Integrative medicine

Over the last 30 years, we have made good progress in developing medical knowledge, but approach towards the patient is still lacking. Two sides are looking at each other across the imaginary Maginot line. All medical professionals are mercenaries of the pharmaceutical industry, and all of “alternatives” are fraudsters. Those sides don’t get hurt; people do. It’s time for change and integration. We can all be flexible enough.

Many faces of medicine

Today’s medicine has a lot of faces. Although we perceive it as one, the approach itself can vary greatly. For example, French or German doctors have at their disposal the same medicines as Croatian, but their style and professional approach may differ: different tests, using and prescribing medications, how to access the patient. This is due to cultural differences, but also differences in education and subsequent mentoring of young doctors. This is seen by all those who go to institutions outside Croatia. The Balkans gets angry at such statements, but the fact that something is different does not mean that something is better or worse, it is simply different. Just as there are differences between countries, so there are countless variations in individual patient treatment.

In the context of phytotherapy and aromatherapy, there are large cultural differences. In old phytotherapy superpowers such as Germany or France, a higher percentage of doctors use herbal preparations and medicines than in Croatia. Some health systems, depending on the type of insurance, also reimburse phytotherapy and homeopathy costs.

Of course, in addition to the so-called “official” medicine, there is also complementary and alternative medicine (CAM). Phytotherapy and aromatherapy are both fortunate and unfortunate to be found in “both” medicines. It is a fortunate circumstance because it is more used and popular among people. It is an unfortunate circumstance that in medical circles it is perceived as a discipline that does not need much professionalism and knowledge. The truth is quite the opposite.

Everybody can be confused by myriads of terminology and names. Complementary, alternative, energetic, integrative, holistic, conventional, official… Therefore, the question arises – how to define them.

Marcia Angell and Jerome P. Kassirer have issued an interesting statement: “There cannot be two types of medicine – conventional and alternative. There is only one medicine that has been adequately tested and one that is not and a medicine that is effective and one that may or may not be effective.” This attitude was heavily criticized. By systematically assessing the Cochrane Database of Systemic Review Papers on Clinical Interventions of Various Types (Mostly Medicines), Ezzo et al. showed that as many as 41.3% of all papers conclude that clinical interventions are either “without evidence of efficacy” or “proven to have no effect”. Therefore, the very definition of conventional medicine as effective and alternative as ineffective or without evidence of efficacy – is very loose. This would mean that phytotherapy itself is divided – if we use a plant that has been clinically studied a lot (example: St. John’s wort), then we are in conventional medicine. If, however, we use a plant that has been used traditionally and has not been clinically studied too (example: Lungworts), then we are in complementary medicine. If that were the case, we’d be in complete confusion.

It is generally difficult to say what complementary medicine is from a legal standpoint. Osteopathy and chiropractic are part of complementary medicine in Croatia, and in the USA they are part of conventional medicine. Traditional Chinese medicine and Ayurveda are part of complementary medicine in the USA and Croatia, and in China and India, where they were created, they are completely official (conventional) medicine. Acupuncture in Croatia has been part of official medicine for the past twenty years, in China it has been part of conventional medicine for at least 4000 years. Reflexology is mostly part of massage in Croatia, in South Africa the parliament adopted the legal concept of occupation “reflexotherapist” as a medical profession in 2000.

There are semantic twists. In The Croatian language, the term “complementary” is preferred because it denotes the property of agreeing or being supportive of conventional medicine, which it really can be. The word “alternative” means that it is alternative to conventional, i.e. implies a certain level of intolerance. I used to hear all this in Croatia, but semantically it doesn’t have to be true at all and depends on subjective opinion.

