The Controversial Cure
By Annie O'Reilly
Editor's note:This is the first article in a two-part series dealing with alternative medicine.
Alternative Medicine: What is it?
Alternative medicine comes in many different forms and is known by various names. It has emerged into American culture in recent years, yet it has been in existence for centuries. For some, it is mainstream and for others it is complementary health care. Alternative medicine includes herbal and supplemental remedies, bodywork, acupuncture, Tai Chi and other eastern practices, hypnotherapy, and spiritual and culturally indigenous healing. These do not comprise a complete list, but they are the most well-known of "new age" methods.
Alternative medicine relies on preventive and holistic measures to heal the body. It "uses an approach...that combines a variety of 'building up' and support techniques for the body's natural immune system" (Wilke, 1997, p.42). These modalities are neither widely taught in U.S. medical schools nor generally available in U.S. hospitals (Guernsey, 1997). In fact, alternative medicine is most attractive to people with chronic disorders who have not been helped by conventional medicine.
"Complementary" is a term widely used, and other terms include "naturopathic," "holistic," and "unconventional." It is often used in conjunction with the terms "wellness" and "body/mind." I like to order these terms in the following way: Wellness is a state of being in good health and alternative medicine is a means of achieving wellness. Conventional medicine is widely used to convey Western or "allopathic" medicine and most authors cite alternative medicine as complementary to this. Mind/body techniques include relaxation, hypnosis and biofeedback which are "supported by years of rigorous Western research, yet still not generally employed" (Guernsey, 1997, p.10).
Mainstreaming of Complementary Health Practices
Alternative medicine is making its way into the health care regimes of Americans and there is a growing number of pet owners using it for their animals as well (Sacks, 1997). People who are suffering from chronic pain and medical conditions are the most attracted to anything that might work. A frequently cited article in the January 1993 New England Journal of Medicine reported the results of a telephone survey of 1,539 people (Weber, 1996). Data from the survey show that, in 1990, one-third of the respondents used an unconventional treatment, paid more visits to alternative practitioners than to primary care physicians, and spent $13.7 billion for those treatments. Most of the care was paid for out-of-pocket. This news can be startling for conventional practitioners but occupational therapists can reap the benefits by joining in and utilizing some of the therapies in their practices. Another effective way might be to work in tandem with licensed alternative therapists for a variety of conditions, but especially for quality-of-life issues like anxiety, pain, and loss of self-care skills (Weber, 1996).
As the growing public demands complementary remedies, the medical establishment is beginning to recognize alternative medicine as legitimate, especially in light of its own dissatisfaction with biomedicine (Weber, 1996). This is evident at the Program of Integrative Medicine of the University of Arizona, whose director is the well-known author and ethnopharmacologist, Andrew Weil, MD. The program has five guiding principles directed at physicians (Weber, 1996):
* Maintain an open mind.
* Encourage careful, controlled studies of "new" therapies.
* Don't ignore or ridicule the potential of the placebo effect.
* Don't accept all new therapies uncritically.
* Avoid arrogant attitudes toward alternative medical practices.
The most significant marker of alternative medicine's mainstreaming into America's health care system is the creation of the Office of Alternative Medicine (OAM) as part of the National Institutes of Health (NIH) in Washington, DC. (Energy Times, 1997). The OAM is now funding studies on complementary treatments for illnesses ranging from AIDS and cancer to depression at several prestigious medical universities.
While alternative medicine may be very attractive, the costs are not, as seen in out-of-pocket payments. However, many mainstream insurance companies are beginning to reimburse alternative therapists. Some of these companies include the Oxford Health Plans, Mercy Health Care of Arizona, and Blue Cross of Washington and Alaska (Weber, 1997). Care is distributed in a number of ways, such as Kaiser Foundation's Alternative Medicine Clinic, which provides acupuncture, hypnosis and Asian herbs. The most impressive program is run by the Oxford Health Plans of Norwalk, Connecticut. A patient wishing to use a particular therapy visits the provider first, who then sends a care plan to Oxford. A panel of medical doctors and alternative specialists reviews the plan and decides whether to reimburse for the treatment (Weber, 1997).
Popular Alternative Therapies:
Dangers and Implications for Occupational Therapy
Herbal Remedies and Dietary Supplements
Herbal remedies and nutritional supplements are gaining a celebrated space on American medicine shelves and in the media. Witness the popularity of St. John's Wort (hypericum) for treating depression after its introduction on a documentary television show. Our knowledge gained regarding herbs has been borrowed from Traditional Chinese Medicine, the Ayurvedic tradition of India, and Native North and South Americans. Traditional Chinese Medicine has been in existence for 3,000 years (Guernsey, 1997). It is based on the concept of balancing the life force or "chi" within a patient's body, through herbs and other methods. "Ayurvedic" medicine dates back 4,500 years ago to the ancient Hindu text, the Rig Veda, which mentions 67 medicinal herbs (Castleman, p.51).
