Editor's Note
Imperfect Blend
“I guess … I’m not … so good.” Between words, the man caught his breath through dusky, pursed lips, his forehead wrinkled in perpetual distress. An uninformed doctor might have called 911, but I knew he had been like this for months if not years. His medication list read like the textbook recipe for congestive heart failure—Lasix, Lisinopril, Coreg. He had been admitted to the hospital multiple times for intravenous diuretics, intravenous pressors, and even hemofiltration, which temporarily helped him shed some water weight and eased his breathing only to have the rattling respirations return shortly after he got home. He knew he was nearing the end. So when I sadly told him I didn’t have too many good ideas for helping him, he accepted the verdict with a wan smile. He had reached the limit.
I remember in medical school when I first realized that modern medicine had limits—that the 20th-century miracle cures of penicillin weren’t repeated for all diseases, that we only controlled most chronic diseases, and that our ability to control them eventually failed. My medical school revelation is experienced daily by patients who bump into the limits of 21st century medicine and search for answers elsewhere, frequently in the world of complementary and alternative medicine (CAM). The number searching is expanding: 38 percent of adults in the United States used CAM in 2007, most of them women, the better educated, and the “not poor,” and all of them people who believe there must be something else available to help.
Medical institutions such as the University of Minnesota, Mayo Clinic, and Allina Hospitals and Clinics have also embarked on the search for something else, establishing centers for the study and application of CAM and incorporating it into their training programs. Some classically trained M.D.s who learned their biochemistry and pharmacology and sampled surgery during their education have sensed that they weren’t getting the whole picture about the interaction between illness and humans and have added CAM to their traditional medical black bag.
The embrace of CAM by reputable institutions and physicians hasn’t totally erased the distrust of and hostility toward it long harbored by the medical establishment. Allegations of quackery and worse still surface, and some physicians shake their heads in dismay when their patients “stray,” sometimes even refusing to continue seeing such miscreants. Although a few in the CAM community suspect concerns about competition may motivate such behavior, many physicians do voice legitimate critiques about the efficacy and scientific proof of CAM.
Yet there is common ground between CAM and conventional medicine. Both want to help patients. Both want their treatments to work. Both aren’t quite sure why some of their treatments do work. And both eventually will hit the wall of what they can do.
Perhaps the blending of complementary and conventional that we’ve seen in the past decade will never be perfect. Some patients and doctors will continue to choose one or the other for their own reasons. Some people such as my end-stage CHF patient aren’t likely to benefit from CAM. But I suspect that the mix of CAM and conventional will become homogenized as both look for something else.
Charles R. Meyer, M.D., editor in chief