It is obvious that the boundary between medicines is sometimes very diffuse, and this mostly emphasized in phytotherapy. There are a lot of definitions that are negative (complementary medicine is the one that is not conventional) and that do not meet the basic logical norms of definitions. Negative definitions easily become both circular (then conventional medicine is the one that is not complementary) and again demolish the basic beginnings of logic. In 1995., a seemingly provocative definition was adopted that complementary medicine is “the one that is beyond the intrinsic politically dominant health system of a particular society or culture in a particular historical period.” While the use of the word “political” is already a bit provocative, we cannot deny the precision of this definition. In China, Chinese traditional medicine is the first and dominant conventional medicine because it is supported by the health system and the political elite. Furthermore, we could roughly say that conventional medicine in Croatia is “everything that goes to the expense of the health care system” and we will not be far from the truth. And “what comes at the expense of the health care system ” is decided by the legislature and the executive branch. The political decision itself is not easy. We can find a good example in fairly liberal Switzerland. In 1999., Switzerland included homeopathy, phytotherapy, neural medicine, anthroposophic medicine and traditional Chinese medicine in basic health insurance. After a lot of controversy over the issue of efficacy, the question of pharmacoeconomics has been raised because this liberalization has not reduced the costs of “former” conventional medicine, i.e. conventional medicines. Therefore, in 2005., the President of the Confederacy abolished funding from the basic health insurance of all five newly listed medical approaches. However, after public pressure, the government was forced to conduct a referendum in 2009., and since January 2012., based on the referendum result, they have been reintroduced into basic health insurance.

Division of medicine according to the substrate

In this chaos of many definitions, it helped me the most when I thought about the very substrate of certain medical approaches. “Substrate” means by which compounds we affect the state of health and disease in a person.

  1. The substrate can be a substance that achieves physico-chemical-biological interaction with the organism. Complete modern conventional medicine, that is, part of that medicine – pharmacotherapy, belongs to this group. All phytotherapy and aromatherapy also belong to this group because they use only plant substances, and the same applies to the herbalistics of Ayurveda and Chinese traditional medicine. More broadly, this also applies to probiotics, vitamin-mineral dietary supplements and even different diets, namely diet therapy and nutrition schools. Changing foods greatly changes the biological processes in our body. In official medicine, there is complete chaos towards accepting such approaches. Officially, the guidelines for doctors also point to dietary measures in diabetes or dyslipidemia (e.g. elevated cholesterol), but skepticism is encountered when we try to help with asthma or rheumatoid arthritis through diet.
  2. An extremely diluted substance can also be a substrate. This is true for homeopathy, but also for Bach drop therapy, and even partly for hydrolatherapy, as substances in hydrolates are often diluted so that we do not expect an actual pharmacological effect. Nevertheless, this is more likely a type of medicine that has for the substrate “energy” or intangible factor, not a substance.
  3. The substrate is only the body, that is, it is a physical manipulative technique. In medicine it is physical therapy, lymphatic drainage and similar techniques, and of course the queen of medicine – surgery. And here it is difficult to find an exact boundary between conventional and complementary, because here we can find various massages, osteopathy, jumeiho, chiropractic and many other techniques. Physical technique doesn’t have to be passive from the patient/person’s point of view, it can also be active. These include exercise, yoga and various other physical exercises aimed at strengthening, stretching and relaxing muscles in the body.
  4. The substrate can be measurable energy/force. Magnet therapy, ultrasound and infrared radiation are today therapies of some private polyclinics. Cryotherapy and balneotherapy also belong here, here the aim is to help by taking away or bringing heat. Going to a spa paid for by the health care system is an example of where we have been embracing such techniques since the time of the Roman Empire, although from the point of view of physiology we would not expect any more spectacular results from them. The popular bioresonance, which measures electromagnetic conductivity and radiation fluctuations and treats the body with them, is not accepted in conventional medicine.
  5. The substrate can be an unmeasurable or unproven “energy”, which we call it in the absence of a better term. Bioenergy, biotherapy, radionics, various healing therapies, chi gong, reiki and a bunch of other techniques of different nouns and theoretical settings, but similar at the core, are absolutely unattractive in modern medicine because there is no measurable input substance. Despite this, they are extremely popular and the statistics of their use among patients are surprisingly high. Pure energy technique is also acupuncture, which in turn is accepted in official medicine, and is accepted because there is seemingly a physical substrate (needle and body). Nevertheless, it is based on energy flows, meridians that we also call in the absence of a better term. No one has proven why, how and by what we measure meridians in individual organs, which are the basis of acupuncture and acupressure for thousands of years. Nevertheless, official medicine accepts it – some acupuncture interventions even come at the expense of the free medical care. It is my personal opinion (and I don’t have to be right) that homeopathy is such an approach, because strictly scientifically, in homeopathic preparations there is no molecule that works pharmacologically, at least not in nearly enough concentration. One of the theories of homeopathy tells how the molecule itself leaves its “electromagnetic imprint” in the preparation itself and thus acts in the body. We can accept it or not, but homeopathic remedies are part of the European Pharmacopoeia. And this speaks of the “confusion” of today’s medicine towards different ways of therapy than pharmacotherapy.
  6. The substrate can also be the relationship between the psyche (spirit, emotion) and body. These are not just various techniques of meditation, visualization, cognitive therapy, various psychotherapeutic techniques, autogenic training. The most common such intervention is prayer. According to American studies, over 40% (and possibly more) of patients actively pray with the aim of healing, and we can only speculate on statistics in Croatia where we have over 80% of Christian believers, not including now other religions that have prayer as part of their religious practice. The use of prayer is precisely proportional to the severity of the disease – more pronounced in tumors, and certainly less for elevated cholesterol. The use of prayer is inversely proportional to the possibility of one’s own responsibility. The tumor looks almost like God’s punishment and is a general perception that there is (seemingly) little we can do about it. Therefore, prayer is the only salvation. On the other hand, elevated cholesterol is often a consequence of lifestyle and we will not really reach for prayer when we know full well that we may have it because we eat sausages at ten in the evening and the responsibility lies with us. No religion has recorded that it is God’s job to hide sausages from you. The perception of these techniques is very diverse. In Japan or India, where meditation is part of a centuries-old culture, it is fully accepted, and in Croatia it is considered as “Eastern- like” often with negative connotations. On the other hand, if you tell a doctor who is skeptical of complementary techniques that you pray for your health, you will not encounter much criticism because of the respect for religious reality. Maybe you’ll just run into skepticism. But even so, some doctors actively propagate hagiotherapy, which as a basic substrate is using prayer. Mainstream medicine has integrated into its system some psychotherapy techniques, at least as a complement to conventional medicine pharmacotherapy. It’s a real shame to only reach for it in cases of mental illness.
  7. The mixture of the above is very common and depends on subjective perception. For example, most people perceive yoga as a type of exercise and relaxation, but some perceive it as a way to better flow ki or chi energy, as it is called in China. Aromatherapy is perceived by some as energy medicine and some as a pharmacological intervention. And prayer is often perceived as a way of opening up to a divine power that is not a measurable category from a physical point of view.