Herbs and nutritional supplements are widely used and beneficial claims have been made for conditions such as indigestion, alcoholism, attention deficit disorder, cancer, heart disease and menopause. Recently, the Food and Drug Administration (FDA) issued regulations for labeling vitamins, minerals, herbs and other supplements. The same type of nutritional labeling found on foods is now required on supplements as well (Steib, 1997). The labels must include information on 14 nutrients, such as sodium, and the part of a plant from which an herbal remedy is derived. Although there has been a recent media blitz on supplements, and research is increasing, these remedies are not put to the rigorous test that conventional medicines are. The most recent supplements to hit the market are natural hormones, such as dehydroepiandrosterone (DHEA) and estriol derived from wild yam. Many women use them to decrease bothersome effects of menopause. They are controversial because their long-term effects are unknown, and they may have short-term side effects (Russell, 1997).
In order for a supplement to become approved by the FDA, it must pass a series of rigorous scientific tests and may cost more than $100 million (Castleman, 1997). In addition, the FDA cannot grant any one company exclusive rights to the medicine because herbs cannot be patented. Supplements are not required to receive FDA approval under the Dietary and Supplement Health and Education Act (DSHEA) of 1994. The act enables herbal companies to make specific claims on their products (Wilke, 1997). In addition, many nutritional supplement companies publish reports on the research that has been done, the benefits, and precautions, if any.
Michael Castleman (1997), the author of Nature's Cures, contends that the majority of herbs are safe. This is demonstrated by the American Association of Poison Control Centers' report of only two deaths due to an overdose of herbs in recent years. The best solution is to become knowledgeable and exercise caution. One often-cited case is of a college student who died of an overdose of ephedra, which is used for sinus congestion (Wilke, 1997). The public often believes that because an herb is natural it has no ill effects. However, there are some that are now known to be hazardous, and these include comfrey (used to improve digestion) and coltsfoot (for cough), both of which may cause liver damage (Castleman, 1997). Other herbs or supplements are contraindicated for certain conditions: thyme-not to be taken with high blood pressure (Hochwald & Roufos, 1997); black cohosh, taken to relieve menopausal symptoms, should be avoided by pregnant women (Russell, 1997); and echinacea, which increases an autoimmune response of white blood cells and therefore is contraindicated for lupus (Bilger, 1997). Pregnant women should consult their physicians before taking any herbal remedies (Castleman, 1997).
Ethical issues abound concerning nutritional supplements. While it is environmentally friendly to encourage organic farming by consuming organic products, it is not ethical to deplete the supply of herbs by reckless wild crafting or the existence of sharks with the marketing of shark cartilage used against cancer (Crabtree, 1996). This has prompted Lori's, a well-known health food store in Rochester, New York, to refuse to sell shark cartilage.
Occupational therapists can be instrumental in helping consumers take charge of their own health by encouraging them to do research. This often helps with personal decision-making and increases consumers' options for dealing with distress and crises (Lerner, 1994). A discerning practitioner researches the properties of various supplements so that she can recommend continuation or avoidance when benefits and risks are known. Finally, just as there is no magic bullet in prescription drugs for mental illnesses, herbs and supplements do not have the last say, either. Consumers need to be encouraged to seek counseling when the underlying causes are psychological. The ethical OT practitioner also encourages consumers to inform their primary care physicians of all alternative therapies being used.
To locate a qualified practitioner, or for more information on herbs, contact: Herb Research Foundation, 1007 Pearl Street, Suite 200, Boulder, CO 80302; (303) 449-2265.
Tai Chi, Qi (Chi) Gong
Acupuncture is a manipulative therapy of traditional Chinese medicine in which the network of body meridians, which connect with internal organs, are outlined and accessed. The insertion of fine needles into body surface points is used to redirect and normalize the flow of Chi, the life force (Chow, 1984). Effie Poy Yew Chow, RN (1984), asserts that acupuncture strengthens a patient's resistance and triggers the release of endorphins (pain-inhibiting chemicals) in the brain. In China, acupuncture is used as an analgesic and an anesthetic. The World Health Organization lists many conditions for which it considers acupuncture to be appropriate: arthritis, asthma, addictions, eating disorders, headaches, high blood pressure, depression and menstrual problems (National Institutes of Health [NIH] Guidelines Panel, 1997).
"Acupressure treatment uses the same points as in acupuncture except that pressure is applied with the fingertips" (Chow, 1984, p. 125). This therapy, which is called Shiatsu in Japan, and is becoming increasingly popular in the U.S.
Tai Chi constitutes the art of maintaining internal and external balance while in movement. David Eisenberg, MD, of Beth Israel Hospital, has done much of the medical research on Chinese medicine. He describes the movements as circular, symmetrical and slow (Lerner, 1994). Chi Gong or Qi Gong involves the use of inner breath and outer muscle strengthening (Chow, 1984). Quiet breathing, combined with effortlessness and flowing movement, is thought to circulate healing energy and promote relaxation. Manipulation of the vital energy or chi inherent in Chinese medicine is believed to alter the course of illness patterns in cancer, arthritis and psychiatric disorders (Lerner, 1994).
