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Chapter 10
Randy J. Horwitz, MD, PhD |
| Introduction Integrative medicine is far more than simply the combination of mainstream (western) medicine with complementary and alternative medicine (CAM). The concept of integrative medicine embraces the philosophies and practices of different healing disciplines and functions as a bridge between them. As it is currently practiced in the United States, integrative medicine is spearheaded by western doctors who have come to appreciate the benefits and the limitations of both conventional (western) medicine and alternative healing practices and philosophies. An integrative medicine doctor practices western medicine and also utilizes other healing techniques either in combination with or, in some cases, as an alternative to conventional healing practices. Integrative medicine was borne of a desire to expand the conventional practice of medicine beyond the traditional boundaries of modern western medicine. Conventional medicine, as it is currently practiced in the west, is one of the youngest of the medical sciences. Yet it has a well-earned reputation for achievement in certain areas such as the introduction of antibiotic therapies, vaccine therapies, and organ transplantation, to name just a few. Sophisticated diagnostic procedures such as magnetic resonance imaging (MRI) and computed tomography (CT) scans reveal the inner structures of the body in minute detail. Ultrasound technology enables us to see blood flow through the body and the tiny beating hearts of babies in the womb. A small amount of blood can be sent to the laboratory to determine a seemingly endless number of details about the body's chemistry. The wonders of modern medicine marvel and amaze us. Advances in western medicine have saved countless lives over the years. Yet despite these advances, many patients and doctors alike believe that some of the humanistic features of clinical medicine have been neglected in the whirlwind of technology. Integrative medicine seeks to restore these attributes to the field of medicine, and to utilize both the newest medical technologies and time-honored healing techniques to optimize patients' health and wellness. In a quest to expand upon the therapeutic choices available to patients, several visionaries from the conventional health care system looked to more traditional healing practices for insights that might aid the sick and suffering. Integrative medicine practitioners utilize a wide variety of healing techniques in addition to conventional treatments. Examples include:
Supporting the self-healing nature of the human body and effecting a positive influence over interactions between the mind and body are two fundamental principles of most integrative medicine practices. Scientific research conducted in recent years has shown the powerful influence of the mind on wellness and disease. Robert Ader's landmark experiments in the 1970's demonstrated the power a mental stimulus can have on the immune system. His work showed that psychological conditioning could destroy a mouse's immune function almost as effectively as a powerful chemotherapy drug.1 Another study found that writing about one's emotions and thoughts can significantly reduce the level of illness experienced by people with chronic diseases such as asthma and rheumatoid arthritis.2 Definition and Principles of Integrative Medicine There are many formal definitions of integrative medicine. We prefer the definition used by the University of Arizona, which established the first university program for fellowship training in integrative medicine.
In addition to this definition, the University of Arizona program has defined several principles that encompass the basic goals of integrative medicine.
Integrative medical practitioners do not wish to transform this approach to healing into a separate field of medicine. Rather, it is our hope that these principles will be integrated into the philosophy of medical care practiced by all doctors. How to Choose an Integrative Medicine Practitioner An ideal integrative medicine practitioner must first be a well-trained practitioner of conventional medicine. He or she must be able to diagnose ailments based on the medical history, physical examination, laboratory tests, x-ray exams, and other diagnostic tests. He or she is able to successfully treat acute ailments that lend themselves to conventional remedies such as antibiotics or surgery that are curative and potentially life-saving. In addition, an integrative medicine practitioner utilizes non-conventional (CAM) diagnostic and treatment techniques if they will benefit the patient. CAM healing techniques are often used when no conventional therapies are available or when they produce side effects that are unacceptable to the patient. It can be challenging to find a qualified integrative medicine practitioner since this approach is relatively new in the United States, and there is no formal accreditation or certifying board. However, the following guidelines may be helpful. Be sure your integrative medicine doctor is a qualified conventional medical practitioner. He or she should have an M.D. (medical doctor) or D.O. (doctor of osteopathy) degree from a recognized medical school. Board certification is another indicator of a doctor's qualifications. It means the doctor has completed several years of training after medical school in a particular specialty area and has passed a rigorous examination in that field. While this does not ensure that you have located a "good" doctor, it certainly reflects his or her level of training. Several national organizations certify doctors in the fields of internal medicine and family practice. The certification status a doctor can be verified on the Internet at www.abim.org or www.abfp.org. Within certain medical specialties, there are also subspecialties. Subspecialty board certification (such as gastroenterology, a subspecialty of internal medicine) can also be verified at www.abms.org. In recent years, several medical universities have established fellowship programs in integrative medicine. While there is no board certification for integrative medicine, university affiliated training programs must meet the university's quality standards. The University of Arizona, the University of California, San Diego with Scripps Institute, Beth Israel Medical Center in New York, and Harvard University (research only) have integrative medicine fellowship programs. A practitioner's participation in an integrative medicine fellowship program is one gauge of his or her qualifications. However, many highly qualified and experienced doctors began practicing integrative medicine before formal fellowship training was available. While these doctors were not formally trained in an integrative medicine fellowship program, many are highly skilled integrative medicine practitioners. It is important to take into account not only qualifications but also a practitioner's experience and your impressions before deciding to work with any health care provider. In summary, people interested in pursuing