Causes of intolerance

The most intolerance today arises between conventional medicine and those techniques used by the invisible substrate (energy medicine). This is how dichotomy arose, the division of understanding the traditional stories and modern science. Equally, a conflict arose that should never have arisen. Today, unfortunately, we live in an age when people tend to be extreme. They become “exclusive” in anything.

People who do “energy work”, whatever that means, can become complete fanatics. Interestingly, it’s very much present in aromatherapy. In a negative aspect, this stems from a desire for dominance, to have “powers” that others do not have. Unfortunately, I have to admit that I’ve met more bluffing than honesty. For example, a person experiencing real spiritual ecstasy holding a bottle of 100% synthetic “essential oil”, pretending to talk to the spirit of the plant in a bottle. Some of today’s shamans give a good story about plants, and in fact they’re dealing drugs. In one school of aromatherapy, a student got extremely sick from the smell of ylang-ylang. Immediately, a whole fuss ensued because ylang-ylang symbolizes sexuality. And so the student received a label of a sexually incarcerated and frustrated person. She was surprised when after a year she smelled a ylang-ylang she liked very much. The explanation was not that in the meantime she became sexually outspoken (whatever that meant), but the problem was that the previous ylang-ylang was a stinking synthetic fake. If there was knowledge and sincerity, the student would have been spared discomfort, and the teacher would have been spared the later epithet with which the student called her. Such examples, the number of which wouldn’t fit into a text of legible size, are precisely the ones causing skepticism.

Physically speaking, energy medicine is not about energy because such aspects of energy are not known, so the name energetic is only a symbolic name for the invisible aspect with which energy medicine deals. Bioenergy, radionics, biotherapy, they’re all different names for similar approaches. One part of energy techniques explains how the substances themselves have some invisible “energy”, that is, something invisible that can have a beneficial effect on human health, such as essential oils or crystals. Of course, this approach is not accepted in physics and in medicine, not only because of the clumsiness of the terminology itself, but also because of the impossibility of measurement. If we rise to the physical level, it should be known that all today’s drugs achieve their effect thanks to electromagnetic force/energy, but we measure the consequences of electromagnetic interactions through biological systems. Anyone who does drug research knows this very well because these electromagnetic interactions are one of the main tools in early research.

