04 January 2010

Stayin' Alive : Complementary and Alternative Medicine

"Tree of Life," working design for Stoclet Frieze, Gustav Klimt, 1905/09.

Stayin' Alive:
Towards a conscious self-health-care continuum
No system of medicine is static, and none has a monopoly on beneficial knowledge or tactics.
By Mariann G. Wizard / The Rag Blog / January 4, 2010

[Introducing a new periodic column by Rag Blogger Mariann G. Wizard, a professional science writer with a wide-ranging knowledge of natural health therapies. Readers may suggest topics for future columns, within the restrictions suggested below, in the Comments section of The Rag Blog.]

“Complementary and alternative medicine” (CAM), in the U.S. and several other nations, refers to health practices that are not currently part of “mainstream” or “conventional” medicine. This flexible definition allows for therapies that accumulate enough scientific evidence -- or generate enough patient demand! -- to become part of mainstream practices.

In the US, for example, chiropractic, once the domain of energetic and sometimes kooky "bone crackers,” has benefited from the experience of practitioners, the development of comprehensive theory and standards of care, and the establishment of accredited colleges, and is now paid for by most insurance plans -- the true test of a treatment’s acceptance! Acupuncture, as well, with demonstrable benefits in pain relief at minimum, has gained mainstream acceptability in the U.S. within very recent memory.

However, the current CAM definition is rather misleading, having been imposed by conventionally-trained and -biased authorities. It is more accurate to think of CAM as all health practices developed over the course of human history, everywhere in the world, before the discovery of microbes, and including many health practices developed since then outside of “Western” medical facilities.

CAM includes, for example, entire multi-modal systems of medicine, such as traditional Tibetan medicine, Ayurveda, naturopathy, and others, some with continuous documentation of use and development over thousands of years. It also includes more recent practices: e.g., aromatherapy, Reiki, and Essiac, each with its own ancient roots.

One difference between most CAM therapies and “conventional” medicine, often cited by CAM skeptics, is a frequent lack of scientific evidence for CAMs, or even “disproof” of their worth. These criticisms are worth a closer look. “Scientific evidence” is not always best acquired in a laboratory setting, and what works in rats doesn’t always have the same effects in people.

Studies are often designed, depending on funding sources, to demonstrate certain hypotheses; their design may not be fair to competitors. Media coverage tends to focus on negative results in science reporting, as it does in other news. For example, a number of studies have found the herb St. John’s wort as effective as prescription drugs in treating mild to moderate depression. However, the most media coverage occurred when the herb was found to be not-so-helpful for serious depression. No one had ever claimed it would be.

So-called “anecdotal evidence” of practitioners and patients provides support for many CAM modalities, and is often discounted by those who understand only randomized, double-blinded, placebo-controlled clinical trials. However, lack of clinical studies is another misleading negative. Such studies are most often funded by pharmaceutical companies, and are extremely costly. Unless a unique, patentable, reproducible compound has been isolated for testing, there is little incentive to fund research on common herbal remedies such as echinacea, ginger, and aloe vera, or even more novel dietary supplements like shark cartilage.

Acupuncture. Image from Phiya Kushi's Blog.

For some therapies, problems in adequate blinding or other study design factors present substantial obstacles to randomized testing. Acupuncture, for example, is difficult to administer in placebo form. Cannabis medications also present problems in blinding, since experienced cannabis users have no difficulty in distinguishing the real thing from placebo no matter how it is administered; the effects speak for themselves. Different study designs often make it difficult to compare “apples-to-apples” -- but this is as true with pharmaceutical drugs as well as with herbal compounds!

Nevertheless, credible research is being done around the world every day on CAMs. For over 10 years, I have reviewed peer-reviewed journal reports of such work for the American Botanical Council’s HerbClips®, and have reported occasionally for ABC’s peer reviewed journal, HerbalGram®, on regulatory and other matters.

During that time, I’ve also -- somehow -- gotten older, and have begun to experience some of the annoying pitfalls of that process, as well as of ordinary hard knocks and exposure to modern living. While I began my work with ABC without any particular prejudice for or against conventional medicine or CAMs, today, I believe that each has its uses, and its distinct limitations.

I haven't accepted medical or other advice to “get used to” chronic pain and increasing disability any more than I’ve accepted war, injustice, disharmony, or exploitation. These may all be losing battles in the long run, but what are we doing that’s any more important?

