Bridging the Gap. James Eugene Munson
In our clinical experience, this is often what we hear from new patients who express their frustration stating, “My doctor can’t do anything except prescribe anti-inflammatories for the pain, so I thought I’d try acupuncture.”
Time and again we consult with individuals seeking complementary modalities to achieve health goals through more natural means and quite simply, conventional medicine struggles to meet these demands. We highly regard this patient curiosity because it empowers individuals to actively participate in their own health and wellness, from illness prevention to recovery. Thus, the limits of allopathic medicine to treat the whole person, dissatisfaction with standard medical care, and a burgeoning field of mind-body medicine shifted the healthcare paradigm. Patients created their own integrative health system by blending a myriad of disciplines: physical exams with their primary physician, access to medication and emergency services, in combination with holistic, natural medicine to address chronic, underlying conditions that encompass the whole person. Naturally, this resulted in integrative medicine (IM) designs that generated a following by larger health institutions, which incorporated mind-body modalities, like yoga or meditation. These early inroads of medical integration provided a refreshing perspective on medicine, an improved outlook on wellness and empowered individuals to do more than merely “take their medicine and call the doctor.”
It is not surprising that subspecialties were born from the foundation of IM. It is even less astonishing that integrative approaches surfaced in the field of oncology. While there are no exact origins of integrative medicine, nor can we link its popularity to a particular individual or institution, there are certainly major influencers, such as Dr. Andrew Weil. Dr. Weil is a classically trained Western medical doctor who pioneered early efforts to align allopathic and holistic medicine. One of the earliest publications on the topic of integrated cancer treatment is co-authored with IO proponent Dr. Donald Abrams. In their book entitled, Integrative Oncology, Dr. Weil outlines the fundamental components that embody an ideal relationship between medical paradigms. He states, “Integrative medicine does include ideas and practices currently beyond the scope of the conventional, but it neither accepts conventional therapies nor accept alternative ones uncritically. And it emphasizes principles that may or may not be associated with CAM (complementary and alternative medicine).”11 Four major tenets are proposed as part of the integrative medical model proposed by Dr. Weil:
•The natural healing power of the organism
•Whole person medicine
•The importance of lifestyle
•The critical role of the doctor-patient relationship12
This viewpoint delineates central characteristics of IM and essentially sets the stage for Western trained physicians to approach patient healthcare and the treatment of disease with strategies that extend beyond linear medicine. These core values illuminate the future landscape of integrated healthcare. It recognizes the individual as a whole system, beyond quantitative measurements based in reductionist biomedical theory to diagnose and treat illness.
The IM principles noted above are embedded in the rich clinical history of Chinese medicine, which was developed thousands of years ago. These core values are not new to those trained in Chinese medicine. They are as inherent to the practice as yin-yang theory. The TCM physician observes disease as a result of imbalance through any combination of vital substances, energy and physiology. The ability to discern the cause of illness results from diagnostic skills that take into account the entire constitution, the whole person. There is no separation within the living organism, and through specialized skill and techniques, TCM optimizes the organism to heal itself. In order to support the body to restore health, the physician utilizes multiple pillars and techniques of the medicine to advise the patient on diet, lifestyle and emotional wellness. Thus, integrative medicine was happening long before modern definitions of it. And yet, because our medical philosophy aligns with Eastern traditions in a Western dominated medical system, Chinese medicine remains heavily scrutinized as researchers seek definitive scientific explanations for how it works, instead of trusting its empirical research and dynamic medical scope.
This reluctance provides insight into Chinese medicine’s limited position in the IO specialty. Is it science or merely an esoteric medical art? It is a great question, some say debate, in our profession as to whether TCM is art or science. If it is the former, the likelihood the entire system of Chinese medicine is ever entirely welcomed into open, allopathic arms is slim. Within the spectrum of Western standards, TCM is not a science, given a deficiency of evidence-based results that indicate clear measurements of success. In a seminal book about Chinese medicine, The Web That Has No Weaver, Dr. Ted Kaptchuk aptly addresses this idea stating, “If we mean by science the relatively recent intellectual and technological development in the West, Chinese medicine is not scientific. It is instead a prescientific tradition that has survived into the modern age and remains another way of doing things. But it does resemble science in that it is grounded in conscientious observation, of phenomena, guided by rational, logically consistent, and communicable thought process.”13 In this construct Chinese medicine, true to its nature, weaves among philosophies of medicine as art and among the confines of medicine rooted in science.
Whichever perception of TCM, science-based medicine leads the charge in the West. Double-blind, randomized studies determine standards of medical intervention, but Chinese medicine is a system that cannot be measured according to these rigid scientific criteria. While there are numerous studies that demonstrate its potential (namely acupuncture), it remains under the microscope, cautiously accepted and subject to Western clinical guidelines. The outcome has resulted in treatments that employ only technical methods of acupuncture therapy for acute patterns or with respect to oncology, palliative care. This is evident in integrative medical facilities that hire licensed acupuncturists and only permit needle-based treatments to address nausea, fatigue or cancer-related pain and prohibit the range of diagnostic methods or techniques integral to TCM. This grossly limits the capacity of Chinese medicine. These barriers will be further explored in this chapter, but first we follow the path from the foundation of IM philosophy into the vast realm of integrative oncology.
From Integrative Medicine, To Integrative Oncology
The endeavor to explore the culture of IO began in 2013 as a byproduct of doctoral research in Chinese medical oncology and a growing specialty in cancer. Even before pursuing a doctorate in TCM, there was a palpable energy emanating from our cancer patients who used the buzzword “integrative oncology” with hope and expectation. While much can be assumed from the terminology and inferred through professional experience, it still required closer analysis. Thus, having focused entirely on the history, evolution, principles and treatment of cancer from a TCM viewpoint, it was only natural to juxtapose this same data to conventional oncology. This examination reviewed the parameters of this multidisciplinary medical approach, carefully peeling the layers away from the ideology of collaborative medicine in order to glimpse at actual practices where the role of Chinese medicine was more closely scrutinized.
The process of discovering a unified definition of IO unveiled extensive interpretations that spanned from prominent cancer hospitals to private clinics. A proponent of collaborative medicine, Dr. Stephen Sagar explains the discipline as, “…both a science and a philosophy that focuses on the complexity of the health of cancer patients and proposes a multitude of approaches to accompany the conventional therapies of surgery, chemotherapy, molecular therapeutics, and radiotherapy to facilitate health.”14 In addition, Dr. Sagar points out that IO philosophy encompasses socio-cultural components to care, recognizing such implications that influence decision-making, as well as access to self-empowering resources that are financially stable, safe and that improve outcomes. This reflects a very real concern in the spectrum of oncology familiar to allopathic and complementary doctors alike: cancer patients are seeking curative outcomes and the diagnosis has the potential to lead vulnerable patients toward therapies that are possibly dangerous, ineffective and carry a hefty price tag.
For example, we consulted with a patient diagnosed with stage III colon cancer actively seeking a multitude of opinions following a surgical resection. His oncologist prescribed chemotherapy to treat the remaining cancer cells, but this patient refused, expressing a deep, visceral response