Science is very skeptical of the so-called energy approach because there is no exact evidence for it, except for the general rule in the theory of relativity that claims that matter and energy are interchangeable anyway. But the laws of relativity are not such that they could explain the effects in medicine. Is there any chance there’s any truth to that? Unfortunately, there is no doubt that people of bad intentions from the world of the so-called alternative completely undermine the possibility of accepting this. But who are we to claim that this is impossible? Today’s science and medicine are very vain, as if we had solved all the mysteries of the universe and found cures for all diseases. And it’s clear to everyone that we know almost nothing, even though we know a lot more than we did a hundred years ago. The fact is that for most diseases today there is no cure, most often we have disease controllers. There is no cure for asthma or rheumatoid arthritis that permanently treats the disease, such as antibiotics in infections: we take it for 10 days and the disease disappears. We’re just alleviating the symptoms or mechanisms of the disease under some kind of control. We often forget that the medicine of the future will view us in the same way that we view medieval medicine of releasing blood or brewing tea, found in selected texts in the Bible. If this statement angers you, work on your vanity. Average medicine in Croatia is often aggressive at the mention of natural molecules, let alone something else “invisible”. Only future decades and centuries and the development of science will reject or accept today’s theories and practices. The first pioneers already have. The famous French virologist Luc Montagnier shocked the scientific public when, in his opinion, he proved the possibility of detecting electromagnetic radiation of highly diluted DNA samples from bacteria, and the DNA molecule of HIV into a patient who tested negative for the HIV virus thanks to antiretroviral therapy. Luc Montagnier is none other than the man who discovered the HIV virus and won the Nobel Prize in Medicine in 2008. Although he made it clear in his interviews that this was not the work that was supposed to prove homeopathy or energy medicine, but was pure work in basic science that should open the door to a different notion of energy and matter in biological systems, this is still too much of a departure from mainstream science and his work has been met with great shock and negative reactions. Only time will tell if Montagnier has stepped into a new, utterly unexplored world, or is headed for a dead end.

In a positive aspect, the spiritual or energetic approach is a reflection of our aspirations to understand domains that are not in the reality we feel with our senses. Interestingly, it’s also the aspiration of today’s science. Most experiments in today’s science handle instrumental analyses that detect something we cannot not understand with our senses such as vision: sugar and sodium in the blood, microscopic structures or subatomic particles. Practitioners who work on the principles of energy work, if they are not devious fraudsters, owe their success greatly to the very important characteristic of working with people that is based on spending time with them, talking, empathy, comfort and understanding. Everything that medicine should theoretically have in dealing with patients, but there is simply no time for it or the medical staff itself is not educated for such a thing. Therefore, the popularity of such a way is also the cry of the modern man, that is, the patient: do not look at me as a sick nostril, vagina, tooth or bladder, but as a person! What to eat? How to change thoughts and attitudes? How to feel and how to deal with it? How to help your whole body and psyche, not just your sick organ? This trend of seeking a holistic or integrative approach is not only a stochastic trend of freaks, but it is seriously discussed in science and is considered to be the answer to general dehumanization, which includes the dehumanization of medicine. Today’s medicine is not only dehumanized by the emergence of ignorance, greed, corruption and lack of money. It should not be forgotten that we live in an age of sickening expansion of bureaucracy and that the average GP has to spend more time on bureaucracy than on the patient.

