The growing application of “integrative medicine”


Over the years, prostate cancer patients (and other types of patients too) have often sought out practitioners of types of health care considered to be “unconventional” by many in the academic and mainstream “Western” medical community. Among the more obvious forms of such therapy are acupuncture, herbal medicine, and “holistic” medical practices.

There has been a tendency to suggest that many of these types of clinical practice are “unproven” by Western standards. In other words, they have never been subjected to the evidentiary standards of the double-blind, randomized, placebo-controlled clinical trial. This is true — but then this can also be said of many standard forms of Western medical care too, and selective thinking when it comes to arguing the evidence in favor of something one believes in has long been a well-established practice across the entire health care enterprise!

What is also true is that there is a considerable body of scientific knowledge behind many “alternative” forms of medical care. It may not be “science” in the most conservative Western academic use of the term, but in other parts of the world it would be considered to be perfectly valid from an evidentiary point of view. As one of the physicians interviewed in the Washington Post article states, “It’s not as evidence-based, which is why doctors are somewhat averse to the practice, but if [they] didn’t work, why would we still be doing them thousands of years later?”

An article today in The Washington Post addresses the growing use of what has now become known as “integrative medicine” — the selective use of both traditional Western forms of care and other traditional forms of care based on other forms of medicine developed in other cultures (Indian, Chinese, African, Native American, you name it). And even more surprisingly, many of the major health insurance giants are willing to cover at least some of these types of care — although Medicare and Medicaid appear to be “behind the curve” on this possibility.

This gradual expansion in what is considered to be “good medical practice” holds significant potential for the long-term management of prostate cancer. It may lead to better methods for long-term prevention and control of relatively low-risk forms of prostate cancer, and it may also encourage complementary forms of care that can alleviate the adverse effects of everything from surgery and radiotherapy to hormone therapy. A small number of well known prostate cancer specialists such as Dr. “Snuffy” Myers in Virginia have long advocated and practiced this type of integrative medicine for their patients. The addition of “wellness” initiatives as a further complement to overall patient health is an additional opportunity that many patients and their doctors are beginning to take much more seriously — from diet to exercise and relaxation methods.

Having said that, The “New” Prostate Cancer InfoLink wouls still like to see some of these less mainstream therapies subjected to rigorous clinical study whenever possible. We know that many of these forms of treatment “work” in many patients. What we don’t know is what we need to know. Can we better identify appropriate patients for specific clinical opportunities? Can we make sure that inappropriate forms of “alternative care” aren’t used on those who won’t benefit? Can we be clearer about the risks associated with these types of therapy? Can we identify how best to combine these therapies with “Western” treatments for which we do have high evidentiary standards of effectiveness and safety?

Personalized medicine of the future should be an opportunity to look at what works and doesn’t work without some of the blinkers of historic bias based on traditions of specific types of learning. The involvment of some of our leading academic medical centers in the advances of “integrative medicine” is an especially encouraging aspect of this opportunity. Tomorrow’s medical graduates are likely to start with less cultural bias about integrative medicine than some of their predecessors who were trained in the medical schools of the mid 20th Century.

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