The above therapies and other complementary practices face many obstacles in the development of practice guidelines. Chief among these is the nature of supporting scientific evidence (NIH) Guidelines Panel, 1997). Some studies of acupuncture rate well under best practice of randomized, controlled trials but cannot claim the body of evidence available to conventional medical research. The problem with researching Chinese medicine and applying practice guidelines is that there is a fundamental difference in terminology and underlying philosophies of disease. "What conventional practice guidelines might describe as 'back pain' or 'rheumatoid arthritis', for example, would be seen in Chinese medicine as an imbalance...of ch'i (body energy) and blood" (NIH Guidelines Panel, 1997, p. 152). However, the first director of the OAM, Joseph Jacobs, MD, urges physicians and the public to give credence to several thousand years of trial and error inherent in some healing practices (Weber, 1996).
When well-trained, an occupational therapy practitioner may begin a group session with Chi Gong as a relaxation technique. Chi Gong is especially useful in groups with Parkinson's patients, the elderly and patients experiencing deficits in dynamic balance. In support groups of patients with arthritis or cancer, Chi Gong is especially relevant as a modality for holistic occupational therapy practice.
For more information, contact the American Academy of Medical Acupuncture, 5820 Wilshire Boulevard, Suite 500, Los Angeles, CA 90036, (800) 521-2262 or the American Association of Oriental Medicine, 433 Front Street, Catasauqua, PA 18032 (610)266-1433.
Body work is often referred to as "hands-on healing" and comprises massage, Feldenkrais and energy healing techniques such as cranio-sacral therapy, myofascial release and therapeutic touch (Guernsey, 1997).
There is evidence that massage stimulates the production of endorphins, the body's natural pain-killers, and lowers blood pressure (Lerner, 1994). For this reason, massage, when administered well, can be relaxing and nurturing. Michael Lerner, president of the Commonweal Cancer Help Center, believes that the effects of massage are transformative. For a cancer patient, "the experience of having a scarred body treated with love and compassion by a truly caring masseuse can be a profound one" (1994, p.361). However, Lerner also cautions that massage may be harmful to cancer patients who have weakened bones. Communication between the patient and the practitioner is paramount to avoid injury caused by deep tissue work.
Feldenkrais, named after its originator, Moshe Feldenkrais, involves the use of gentle movement sequences to re-educate the nervous system and create an opportunity for new movement awareness (Scott, 1997). Feldenkrais experts receive extensive training and are certified to practice. Most patients include those in chronic pain or those with neurological disorders, such as cerebral palsy and stroke. Most recently, Feldenkrais is being practiced on animals, as a palliative technique during the final stages of death, (Scott, 1997).
Craniosacral therapy and myofascial release are often taught to physical and occupational therapists, chiropractics and massage therapists. With hands-on, subtle manipulations, the practitioner encourages the flow of cerebrospinal fluid and also breaks up adhesions in the fascia covering muscles (Barnes, 1990). Relief from body aches can be dramatic, but the manipulations usually need to be carried out over a period of time. Other conditions treated with this therapy are cerebral palsy, stroke and back pain. These treatments are contraindicated for certain cancer patients, to avoid cancer cells metastasizing with the flow of the body fluid (Barnes, 1990).
Therapeutic Touch is a modern version of the ancient system of 'laying-on-of-hands,' except that the hands are kept slightly above the body" (Lerner, 1994). As the hands are held near the body, their electromagnetic energy is sufficient to influence ionic molecules in the body. Whatever the cause of the chronic pain, body tissues give off low-level input into the central nervous system. "Scanning touch can disperse some of those positive ions and restore capillary perfusion" (McCormack, 1993, p. 110). Therapeutic Touch can be particularly useful for people who are hypersensitive to contact touch.
Since body work can be quite intimate, it is extremely important that the practitioner be well-trained and trustworthy. Word-of-mouth referrals are often the best way to ensure against irresponsible treatment. A phone call to a reputable organization may also help to prevent malpractice.
In regard to body work, contributions from occupational therapy can greatly enhance a client's involvement in his own healing. This can be done by asking the client to recall experiences of healing and to focus attention on bodily and emotional responses to any of the above therapies. In addition, urging the client to keep a journal of feelings and awareness surrounding the alternative therapy may help to build self-confidence (Weil, 1997).
For further information, contact the American Massage Therapy Association, 820 Davis Street, Suite 100, Evanston, IL 60201; (847)864-0123; the Feldenkrais Guild, 524 Ellsworth Street, PO Box 489, Albany, OR 97321; (800)775-2118; Nurse Healers Professional Associates, Inc., (Therapeutic Touch), 1211 Locust Street, Philadelphia, PA 19107 (215)545-8079; The Upledger Institute, (Craniosacral Therapy), 11211 Prosperity Farms Road, Palm Beach Gardens, FL 33410.
Next Week: Hypnotherapy,
Spirtual and Indigenous Healing
Annie O'Reilly, OTR, BCP, is employed at the School of the Holy Childhood where she works with children and adults with developmental disabilities. In addition to working, Annie is busy finishing a master's program in Counselor Education at SUNY Brockport near Rochester, New York, and sending two children to college.