Like many folks, I am very concerned with the prevalence of chronic disease and mental illness within our communities. For quite some time I have been actively promoting a focused shift toward prevention and recovery, both inside and outside of Medicine. This doesn’t meet much resistance and most practitioners and patients acknowledge that lifestyle choices (diet, exercise, not smoking, etc.) have an impact on health; “good” choices lead to better health, “poor” choices lead to worse health.
I also highlight that the Conventional approach to chronic disease and mental illness tends to focus on treatment more (I didn’t say exclusively) than it does on prevention and recovery, and I encourage that we shift our attention accordingly at both the population level (health literacy, policy, etc.) and the individual level (for each patient). This sometimes meets resistance, but even those who resist acknowledge problems with things like overdiagnosis and over-medication.
When I bring up the phrase “Integrative Medicine”, the resistance appears. It is significant at times and can be downright vile. I don’t think this needs to be the case and am actively trying to change the environment to encourage respectful discussion on overall health as well as the topic of Conventional Medicine, Integrative Medicine, etc.
This week I created a crude image and posted a tweet to highlight the differences between Conventional Medicine, Alternative Medicine, CAM (Complementary & Alternative), along with Integrative / Lifestyle / Preventive Medicine. I also included SCAM (So-Called Alternative Medicine) and charlatans, primarily to highlight that there are some bad players in medicine, though they are primarily not really medicine or on the fringe of medicine. Here is the tweet.
One MD asked “if a physician considers nutrition, sleep, fitness, stress reduction, consideration of psychosocial dimensions of life, meaning in life, persons preference, are they practicing CAM or Conventional Medicine?” I found the choice of CAM as the comparator interesting because this seems more of a question comparing Conventional Medicine to Integrative Medicine (which includes Conventional Medicine). An MD also reached out to me independently to share their thoughts and concerns with this image. What followed was a very respectful conversation that I hope you’ll find a wee bit enlightening. The highlights of the conversation follow:
IMO where we fall short the most in terms of having a healthy society lies outside the domain of medicine all together --> its politics, policies, education, economics, social structures, food supply, socieoecomic disparities, lack of mental health, unequal opportunities, lack of city/town planning, etc. There are plenty of things to be critical about conventional medicine and perhaps we miss finding and treating the root cause because of too busy putting out fires, lack of time, reliance on medications for sure. At the same time there is a lot of criticism that could be applied to CAM and harm that can arise out of it. It is wonderful when it all works together or when a person finds great benefit in treatment. I think your Venn diagram was misleading. Many that practice conventional therapy are approaching patients in a holistic manner, treating, and leading them in such a way but would never consider they are practicing "integrative medicine". I also think there is a lot more pseudoscience in CAM than you believe (there are actually plenty of MDs using pseudoscience as well = sadly these are some of the "functional medicine" folks out of Cleveland Clinic who one may say are practicing holistically while selling sham products and disinformation.)
Lots to respond to.
1) I agree that much of the healthy society stuff lies outside of medicine, where you suggest
2) I think that's exactly why Conventional Medicine misses finding and treating root causes -- my hope is that we (the bigger we) can see this as a starting point and seek to improve
3) Definitions -- CAM, Alternative Medicine, Integrative Medicine (holding off on Functional for a second) are all different, yet are often used interchangeably. Most don't understand the differences. That was part of the purpose of the graphic.
4) Agree there are also issues with CAM, IM, etc.
5) I've spoken to a few CM practitioners that read the definition and suggested that they were also practicing IM. Others have been trained to see the term as a bad thing and don't want to be considered as practicing IM.
6) I agree with your comments on pseudoscience, my point is that it's essentially a throw away term because it's pretty much undefinable, and exists throughout all of medicine (e.g. respected psychiatrist claims polypharmacy in psychology is based on pseudoscience)
7) I almost never talk about Functional Medicine -- I don't think it's "all bad", but I do see just a bit too much marketing hype
One of my goals is to end the divisiveness in this whole area. The discussion doesn't need to incite anger. There's a lot to learn from each, and we'd be far better off trying to take the best practices and uniting them in order to get better overall health outcomes.
