Integrative Medicine: Who Makes The Rules?
The hottest trend in health care these days may be “integrative medicine,” which claims to blend the best ideas from alternative medicine and conventional practice.
But there is vast disagreement on what the best ideas are. And it’s not clear who will decide.
Some, like Tampa General Hospital, advertise “integrative medicine” but list only a few commonplace practices that are risk-free and popular with patients. Think massage and meditation.
Others who use the label “integrative medicine” offer a completely different set of services, anathema to mainstream doctors. Think homeopathy, colon cleansing, or blood irradiation.
Dr. David Gorski is co-founder of the non-profit Society for Science-Based Medicine. He says “integrative medicine” is just a euphemism for unproven therapies. It’s the use of language to justify tests and treatment that lack a scientific basis, he said.
“The practices that are positive in integrative medicine are already part of regular medicine – get enough sleep, lose weight, keep your nutrition up, exercise,” Gorski says. “There’s nothing unique about that."
But there is a patient demand for integrative medicine, and the new field is attracting conventionally trained doctors who are fed up with coverage constraints.
“It’s cash or credit on the barrelhead without that nasty mucking about with insurance,” Gorski said.
Because of the demand for integrative medicine, a Tampa-based non-profit, the American Association of Physician Specialists, has created a fellowship program and board certification in the specialty. AAPS board certification is recognized as legitimate by Florida’s medical boards.
Some physicians remain in a traditional practice setting while adding elements from integrative medicine. One is Dr. Amber Orman, radiation oncologist at Moffitt Cancer Center in Tampa, who treats breast cancer.
Her aim is to listen to patients and build trust, so they will be more likely to follow the treatment plan with the best odds of beating the cancer. She coaches them on nutrition and lifestyle changes that help them heal and feel better. Sometimes, if they’re anxious or in pain, she refers them for acupuncture.
Whatever helps a patient is worth a try, as long as it’s not risky, Orman says.
“Even the placebo effect is an effect,” she says. “There is value in making somebody feel better, even if we don’t understand it.”
For family practitioner John Monhollon, of Florida Integrative Medicine Center in Sarasota, the label “integrative medicine” has a much broader scope. His practice offers hormone replacement, homeopathy, low-level laser therapy, and intravenous treatments.
Aside from infusion of vitamins and nutrients, his IV treatments are controversial, including putting some of the patient’s blood through an ultraviolet light machine and then returning it to the body. He also provides chelation therapy for prevention of heart disease.
Chelation is approved for heavy-metal poisoning, but its use in heart disease is experimental. The theory, that it can remove plaque from blood vessels and lower the risk of heart attack, is still being studied by the National Institutes of Health after an initial large-scale trial found significant benefit only for diabetics.
But then there's Todd Anderson of Sarasota. “Chelation saved my life, I have no doubt.”
Thirteen years ago, when he was 45, a cardiac catheterization showed he was headed for a heart attack. He underwent bypass surgery, but three of the four grafts failed.
Because of his family history, he was at high risk for a major heart attack. He was short of breath, his chest pain growing worse.
In desperation, he tried chelation, an IV treatment for metal poisoning. He'd heard it could clean plaque out of blood vessels.
When Anderson visited his cardiologist six months later, he aced the treadmill test and got a clean bill of health. The doctor said that Anderson must have grown new collateral arteries – a phenomenon that does happen sometimes.
“I explained to him that I’d been doing chelation therapy and he said, ‘Chelation’s a crock.’ So I basically just switched cardiologists to one with more of an open mind,’” Anderson said.
Monhollon, who treated him, said that when he opened his practice years ago he assumed he would take insurance. But he quickly got disillusioned.
“What I do requires long office visits,” an hour and a half for the first one, he said. “So I would go under if I took the money the insurance company was willing to pay, and the patient wouldn’t get well if I tried to do my stuff in that tiny little time slot.”
Stan Welch, 68, a construction project manager, comes into Dr. Monhollan’s center for a series of 12 chelation treatments every couple of years. The series costs about $1,200, he said, but that’s cheaper than getting sick.
Chelation therapy, he says, is “preventive maintenance.”
Welch has spent his entire life eating only whole foods, nothing processed, he said. He fasts from time to time.
“I thought it would be a good model to live my life by. So that is what I’ve done."
The burden of setting boundaries for appropriate integrative medicine practices may fall to the state disciplinary boards, the Florida Board of Medicine and the Board of Osteopathic Medicine. But they have to be careful how they handle it.
Many years ago, the Board of Medicine tried to punish doctors who engaged in chelation therapy for heart disease. But the state Supreme Court ruled that the board was restraining competition.
Author Andrew Weil MD, who popularized the concept of “integrative medicine,” says it means being willing to consider ideas from any source that improve doctors’ ability to help patients heal and stay healthy, rather than just manage disease symptoms.
Too many people misunderstand and think he’s pushing alternative medicine, he said in aYouTube video. Weil says that some ideas from alternative medicine aren’t worth adopting.
“They range from ones that are sensible and worth incorporating into mainstream medicine to others that are foolish and a few that are dangerous,” Weil says. “The challenge is to sort through all that and see what’s useful and what’s not.
“I’m in no way an uncritical proponent of alternative medicine,” Weil says. “And I in no way reject conventional medicine. The goal is to take the best of both worlds.”