Nevertheless, the skepticism of medicine has its very positive side. It is based on rational, on analyzing experiences and objective assessment around the effectiveness of therapy. Such an approach is commendable, because anything that passes into the domain of blind belief or discipleship becomes a pathological model of behavior. Most healthcare professionals are shocked by Google educated people, who interpret scientific papers without basic knowledge of biomedicine and chemistry. They especially abhor forums, which often plays a positive role, but at the same time a lot of nonsense can be found there. MMS (magical mineral substance, as they were called, mixtures of citric acid and sodium hypochlorite, or bleach), cure HIV in 3 days. But that “naughty” pharmaceutical industry doesn’t want you to know that. If that were the case, some pharmaceutical giant would have bought all the world’s stockpiles of sodium hypochlorite a long time ago. Also “naughty” medicine does not want you to know that magnesium chloride treats all tumors with 100% efficiency. I wouldn’t want to remember the late patients who weren’t in the domain of that magical statistic. It’s generally known people prefering a colorful lie to a gray truth. Sometimes you need to be like the grandmother from the “Stribor’s Forest”, who chose to live in (hard) truth, not deceptive magic. The deceptive truth, unfortunately, “kills” the basic good idea also.

Resistance to the “energy” approach doesn’t exist only in medicine, but also in the average western man. The fact is that energy approaches are full of elements of Eastern cultures and even occult practices, which is repulsive to many because it is against their religious or general life beliefs. This breeds extremes again: some fanatically imitate life in the East in an environment where such behavior is illogical or unnecessary, and on the other hand, fanaticism against everything occurs, so we have already experienced that yoga, which is based on ordinary exercise, should be declared a satanic work behind which exorcism needs to be carried out.

Even major critics of complementary medicine clearly acknowledge that conventional medicine can learn a lot from the popularity of complementary medicine. Ineffectiveness of treatment, side effects of drugs, psychological approach to the patient, empathy, advice on changing lifestyle habits and life circumstances – all these are the reasons why people reach for complementary medicine. Conventional medicine should not take this as a warning that threatens the existence of medicine, but as a incentive for progression in other directions, not just pharmacotherapy.

Personally, I think the arguments are outdated. Not once did people come to me who, for example, solved the problem of long lasting headaches with biotherapy. I have no idea what these techniques are, but am I going to yell at these people because they’re getting better? Then where is my ethics, if I don’t wish the patient well just to satisfy my mental concepts of treatment? With layman’s eyes, I view the advancement of today’s physics as science. It’’s more fantastic than the craziest “alternative” theories. More than a hundred years ago, Einstein confirmed that matter and energy are the same thing. In the last 30 years, we’ve found particles that go back in time and change it depending on the future. The fact that matter/energy from which we are made is only a minority in the universe: there is only about 5% of what is known today. About 27% is dark matter that we may only have detected and a few tons of it theoretically passes through. The rest in the universe is dark energy whose function of expanding the universe I can understand, but I will not understand its structures and laws in this life. In other words, until about thirty years ago we were unaware of “only” 95% of the universe, and we thought at the time that we knew a lot. We’re not sure yet, but it’s mathematically possible that we live in a multiverse, a universe made up of an infinite number of other universes. This means that there are also an endless number of copies of each of us. Depending on the theory, we’re not sure if it has 10 or 26 dimensions, and we’re only aware of three of them. According to some theories, space has its dimensions, and the time has its dimensions, which is for the average mind completely incomprehensible.

It will only take time, perhaps in just a few generations, to incorporate these concepts and their legalities that have yet to be discovered into the perception and action of the plant or animal organism.

Therefore, such subjective perceptions need to be reconciled. Complementary medicine can be an excellent complementary method of scientific understanding, if nothing else then for didactic or empathic reasons. On the other hand, scientific, rational notion, also has its poetic beauty. What is important is that the so-called “energy approach” is not to compensate for ignorance and methods of selling poor quality. It is very important that complementary medicine never forcibly excludes conventional. Not once have we had examples of deaths of patients who stopped taking insulin or chemotherapy because they were told to.

Especially energy work must not be a way to rob people. Unfortunately, behind grandiose spiritual tracts and speculative scientific theories, this often remains the main motive.

Integrative medicine

In response to the overwhelming “quarrels” of conventional and complementary medicine, one middle and moderate path has developed. People don’t exist because of drugs, drugs exist because of people. All medical professionals exist because of patients. Patients come first, followed by earnings, scientific papers and career advancement. Seemingly we all know that, but do we fully understand this and do we implement it in business? Modern social/business currents often have negative consequences. It has already been said how much bureaucracy can stifle the average doctor; there is always a fear of some kind of control, and some patients, on the wings of social incitement to aggressiveness, think in advance about how they will sue a doctor. Every once in a while, sales representatives come into their offices, advertising some tenth version of the same drug, and they make fools of themselves and the doctor, explaining how great their medicine is. This has become so tedious that sales representatives today mostly resort to explaining the financial and logistical rather than pharmacological benefits of the drug. Pharmacists waste enormous time studying the intricacies of marketing discounts, special sales actions, and loads of sales documentation. The system has slowly made a pathological shift that will not be easy to correct.

