Contentious spring blasts by Forbes, The Economist
Offset by careful analysis in Atlantic Monthly.
I don’t know what happened earlier this year to draw the attention of the mainstream media to integrative medicine, but the subject has been batted around this spring among Forbes, The Economist — both of which expressed caustic disbelief that integrative medicine provides any benefit, and the Atlantic Monthly, which probes deeply into the sources for that disbelief to find that conventional medicine is broadly embracing integrative approaches.
Atlantic writer David H. Freedman contributed a long and thoughtful analysis on the growing acceptance and place of integrative therapies in the July issue of Atlantic Monthly magazine. I prepared the following commentary for The Integrator Blog, the primary site for the professional integrative practitioner community, research and business development.
A commentary:
“The Triumph of New Age Medicine,”
by David H. Freeman
Atlantic Monthly Magazine, July/August, 2011
This article is an important appraisal of the view of the future that the integrative medicine and practice communities can now see before them; even as integrative medicine itself has in recent weeks come under some conservative media skepticism from Forbes magazine and The Economist.
- David H. Freedman
It is important because once you pass through the expected but decreasingly dense tangle of skepticism, writer David H. Freedman is able to highlight and describe in comprehensible fashion the aspects of integrative medicine and practice that have sustained their advancement and will continue to do so.
As a journalist, Freedman is interested in burrowing into the general assumptions of professional cultures whose work has great reach and great consequence. He wrote the book, “Wrong: Why Experts Keep Failing Us-And How to Know When Not to Trust Them.” Last November Atlantic Monthly published his eye-opening account on the work of meta researcher John Ionnides, MD, whose examinations of medical research in the 1990’s exposed a dysfunctional system and unreliable results (conditions that inspired in part the program for Comparative Effectiveness Research developed by the Institute of Medicine in 2009 as part of the American Recovery Act).
Freedman’s starting premise in this piece appears to be the question:
“How come alternative medicine is still here?”
The articles in Forbes and The Economist basically bark out a similar question, recounting what by now are standard objections to the adoption of anything “integrative:” there is no proof — no evidence-base; any alleged benefit is due to the placebo effect; these so-called practitioners are duping the public through slick marketing; medical schools condoning this are deluded; some of this stuff is downright dangerous; it is all quakery run amok.
For the general reader Freedman’s piece includes a couple of unnecessary distractions, starting with the title phrase “New Age Medicine,” which no doubt Freedman did not write. Those words still retain powerful connotation for things way out of the mainstream: tie-dyes, a perpetual daze, the 60s, Drs. Cheech & Chong, and now marijuana clinics lining California strip malls.
Freedman also makes the decision to use “alternative medicine” throughout. “Alternative” is an “instead of” term, which immediately sets the integrative and “real” medical communities on opposite sides of the room. Had he used “complementary” the story would be more easily digested by the general reader and it would more accurately describe the current state of integrative and conventional relations.
It isn’t helpful, for instance, to suggest that a representative example of current integrative treatment might include “hologrammed silicone bracelets.” But there it is, to capture the mind’s eye of the general reader.
So his story rolls out a little unevenly. It is not unlike following a mosaic through a gallery of 30 rooms, the images on the walls of each revealing a little more of an unfolding theme that will ultimately infuriate the critics.
An Alternative Medicine Portrait Gallery
Which means, as is most often the case with articles on this topic, the mosaic must wend its way through the obligatory Quackaderium, where skeptics (including the author of the Forbes’ critique) rain down aspersions on the qualifications, intention and motivation of integrative professions and on the “gullible” public to whom they are “marketing.” Freedman eventually sets these assertions against the prevailing realities, but I wondered how many readers would reach this section and think “just more of the same,” and go back to email.
But on balance, Freedman’s trip through the gallery, reveals a collection of fairly-drawn portraits: on the questions of evidence and the apparent omnipresence of the placebo; the inadequacy of RCTs; the loss of healing sensibilities among physicians; real patients he observes in treatment; and the depth of integrative acceptance now in place in the most well known of conventional care institutions. A few noteworthy observations:
- “To focus on alternative medicine’s placebo effect ignores what may be its largest benefit-its adherence to a ‘healing’ model of patient care.”
- “The medical community knows perfectly well what sort of patient-care model would work better against complex diseases… the promotion of a healthy diet, encouragement of more exercise, and measures to reduce stress.”
- “Every single physician I spoke with agreed: the current system makes it nearly impossible for most doctors to have the sort of relationship with patients that would best promote health.”
- “A medical system that successfully guided patients toward healthier lifestyles would almost certainly see its cash flow diminish dramatically.”
- “Other sorts of professionals could be better at the healing, bonding … and for less money. These might include behavioral-medicine therapists, social workers, nurse practitioners, or even some entirely new sort of practitioner specially trained for the task.”
- “But what’s the sham treatment for being a caring practitioner, focused on getting a patient to adopt healthier attitudes and behaviors?” Citing UC Davis neuroscientist Clifford Saron: ‘…Science has to learn to listen in a sophisticated way to what individuals report to us.'”
- “Ultimately, what today’s medical students think about alternative medicine will be more important to the future of medicine than what anyone else thinks of it.”
Eventually the trip through the Freedman gallery takes him into the Mayo Clinic (literally), where his account of observations, conversations, and commentary reaches a kind of reality crescendo. He writes:
This notion that alternative medicine is a legitimate response to mainstream medicine’s real shortcomings is one I heard, in variations, from everyone I spoke with at the Mayo Clinic.
That includes the assessment of the dean of Mayo’s medical school, Keith Lindor.
And your local Mindfulness, Yoga, and Meditation therapist?
Freedman here is interested primarily in the attitudes within the conventional medical establishment, so he does not address the growth and maturation of the specific complementary and alternative medicine (CAM) disciplines, such as acupuncture, Chinese medicine, manipulative and energy therapies. The work of such practitioners and the educational institutions that have trained them, are also growing closer to the conventional care system: for instance in agreements between local integrative practitioners and nearby hospitals that are now adding wellness and integrative services.
Freedman’s overall assessment presents for general readers a view of a future in which medicine has changed substantially: through widely available integrative practices and attitudes that have been experienced and accepted by literally millions of individual clients over the last generation. It is a history of health benefit simply no longer avoidable. As Freedman quotes Mayo’s Lindor:
One of the most common complaints we see from patients is chronic abdominal pain, and we only figure out what’s wrong 10 percent of the time. These people deserve a chance to be helped by someone who takes a different approach.
As a practical matter, objections like those published in Forbes and The Economist will continue to appear, in part because — as one integrative medicine leader observed not too long ago — alternative medicine “…is like the environment and global warming. It is a cultural phenomenon: an argument you can’t win.”
Unlike the ozone, however, integrative practice occurs at ground level, and carefully researched articles like Freedman’s illustrate how the benefits of such practices are making their own argument and now have the ear of a sizable portion of the nation’s health community.