Tired of Killer 'Cures'?

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http://www.washingtonpost.com/wp-dyn/articles/A37307-2002Aug19.html

From The Washington Post

Tired of Killer 'Cures'?

It's Time, Says the Author, to Rethink The Alternatives

By S. Gordon

Special To The Washington Post

Tuesday, August 20, 2002; Page HE01

( S. Gordon, MD, former chair of the White House Commission on

Complementary and Alternative Medicine Policy, is the director of the

Center for Mind-Body Medicine in Washington, a clinical professor of

psychiatry and family medicine at town Medical School and author of

" Manifesto for a New Medicine: Your Guide to Healing Partnerships and the

Wise Use of Alternative Therapies. " )

The signs and symptoms of crisis in our health care system have become

front-page news in recent weeks. Treatments that were routine -- widely

accepted by physicians and embraced by the public -- have proven

inappropriate, possibly dangerous and wasteful.

The federally funded Women's Health Initiative appears to have demonstrated

that the hormone replacement therapy (HRT) that was supposed to prevent

heart disease in menopausal women actually increases its likelihood. A

well-executed study on the surgical treatment of osteoarthritis of the knee

(published in the New England Journal of Medicine) showed that a placebo

group -- patients who only thought they had surgery -- actually did as well

as those who were operated on. And, a few weeks ago, a lead article in the

New York Times reported on several major studies that show that more

conventional health care and more medical specialists do not necessarily

produce improvement in health status for both older people and newborns.

This cluster of disturbing findings is simply the most recent and visible

manifestation of the limitations and counterproductiveness of an approach

to health that places overwhelming emphasis on expensive and often side

effect-laden surgical and pharmacological treatments, an approach that has

largely devalued prevention, self-care and the perspectives and techniques

of the world's systems of traditional medicine and healing.

Over the last several years we have learned that the treatments we

routinely provide are, even when appropriately used, the fourth leading

cause of death in our country.

While we argue about whether or not prescription drugs should be provided

through Medicare, old people's medicine cabinets are bulging with

prescribed bottles that are, according to many well-done studies, often

unnecessary, redundant and dangerous, as well as prohibitively expensive.

In spite of tens of billions of dollars of investment in research and

treatment -- and some real improvements in the treatment of some cancers --

more than 500,000 Americans still die of cancer each year, and millions

more who " do well " suffer terribly from the side effects of their treatment.

The surgeon general tells us that the percentage of obese teenagers has

doubled in the last two decades and that these overfed and under-exercised,

and often anxious and depressed, young people are falling victim to chronic

illnesses such as diabetes, heart disease and perhaps cancer at

ever-earlier ages. Our newborns continue to die at rates significantly

higher than those in a number of other developed countries.

Meanwhile, our health care costs, already more than twice as much per

person as those of any other developed country, are escalating out of

sight. A recent article in Health Affairs predicted that if costs continue

to escalate at current rates, expenditures will double in 10 years.

Outside the System

Americans in unprecedented numbers are looking for relief outside the

current system. They want help with preventing and treating the chronic

illnesses that threaten, disable and dismay them -- heart disease, chronic

pain, HIV, obesity, depression and cancer -- and from the side effects that

the state-of-the-art conventional treatments for these illnesses often

produce.

They are also looking for a more intimate relationship with their health

care providers. They want health professionals who will respect them as

partners in their care and who see and understand them as whole people with

complex lives, not just " lesions " and lab values.

Many of these people are looking to other approaches to healing. According

to one study, published in the Journal of the American Medical Association

in 1998, 42 percent of all Americans are using other than conventional

therapies as alternatives or complements to conventional medicine. They are

making 200 million more visits to " complementary and alternative health

care providers " -- acupuncturists, chiropractors, massage therapists and

others -- than to primary care physicians.

The White House Commission on Complementary and Alternative Medicine

Policy, which I chaired, was created in 2000 to assess these and other

developments and to formulate recommendations to make the benefits of

complementary and alternative medicine (CAM) and its broader, more holistic

perspective available to all Americans. The commission was established

because of enormous public and congressional interest in CAM. The

commission's work coincided with a similar study by the World Health

Organization on the possible benefits of traditional systems of healing and

of such modern CAM approaches as large-dose vitamin supplementation and

homeopathy.

