The lure of “integrative medicine”

It has been fascinatingly frustrating over the past couple of weeks to see faculty and students at the University of Toronto defending “alternative” and “integrative” and “holistic” medicine with all of their might. They are portraying this entire issue as an “us vs. them” debate, as if anyone opposed to the idea of integrative medicine is also blind to new ideas, opposed to non-prescription treatments, and has no interest in patient satisfaction. Nope, we actually care about all of those things. And we care about the patient’s pocketbook and about the scientific method.

I had an interesting patient encounter recently that brought this entire issue into focus. This is a patient with confirmed hypothyroidism on thyroid replacement, who came in feeling tired, moody, and feeling anxious. Pretty standard for most of her visits. She brought in a list of products that had been recommended by her naturopath. First I thanked her for trusting me enough to ask for my opinion, as I have learned that starting the encounter by scoffing won’t get me far. The list was a cornucopia of products which I know have not convincingly shown any benefit, which I informed her of in the gentlest of ways.

I paused and asked her “What exactly about how you feel do you wish were different?”. She said she wanted to have more energy and be less stressed and angry. I asked how she feels when she leaves the naturopath. Fantastic, she said. After a fascinating discussion with her and her husband, I learned that my patient is quite religious, and has been frustrated for the past decade that she hasn’t found anyone locally who shares her sense of spirituality. Until she met this naturopath, as they have very in-depth discussions about her faith. I explained to her that the benefit she is seeing from the naturopath is from a sense of camaraderie, and not any diets or supplements or treatments she is offering. I told her that she can feel free to continue seeing the naturopath, as long as she realizes she is essentially paying for companionship. The pricey supplements and herbs are just along for the ride, and are unproven in terms of safety and efficacy. An expensive placebo while the companionship provides all of the benefit.

Can you imagine if physicians used the same predatory techniques that these alternative practitioners do? A patient comes in with viral pharyngitis, and I tell them it will resolve on its own, not to worry. It resolves on its own within 48 hours. Or….I could offer them some special herbal concoction, and voila! The herbs cured the sore throat in just 48 hours! Amazing! Dr. Elia is the hero! Patients need to realize the humility that physicians show in allowing the concept of tincture of time to run its course without creating a false sense of a cure through bogus practices. I am bound by evidence and science, not by pricey cures and by the ego-boosting of “curing” illnesses. The public would truly be amazed at the proportion of my day spent simply ruling out serious disease and providing reassurance, allowing time to take its course. Not as sexy as being a hero, but it’s the only ethical way to practice.

We as physicians see an endless list of ailments for which we have few options available. That doesn’t simply mean we don’t have a pharmaceutical remedy for the ailment, but that our interpretation of the evidence does reliably point to a specific treatment for which we are confident in its efficacy, drug or non-drug.

Interestingly, most of these “incurable” ailments are exactly the same ones that many “alternative medicine” providers conveniently claim to have the solution for. Chronic pain, stress, obesity, menopause, fatigue, IBS, chronic headaches…I always chuckle when I visit the websites of these providers because they have not found a miracle cure, they have simply found a lucrative market.

“Integrative health practitioners” often point to patient satisfaction as a rationale for their existence and for funding, which is completely insufficient as a measuring stick for appropriateness in health care. We know that simply having an individual listen to your concerns and show empathy will improve outcomes, regardless of the form it takes. So take Reiki, and craniosacral, and therapeutic touch, and any mind-body energy life-force practices, and call them what they truly are. Relaxing companionship. Then let’s have a discussion about whether public funds should be directed towards that end.  And let’s tell private-paying patients that they are paying for companionship and relaxation. But don’t try and explain these techniques via unproven scientific principles as a means to give them legitimacy. Perhaps many of these practitioners can work to develop self-directed education programs for patients to help those improve their own stress. Less lucrative, but far more patient-centred.

So here’s my message to my patients, and to all patients out there. The terms holistic, and integrative, and alternative, and complementary, have become impressive marketing terms. But in terms of your treatment, they are meaningless. Medicine is only medicine if it works, and we don’t need these false-balance terms to muddy the situation. You want treatment that is effective, safe, and patient-centred. As your physician, I will offer you whatever treatments I believe will help you. That may include advice on exercise, nutrition, relaxation, relationship advice, and in some cases, pharmaceutical medications when appropriate. I will do it at the lowest possible cost, and I will always try to make you self-sufficient through self-directed treatments. For other practitioners to imply that “integrative medicine” is somehow distinct from what I provide as a physician is frankly insulting. If a patient chooses to seek the care of another practitioner in addition to my care, I will gently warn them to be as skeptical of the benefits of those therapies as they would be of pharmaceuticals. And I warn them that they may unwittingly end up paying for relaxing companionship.