Understanding the appeal of ‘alternative medicine’

The Healing Paradox. I hesistate to use the title alternative medicine as that gives the herbs and incantations more credit than they deserve. Given the public’s fascination (and financial investment), we (physicians) need to better understand the phenomenon.

But my morning paper, laden with science, also carries evidence of our distrust of science and our search for another kind of healing. You’ve seen it: a full-page advertisement for a product that you know is too good to be true. The text has large type, a before-and-after picture, no listing of the contents of the product and a blizzard of endorsements from ‘’scientists’’ and ‘’patients’’ that take the place of data. These products are life extenders, fat fighters, growth-hormone releasers, relievers of limb pains, rebuilders of muscle and bone and sometimes all of the above together. I think of them as quark drugs, phantoms that if they could be studied in careful trials would soon lose the ‘’r’’ for a ‘’c’’ and be revealed for what they are.

But the market for such remedies is huge. Indeed, estimates are that nearly half of all adult Americans use some sort of dietary supplement, and the sales of these products in 2000 amounted to more than $15 billion! I plead guilty: echinacea and ginkgo have made appearances in my medicine cabinet, as I reached for magic for some ailment or other. I had no guidance, no data of the sort a scientist should accept, no package insert. I tried them on faith. Alas, they did nothing.

The author describes the phenomenon and then tries to understand. I think he probably has figured it out.

Therein lies the rub: we are perhaps in search of something more than a cure — call it healing. If you were robbed one day, and if by the next day the robber was caught and all your goods returned to you, you would only feel partly restored; you would be ‘’cured’’ but not ‘’healed’’; your sense of psychic violation would remain. Similarly with illness, a cure is good, but we want the healing as well, we want the magic that good physicians provide with their personality, their empathy and their reassurance. Perhaps these were qualities that existed in abundance in the prepenicillin days when there was little else to do. But in these days of gene therapy, increasing specialization, managed care and major time constraints, there is a tendency to focus on the illness, the cure, the magic of saving a life.

Science needs to be more cognizant of the other magic, the healing if you will, even as we reach for the proven cures. We need to develop and refine that magic of the physician-patient relationship that complements the precise pharmacologic interventions we may prescribe; we need to ensure the wholeness of our encounter with patients; we need to not lose sight of the word ‘’caring’’ in our care of the patient. And doggedly, in this fashion, one patient at a time, we can restore faith in the fantastic advances of science we are privileged to witness.

And healing takes time. Insurers (I certainly love to pick on them) do not reimburse healing. Maybe this is the fundamental flaw in how we finance medical care.

The health care crisis – insurance execs weigh in

Some Tentative First Steps Toward Universal Health Care. Please read the article from the NY Times. The insurance companies are worried (as well they should be).

Many health plans are developing or offering insurance with lower premiums and slimmer coverage to attract customers who cannot afford more comprehensive policies. Executives at Blue Cross Blue Shield of Montana are pressing state legislators to raise the cigarette tax to subsidize basic coverage. Another insurer, Blue Shield of California, proposed a plan this week for health insurance for all state residents. And Dr. William W. McGuire, chief executive of the UnitedHealth Group, the largest private insurer, has written to every member of Congress calling for “essential health care for all Americans.”

Health insurers, which have long ranked high among the country’s most disliked businesses, frame many of their proposals in public policy terms. But they also have strong business reasons to become involved in the debate over helping the uninsured. They want to add young, healthy members to their insurance pools to spread the cost of caring for the sick. They are also eager to add members whose premiums would be paid with tax money or government subsidies.

Several insurance executives also said pressures generated by the uninsured were raising a threat to the system that could lead to government intervention if insurers did not develop a plan first.

“If we don’t do something in a darn hurry about the uninsured, the whole health care system in this country is going to collapse and the government will step in,” said Chuck Butler, a vice president of Blue Cross Blue Shield of Montana. “People will say, enough is enough.”

We need more creative solutions. Readers added several excellent comments to yesterday’s stories. MSAs (medical savings accounts) could be a method, however, one needs money to have such an account.

With insurers pushing and I suspect physicians not far behind, we should have some experiments started in the near future. I prefer the demonstration project approach then instant national policy. We must understand the intended and unintended consequences of any proposal. Unintended consequences are much easier to see in retrospect!