Which doctor, or witch doctor?

September 29, 2007 20:57

The rise of medical charlatans touting phony cures obscures genuine benefits of integrative medicine.

Which doctor, or witch doctor?

witch doctor 224.88. (photo credit: Rabin Medical Cener )

Hundreds of programs for non-physicians around the country and high-priced ads from charlatans promising "cures" for a variety of diseases have given non-conventional medicine a bad name. Totally unsupervised "alternative" therapists who "graduate" from these courses and swindlers whose mere touch is claimed to make serious disease evaporate tempt desperate patients. Many practitioners use the term "alternative medicine," as if the vast compendium of medical knowledge accumulated over centuries, especially the evidence-based medicine of the past few decades, can be equated with unproven treatments. However, there are herbs that can help patients as much or even more than some pills. And tai chi can reduce falling in the elderly, shiatsu can relax patients with hypertension, and acupuncture can relieve lower back pain. Some complementary medicine treatments can even help cancer patients. Dr. Opher Caspi, director of the year-old Integrative Medicine Unit at the Rabin Medical Center in Petah Tikva, says it observes strict rules when dealing with patients. "Therapies must be proven safe. They must not interfere with treatments that patients are already taking. And they must have a profile of efficacy," says Caspi, who not only is an internal medicine specialist but also has a Ph.D. in psychology. "Our treatments are offered as packages by physicians who seriously studied complementary medicine, and not as independent therapies." Everything is assessed according to this measure. "Homeopathy is very popular here and in the US, but we don't use it on cancer patients, as it hasn't been proven effective against cancer." Shark cartilage, a complementary cancer therapy offered in the US, has no effect on extending the lives of cancer patients, according to a rigorous study recently presented to the American Society for Clinical Oncology. However, some preliminary studies have provided encouraging evidence that ginseng and flaxseed might have some benefit. CASPI, A graduate of The Hebrew University-Hadassah Medical School who spent years studying internal medicine at the Hadassah University Medical Center, knows what is going on in complementary medicine abroad, as he spent a year in China learning traditional Chinese medicine and then six years studying integrative medicine (which integrates conventional and complementary medicine) at the University of Arizona - regarded as the world's leading center in this field. Since 2001, he has been a member of the research team based in Beijing that is examining the efficacy of acupuncture as part of a package for treating children with cerebral palsy. He also coordinates a course in integrative medicine at Tel Aviv University's Sackler Medical Faculty. He is one of about 100 physicians who are members of the Society for Integrated Medicine in the IMA. The Rabin Medical Center unit, located in the Davidoff Center on its Beilinson Campus, is the only integrative medicine facility of its kind in Israel, says Caspi. "The tragedy of complementary medicine is that some think it is an alternative; there is a danger of people going to charlatans and forgoing conventional treatment. IN FEBRUARY 2005, Caspi was appointed by Health Ministry director-general Prof. Avi Yisraeli to coordinate a committee to prepare legislation on supervision of complementary medicine therapies. The 19-member body is chaired by Dr. Yitzhak Zeides, director-general of Sheba Medical Center. Caspi says he is well aware that in 1992, the report of the Public Commission on Complementary Medicine - which was headed by retired Supreme Court justice Menachem Elon and deliberated for three years - was thrown into the dustbin after the majority of members recommended that unconventional medical techniques such as homeopathy, iridology, aromatherapy, shiatsu, reflexology, acupuncture and naturotherapy should not be outlawed if they don't cause harm. The minority on the commission, however, urged strict standards and licensing. They argued that the "drastic" proposals of the majority, based on the British model, were "not suited" to the Israeli reality of general disregard for many laws, and would create "complete lack of control. The charlatans will have a field day and the innocent public will be thrown to the wolves." The IMA lobbied against implementation of the Elon Commission's recommendations,, and nothing came of it - except, perhaps, a market in which anything was allowed de facto. "We know our committee is not the first. We are hearing representatives of the IMA as well as complementary medicine practitioners. There is no advance commitment from the ministry to accept our recommendations; either they will implemented, or they will be forgotten. There is a chance that it will not lead to anything, but we hope it will," Caspi says. Today, the health funds offer members who take out supplementary health insurance policies the opportunity to consult with complementary medical therapists for a reduced fee, and there are hospitals such as Hadassah, Shaare Zedek and Assaf Harofe Medical Centers, for example, that