LEXINGTON A few weeks ago, I was in Lexington’s Good Foods Coop selecting some must-have organic cosmeceuticals to take back to New York with me. I’m working up there on a new media project to help patients gain access to the physician insights we discover each month in this magazine. We’ll talk more about it in coming issues, but suffice it to say that patients struggle to get the most out of their healthcare experiences. The interesting thing is patients are eager to do so.
Take the rising use of complementary and alternative medicine (CAM) for example. If you believe everything you read, you’d think the rising use of CAM correlates with patient dissatisfaction in organized medicine.
This is untrue. Research shows that CAM users are no less satisfied with traditional medicine than nonusers. 1 What CAM users certainly are – especially if we encounter them at the Good Foods Coop – is passionately invested in their health outcomes.
In this small aisle of organic beauty products I share with the shoppers of vitamin supplements beside me, I overhear a woman say to her companion, “That’s the one Dr. Jim told me to get when we were in Midway.” She then reaches across her cart to pick up a small bottle of vitamins, turning it deliberately for a few moments. I smile a knowing smile.
She’s referring to Jim Roach, MD, founder of the Midway Center for Integrative Medicine. Not only have I enjoyed the occasion to interview Roach for this magazine, I have also attended one of the Healing Young Brains symposia that the Midway Foundation puts on each year. Besides, it seems like every savvy customer around here speaks his name in the vitamin aisle of this popular store.
That’s when It occurs to me that Roach’s handle on the business of patient empowerment and, thus, customer satisfaction is worthy of understanding regardless of a provider’s personal preference on the use of CAM.
The fact is CAM use is growing. The most recent measures were in the 2007 National Health Interview Survey (NHIS), which showed 38% of adult healthcare consumers chose CAM therapies either in conjunction or as an alternative to allopathic therapies. The reasons are highly varied, from cultural to economic and beyond. But at $38B in out-of-pocket spending, there is no doubting the consumers’ desire to spend on products and services that meet their goals for integrative health.
This month we talk with Dr. Jim Roach, founder of the Midway Center for Integrative Medicine, to gain some context on the integration of CAM into medical practice.
IN THE DEVELOPED WORLD, WE HAVE THIS PHENOMENON WHERE THE ENVIRONMENTAL TOXINS ARE UP, NUTRITIONAL HEALTH IS DOWN, AND METABOLIC DISEASES ARE UP. WHAT IS HAPPENING TO US?
JR: One big thing that has happened is that our nutrition is diminishing substantially from when I grew up. When I grew up, on the supper plate there were always vegetables and whole foods. Now we eat mostly processed meals. Out of the 21 meals we eat a week, on average 17 of those meals we are eating out of the house. Those foods are processed and they are low nutrient foods for the most part. It is very difficult to get healthy whole foods that are preserved in a way that can be served at a restaurant. Families are also not sitting down and eating together. Eating on the run you do not digest as effectively; that’s why we encourage our patients to chew their food 30 to 100 times to get it into the liquid form before they swallow it.
Also, each of us has hundreds of chemicals in our bloodstream that didn’t exist sixty years ago. These chemicals are primarily stored in brain tissue, and we don’t know how they are affecting us. Children are not nourished as well as they used to be – 70% of us are magnesium deficient, 50% are zinc deficient. Those are very key minerals to our health involving relaxation, hormone modulation, and disease prevention.
We also have these new toxins. The question is being raised: do these new toxins literally change some of our DNA? There is an epidemic of brain disorders caused by this. It seems to me that one in three children have significant brain issues. In South Korea, they are now finding that one out of 35 children suffer from autism.
DESCRIBE FROM YOUR PERSPECTIVE THE CONFLICT BETWEEN TRADITIONAL AND ACADEMIC MEDICINE?
JR: It is a very complex and involved question because there are so many factors that come into play.
First of all there are economic pressures on physicians these days. There was a time when physicians had a reasonable amount of time to interview patients, to really get a deep understanding of what was happening before they prescribed a therapy. Economically, if physicians try to go that approach these days, their income suffers substantially. So the way that the medical system is set up now is that physicians have to see patients in fifteen minutes to maintain the same income level. Physicians are unable to get the information they need to form optimal recommendations.
