Clinician's Guide to Holistic Medicine / Edition 1 available in Paperback
- Pub. Date:
- McGraw-Hill Professional Publishing
Table of ContentsChapter 1: Introduction. Chapter 2: Cardiovascular Disease. Chapter 3: Cancer. Chapter 4: Gastrointestinal Disease. Chapter 5: Neurological Disease. Chapter 6: Endocrinological Disease. Chapter 7: Gynecological Disease. Chapter 8: Psychological Disease. Chapter 9: Respiratory Diseases. Chapter 10: Musculoskeletal Diseases. Chapter 11: Geniotourinary and Men's Diseases. Chapter 12: Opthalmological Diseases. Chapter 13: Systemic Diseases. Chapter 14: The Nature of Health Promotion. Appendix: Glossary of Terms.
Most physicians are quite aware of the two Eisenberg et al. surveys of over one thousand randomly selected consumers in 1991 and 1997, concluding that 32 and 41 percent, respectively, used some form of alternative healthcare services or products. 2,3 Termed "unconventional" in their first survey, Eisenberg et al. defined "alternative" as embracing those products, services, and practices related to interventions not taught widely in medical schools and not generally available in US hospitals. Consumers in 1997 were estimated to have spent $26 billion of largely unreimbursed, out of pocket, discretionary income. And further, 75 percent did not inform their physicians of what they were doing. The depth of this shift incorporating medically unrecommneded alter native initiatives intended to prevent or treat common chronic conditions should not be underestimated.
The motivations of users of alternative options appear to be deeply rooted in a paradigmatic shift of values. Astin's randomized survey of 1,000 adults confirmed the Eisenberg estimate of incidence of use exceeding 40 percent of US consumers. The significance of the study could be summarized in the following conclusions. Those responding affirmatively to using alternative services and products:
1. were not especially disenchanted with conventional medical care;
2. were generally more educated than those not using alternative services;
3. were generally sicker that those seeking conventional care;
4. sought alternative care most often for chronic pain, anxiety, urinary tract problems, and back problems;
5. were inclined to use both alternative and conventional resources;
6. were prone not to tell their conventional practitioners what they were doing;
7. were significantly more likely to come from a segment of people within society who could be described as cultural creatives, with intense commitment to (1) environmental concerns with earth ecology, (2) feminism and feminine values, (3) personal growth psychology, and (4) spirituality;
8. were also significantly more likely to have had a "transformational" experience which motivated them to choose to have their medical care congruently aligned with their altered and newly found worldview;
9. expressed a holistic orientation in regard to health;
10. made up 41 percent of all respondents, totally consistent with the findings in the second Eisenberg survey.
The significant trend in which only a small percentage of users used alternatives exclusively without conventional resources is notable. This, combined with the tendency for them not to inform their conventional physicians about their alternative interests means they were assertively making their own decisions about how to combine available treatment options, mixing and matching their conventional and alternative choices as they saw fit. Users of alternatives in this study were not generally dissatisfied with conventional care, but motivated by poorer health status, commitment to environmentalism, feminism, spirituality, and personal growth ,,psychology. They were generally more highly educated, espoused a holistic orientation to health and life, and many had had a transformational ewperience that shifted their worldview. These aspects of users of alternative medicine describe a significant pattern which heralds a paradigmatic shift in society, including the means by which healthcare services are used and delivered. Many individual comments of respondents in the Astin survey expressed the opinion that their interest was in part due to the fact that alternative practitioners "promote health rather than just focusing on illness. " This underscores the need to respond with a greater emphasis on health promotion and make such services available to the segment of society that considers this a priority.
Although public interest in alternative medicine had been building slowly from the 1960s, little professional attention or interest was elicited until the 1990s. The only professional membership organization addressing the entire spectrum of complementary topics was initiated with the founding meeting of the American Holistic Medical Association in 1978. Widespread interest in the field awaited the publication of Eisenberg's "Unconventional Medicine in the United States" in the New England Joumal of Medicine in 1993 . Public interest has continued to expand, playing some role in the formation of the Office of Alternative Medicine within the National Institutes of Health by an Act of Congress in 1993. That office has recently been upgraded to the status of a separate office within the National Institutes of Health with an eight-fold increase in funding to $60 million in the 1999-2000 federal budget.
The changes occurring in professional medical circles in relation to holistic and complementary medicine reflect to some degree the previously mentioned consumer interest, but also burgeoning interest on the part of students, residents, and practicing physicians. Over one hundred medical schools now have at least one course devoted to alternative, complementary, or holistic medicine. 5 Affiliated institutes, or full-fledged departments devoted to these topics, have been established as well in a small number of institutions.
In the mid-1990s, three medical journals devoted to peerreviewed publishing of alternative studies began publication. In November 1999 the journals of the AMA, including JAMA, devoted an issue to alternative and complementary medicine, publishing studies demonstrating both positive effects and lack of effectiveness of alternative treatments. Reactions to the choice of the AMA journals to publish in this field were, expectedly, mixed.
One of the steps leading to the establishment of a specialty within the framework of American medical practice is the assembling of a database of research information which permits an area of medical interest to clearly distinguish itself from other fields of medical interest. Over the last ten years that has been accomplished, as witness the publishing of a number of alternative books and compilations of data.
A further step in marking the evolution of the holistic paradigm was the initiation of a certifying examination by the American Board of Holistic Medicine in December 2000. Establishing minimum standards through a peer-developed written examination began to give greater definition to the development of complementary approaches as a specialty within the medical community.
Clinician's Guide to Holistic Medicine is offered as an additional resource emphasizing the shift from the duality of either-or thinking of conventional vs. alternative approaches to the unity of one holistic medicine, incorporating the best of both.
Copyright 2001 by The McGraw-Hill Companies, Inc. Used with permission.