We seem to be branching out and saving the world well here.
Thanks for pointing me to http://ethicalnag.org/2012/03/06/the-new-therapeutics-10-commandments/. Having worked on the idea of sustainable medicine for a few days now, I found that Dr Robert Verkerk’s article at http://www.anheurope.org/campaigns/sustainable-healthcare#ACNEM_article says the same things; but with figures. To find that western medicine is the third leading cause of death in USA is surprising.
My last post covered what a private funder may do, under the terms – both ‘alternative’ and ‘complimentary’ to the orthodox mindset. A private funder has one goal in mind – as we all would for ourselves – pragmatic all the way – what works? But what does ‘work’ mean, and how to make that personalized in a patient’s own case when it is the privately funded person seeking?
Possibly as part of this change in perspective in the population, there is a colossal movement towards what is seen as ‘unconventional’ in orthodox medicine. This is covered in the work of many writers to numerous to mention.
This move towards a different health paradigm may be driven by people seeing past the idea that ‘doctor knows best’ as they get more educated and information is far more available. Also, perhaps as Verkerk says – ‘chronic disease rates, in contrast (to acute) have risen significantly’.
We are living longer in discomfort and want answers. As we have seen, the use of what is called ‘CAM’ is resorted to by those both ‘well and worried’, and those desperately ill.
The Crystal paper shows that the latter may take it up more (47% wanting to better their quality of life, as opposed to 12% thinking that their orthodox cancer therapy would). This shows there are differing perceptions and motivations within the patient population as to what form of therapy may perform best in differing situations.
The Crystal paper does not talk of those who chose not to take up orthodox therapy. Molassiotis et al (2005) say that ‘depending on the instrument used to collect the data, the particular population under study, the sample size and the CAM definition used, studies report rates from 37% to 87% [7–11]’.
They further state that (only) ‘<4% used CAM to directly fight the disease (i.e. as an alternative cancer treatment) and the overwhelming majority used CAM to complement their cancer treatment or help them cope with the treatment and/or its side-effects’.
Patients are quick to realise that they have unmet needs. Coulter & Willis (2007) quote Austin (1998;1552) ‘the majority of alternative medicine users appear to be doing so not so much as the result of being dissatisfied by conventional medicine, but largely because they find their health care alternatives to be more congruent with their own values., beliefs and philosophical orientation towards health and life’
Coulter (2012) speaks of patient lead combinations of treatment – and that this is the most common (83%) factor in incorporating CAM in orthodox hospitalized care.
This all leads to the point that public funding is about spending taxpayers’ money. It is obvious that possibly a half of these taxpayers are privately spending on CAM. Probably far more than $0 – $660 a month the outdated Crystal (2003) paper states. We have all seen in our daily life the growth of the vitamin/herb concoctions in the supermarkets and pharmacies – this CAM idea is big business.
In speaking of public funders’ dilemmas, there is a piece missing. I looked into sustainability. As it is very easy to discover, cancer is an aging person’s problem; the population is aging, and there seems to be no end of costs related to cancer and its return whilst taking taxpayers out of the workforce, and needing more and more ‘health’ services.
Also missing is safety. Whilst the finger keeps being pointed towards a possible herb /vitamin/drug reactions – there seems to be little said about cleaning up what is a catastrophic problem. Verkerk as the article above (2009) talks of preventable deaths. This surely is a concern as a public funder. ‘Orthodox medicine is unequivocally the third leading cause of death in the USA.
This situation seems similar in most other western countries’. Verkerk goes on to say that between the annual ‘cost’ (someone is making a lot of money) of prescriptions in 2007 in USA alone of being about $165 billion, adverse drug reactions (taking four or more drugs) increase exponentially giving this the fourth most likely cause of death in the USA.
There seems to be an assumed position of CAM having to prove itself, against the conventional as if that is safe and effective. EBM was instigated not for this purpose but to try to standardise what was happening in conventional medicine.
Even the originators of the concept (Sackett and colleagues) in 1992, were four years later suggesting that the almost exclusive reliance on evidence from RCTs for the treatment and determination of treatment and care regimes to being misinterpreted.
When we are asked – ‘how can research answer funding questions?’ I suspect we need an individualized and holistic look at each person, not at the individual therapy. The patients may inherently know this as they strive for their own individualised care.
In any of the categories I posted last, a family member or the patient themselves could go online and discover that there are many options besides the ones given out ‘freely’ (funded by the public purse).