A lot of this information that we find so vital in our practice is nutrition information – what are these patients eating and do you have time to teach them about what they need to be eating. I am continuously gaining a new appreciation about how important, really vital, nutrition is to health.
Couple with that what I’ll call spirituality, as your ability to deal with stress is a major factor as well. If you don’t get those two aspects right, regardless of what the acute illness may be, long term those patients are going to suffer.
More and more, commercial interests are taking a larger role, and that can have adverse effects. For example, if you have a professor at a medical school, they have to do research to maintain their position as a professor. So they are searching for research dollars and they go to pharmaceutical companies. If you do a study for those companies and your study is not favorable, will a pharmaceutical company offer you research dollars the next time? And if they don’t, does that jeopardize your university job? Does that increase the risk of bias towards a positive result? With the emphasis in medical schools on the growing number of pharmaceuticals, there is less time and likely less emphasis on nutrition. This is despite the fact that nutrition may be more important than ever.
Pharmaceuticals should be the last line of defense. Because physicians don’t have time to adequately address health concerns, it is very easy for them to initiate with a pharmaceutical approach as opposed to a lifestyle approach. This becomes a very expensive approach relative to a lifestyle approach.
Then, there is a centralization of medicine. As doctors in rural Kentucky and other places are financially having a difficult time surviving, these doctors will affiliate with hospitals for financial reasons, and the bigger the organization, typically the less sensitivity to the needs of the patient. The focus increasingly at each higher level is more on the economic impact of treatment interventions as opposed to what might truly be best for the patients. I’m very concerned about the centralization that is occurring and the ultimate impact that will have on health.
WHAT ROLE DOES THE FUNCTIONAL MEDICINE ASSESSMENT PLAY IN MEDICINE?
JR: To me, that is the biggest take home message for practitioners. The message is that there are more rocks we can look under. And that is really good news.
Currently, physicians do basic testing, but they can learn additional tests to be done that are covered by insurance that would give information that would help more fully explain what is going on. So, the example I like to use is depression. I don’t consider depression to be a diagnosis; I consider it a symptom. It could be a symptom of omega 3 deficiency, vitamin B12 polymorphism, vitamin D deficiency, testosterone deficiency, mercury toxicity, fast food, or stress.
The good news is that if we look more comprehensively we can find root causes of these issues and find cures. That is a word that is not often used much in medicine these days. We use a lot of treatments for symptoms, but when I deal with patients who have chronic fatigue or fibromyalgia, if you try to treat each of their 25–30 symptoms with a medication, then they become toxic. You need to be doing those underlying studies that allow you to connect the dots and find true answers and long term cures.
WHAT SHOULD PHYSICIANS KNOW ABOUT NATUROPATHY?
JR: Physicians understand that there is a danger in naturopathy, in that naturopaths, because of a wide variation in training and clinical skills, can misdiagnose or fail to appreciate the acute gravity of a health problem. That is a very rational concern.
Naturopaths, on the other hand, have the ability to teach us something. They figured out ways to help patients without having to write a prescription. A highly skilled naturopathy is what physicians should be doing before they ever write their first prescription – emphasis on nutrition, connection with the patient, some cutting-edge tests, and reasonable non-pharmaceutical interventions.
The future is incorporating the very relevant information the naturopaths have learned into a more open, integrative medical approach. Those who categorically say that naturopaths have no beneficial role in health will not learn anything from their success. You have to be open and know that everyone has the ability to teach us something from their life and their life’s work. I think that welding the two concepts together is important. Functional medicine and integrative holistic medicine are doing exactly that – learning those lessons and achieving superior outcomes in chronic disorders.
Nahin RL, Barnes PM, Stussman BJ, et al. Costs of Complementary and Alternative Medicine (CAM) and Frequency of Visits to CAM Practitioners: United States, 2007.
Research shows that CAM users are no less satisfied with traditional medicine than nonusers. What CAM users certainly are is passionately invested in their health outcomes.