What Is 'Good Medicine?'

While attending a recent Harvard Medical School symposium on Complementary and Alternative Medicine, it became apparent that this emerging field has lost its previous Cinderella status. Books, tapes

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While attending a recent Harvard Medical School symposium on Complementary and Alternative Medicine, it became apparent that this emerging field has lost its previous Cinderella status. Books, tapes and journals now abound in this rapidly growing business, estimated at around $30 billion per year in the United States alone.

Alternative and complementary therapies have long been a polarizing issue in the medical field. In the early 1900s, the Dean of Harvard described the homeopathic movement as a "mingled mass of perverse ingenuity ... and of artful misrepresentation." Samuel Hahneman, the founder of homeopathy, responded, "Allopathy (conventional medicine) is the non-healing art, which shortens the lives of 10 times as many human beings as the most destructive wars and rendered many millions of patients more diseased and wretched than they were originally."

Even just 10 years ago, alternative medicine was not widely accepted in this country. Since then, the medical community has taken quite a leap.

An Integration: East Meets West
At this year's conference in Boston, things were different. The Dean of Harvard Medical School shared the same podium as homeopaths, acupuncturists and fellow physicians. The resounding theme was based on collaboration and sharing, a call for scientific evidence (not personality) to judge medical outcome.

It's clear that skeptics of alternative medicine might never be convinced and enthusiasts might never be dissuaded, but we all need a balanced evaluation of the exuberant claims that presently exist in the health care market.

Ancient Theories: Modern Science
Since "science" has become involved in the evaluation of complementary and alternative medicines, we've discovered some interesting data. We've learned that complementary and alternative medicines might or might not be beneficial for our health. Under certain circumstances, they might even be harmful.

Some expected research results have indicated that chiropractic and osteopathy have both been shown to be effective for lower back pain. Outcomes of evaluations of herbs have also been as expected: St. John's Wort is effective for depression, Gingko Biloba for dementia and Saw Palmetto for benign prostatic hypertrophy. In addition, psychological support groups have been shown to be beneficial for patients suffering from breast cancer.

Scientific evidence now gives credibility to acupuncture, a technique that's been used for more than 3,000 years. Dr. Kathleen Hui recently completed a study at Harvard, which was published in Human Brain Mapping, revealing that acupuncture needling of a point on the hand can cause blood flow changes to structures deep within the brain. Acupuncture has been shown to relieve nausea, dental pain, headaches and other conditions as well.

Some more surprising results have been that homeopathy is as effective as a standard antihistamine for vertigo (dizziness). More interesting was a study on the Chinese art of Moxibustion, the burning of an herb, moxa, over acupuncture points. In a study on pregnant women whose babies were in the breech (head up) position, the burning of moxa over one of their toes resulted in the baby turning to the normal (head down) position. An increasing body of research is validating ancient theories that span many centuries.

Some studies have shown a lack of efficacy. For instance, acupuncture was shown to be of no benefit for patients suffering from peripheral neuropathy (nerve disorders), and garlic didn't lower high cholesterol.

In some instances, alternative therapies have been shown to have negative side effects. Gingko might cause bleeding. St. John's Wort might result in photosensitivity, cataracts and interfere with other drugs, such as Cyclosporin and selective serotonin reuptake inhibitors (Prozac, Zoloft, Paxil). There's a growing list of herb-to-herb and herb-to-drug interactions. So it's important to discuss your herbal/vitamin supplements with your medical doctor.

What does all this mean? Ultimately, we're learning that there's no perfect medicine. Conventional and alternative therapies both have potential and promise for both good and harm. Since 64 percent of our country's medical schools now offer courses in alternative therapies, the doors have been opened for the moment of truth.

During this new century, we'll continue to see an integration of what truly works, as alternative therapies turn into mainstream medicine. There will no longer be the division between alternative and conventional medicine. There will only be good medicine.

And good medicine is when we as physicians are governed by compassion and good judgment with full scientific backing.

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