The commission recently completed a report, which the White House is

studying, that will soon be on the desks of all members of Congress.

The commission's recommendations -- based on 20 months of public testimony

and discussion with most of the major conventional medical, as well as CAM,

organizations -- can help to enlarge our perspective and refocus our

attention. They point to the need for a better balance between the current

research emphasis on finding " magic bullets " -- single drugs, procedures

or, indeed, single alternative therapies -- and the creation and

investigation of comprehensive therapeutic approaches that combine the best

of conventional, complementary and alternative therapies.

In place of the current emphasis on finding and using more, and more

expensive, high-tech interventions, the commission stresses the importance

of an informed public, of self-awareness and self-care (including

nutrition, exercise and mind-body approaches) in both clinical work and

health professional education, and of the role of physicians as teachers as

well as " treaters. "

Time for a Change

The commission's report is particularly relevant now, as the results of

studies that highlight health care shortcomings accumulate.

The newspapers tell us that osteoarthritis of the knee does not benefit

from surgical intervention and does only middling well with

anti-inflammatory drugs. The commission report offers another, nonsurgical,

non-pharmacological way. We would suggest that it's time to do a major

study on a comprehensive approach to osteoarthritis, one that combines

self-care with safe and effective remedies that are largely free of side

effects.

There is evidence, for example, that exercise, acupuncture, yoga, massage

and an inexpensive supplement, glucosamine sulfate, are each of some help

and that dietary change and weight loss can also produce real improvement

in symptoms.

More than 40 million Americans currently suffer great pain and endure

limitations of movement because of osteoarthritis. They pay tens of

billions of dollars each year for doctors and drugs, and cost our economy

tens of billions more in lost time at work.

Why not combine these CAM therapies, together with group support, and study

this approach for cost-effectiveness as well as for safety and

effectiveness? We can do the study with a tiny portion of the $1.5 billion

we will save each year if we refrain from unnecessary knee surgery. And if

this holistic approach proves helpful, we may find ourselves saving tens of

billions more. The commission noted that Dean Ornish's program for

reversing heart disease, the nation's leading cause of mortality,

represents a pioneering effort to demonstrate the effectiveness and

cost-effectiveness of this kind of comprehensive program.

In a program based on education and self-care, Ornish teaches patients to

combine significant dietary modifications, physical exercise, yoga and

stress management in the context of a supportive group. Several studies

published in prestigious journals have demonstrated improved physical

functioning and quality of life in Ornish's patients. The diameters of

their coronary arteries have increased and they have no longer needed

coronary bypass surgery. Meanwhile, their insurers have saved up to $30,000

for each person enrolled in the study.

Much medical effort is lavished on ensuring that patients " comply " with

doctors' orders, whether or not these orders are for treatments that are

effective, appropriate and cost-effective. The commission lays out a plan

for the full participation of all Americans in every aspect of their health

care -- in setting public health priorities, as well as in deciding on,

formulating and carrying out their own therapeutic regimens.

The commission recommends that the government make it possible for us to

make these decisions wisely by making the best information about the

benefits and hazards of all forms of health care easily available -- to

ordinary people as well as to the health professionals who serve them.

We urge as well a significant redirection of effort and funds to the

prevention of illness and the promotion of health and wellness. Though some

continue to argue about the state of the evidence, it seems to us quite

clear that if our children learn to eat and exercise better, and learn how

to deal with stress more effectively, they will be able to forestall much

of the later suffering -- the debilitating and life-threatening chronic

illnesses -- for which they seem to be headed.

Finally, we need to make sure that we continually keep the broadest

possible perspective on what is and is not working, and are willing to

raise questions about any orthodoxy -- conventional or alternative -- that

may restrict our vision.

The bad news about hormone replacement therapy and current treatments for

osteoarthritis, as well as the rising human and economic costs of our

inefficient and too-often ineffective system of health care, can, we

believe, be an opportunity. Now is the time to reassess and readdress the

shortcomings in our approach to health care as well as in the individual

interventions we use -- and to look closely at approaches that may save us

all large sums of money, as well as untold suffering.

© 2002 The Washington Post Company