The goal of integrative medicine is not only to diagnose and give the drug, that is to observe a narrow segment of one person. It is a typical approach in integrative medicine to examine more than just a disease in history: what is the diet and lifestyle habits, what are the professional and private circumstances of a person, whether psychological help is needed, i.e. psychotherapy. Integrative medicine tries to eliminate other factors that contribute to the occurrence or exacerbation of the disease, but also to eliminate the devastating consequences of the disease on the psyche. Chronic urogenital infections, allergic diseases such as atopic dermatitis, chronic skin diseases such as psoriasis – there are thousands of examples of such relatively “less dangerous” diseases that can leave devastating consequences for a person’s quality of life and mental and emotional integrity. Of course, we expect this from today’s medicine, but frankly, how many doctors with twenty patients in the waiting room have realistic time to deal with such questions? And furthermore, is it realistic for a doctor to do this for free? At a time when the public health care system has a chronic hole in finances, we will not experience this approach so easily to come to life. Integrative medicine is generally not focused on an invisible sphere whose existence has not yet been proven, at least not in the form that is common today. Integrative medicine uses both classic medicines in medicine, but also herbal remedies, dietary supplements, depending on the doctor’s assessment and his/her experience and knowledge. The approach is holistic in a own way. The word holistic comes from the Greek word holos (ὅλος)which means whole, comprehensive, complete. And that’s exactly what defines integrative medicine. The term holistic medicine has unfortunately become distorted. For example, energy work in aromatherapy is often referred to as holistic, although this does not have to be the case at all. Holism includes very solid knowledge of medicine and pathophysiological processes, just like pharmacology, so this area requires both experience and literally erudition in the field of medicine. In addition to deep specialization as one of the approaches to medicine, such as certain areas of surgery, a holistic, integrative approach is equally demanding due to the need for wide knowledge and experience. Because of “contamination” and abuse of the very name of holism, I personally prefer the word integrative medicine. There are also scientific journals on the subject, such as Integrative Medicine: A Clinician’s Journal and the European Journal of Integrative Medicine.

Integrative medicine has, of course, fierce critics. David Gorski calls it quackademic medicine. Nevertheless, it is my experience that many doctors, especially in private practice, apply some some basics of integrative medicine. I often find prescribed probiotics, teas, vitamin supplements and even psychotherapy in completely physical diseases and ailments. It depends on style and specialization. As far as I can see, dermatologists and gynecologists are generally somewhat more open to different approaches, while internal medicine is more closed to this. Medical professionals are sometimes skeptical of ignorance. Finish college, do your internship and specialize and then continue to learn other approaches, with your continuing education? It’s not that simple and requires extra time. This is especially true of phytotherapy, which really is a big theoretical bite. One mother told a doctor that she was giving her daughter borage oil. The doctor replied, “What am I going to tell you when I don’t know what borage is?”. Very often doctors embark on new teachings precisely because of their patients.

One should embrace the best of all approaches and, if the need arises, combine several of them. To look at the patient not as a disease sufferer, but as a sick person. This is the basis of integrative medicine and a great relief for the patient. Here is one example that is very common: a patient who has long been troubled by the Escherichia coli infection in the urinary system has been given a new antibiotic. But it also comes to me for advice on herbal therapy and does not know how I will react to the fact she is taking drugs. She is in the dilemma of whether the medications will help because it hasn’t helped for the last three times, and yet she is afraid not to take the medicine. The thing is very simple: yes, start taking the drug, and it is up to me to suggest to which tea you will drink after antibiotics, you will probably also get probiotics that can be useful. And so we will add up the two mechanisms of action, because even bacteria cannot be resistant to both antibiotics and natural compounds. Furthermore, I legally cannot intervene in official therapy, the person came only for additional advice. You can’t imagine a patient’s relief. Today, everyone is over-trained on exclusiveness.

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