Tired of killer cures?

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Tired of Killer Cures?By James S. GordonSpecial To The Washington PostTuesday, August 20, 2002; Page HE01The signs and symptoms of crisis in our health care system havebecome front-page news in recent weeks. Treatments that were routine -- widely accepted by physicians and embraced by the public -- haveproven inappropriate, possibly dangerous and wasteful.The federally funded Women's Health Initiative appears to havedemonstrated that the hormone replacement therapy (HRT) that wassupposed to prevent heart disease in menopausal women actuallyincreases its likelihood. A well-executed study on the surgicaltreatment of osteoarthritis of the knee (published in the New EnglandJournal of Medicine) showed that a placebo group -- patients who onlythought they had surgery -- actually did as well as those who wereoperated on. And, a few weeks ago, a lead article in the New YorkTimes reported on several major

studies that show that moreconventional health care and more medical specialists do notnecessarily produce improvement in health status for both olderpeople and newborns.This cluster of disturbing findings is simply the most recent andvisible manifestation of the limitations and counterproductiveness ofan approach to health that places overwhelming emphasis on expensiveand often side effect-laden surgical and pharmacological treatments,an approach that has largely devalued prevention, self-care and theperspectives and techniques of the world's systems of traditionalmedicine and healing.Over the last several years we have learned that the treatments weroutinely provide are, even when appropriately used, the fourthleading cause of death in our country.While we argue about whether or not prescription drugs should beprovided through Medicare, old people's medicine cabinets are bulgingwith prescribed

bottles that are, according to many well-donestudies, often unnecessary, redundant and dangerous, as well asprohibitively expensive.In spite of tens of billions of dollars of investment in research andtreatment -- and some real improvements in the treatment of somecancers -- more than 500,000 Americans still die of cancer each year,and millions more who "do well" suffer terribly from the side effectsof their treatment.The surgeon general tells us that the percentage of obese teenagershas doubled in the last two decades and that these overfed and under-exercised, and often anxious and depressed, young people are fallingvictim to chronic illnesses such as diabetes, heart disease andperhaps cancer at ever-earlier ages. Our newborns continue to die atrates significantly higher than those in a number of other developedcountries.Meanwhile, our health care costs, already more than twice as much perperson

as those of any other developed country, are escalating out ofsight. A recent article in Health Affairs predicted that if costscontinue to escalate at current rates, expenditures will double in 10years.Outside the SystemAmericans in unprecedented numbers are looking for relief outside thecurrent system. They want help with preventing and treating thechronic illnesses that threaten, disable and dismay them -- heartdisease, chronic pain, HIV, obesity, depression and cancer -- andfrom the side effects that the state-of-the-art conventionaltreatments for these illnesses often produce.They are also looking for a more intimate relationship with theirhealth care providers. They want health professionals who willrespect them as partners in their care and who see and understandthem as whole people with complex lives, not just "lesions" and labvalues.Many of these people are looking to other approaches

to healing.According to one study, published in the Journal of the AmericanMedical Association in 1998, 42 percent of all Americans are usingother than conventional therapies as alternatives or complements toconventional medicine. They are making 200 million more visitsto "complementary and alternative health care providers" --acupuncturists, chiropractors, massage therapists and others -- thanto primary care physicians.The White House Commission on Complementary and Alternative MedicinePolicy, which I chaired, was created in 2000 to assess these andother developments and to formulate recommendations to make thebenefits of complementary and alternative medicine (CAM) and itsbroader, more holistic perspective available to all Americans. Thecommission was established because of enormous public andcongressional interest in CAM. The commission's work coincided with asimilar study by the World Health Organization

on the possiblebenefits of traditional systems of healing and of such modern CAMapproaches as large-dose vitamin supplementation and homeopathy.The commission recently completed a report, which the White House isstudying, that will soon be on the desks of all members of Congress.The commission's recommendations -- based on 20 months of publictestimony and discussion with most of the major conventional medical,as well as CAM, organizations -- can help to enlarge our perspectiveand refocus our attention. They point to the need for a betterbalance between the current research emphasis on finding "magicbullets" -- single drugs, procedures or, indeed, single alternativetherapies -- and the creation and investigation of comprehensivetherapeutic approaches that combine the best of conventional,complementary and alternative therapies.In place of the current emphasis on finding and using more, and