A year or so ago on a rainy day, a homeless guy at the downtown library asked me why so many -- pardon the expression, "older ladies in Austin" -- were sporting, as I was, a knee or elbow athletic brace. I stopped and thought about it for a minute. "Because," I finally said, "we are fighting death to the finish!"

No system of medicine is static, and none has a monopoly on beneficial knowledge or tactics. ABC’s knowledge base -- including my own work -- has been priceless in helping me assess CAM options for my use, and even for friends and family facing health concerns. Like a growing world majority, I now consciously combine CAM practices with conventional medical care in a personal health continuum, making the decisions that affect, literally, my life, for myself, like we used to say in Students for a Democratic Society. I consider myself a “health independent” in the same sense that some voters claim independence from major political parties!

The fact is that conventional medicine is very poor in its ability to treat chronic illnesses, and most CAMs are ineffective or unnecessarily slow in treating acute illnesses such as infections. The fact is that professional health care providers of any kind are becoming less accessible to many of us, and that the costs of health care seemed doomed to skyrocket. The smart thing to do, it seems to me, is to use whatever we can to stay healthy!

Meanwhile, there is a skill to assessing unfamiliar health practices, products, and practitioners that I believe can be applied whether these are “conventional” or CAM-related, and I propose to try to impart some of that skill to readers of The Rag Blog.

If you have questions or suggested topics related to natural health practices, please post them in the Comments section of this article! For the record, I will NOT attempt to diagnose any symptoms, diseases, or medical problems. I will NOT recommend specific products, practices, or practitioners, except as examples of alternatives to be considered. I will NOT answer any questions of an intimate nature, e.g., what to do if you have an erection lasting longer than four hours! If none of you slackers have any interesting questions, I will merely regale you with my own adventures in health care; Lord'a'mercy; we are getting old!

I WILL freely discuss health-protective measures such as diet, exercise, and stress relief. I WILL consult with and drag in health care practitioners, researchers, and patients of all kinds as needed, some of whom may let me quote them. I MAY prescribe familiarity with controversial theories, regulatory policies, and historical tirades; take as directed: always with a grain of salt. Your life and health are your most valuable possessions -- guard them well!

Next week: “Osteoarthritis: it takes a village.”

"Bee's Knees," by tyrone_31 / photobucket.
Prevention tip of the week:
Save your knees now!

Everybody should do this mild exercise several times a week if at all possible! Especially if you have weak knees, or “bad knees run in the family," if you’ve had any kind of knee surgery short of a replacement, or if you do any running or jumping, this is a great way to strengthen and protect the most complex joint in your body.
  1. Lie flat on your back on the floor, with feet more or less in line with your shoulders.
  2. Extend your arms comfortably from your shoulders, so that, seen from the ceiling, you make a sort of “t” shape.
  3. Pull your knees up and your feet towards your buttocks as far as you comfortably can, keeping your feet slightly separated and your feet flat on the floor. Seen from the side, you look a little like this: _/\__o
  4. Keeping your upper body flat on the floor, gently lower both bent knees as far as you comfortably can to the right side of your body. Your left hip will lift off the floor. Seen from the ceiling, your knees look like a double chevron: >>. Stretch a little tiny bit closer to the floor with both knees, and hold for 20 seconds.
  5. Return to position 3 and reverse, lowering knees to the left side: <<. Stretch and hold.
  6. Repeat twice, three times a week, for six months. If you feel the improvement, KEEP DOING IT AS LONG AS YOU CAN GET DOWN ON THE FLOOR AND GET UP AGAIN! Don't do it in bed or lying on the couch; you may throw your back out, and I don't want you blaming me for your sciatica!
Hint: If your low-side knee doesn’t go all the way flat to the floor, or the high-side knee doesn't go parallel to the floor when you stretch to left or right, well, that is a goal you can set. Gently stretch as far as you can without discomfort; and next time go a millimeter further!

This stretch, unlike the bicycling motion often used in post-surgical knee rehab, strengthens muscles and ligaments along both sides of the kneecap that help keep the joint stable -- if you’ve ever felt the sickening sideways lurch of thigh-bone or leg-bone pulling away from knee-bone, you know the importance of these supportive structures!

Thanks for this tip to Wendee Whitehead, Doctor of Chiropractic, Austin, Texas, whose exact words to me were, “Knees are totally fixable!” Keep yours strong and flexible with this simple, zero-impact move.

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