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Integrated Medicine - An Approach to Optimum Health; Removing Divisions in Health Care

by Dr Rajendra Sharma(more info)

listed in integrated medicine, originally published in issue 240 - August 2017

We must remember that originally medicine used in healing and treatment by the evolving human species was entirely ‘natural therapy’. This included herbal/botanical medicine that developed in societies which first annotated the passage of information. These methods have been around since time immemorial, as the Chinese, Tibetan and Ayurvedic physicians are estimated to have started practicing and acquiring such knowledge over 4,000 years ago.

So, What Is Integrated Medicine?

Integrated Medicine (IM) unites orthodox, drug-led medicine, with the safe and effective alternatives provided by complementary medicine. It recognises and considers the use of all appropriate therapeutic approaches from both conventional and Complementary and Alternative Medicine (CAM). This imbues IM with a vast variety of healthcare specialities and disciplines, all with the aim of achieving healing and ultimately returning a patient to optimal health through the restoration of function. Functional Medicine (FM), an emerging term which has evolved from the myriad of options of CAM, recognises the ‘dysfunction’ of cellular physiology and biochemistry as the cause of chronic conditions. Returning cells to ‘function’ offers cure – it is, after all, what the body does when it can. 

Dr Sharma at Desk
The Author at his Desk

In isolation, conventional medicine is predominantly based on the use of artificial, man-made drugs to placate the symptoms of illness with little focus on cure. Treatment of the underlying cause of a disease tends to stop with hand-outs, generally at the end of a brief consultation, advising on basic life-style changes, dietetics, and a recommendation to exercise more. Worryingly, these hand-outs can contain poor advice.  At a typical practice, a patient is afforded only 7 to 15 minutes (depending on where you live) with a variety of interchanging GP’s.   This is drawing patients towards the more intimate integrated form of medicine, which lays emphasis on the importance of a close patient-doctor relationship with the “family doctor”.

What Constitutes Proof Of Efficacy?

‘A lack of evidence is not evidence of a lack of efficacy’.

Most detractors of IM will argue there is a lack of published evidence to prove the capability of CAM and it is generally agreed that too few studies on CAM/IM are initiated and concluded. Despite complementary practitioners and centres not having the necessary funds to publish large studies, there are an astonishing amount of smaller studies and peer-reviewed, published scientific evidence supporting the plethora of naturopathic therapies. We must not allow a lack of evidence to reflect a lack of efficacy.

The Change From Natural To Synthetic Medical Treatment

The change to drug-based, symptom-focused medical care can be traced back to 1847 – the year that The American Medical Association (AMA) was founded by powerful families with interests in the sale of early pharmaceutical medication. Traditional health systems such as herbal/botanical medicine, Homeopathy, acupuncture, chiropractic, nutritional medicine, and some of the more esoteric healing therapies, are repeatedly discredited in favour of the comparatively nouveau ‘scientific’ medicines, derived and sold under patents allowing profits to their manufacturers. The AMA claimed its formation was to “promote the art and science of medicine for the betterment of public health”, but the paradigm they set in place to establish the first pharmaceutical governing body shows how initially the AMA was clearly a corporate entity.

The AMA, and countless subsequent medical associations worldwide, have from their outset done more to discredit what they consider ‘alternative medicines and therapies’ than any other process or entity. The governance of health care is now majoritively administered by orthodox institutions and scientists funded directly or indirectly by the pharmaceutical industry. We cannot ignore the likelihood that these bodies have a vested interest in contradicting the promotion of good health or the potential of healing through CAM therapies. Even the use of preventative medicine seems to be ignored in medical education in favour of a paradigm geared predominantly towards promoting the use of pharmaceutical drugs and surgery as therapeutic treatments. 

The concept of a ‘typical modern-day drug trial’ is in itself a questionable modus operandi. In early 2016, Wikipedia listed 173 drugs withdrawn after passing safety and efficacy trials since the mid-1960s. The EU has passed and withdrawn 19 drugs between 2002 and 2011. These are not unusual drugs used in rare diseases, but include medication used by millions of people worldwide. Rofecoxib (Vioxx) was passed by the FDA in 1999 as a cyclooxygenase 2–selective, nonsteroidal anti-inflammatory drug (NSAID). It was withdrawn 5 years later having been linked to over 27,000 heart attacks or sudden cardiac deaths between 1999 and 2003.[1,2] Published ‘experts’ in the UK frequently disparage the use of CAM, but in my view publications disparaging CAM should be reviewed with these statistics in mind.

Placebo?