moreexpensive, high-tech interventions, the commission stresses theimportance of an informed public, of self-awareness and self-care(including nutrition, exercise and mind-body approaches) in bothclinical work and health professional education, and of the role ofphysicians as teachers as well as "treaters."Time for a ChangeThe commission's report is particularly relevant now, as the resultsof studies that highlight health care shortcomings accumulate.The newspapers tell us that osteoarthritis of the knee does notbenefit from surgical intervention and does only middling well withanti-inflammatory drugs. The commission report offers another,nonsurgical, non-pharmacological way. We would suggest that it's timeto do a major study on a comprehensive approach to osteoarthritis,one that combines self-care with safe and effective remedies that arelargely free of side effects.There is evidence, for

example, that exercise, acupuncture, yoga,massage and an inexpensive supplement, glucosamine sulfate, are eachof some help and that dietary change and weight loss can also producereal improvement in symptoms.More than 40 million Americans currently suffer great pain and endurelimitations of movement because of osteoarthritis. They pay tens ofbillions of dollars each year for doctors and drugs, and cost oureconomy tens of billions more in lost time at work.Why not combine these CAM therapies, together with group support, andstudy this approach for cost-effectiveness as well as for safety andeffectiveness? We can do the study with a tiny portion of the $1.5billion we will save each year if we refrain from unnecessary kneesurgery. And if this holistic approach proves helpful, we may findourselves saving tens of billions more. The commission noted thatDean Ornish's program for reversing heart disease, the

nation'sleading cause of mortality, represents a pioneering effort todemonstrate the effectiveness and cost-effectiveness of this kind ofcomprehensive program.In a program based on education and self-care, Ornish teachespatients to combine significant dietary modifications, physicalexercise, yoga and stress management in the context of a supportivegroup. Several studies published in prestigious journals havedemonstrated improved physical functioning and quality of life inOrnish's patients. The diameters of their coronary arteries haveincreased and they have no longer needed coronary bypass surgery.Meanwhile, their insurers have saved up to $30,000 for each personenrolled in the study.Much medical effort is lavished on ensuring that patients "comply"with doctors' orders, whether or not these orders are for treatmentsthat are effective, appropriate and cost-effective. The commissionlays out a plan for

the full participation of all Americans in everyaspect of their health care -- in setting public health priorities,as well as in deciding on, formulating and carrying out their owntherapeutic regimens.The commission recommends that the government make it possible for usto make these decisions wisely by making the best information aboutthe benefits and hazards of all forms of health care easilyavailable -- to ordinary people as well as to the healthprofessionals who serve them.We urge as well a significant redirection of effort and funds to theprevention of illness and the promotion of health and wellness.Though some continue to argue about the state of the evidence, itseems to us quite clear that if our children learn to eat andexercise better, and learn how to deal with stress more effectively,they will be able to forestall much of the later suffering -- thedebilitating and life-threatening chronic

illnesses -- for which theyseem to be headed.Finally, we need to make sure that we continually keep the broadestpossible perspective on what is and is not working, and are willingto raise questions about any orthodoxy -- conventional oralternative -- that may restrict our vision.The bad news about hormone replacement therapy and current treatmentsfor osteoarthritis, as well as the rising human and economic costs ofour inefficient and too-often ineffective system of health care, can,we believe, be an opportunity. Now is the time to reassess andreaddress the shortcomings in our approach to health care as well asin the individual interventions we use -- and to look closely atapproaches that may save us all large sums of money, as well asuntold suffering.James S. Gordon, MD, former chair of the White House Commission onComplementary and Alternative Medicine Policy, is the director of theCenter for

Mind-Body Medicine in Washington, a clinical professor ofpsychiatry and family medicine at Georgetown Medical School andauthor of "Manifesto for a New Medicine: Your Guide to HealingPartnerships and the Wise Use of Alternative Therapies."© 2002 The Washington Post Company "Our ideal is not the spirituality that withdraws from life but the conquest of life by the power of the spirit." - Aurobindo.

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