Natural Medicine: Often a Safer Alternative to Traditional Medical Care

It should be obvious the best way to avoid the dangers of hospitals is to avoid ever needing to enter one. One approach worth considering is to take a closer look at what originally was called natural medicine. Later names were holistic, then alternative or complimentary. As this type of medicine became more popular, it was termed integrative to foster an integration with conventional medicine. Integrative medicine is also called functional medicine.

Natural medicine was dominant throughout centuries and in some cases, such as Ayurvedic and Chinese, for millennia. These medical practices were saving lives and treating chronic conditions quite well until the late 19th and early 20th century. After the discovery that germs caused many diseases and inventions like x-rays and antibiotics offered new ways to diagnose and treat conditions, natural medicine fell from favor. Courses in it were dropped from medical colleges; new schools of medicine focused on defeating these external causes of illness by drugs, surgery, or even radiation.

Natural medicine practitioners were relegated to the ranks of quacks and their many cures called outdated. With the development of a cozy alliance between large pharmaceutical companies and the Food and Drug Administration, financial support for research into and use of inexpensive natural cures dried up. No self-respecting M.D. would think of prescribing something that not approved by the FDA after lengthy drug trials undertaken by companies with a stake in expanding the use of expensive prescription drugs.

Despite all the “modern” advances, evidence continued to mount, particularly by the 1940s and 1950s, that the “pure scientific” approach taken by allopathic (traditional) practitioners was not working so well. People kept getting sick, chronic conditions continued to plague patients, and the cost of being ill continued to rise. Some pioneers in re-popularizing natural medicine started writing books—a number of which became best sellers. By the 1990s, enough confidence in natural approaches to health had developed that even caused the U.S. Congress to take a hand. In 1994 the Dietary Supplement Health and Education Act was passed opening the door for research into the value of natural supplements and therapies. 

As evidence of the continued problems with a purely allopathic approach to health grows, you might want to consider the following:

•    “Health Spending Will Climb to Nearly One-Fifth of GDP.”  By 2021 according to estimates from the federal government (actuaries from the Centers for Medicare and Medicaid Services), “health spending will account for 19.6 percent of the gross domestic product in 2021.” The percentage of gross domestic product allocated to health expenditures in 1960 was 5.2 percent.

•    “US Health System Ranks Last Among Eleven Countries on Measures of Access, Equity, Quality, Efficiency and Healthy Lives.” Although the U.S. devotes twice as much money to health care as other industrialized countries, it ranks last among Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the United Kingdom.

•    The primary focus of allopathic medicine as well as health care dollars is on treatment. Generally, 95 cents of every healthcare dollar goes to treat disease after it has already occurred. “At least 75 percent of these costs were spent on treating chronic diseases such as heart disease and diabetes that are preventable or even reversible” according to a report by Dean Ornish, MD, founder of the Preventive Medicine Research Institute. In the same article, Dr. Ornish went on to note, “When I lecture, I often begin by showing a slide of doctors busily mopping up the floor around an overflowing sink, but no one is turning off the faucet. Similarly, Dr. Denis Burkitt (who discovered Burkitt’s lymphoma) once said that raising money to pay for ambulances and a hospital at the base of a cliff is not as smart as building a fence at the top to keep cars from falling off.

•    A study based on 1984 data estimated that up to 98,000 Americans die each year from medical errors. In 2013, an updated report titled “A new evidence-based estimate of patient harms association with hospital care,” by John T. James was published in the Journal of Patient Safety (2013 Sep; 9(3):122-8.). James reported, “A lower limit of 210,000 deaths per year was associated with preventable harm in hospitals.” Because of limitations including the incompleteness of medical records, “the true number of premature deaths associated with preventable harm to patients was estimated at more than 400,000 per year.”

However, there is a light at the end of the tunnel and it is not a train. In the words of Bob Dylan, “The Times They Are a-Changin’.”

Major medical centers such as the Cleveland Clinic have established several important operations in natural medicine, especially the Center for Functional Medicine. At the clinic in addition to allopathic care there are treatments and services offered in the following areas: Acupuncture, Brain Health & Wellness, Chinese Herbal Therapy, Disease Reversal Programs, Guided Imagery, Holistic Psychotherapy, Lifestyle Management Programs, Massage Therapy and Reiki Therapy.