There is criticism from anti-CAM factions of such therapies working through placebo-effect. Placebo has its place in healing. That placebo is criticised as a healing technique in itself, is itself questionable. After all, placebo is actually the most proven of all therapies: most drugs are tested against placebo and it nearly always has some benefit and sometimes more so than the drug being tested. In effect, therefore, there is a huge body of evidence supporting placebo benefit. If CAM were only to be working through placebo, it should automatically be considered a main stay of conventional therapy! Regardless, CAM has frequently been proven to have benefit, as detailed in the large bodies of evidence-based global CAM research provided by the following institutions:

Medical training, without doubt, teaches doctors to scrutinise evidence, but with most GPs spending up to 40% of their time on administration they rarely have time to study and consider therapies outside of their initial symptom-based training. Moreover, the major general practice journals offer an integrated commentary only very rarely. Equally, the majority of CAM practitioners are not taught to scrutinise evidence and often eulogise what they hear from exuberant characters in lectures or courses without examining the evidence. Furthermore, most CAM training fails in educating on the dangers of missing a sinister diagnosis of an acute illness, or treating having missed a disease of swift, dire consequences. Whilst these circumstances exist we will continue to have doctors without interest or knowledge in alternatives, and continue to have complementary medical practitioners without the safety net of medical training. The Integrated Doctor is at the very least overcoming those obstacles.

Growing Popularity

In 2010, a study by Hunt KJ et al recorded data from 7630 respondents in the UK. In the previous twelve months,

  • 12.1% of those asked had seen and consulted a CAM practitioner.
  • 29% had been taking prescription drugs and used CAM alongside.

There are many reasons for the popularity of IM, and it is not just the public that are showing interest. A Californian study in 2015 has shown 75% of 1,770 USA medical students ‘…think it would be beneficial for conventional Western medicine to integrate with complementary and alternative medicine (CAM)’.[3] Furthermore, in 2008 the UK annual spend on alternative health treatments was £4.5 billion, a market that has grown by nearly 50 per cent in the last decade.[4]

As global health systems feel the pressure of increasing costs, introducing IM into national health care seems logical and has been proven a viable option. The budget for the NHS in England for 2016/17 is £120 billion, and is anticipated to rise by nearly £35 billion (an increase of 35%) by 2020/1. Treatment for patients with chronic diseases accounts for up to 86% of our nation’s health care costs,[5] which arguably makes the cost of care, using the current model, economically unsustainable. We need to find ways of changing this paradigm.

There are a number of studies suggesting that CAM may reduce medical expenditure and costs,[6] but despite doctors and academics recording encouraging evidence that they are seeing benefits from their patients’ use of IM, CAM is often the recipient of concerted attacks questioning its efficacy and reliability.[7]  Frequently these studies fail to take a balanced view of the evidence, and are arguably orchestrated by those with vested interests elsewhere. Unfortunately, lack of financing means a broad defence of IM has yet to be established and studies struggle to be funded.

The Integrated Approach to Optimum Health

Understanding the impact of nutritional and environmental factors on ourselves (our input) combined with the way we handle this (our processing) will govern our long-term health. As individuals we must take responsibility, but our medical professionals and, perhaps most importantly, those that govern the health of our nation (and planet) have to focus on a change of paradigm and hail as the main mantra “Prevention is better than cure”. We need to learn from an early age about our body. We need to use Functional Medicine diagnostic programs to understand our personal physiology and biochemistry. We need to learn how to screen whether we are becoming dysfunctional before cellular, tissue, and organ failure occurs. Conventional ‘screening’ is about catching illness early, but often that is too late.

We cannot bypass the basics:

  • Eat well            Stay within a healthy weight range.
  • Exercise           Stay fit.
  • Avoid bad habits          Stay away from toxins
  • Be happy          Stay positive.

Combine these guidelines with a recognition of your genetic/hereditary medical history and you can create an Optimum Health plan.

Genomic Testing

Consider having your genes tested. Genomic testing is now advanced enough to advise us on preferential diets, exercise programs, detoxification capability, and many other areas that can guide us in our individual behaviour patterns.

Fitness

We need to have a fitness program that suits us. Our structure should be analysed and maintained by physical therapists, ranging from Yoga and Tai Chi teachers to shiatsu and massage, and reparative techniques for when things go wrong, such as physiotherapy, osteopathy, and chiropractic. Exercise must include stretching and correct breathing. Breathing correctly in itself can alter so many functions in the body.

Stress

We need to recognize as early as possible physical changes associated with stress. Stress increases adrenalin which alters most metabolic functions. Stress creates a demand for cortisol which leads to sex hormone imbalance. Investigations such as Heart Rate Variability assessment can provide advanced notice of stress changes. Blood, stool, saliva and urine tests can define nutritional status, detoxification capability, recognition of toxic levels, hormonal and neurotransmitter profiling and, perhaps most importantly if, indeed, ‘death starts in the colon’, measure beneficial or pathogenic bowel bacterial balance and digestive capability.

Sleep

Stress also disturbs sleep – the most important restorative process in the body. An integrated approach to health must take into account our time in bed, and the importance of allowing us enough rest and relaxation.

