Tired of Killer Cures?

[Guest guest]

Tired of Killer Cures?

By James S. Gordon

Special To The Washington Post

Tuesday, August 20, 2002; Page HE01

 

 

The signs and symptoms of crisis in our health care system have

become front-page news in recent weeks. Treatments that were routine -

- widely accepted by physicians and embraced by the public -- have

proven inappropriate, possibly dangerous and wasteful.

 

The federally funded Women's Health Initiative appears to have

demonstrated that the hormone replacement therapy (HRT) that was

supposed to prevent heart disease in menopausal women actually

increases its likelihood. A well-executed study on the surgical

treatment of osteoarthritis of the knee (published in the New England

Journal of Medicine) showed that a placebo group -- patients who only

thought they had surgery -- actually did as well as those who were

operated on. And, a few weeks ago, a lead article in the New York

Times reported on several major studies that show that more

conventional health care and more medical specialists do not

necessarily produce improvement in health status for both older

people and newborns.

 

This cluster of disturbing findings is simply the most recent and

visible manifestation of the limitations and counterproductiveness of

an approach to health that places overwhelming emphasis on expensive

and often side effect-laden surgical and pharmacological treatments,

an approach that has largely devalued prevention, self-care and the

perspectives and techniques of the world's systems of traditional

medicine and healing.

 

Over the last several years we have learned that the treatments we

routinely provide are, even when appropriately used, the fourth

leading cause of death in our country.

 

While we argue about whether or not prescription drugs should be

provided through Medicare, old people's medicine cabinets are bulging

with prescribed bottles that are, according to many well-done

studies, often unnecessary, redundant and dangerous, as well as

prohibitively expensive.

 

In spite of tens of billions of dollars of investment in research and

treatment -- and some real improvements in the treatment of some

cancers -- more than 500,000 Americans still die of cancer each year,

and millions more who " do well " suffer terribly from the side effects

of their treatment.

 

The surgeon general tells us that the percentage of obese teenagers

has doubled in the last two decades and that these overfed and under-

exercised, and often anxious and depressed, young people are falling

victim to chronic illnesses such as diabetes, heart disease and

perhaps cancer at ever-earlier ages. Our newborns continue to die at

rates significantly higher than those in a number of other developed

countries.

 

Meanwhile, our health care costs, already more than twice as much per

person as those of any other developed country, are escalating out of

sight. A recent article in Health Affairs predicted that if costs

continue to escalate at current rates, expenditures will double in 10

years.

 

Outside the System

 

Americans in unprecedented numbers are looking for relief outside the

current system. They want help with preventing and treating the

chronic illnesses that threaten, disable and dismay them -- heart

disease, chronic pain, HIV, obesity, depression and cancer -- and

from the side effects that the state-of-the-art conventional

treatments for these illnesses often produce.

 

They are also looking for a more intimate relationship with their

health care providers. They want health professionals who will

respect them as partners in their care and who see and understand

them as whole people with complex lives, not just " lesions " and lab

values.

 

Many of these people are looking to other approaches to healing.

According to one study, published in the Journal of the American

Medical Association in 1998, 42 percent of all Americans are using

other than conventional therapies as alternatives or complements to

conventional medicine. They are making 200 million more visits

to " complementary and alternative health care providers " --

acupuncturists, chiropractors, massage therapists and others -- than

to primary care physicians.

 

The White House Commission on Complementary and Alternative Medicine

Policy, which I chaired, was created in 2000 to assess these and

other developments and to formulate recommendations to make the

benefits of complementary and alternative medicine (CAM) and its

broader, more holistic perspective available to all Americans. The

commission was established because of enormous public and

congressional interest in CAM. The commission's work coincided with a

similar study by the World Health Organization on the possible

benefits of traditional systems of healing and of such modern CAM

approaches as large-dose vitamin supplementation and homeopathy.

 

The commission recently completed a report, which the White House is

studying, that will soon be on the desks of all members of Congress.

 

The commission's recommendations -- based on 20 months of public

testimony and discussion with most of the major conventional medical,

as well as CAM, organizations -- can help to enlarge our perspective

and refocus our attention. They point to the need for a better

balance between the current research emphasis on finding " magic

bullets " -- single drugs, procedures or, indeed, single alternative

therapies -- and the creation and investigation of comprehensive

therapeutic approaches that combine the best of conventional,

complementary and alternative therapies.