have integrative medicine units. "But ours is comprehensive, and we treat cancer patients all day." Under one roof, the Beilinson center concentrates oncologists, hematologists and other experts in a wide variety of cancers along with doctors who have studied complementary medicine. "We have a repository of knowledge that helps both patients and staff. We have a constant dialogue, at the level of the individual patient, on what could help. We think how to work together and find proven therapies when there is no other solution. For example, when cancer patients suffer from tiredness, weakness or neuropathy due to toxic chemotherapy," explains Caspi. "There are patients who cannot undergo conventional treatments because they suffer from depression or anxiety. Our center deals with all stages of cancer. A psychologist is available at no cost, thanks to a donation from the Israel Cancer Association and a job slot funded by the Health Ministry; this service includes medical hypnosis, directed imagery, meditation workshops and preparation for surgery." Conventional doctors who denigrate complementary medicine claim that patients benefit merely from the "placebo effect" - they think it will help, so it relieves their symptoms. "There can be a beneficial effect from a placebo; I know that well, as I have a doctorate in psychology. Research shows that some complementary medicine therapies go beyond the placebo effect and have an actual therapeutic benefit. With some of them, we know how they work, and with others, we don't." Certain herbs, such as the Chinese plant astragulus, have been found to help fight lung cancer along with chemotherapy better than chemotherapy alone. The combination can improve the quality of life and survival rates, says Caspi. "We can help patients whose blood counts are too low for them to be accepted for chemotherapy. So complementary therapy may increase their chance for survival and even indirectly lead to a cure." Supplements such as GLA can boost the anti-cancer effect of Herceptin, taken by breast cancer patients. Ginseng can be effective against fatigue. CASPI WARNS patients with serious illness who buy supplements at health food stores to be very careful. Only a few products are checked by the government, he states, as food supplements are approved by the Health Ministry only if they don't cause harm, but are not required to prove efficacy and cannot make therapeutic claims. "Today, almost all quality control is voluntary. There are private importers who care enough and do it, but there are others who do not. Israel is too small a market for there to be local labs testing products. When you go into a health food store, you can get dizzy." He met recently with the ministry's chief pharmacist, Batya Haran, about requiring supervision of certain non-medical products shown to have therapeutic effects. "She is in favor, but for this she needs funding." Caspi and his staff are careful to find out whether cancer patients take food supplements like vitamins, homeopathic solutions and other non-medications. "In many other centers, patients don't tell their doctors what they are taking on the side. But these can also interfere with cancer treatments. It's a two-edged sword. Cancer patients getting radiotherapy mustn't take antioxidant vitamins because these can hurt the efficacy of radiation. We always ask." The basket of health services does not include complementary medical treatments, but because of its direct connection to Clalit (the country's largest health fund), Caspi's center has agreements for subsidized care to members of its supplementary health insurance plans. But it accepts patients from everywhere, and charges are kept low. For example, the charge for an acupuncture treatment is "rock bottom for an academic institution, at just NIS 150," Caspi says. There are also numerous haredim and Arabs, who generally have lower incomes, among their patients. The Rabin Medical Center's integrative medicine unit is planning to establish a special place for women's health that would bring together conventional and complementary medicine. He says such treatments can help with premenstrual syndrome (PMS), for example. The idea at Rabin is eventually to incorporate integrative medicine for all kinds of problems, from infertility to heart disease and diabetes. Caspi expects that the Rabin center's success at integrating conventional and complementary medicine will lead to the establishment of similar units in other hospitals. He also hopes for a consumer movement - even a national institution - that will educate the public on how to be healthy. "It's important for there to be pluralism in medicine, but it is a tragedy that there is no informed consumerism to help patients get help. There are campaigns to encourage road safety. Why is there no campaign for wise use of health treatment?" Caspi asks. "Paternalistic doctors are behind us. With the Internet. everybody turns into a mini-doctor. But while having information is good, much of it is misleading. It's do-it-yourself medicine. But my experience is that what pushes cancer patients to go for complementary therapy is pragmatism, not that they seek holistic therapy. They have needs, and in many cases, we know how to help them."

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