No worries. You have a lens on this that is different than mine and may have more insight in 'who is at war with who.' I personally don't see the war but do feel frustrated at times .. I feel frustrated by conventional medicine. I often feel more frustrated by CAM. I personally don't see it as a war but am upset when I hear naturopaths recommending against vaccines or when non-conventional practitioners enable patients to avoid life sustaining therapies. We talked about it before but there needs to be professional standards, increased oversight/regulation, evidence based therapies (a now bastardized word). Many patients hold belief systems that are illogical and fed by fear (and saying one is at odds with conventional medicine for many people can stoke their fears and mistrust of conventional medicine - what? you just want to give me a pill and not treat the root cause of my symptoms?! And sometimes no amount of logic or persuasion can help) - they are vulnerable and prone to falling into hands of quackery. What I see is practitioners that don't have conventional training I see that they get way over the head really quickly -- they do fine for the worried well but harm when they are the "most responsible clinician." They order tests that are not standardized, are expensive, and of limited value. They say medicine is often about entertaining the patient while nature heals - well I see a lot of "proactive" prescribing of herbs, neutracuticals , for things like adrenal fatigue. This doesn't sound naturopathic at all. When asked my opinion I say, how about eat healthy, get good sleep, fresh air, and stop taking all these pills - who is the naturopath now? The family doctor will provide the safety net. Those that truly practice integrative medicine by pulling together the best of both worlds I think is quite rare and an unusual privilege for a patient to experience.
Indeed I do have a different lens. Mine is that of a patient, one of many that have benefited from many different Integrative Medicine practitioners. I fully recognize the issues you mention but can't ignore the number of people that have benefited from really good Practitioners. Sadly I think it has become a war, but that's probably because I spend too much time on twitter. The number of academics, non-MDs and other Debunkers that seek to have people believe IM is totally disreputable are the ones that are most fueling distrust in medicine. "Falling into the hands of quackery” is a legitimate concern as is "falling into the hands of a false no hope diagnosis". I'm also concerned about IM Practitioners getting over their head but they are rarely the "most responsible clinician", though many Debunkers on twitter would have you believe this is way too common. I'm also concerned about Conventional Medicine Practitioners getting in over their head especially related to chronic disease. Many of the claims made against CM Practitioners not understanding/ dealing with diet and root cause are not without merit. ... Many of the tests you talk about sound like Functional Medicine, I've acknowledged that I'm less comfortable with FM. I don't know you well but you sound like a really good doctor with really good practice, I've met quite a few like you here and our conversation has always been respectful. I'm quite concerned (don't know if this is true) that doctors like yourself are being inundated with propaganda noise based on painting people like Mark Hyman and Dr. Oz as opportunistic and profiteering. In real life, the Practitioners that I've met respect Conventional Medicine Practitioners and also understand the constraints that the healthcare system has put them under. There is a way to find the best of both worlds to make prevention and recovery far more "the norm", so that patients having the privilege of a pleasant experience is far more common.
As far as Mark Hyman and functional medicine, I don't think most naturopaths do any better, but I have less tolerance for physicians who peddle pseudoscience and practice in a predatory fashion under the guise of "health and wellbeing" as they should know better. At this moment it isn't a topic I feel strong about in terms of reconciling conventional medicine (which I call medicine), integrative medicine, and CAM. I am however interested in improving healthcare, physician health, health of society, trust and respect in science.
This was a very respectful conversation that highlighted many key areas of both agreement and disagreement. The MD raised very valid concerns as did I. And the punchline is that we have the same goal. We both are interested in improving healthcare, physician health, health of society, as well as trust and respect in science (and medicine). Debating at the extremes without considering all viewpoints is not going to help any of this.
As I was preparing to finish this article, I was alerted to an article published in Slate by Kavin Senapathy who has been quite active in the pro-GMO movement for a number of years. I haven’t always agreed with Kavin’s position but the title of this article grabbed my attention, it was “Why I Stopped Defending GMOs”. This brought me back to the comment the MD made above, wondering “who is at war with who”.
I shared the tweet and added some of my own commentary:
My goal in sharing this exchange and my subsequent challenge to Debunkers was not to suggest I or anyone have all the answers. Rather, it was to highlight that most of the debate points and issues are fairly well known and accepted. Respectful conversations can be had. This doesn’t have to be a war, whether on social media or in real life. Many are interested in improving healthcare, physician health, health of society, as well as trust and respect in science (and medicine). Most are NOT interested in reconciling definitions of types of medicine and prefer the term “Medicine”. Debating at the extremes without considering all viewpoints is not going to help any of this. It might be time to stop trying to outargue the other side and have a dialogue that weighs all the facts.
Definitions matter. Language matters. Engagement matters.