 

In place of the current emphasis on finding and using more, and more

expensive, high-tech interventions, the commission stresses the

importance of an informed public, of self-awareness and self-care

(including nutrition, exercise and mind-body approaches) in both

clinical work and health professional education, and of the role of

physicians as teachers as well as " treaters. "

 

Time for a Change

 

The commission's report is particularly relevant now, as the results

of studies that highlight health care shortcomings accumulate.

 

The newspapers tell us that osteoarthritis of the knee does not

benefit from surgical intervention and does only middling well with

anti-inflammatory drugs. The commission report offers another,

nonsurgical, non-pharmacological way. We would suggest that it's time

to do a major study on a comprehensive approach to osteoarthritis,

one that combines self-care with safe and effective remedies that are

largely free of side effects.

 

There is evidence, for example, that exercise, acupuncture, yoga,

massage and an inexpensive supplement, glucosamine sulfate, are each

of some help and that dietary change and weight loss can also produce

real improvement in symptoms.

 

More than 40 million Americans currently suffer great pain and endure

limitations of movement because of osteoarthritis. They pay tens of

billions of dollars each year for doctors and drugs, and cost our

economy tens of billions more in lost time at work.

 

Why not combine these CAM therapies, together with group support, and

study this approach for cost-effectiveness as well as for safety and

effectiveness? We can do the study with a tiny portion of the $1.5

billion we will save each year if we refrain from unnecessary knee

surgery. And if this holistic approach proves helpful, we may find

ourselves saving tens of billions more. The commission noted that

Dean Ornish's program for reversing heart disease, the nation's

leading cause of mortality, represents a pioneering effort to

demonstrate the effectiveness and cost-effectiveness of this kind of

comprehensive program.

 

In a program based on education and self-care, Ornish teaches

patients to combine significant dietary modifications, physical

exercise, yoga and stress management in the context of a supportive

group. Several studies published in prestigious journals have

demonstrated improved physical functioning and quality of life in

Ornish's patients. The diameters of their coronary arteries have

increased and they have no longer needed coronary bypass surgery.

Meanwhile, their insurers have saved up to $30,000 for each person

enrolled in the study.

 

Much medical effort is lavished on ensuring that patients " comply "

with doctors' orders, whether or not these orders are for treatments

that are effective, appropriate and cost-effective. The commission

lays out a plan for the full participation of all Americans in every

aspect of their health care -- in setting public health priorities,

as well as in deciding on, formulating and carrying out their own

therapeutic regimens.

 

The commission recommends that the government make it possible for us

to make these decisions wisely by making the best information about

the benefits and hazards of all forms of health care easily

available -- to ordinary people as well as to the health

professionals who serve them.

 

We urge as well a significant redirection of effort and funds to the

prevention of illness and the promotion of health and wellness.

Though some continue to argue about the state of the evidence, it

seems to us quite clear that if our children learn to eat and

exercise better, and learn how to deal with stress more effectively,

they will be able to forestall much of the later suffering -- the

debilitating and life-threatening chronic illnesses -- for which they

seem to be headed.

 

Finally, we need to make sure that we continually keep the broadest

possible perspective on what is and is not working, and are willing

to raise questions about any orthodoxy -- conventional or

alternative -- that may restrict our vision.

 

The bad news about hormone replacement therapy and current treatments

for osteoarthritis, as well as the rising human and economic costs of

our inefficient and too-often ineffective system of health care, can,

we believe, be an opportunity. Now is the time to reassess and

readdress the shortcomings in our approach to health care as well as

in the individual interventions we use -- and to look closely at

approaches that may save us all large sums of money, as well as

untold suffering.

 

James S. Gordon, MD, former chair of the White House Commission on

Complementary and Alternative Medicine Policy, is the director of the

Center for Mind-Body Medicine in Washington, a clinical professor of

psychiatry and family medicine at Georgetown Medical School and

author of " Manifesto for a New Medicine: Your Guide to Healing

Partnerships and the Wise Use of Alternative Therapies. "

 

 

 

 

 

© 2002 The Washington Post Company