Nutrition

Our nutritional intake must be enjoyable or we will not stick with it, and we must learn that being tempted by unhealthy foods is okay in moderation and in association with a predominantly healthy intake. As a result of over-farming, much of our soil no longer contains an optimal level of nutrients. We have polluted our water with industrial waste and excreted medicinal compounds. Our land is watered by this or by polluted rain, so our vegetation and livestock become contaminated. This means our food chain provides us with toxins that our detoxification system is overwhelmed by, or simply may not be able to remove. We need to adjust our healthy ageing lifestyle, which minimally requires nutritional and exercise advice, and ideally, the use of supplemental medicines.

Cover Live Longer, Live Younger

Integrated Medical Therapy

It is said the Chinese Barefoot Doctors circulated from village to village and were paid only when they found the family well. The integrated physician must now take responsibility for preventing a patient’s descent into illness and cannot continue to be lauded for the prescribing of medication that relieves symptoms. It is no longer acceptable that mainstream medicine ignores the evidence presented by Functional Medicine and CAM that actually encourages the body to repair and return to health. Drugs masking symptoms is the blessing given by many medications but should not be touted as ‘curative’ whilst we live in the hope that the body will repair itself.

Doctors trained in Integrated Medicine  (IM) , offering therapy in both conventional and IM approaches, can deal with symptoms whilst potentially treating underlying dysfunction. My practice, like others with an integrated approach, brings into play nutritional therapy inclusive of high-dose intravenous nutrition, Bioidentical hormone replacement therapy and botanical/herbal medication that may offer options for intractable, unresponsive or chronic conditions. This is in addition to approaches to maximize optimum health, which may offer greater success rates in, for example, fertility issues,[8] or lead to healthier preparation for pregnancy, preparation for extreme endurance performances (marathons, etc) and, hopefully, preferential outcomes of surgery.

Evolutionarily, we have swung from using natural medicines and having short but healthy lives, to a drug-based society where longevity associated with disease is the expected norm. An integrated approach can and should provide a combination of both, allowing a long, healthy, and happy life.

References

  1. www.pnhp.org/news/2004/november/fda-memo-indicates-vioxx-might-have-contributed-to-about-27k-heart-attacks-death
  2. FDA Memo re Refecoxib www.druginjurylaw.com/vioxxgraham.pdf
  3. www.medicine.news/2015-09-21-even-medical-students-want-conventional-medicine-to-include-alternative-therapies.html  Is complementary and alternative medicine (CAM) cost-effective? a systematic review
  4. www.cdc.gov/chronicdisease/
  5. Lind BK, Lafferty WE, Tyree PT, Diehr PK. Comparison of health care expenditures among insured users and nonusers of complementary and alternative medicine in Washington State: a cost minimization analysis. J Altern Complement Med 16(4):411-417. 2010.
  6. www.telegraph.co.uk/news/health/alternative-medicine/3355120/Complementary-medicine-seeking-out-alternatives.html   
  7. http://bmccomplementalternmed.biomedcentral.com/articles/10.1186/1472-6882-7-17
  8. Nita Maha1 and  Alison Shaw2Perspectives of complementary and alternative medicine (CAM) practitioners in the support and treatment of infertility.  https://bmccomplementalternmed.biomedcentral.com/articles/10.1186/1472-6882-14-394

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About Dr Rajendra Sharma

Dr Rajendra Sharma MB BCh BAO LRCP&S(Ire) MFHom is a fully qualified doctor with a specialist interest in Integrated Medicine. He is a fully qualified doctor trained in conventional medicine with post-graduate qualification in Homeopathy and training and practice in Functional & Complementary medicine. His special interest is working with patients with chronic disease and illustrating it’s underlying causes particularly CFS/ME, cancer and other difficult conditions that respond poorly to conventional medicine. Treatment of conditions focuses on encouraging the body’s innate healing ability using life-style, exercise, nutritional and non-pharmaceutical medicines whenever possible. Until recently he was the Secretary to the British Society for Ecological Medicine (the largest body of conventionally trained doctors working in Integrated Medicine) and was the Education Moderator – in charge of continual professional development and training doctors wishing to enter the field. This involved teaching about diagnostic investigations into environmental causes of disease such as metal toxicity, food allergy, pollution, chronic infection and mitochondrial dysfunction – all very relevant to CFS – and non-conventional therapeutic approaches.

He is the author of The Family Encyclopedia of Health and in 2014 published the ‘all you need to know’ healthy ageing book, Live Longer Live Younger. It won “The Janey Loves 2016 Platinum Book Award” (Radio 2’s Steve Wright in the Afternoon’s Health Advisor – Janey Lee Grace). He was the Medical Director at The Hale Clinic in the 1990s and, until 2012, Medical Director of the pioneering The Diagnostic Clinic where new care initiatives in health screening were forged. These included the broader introduction of investigating underlying causes of epigenetics in genomics, cancer and mitochondrial testing. Please visit  www.drsharmadiagnostics.com

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