an integrative medicine approach to health care should choose a doctor who
is knowledgeable and experienced in both conventional medicine and
other healing disciplines. Integrative Medicine and Chronic Hepatitis C A typical visit to an integrative medicine doctor often begins much like a conventional medical visit. You will likely be questioned about your medical history, symptoms, and the specifics of your hepatitis C experience including recent laboratory studies (genotype, viral load, liver enzymes, etc.) and treatment to date. An integrative medicine doctor is also likely to ask other questions about your life and experiences that may be unlike those you've been asked by other health care providers. The point of these questions is to help your doctor get to know you, and who you are is more than the sum of your medical data and symptoms. Some topics often included in an integrative medicine interview include:
An integrative medicine practitioner uses the information you provide to help him or her tailor your treatments to suit your personal preferences, lifestyle, and personality. The information you provide can be particularly helpful in choosing mind/body interventions that are likely to be beneficial. Following the initial interview, the review of your current symptoms and physical exam are generally much like a conventional medical visit. Practitioners skilled in traditional Chinese medicine may include a tongue and pulse examination, two diagnostic skills not used by conventional medical doctors. The doctor then reviews the information gathered during your visit along with your medical records (including liver biopsy, ultrasound, and laboratory results). After considering all of this information and discussing treatment options and goals with the client, a treatment plan is prepared. Integrative medicine doctors may recommend many different healing techniques. The choice of recommendations varies with each patient. Taking into consideration a person's specific medical condition and goals, and a reasonable chance of success, an integrative medicine doctor may well recommend conventional interferon-based therapy. Both conventional and alternative techniques are often used to help decrease the occurrence and severity of side-effects for people on conventional therapy. For a number of patients, HCV viral clearance may not be an immediate goal of integrative medicine therapy for chronic hepatitis C. Among these patients, the focus is typically on decreasing liver inflammation since it contributes to the fibrosis and scarring that can lead to cirrhosis. In addition, maintaining liver functions such as detoxification and making nutrients is a high priority. If a person's functional capabilities can be maintained and disease progression can be prevented or slowed with minimal side effects, then the goals of integrative medical therapy for HCV have been accomplished. Before exploring some of the healing techniques integrative medicine doctors commonly use in treating chronic hepatitis C, I want to address the topic of liver biopsies. In our practice, we often propose liver biopsies - but only if the results may influence future management. For example, if a patient is adamant about not using interferon-based therapy under any circumstances, a liver biopsy will not provide the patient with more management choices. However, for a patient who is considering conventional therapy, a liver biopsy provides very useful information that may well influence the timing and/or decision to treat. For a person who would like to delay treatment until such time as there is marked deterioration in liver status, a liver biopsy gives a baseline assessment of the current state of the liver and enables the treatment team to monitor for disease progression. Postponing therapy is a personal choice. However, we try to make sure a patient has all of the facts needed to make an informed decision. Eligibility for future treatments is a factor in some patients' decision to postpone conventional treatment. Say a remarkable new therapy with great preliminary success in the laboratory is discovered tomorrow. The new treatment will most likely be available first to "treatment naïve" people in clinical trials. Someone who is treatment naïve has not received prior treatment for the condition being studied in a clinical trial. Allowing only people with no prior treatment into a trial eliminates the possibility that previous treatment effects will influence response to the new therapy. Thus, the first people who are most likely to receive new therapies are those with previously untreated hepatitis C. Typically, if a new therapy is successful in treatment naïve people, it will then be studied in people whose prior therapy failed. The timeframe between these two types of testing is variable. Thus, this issue may not be as clear-cut as it first appears. Healing Techniques That May Be
Used In an Integrative Medicine Treatment Plan for Chronic Hepatitis C Mind-Body Medicine Clinical hypnosis is another mind/body technique that has been useful in people with hepatitis C. Hypnosis uses subconscious suggestions given during a trance state. A hypnotic trance is nothing more than a daydream state. There is no loss of control during the induction of a trance. A trance is simply a form of deep relaxation. A hypnosis session will leave you relaxed yet invigorated. You need not fear that you will quack like a duck or sing like Elvis. Clinical hypnosis is not a form of entertainment but a genuine healing technique. We recommend people work with a practitioner certified by the American Society for Clinical Hypnosis (www.asch.net). Traditional
Chinese Medicine
Herbs &
Nutritional Supplements
Other Interventions That May Be Used to Manage Chronic Hepatitis C
Summary Integrative medicine is a relatively new approach to health care that incorporates the best of both conventional medicine and CAM. Broad ranges of healing techniques are used by integrative medicine practitioners to treat chronic hepatitis C. Treatment plans are tailored to meet the unique needs, goals, attributes, and personality of the individual. People interested in an integrative medicine approach to managing chronic hepatitis C should seek well-trained, qualified practitioners.
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traditional Chinese medicine