Fallen Through the Cracks: Why We Desperately Need Integrative Medicine
It’s September 2016. I’ve just returned from working on a research project in South America, and I decide to check out the stomach issues I’ve been having and the persistent backache that’s built up over the course of a year.
After multiple visits to specialists and an expensive endoscopy and MRI, I’m somewhat puzzled to leave with more questions than answers. “There’s not much we can do to help you with this,” the gastroenterologist and spinal specialist blankly tell me. “Have you considered acupuncture?”
Like many others, I’ve fallen through the cracks of the modern Western medicine.
While society sings the highest praises to our latest scientific advances in medicine, the best doctors in Washington, D.C. can’t help me with either of the two chronic health conditions I’m experiencing. With an irony that’s not lost on me, they refer me to go see an acupuncturist.
The irony lies in the fact that, while many physicians are quick to dismiss acupuncture, it’s often a last resort for patients when those same physicians are unable to provide treatment or even relief for chronic illnesses. Frequently, patients seek complementary and alternative medicine when conventional medicine fails them, as it did me.
As Deepak Chopra urges in an article for the American Medical Association’s Journal of Ethics, we must reevaluate the bristling barrier that’s been built up between conventional and complementary and alternative medicine. He envisions an “expanded medicine in the future, not alternative or mainstream medicine as divergent or warring camps.” After all, he elaborates, both “types” of medicine “share core values: treating the whole patient, reducing suffering, closing the gap between healer and healed, and doing the least harm while bringing the greatest good.”
Together is better, and this is exactly why we need integrative medicine.
Integrative Medicine > Complementary and Alternative Medicine
Dr. Emily Ratner, the founding medical director of the MedStar Health’s Center for Integrative Medicine, embodies Chopra’s vision for the future of medicine.
Working as a healthcare innovation fellow through the Health for America at MedStar Health program , I have a chance to speak with Dr. Ratner. She eloquently explains her vision for providing optimal whole-person, patient-centered care: “Integrative medicine should just be medicine — a seamless combination of conventional and nonconventional therapies that have the appropriate scientific evidence of efficacy and safety.”
Dr. Ratner makes a clear distinction: integrative is not the same as “complementary and alternative,” the latter terms implying that nonconventional practices can only occur “parallel to” or “instead of” conventional care.
The reality is that a separation between conventional and nonconventional medicine can be dangerous. Cancer patients, for instance, who choose to use herbal supplements to address the side effects of chemotherapy and radiation might not be aware of potential herb-drug interactions. Supplements may give rise to pharmacokinetic interactions with anticancer drugs, which may lead to a diminished efficacy of treatment.
Additionally, primary care physicians and complementary and alternative practitioners often don’t communicate, Dr. Ratner elaborates. On the other hand, integrative medicine practitioners such as herself have a distinct advantage: “I’m part of a larger system, and while I may be treating someone for one thing, I can recognize other problems and refer [the patient] to another part of the network.”
An anecdote from her practice illustrates the point. An elderly patient in his eighties suffering from peripheral neuropathy was coming to see Dr. Ratner for acupuncture treatment. During the visit, she noticed a very slow heart rate which didn’t feel right to her. After sending her patient to the emergency department, Dr. Ratner learned that the elderly man was diagnosed with an abnormal heart rhythm and required more specialized medical care.
Outside of integrative medicine, this synchronicity is more difficult. “Allied practitioners are used to practicing in a different culture — on their own, in individual offices — and often [they] can’t discuss with other practitioners in a larger system,” Dr. Ratner explains.
A light of hope for those left behind by conventional medicine
“Everything else didn’t work, so that’s why they came to see us.”
-Dr. Emily Ratner
The “final pass” clinic. The last attempt. According to Dr. Ratner, 90% of her practice with the integrative medicine practitioner team in Olney, Maryland is taking care of patients who have slipped through the net of Western medicine.
She and other integrative medicine practitioners offer a last hope for patients searching for alleviation for their unrelieved suffering.
“A gentleman with glioblastoma multiforme came to me,” Dr. Ratner describes, “suffering from excruciating headaches. He had tried everything in conventional medicine, and was taking opiates to control the pain. When I started seeing him to manage the pain with acupuncture, his suffering was reduced, and while he was not completely off of opiates, the dosage decreased from four times a day to only once or twice per week.”
The real focus of integrative medicine, Dr. Ratner laments, should be on prevention. “Nutrition education as a child,” she elaborates, “is better than just prior to bariatric surgery.”
However, until integrative medicine receives the support it needs and until financial incentives are realigned with patients’ best interests, “it is too late for [many patients] to prevent [illness],” says Dr. Ratner. “They have fallen through the cracks, and I care for those who have fallen through the cracks.”
As a patient myself, I hope my voice rings loud and clear: I want better care, and I believe integrative medicine can deliver. As a matriculating medical student, I plan to dedicate myself to building upon bridges that others, like Dr. Ratner, have already started building.
As of now, I am seeing an acupuncturist for treatment every week — something I wish the conventional specialists I saw had encouraged from the start. This is my hope for the future — that integrative care is made a standard practice rather than a final resort.
Ekaterina Vlasova is an integrative medicine enthusiast who has focused her early career on this domain and who was recently accepted to medical school to advance her related work. Her posts represent her views and that of the professionals she interviews.