The extra information is easily found on-line, or through listening to others who tell their stories personally (as so many are affected by cancer directly now), or through just watching and making their own judgments may be better or not.
They may be safer, or not.
- Who pays the cost in all aspects if a mistake is made?
- Who thus has the most to lose?
- Who knows this?
The patient also knows that oncology just focuses on the cancer – not the whole person.
Perhaps we need a sense of perspective. As we see in the great graph of health expenditure and results above – there is no necessary gain for throwing money (in fee for service orthodox treatment I would argue when cheap and simple though life changing lifestyle changes could be implemented – at least to avoid reoccurence – a causal relationship has been detected in up to 80% of cancers with diet and toxins – points I belaboured earlier in the past few weeks).
As we are speaking of public funding and of the rising costs and health burden form the new ways of NOT living according to nature, I turned to sustainability.
Dr Daniel Callahan speaks of needing a new way of thinking about medicine – as a health revolution – just as there have been in his lifetime – in civil rights, the environment and for feminism. As he also says in http://www.projectsyndicate.org/commentary/sustainable-medicine
‘Most fundamentally, a finite model of medicine must accept human aging and death as part of the human life cycle, not some kind of preventable condition. Medicine must shift its focus from length of life to quality of life. A medicine that keeps people alive too long is not a decent and humane medicine. We can live to be 85, but we are likely to do so with chronic conditions that leave us sick and in pain.’
Turning back to the chronic illness issue of cancer – should conventional therapy be decided upon, what would decide a person to use whatever else would be dependent on their perception of their unmet needs.
The amelioration of treatment side effects, and the usefulness of treating the person, as a whole unit – not just as the carrier of the cancer – is outside the realms of oncology. Here we have the paradigm shift again. Coulter (2004) talks of a philosophy of health.
‘In CAM, health is the natural state and the innate tendency of the body is to restore the health. Health is also the biological, socio – philosophical and spiritual factors, and optimal health is unique to an individual.’ Is formal research the best way to discover the individual’s best path? Interventions for peace of mind, mood enhancing and coping strategies may be found more in the apparently unconventional ‘CAM” pursuits.
As it is highly unlikely a person will only of one ‘unconventional’ intervention – Crystal (2003) found that of the 47% CAM users, 80% used more than one type of therapy, 40% reported using four or more different types of therapies, and 14% used at least seven different therapies. How does this get studied in isolation? A one on one, highly anecdotal individualised programme for each patient is what any natural therapist would do.
Then, as I have posted from a Chinese medicine text earlier, ten practitioners could easily come up with ten totally different formaulae for the same person and condition – with all being safe and effective, and none ‘wrong’. ‘Is there one ‘right’ way and can we find it through reductionism?’ may be more the question.
If seeing all RCT as being the ‘best’ research, maybe a funder will never get to why people are using more than what the doctor of oncology offers. Whilst the patient may be funding for quality of life, not just drawing breath may be a more humane goal, as stated by Dr Callaghan above, what is the funder funding for?
It is a very large task indeed – to go past just being alive – how to extrapolate any form of intervention into the profound shift needed in the essence of the person – that may instigate the healing – and how to research and quantify joy and inner bliss?
It has been a very fulfilling and enlightening assignment.
- Chrystal K, Allan S, Forgeson G, Isaacs R, (2003). The use of complementary /alternative medicine by cancer patients in a New Zealand regional cancer treatment centre. The New Zealand Medical Journal. 2003 Jan 24 ;116(1168):U296. URL: http://www.ncbi.nlm.nih.gov/pubmed/12601420
- Coulter, I, Integrating the Paradigm Clash: The practical difficulties of integrative medicine. The Mainstreaming of Complementary and Alternative Medicine (ed Tovey, P., Easthope, G., Adams, J., Routledge (2004)
- Coulter, I., Willis, E, Explaining the Growth of complementary and alternative medicine, Health Sociology Review Vol 16, Oct 2007
- Coulter, I, The Future of Integrative Medicine: A Commentary on CAM and IM, (2012) (ed Adams, J, Broom, A), Imperial College, London
- Molassiotis, A et al, Use of complementary and alternative medicine in cancer patients: a European survey Annals of Oncology 16: 655–663, 2005 doi:10.1093/annonc/mdi110 (2005)
- Verkerk, R (2009) Can the failing western paradigm be shifted using the principle of sustainability? Australian College of Nutritional Medicine Journal (Oct 2009).