The Real Issue With CAM
All kidding aside, I've been thinking about CAM (complementary and alternative medicine, also called Integrative medicine by those who feel that makes it more acceptable) a lot lately. Obviously much debate centers on efficacy of unproven treatment modalities, although it can certainly be said that there is no such thing as 'alternative' medicine; there is only medicine that has been proven to work, and medicine that hasn't. While it is important to consider evidence, efficacy, and even plausibility, that's not what I'm talking about.
The real issue with CAM is unmet needs.
When people get hurt or sick, they seek medical attention. Their needs, generally speaking, are for an accurate diagnosis and effective treatment that isn't too unpleasant or expensive, from a friendly-enough doctor with acceptable facilities. When these needs are met, there is no impetus to seek out any kind of alternative care. The system works; everyone is happy
Often enough, though, all of those needs are not met completely. The doctor was brusque (although the diagnosis was right and the treatment worked) or the staff was rude (but the doc was great.) Or they couldn't make a diagnosis (but the symptoms resolved on their own) or the suggested treatment was too expensive (but the diagnosis was right and the nurse was wonderful.)
Different people attach more or less importance to each of these elements; that is, they have different needs. Some people need to understand their diagnosis in greater detail than others. Some people want to know about every single possible treatment option, even those that may not be appropriate for them, because they just want to know. Other folks just say, "Just tell me what to do to get better and I'll do it." Different doctors meet different patients' needs differently in different situations. When one or more of those needs are not met by "conventional medicine" the patient may look elsewhere for relief; to have their needs met.
A patient with vague complaints of fatigue, pain and malaise may go through multiple investigations at the hands of numerous doctors and emerge without a satisfactory diagnosis. Without a diagnosis, treatment options may be limited. Symptomatic care may or may not be tried. Mental health treatment may be recommended; that recommendation may be accepted or rejected. It's easy to see patients' frustration build as their need for diagnosis, relief, validation, whatever, are not met. So they turn elsewhere: the chiropractor; the LLMD; the Reiki master; the acupuncturist.
Each of these practitioners manages to meet patients' needs. They diagnose invented conditions, but they provide a diagnosis. They perform treatments that have no scientific plausibility, but "at least they're doing something." They often spend long periods of time with patients, listening and providing validation that "something's wrong" even if the doctors could never find out what. They meet the patients' emotional need to be heard. They may not provide accurate diagnosis or effective treatment, but they are certainly meeting needs; otherwise they wouldn't exist.
Take another patient diagnosed with cancer. His primary need is for a cure, although sometimes we can't do that. Failing that, we must meet his need for hope; hope that pain will be managed, that he won't be abandoned; all of his emotional needs. If another can be cured, she needs to know that she can tolerate the treatment; that the vomiting can be treated; that she won't be too tired to take care of her kids; again, mainly that her emotional needs will be met. Even when we cannot cure, we can often do a decent job of meeting patient needs.
So when we can't, is it any wonder they turn to laetrile? To diet cures? To all manner of alternative treatments that meet their need for hope, even if not their desire for a physical cure.
Why do doctors turn to providing "alternative" care? What makes them do the mental somersaults required essentially to renounce their scientific training (in the name of "open-mindedness", they tell themselves)? Sometimes, perhaps, it's from disillusionment with patients' poor responses to what they've been taught they have to offer, but I'd wager that far more frequently the underlying motivation is economic.
An alternative (or complementary; or integrative) practice is a cash practice. It's a golden opportunity to ditch the insurance slavemasters, while convincing oneself that one is still helping people; albeit only those who can afford one's services.
Some of us -- those of us who truly understand the science as well as the art of medicine -- couldn't imagine that financial need would ever trump our integrity to the extent required to open an alternative practice, but for many others, when the physician's need to earn a living wage is not met by practicing conventional medicine, turning to CAM is often an economically viable option.
If conventional medicine were able to meet all of our patients' needs all of the time, and if all physicians were able to earn whatever amount of money required to meet their needs, there would be no such thing as CAM.
Researching new medical modalities is important. Who knows which alternative therapies are simply not proven "yet"? It is also important to debunk junk science when it represents a clear danger to patients. However as we go around and around with the debate, perhaps some of our energies would be better spent trying to improve the job we do of meeting our patients' needs. Then there wouldn't be a need for CAM.