Introduction
Holistic healthcare is a phrase that is surfacing in the medical community with increasing regularity. In an article published in the 1993 New England Journal of Medicine, David Eisenberg, Director of the Division for Research and Education in Complementary and Integrative Medical Therapies at Harvard Medical School, reported that thirty-three percent of the American public has used some sort of alternative holistic therapy (Stephenson, 2003b). Also referred to as naturopaths, holistic healthcare providers attempt to treat the person as a whole; teaching their patients that prevention is the best way to combat disease. They spend a great deal of time getting to know a patient’s habits and symptoms ultimately "prescribing" lifestyle changes that will ensure the optimal health for the patient. This approach is attractive to public burdened with rising healthcare costs and frustrated with allopathic physicians who have less time to spend listening to their patients’ concerns.
Despite the allure of holistic medicine, the philosophy does have some critics. The reaction of the allopathic medical community to holistic health practitioners and methods has not always been welcoming and many natural healing products and therapies are coming under increasing scrutiny. Its members and its critics are currently evaluating the future of the holistic healthcare industry. Investigating the origins of holistic healthcare and comparing holistic medicine’s methods to those of traditional allopathic medicine enables us to obtain a deeper understanding of the issues facing practitioners and patients and to assess the future of holistic healthcare.
Origins of Holistic Healthcare
Holistic healthcare is an ancient practice dating as far back as 5000 years ago when eastern civilizations used natural cures and remedies (Walter). For example, acupuncture is a natural remedy employed by many holistic healers today. This method can trace its origins back 2000 years during which time its principals were recorded in the Yellow Emperor’s Huang Di Nei Jing. Modern day practitioners may also borrow from Ayurvedic techniques, a philosophy, which precedes written history in India. In Ancient Greece, Hippocrates advocated therapies that encouraged the body to heal itself, emphasizing the healing properties of nature. The Greek philosopher, Socrates stated "for the part can never be well unless the whole is well (Brown)." These early healers laid the groundwork for a philosophy of medicine that has endured the centuries. Naturopathy found its way to the United States around 1895. In 1902 German naturopath, osteopath, chiropractor, and M.D, Benedict Lust founded the American Institute of Naturopathy (Wholehealth MD). This long history counteracts the claim made by some opponents that holistic medicine is a construct of "New Age" philosophy.
In the Encyclopedia of Natural Medicine, naturopaths Michael Murray, N.D., and Joseph Pizzorno, N.D discuss the four cornerstones of natural health; positive mental attitude, a healthy lifestyle that incorporates exercise, sleep, and healthy habits, a health promoting diet, and supplementary measures such as nutritional supplements and physical care of the body (18). According To Dr. Andrew Weill, Director of the University of Arizona's Program in Integrative Medicine, the focus on natural health as a preventative measure is the most fundamental difference between naturopathic medicine and allopathic medicine (Stephenson, 2003a). Naturopaths are generally more proactive, they feel that a healthy body will combat disease on its own when properly nourished. Allopaths tend to be retroactive. They concern themselves primarily with treatment of a disease and suppression of its symptoms.
The treatment options used by most allopathic physicians are primarily drugs and surgery. They may fall back such issues as diet and exercise but few traditional MD’s recommend radical lifestyle changes. The holistic healer evaluates a patient’s lifestyle choices as well as their medical history. They make an effort to get to know the patient well enough to understand what personal issues may be effecting their health. Holistic healers employ many different therapies. These therapies vary according to the individual and their conditions. Naturopaths may suggest diet changes, exercise, environmental adjustments, or even relationship and spiritual counseling. In case of an illness or specific physical condition, therapies might include herbal medicine, homeopathy, acupuncture, manual medicine (chiropractic or other touch based healing techniques), and physical therapy. Naturopathic physicians as a last resort use drugs and surgery (Murray, 7)
Dr. James Whorton, professor of Medical History at the University of Washington School of Medicine in Seattle, points out another difference. "… allopathic doctors [conventional MDs] have been allotted fewer and fewer minutes per patient visit over the last twenty years and people do want to have more time seeing their practitioners. And alternative doctors do typically give patients quite a bit more time (Stephenson, 2003d)." Allopathic doctors have very little time for interaction with their patients while naturopaths tend to spend a great deal more time with an individual. This gives holistic practitioners a chance to get to know their patients and their problems. In fact, the American Holistic Medical Association addresses this issue in their statement of principals, stating "The ideal practitioner-patient relationship is a partnership, which encourages patient autonomy, and values the needs and insights of both parties. The quality of this relationship is an essential contributor to the healing process (AHMA)"
Challenges facing Holistic Healthcare
Holistic medicine’s reputation suffers greatly because of its practitioners’ inability to prove their methods scientifically. Extremely individualized treatment plans make it very difficult to subject naturopathic methods to any sort of controllable clinical trial. This makes it almost impossible to gauge a particular treatment’s effectiveness. Allopathic medical professionals are able to cite specific studies that prove the effectiveness of the treatments that they prescribe. The inability of holistic healers to do the same produces a great deal of skepticism in the public and amongst allopathic professionals in particular. There are also concerns about many of the supplements recommended by holistic healers. The Dietary Supplement Health and Education Act of 1994 contains provisions that allow these types of supplements to be marketed to the public without FDA testing (Stephenson, 2003c). The manufacturer is under no obligation to back the claims on the bottle labels with experimental evidence. There are huge concerns about the quality and safety of these supplements. Some holistic healers counter this issue by counseling their patients to prepare their own supplements with herbs from well-known sources. In cases where less obtainable supplements are prescribed, the consumers are at the mercy of the manufacturer.
