doctor entered the exam room having looked at her X-ray -- but not having examined or spoken with her -- and said, "Your pain is not coming from your spine." Judy resented his instant pronouncement and was disappointed with the results when he tried to treat her. Soon after, Judy went to a chiropractor whose manipulations were helpful, but only for a few days or weeks.
Then she met an instructor of Pilates, an exercise system that emphasizes body alignment and correct breathing. He worked with her patiently, teaching her how to sit at her desk and in the car. He suggested repositioning her work space so that her right side would face the wall of her cubicle, encouraging her to stretch her left side. With his advice and regular Pilates exercises, she has been pain-free for more than five years.Not So Fast
Judy summarized her experiences without mincing words. A conventional doctor "listens to my symptoms and is quick to prescribe a medicine or to order tests. My instructor listens to my story and works with me." I asked her for another example.
"Well, do you remember two weeks ago, when I had a terrible cold, followed by a cough, low-grade fever and lots of sinus drainage, and I came to your cubicle? In less than a minute -- listening to my symptoms -- you said, 'You have sinusitis' and called in antibiotics." The drugs worked, but she thought the encounter was a little too quick. "I am not criticizing you, but that is how conventional doctors work."
What Judy, like Pat, has decided is that she needs both a conventional doctor and an alternative therapist.
That is often the case. In a national survey published in 1998, John A. Astin, a researcher at Stanford University School of Medicine, found that most Americans did not seek alternative medicine because they were dissatisfied with their doctors, but rather because alternative care was more consistent with their values and philosophical orientation. Judy, Pat and most alternative medicine followers and providers see themselves in a "mind-body-spirit" continuum.
As for myself, I'm not about to take up Pilates or become my mom's reiki pupil. But I have taken my father's ayurvedic advice and started drinking two glasses of lukewarm water in the morning. I am not sure if it is helping, but it sure keeps me regular.
Manoj Jain is an infectious-disease specialist in Tennessee. Comments: email@example.com.