Seattle and San Diego residents are fortunate to have accredited universities in science-based natural medicine. See Bastyr University (Kenmore, WA) and the Bastyr Center for Natural Health, the teaching clinic of the university in Seattle, WA.

Physicians’ Ignorance of Current Research: Another Hospital Danger

To quote an Ear, Nose and Throat specialist when I questioned his recommendation of an invasive procedure after reading multiple reports in PubMed (see “Finding Medical Information Online,” this blog 3/7/2015)  about the inefficacy of the test, “I don’t have time to keep up with medical research! I rely on what I learned in medical school.”  That was the last visit I ever made to that doctor. (See also this blog, Tuesday, November 5, 2013,  “The Importance of Current Clinical Knowledge for Doctors.”)

Physicians have known, or could have known, for at least 24 years about certain drugs dangerous for the aged when a report that became known as the Beers Criteria described inappropriate medication use in nursing home residents was published in the Archives of Internal Medicine. There is even a common abbreviation for this type of medication—PIM (Potentially Inappropriate Medicines). The Beers Criteria later was modified to apply to all persons aged 65 or older. There were various editions with associated critiques, reviews, and comments published over the years. A major update came out in 2003 and in 2012 the American Geriatrics Society published a special article listing 40 additions of specific drugs and classes to the Beers Criteria.  

The Beers Criteria list includes some very common drugs in classes such as these:
Nitrofurantoin: prescribed for urinary tract or bladder infections; has the potential for pulmonary toxicity and there are safer alternatives;
Alpha blockers including Doxazosin, Prazosin and Terazosin; high risk of orthostatic hypotension;
Benzodiazepines: Alprazolam, Lorazepam, Diazepam, Flurazepam and others: increased sensitivity, risk of cognitive impairment, falls, fractures, motor vehicle accidents;
Multiple types of NSAIDS like ibuprofen, naproxen, diclofenac and even aspirin at more than 325 mg/day; increases risk of GI bleeding or peptic ulcer disease particularly in those >75 years or taking corticosteroids, anticoagulants or anti-platelet agents.

There are many more drugs on the Beers list, far too many to list here. More importantly, newer studies have found even more drugs that are commonly prescribed by physicians unaware of these criteria (more than once when I have mentioned Beers to a doctor, even in a hospital I have been met by what some call the “Monkey” look, that is, complete unawareness.

Now multiple studies recommend something called “STOPP (Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions).” Evaluations of this tool report generally report significant increases in the specificity of identifying PIMs among the elderly. One of these was published in the International Journal of Clinical Pharmacology and Therapeutics titled, “STOPP (Screening Tool of Older Person’s Prescriptions) and START (Screening Tool to Alert Doctors to Right Treatment).

This report of a study noted, “Older people experience more concurrent illnesses, are prescribed more medications and suffer more adverse drug events than younger people. Many drugs predispose older people to adverse events such as falls and cognitive impairment, thus increasing morbidity and health resource utilization. At the same time, older people are often denied potentially beneficial, clinically indicated medications without a valid reason.”

As described in an abstract of the article, “STOPP is comprised of 65 clinically significant criteria for potentially inappropriate prescribing in older people. Each criterion is accompanied by a concise explanation as to why the prescribing practice is potentially inappropriate. START consists of 22 evidence-based prescribing indicators for commonly encountered diseases in older people.” The article concluded, “STOPP/START is a valid, reliable and comprehensive screening tool that enables the prescribing physician to appraise an older patient’s prescription drugs in the context of his/her concurrent diagnoses.”
Now, if you have a good relationship with your primary care doctor or some specialist prescribes a new drug for you, you might ask if the drug is on the Beers List or the STOPP list. If the doctor has never heard of either one, possibly you might want to consider a second opinion. Better still, go to each health-related visit armed with a copy of at least the STOPP list. Here is one source for the list from Emory Center for Health in Aging. You can print your own copy.