Laws affecting the practice of naturopathy vary from state to state. Naturopaths may practice legally in: Alaska, Arizona, California, Connecticut, Hawaii, Kansas, Maine, Montana, New Hampshire, Oregon, Utah, Vermont, Washington, Idaho, the District of Columbia, Puerto Rico, and the Virgin Islands. In the state of Iowa, a naturopath must be a licensed MD or DO. ND’s and other holistic practitioners such as direct entry midwives are not allowed to practice medicine in Iowa (Mowery).
The Allopathic Reaction to Naturopathy
As mentioned above, allopathic practitioners tend to be mistrustful of holistic methods citing the fact that these methods have not been proven scientifically. Some feel very strongly that the results obtained by many alternative therapies are due to the phenomena known as the placebo effect (Stephenson 2003e). The placebo effect occurs when results achieved are due to a patient’s belief in the effectiveness of their treatment rather than any pharmaceutical value of the treatment
Traditional physicians also warn people against accepting the idea that because something is natural it is to be considered safe. Marcia Angell, senior lecturer in the Department of Social Medicine at Harvard Medical School, is an outspoken critic of alternative medicine. Angell warns against herbal supplements, "I don't think people realize that there are no manufacturing standards…Consumer Reports did a study of ginseng showing that different brands of ginseng labeled as having the same concentration of ginseng in them, vary tenfold in the amounts of ginseng that they had in the bottles, and some of them didn't even have any ginseng in the bottles (Stephenson, 2003a)." These supplements have also not been tested for reactions when combined with other supplements or pharmaceutical drugs a patient may be taking. For example a patient with high blood pressure who would take ginseng to improve their energy levels has no way of determining if this supplement would interact with their prescribed medications.
The Iowa Board of Medical Examiners has issued a position statement that questions the effectiveness and safety of naturopathic therapies. The Board states, "Most natural methods utilized in naturopathy are largely unproven and are not grounded in peer scientific research (Mowery)." The necessity for the naturopathic community to devise some means of proving the effectiveness of their methods is apparent.
The Future of Holistic Healthcare
The future of holistic healthcare may be in the growing number of physicians trained in both schools of healthcare. Allopathic practitioners trained in alternative therapies can choose to implement natural therapies in conjunction with more traditional medical practices or refer a patient to the appropriate naturopathic practitioner (Wholehealth MD).
Conclusion
The wisdom of fighting disease by maintaining optimal health is not some "New Age" hocus-pocus. This philosophy of holistic medicine has been with us since ancient times. There are many beneficial aspects of a holistic approach to medicine. Holistic medical practitioners seem more approachable, employing a far more comprehensive and humanistic methodology. Patients of holistic practitioners are able to take charge of their own health and avoid sickness altogether. Despite these advantages, practitioners also face some obstacles. Before the benefits of holistic healthcare can be properly assessed, practitioners must devise a way to prove the effectiveness of their treatments. The government must also impose some sort of standards on the dietary supplement industry. Once these goals are accomplished and allopathic physicians concerns have been addressed, the two schools of medicine can work as one unit providing quality healthcare to all.
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