Secret Sauce and
Positive Side Effects in Treatment Via Whole-Person Integrative Medicine
This article was first written as an as-yet-to-be published column in the consumer magazine, Alternative Medicine. It was first published on the internet here at the Huffington Post.
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Those
who grow up experiencing medicine and medical treatment as pharmaceuticals, diagnostic
procedures, and surgery can have trouble with the idea of "positive side
effects."
 What would make them positive?
Multiple
pages of small print warn us of nagging and sometimes awful adverse effects of
drugs. Diagnostic imaging shoots rays through the system that can be harmful. Any
incision is stress on the body, even if there is no adverse event from a
surgery.
Regular
medicine teaches us to weigh pros and cons. The end justifies the means.
The
knees of a medical doctor, researcher, or even a patient who is born, bred, and
educated in this context, can quickly jerk to dismiss anyone who has the
audacity to claim that there are beneficial side effects from their treatment
process. The therapy itself may be suspicious. Now I am to believe there are positive
side effects?
Such
claims easily evoke the image of some huckster on the back of covered wagon.
This
theme has interested me for years. My spouse is a doctor of naturopathic
medicine. Like most integrative health and medicine practitioners, she mainly
uses various natural modalities while partnering with her patients to engage
diet, lifestyle, stress, emotional, and other issues related to their health: classic,
whole-person care.
 Jeana Kimball, ND, MD: the noted spouse
In
talking with her about her practice, I sometimes hear a common theme regarding
those who come to her with particularly challenging cases. A patient might present
with X-say, a digestive problem. A month later, following treatment, the
patient comes back. X, the presenting
condition that was the focus when the patient made the appointment, might not
have budged. Yet Y, a skin condition; Q, a problem with sleep; and H, a
tendency toward depression, may have all gotten better.
X
might budge the next month, or in six, or it might keep rebounding. Yet other
individualized symptoms that may or may not be perceived as linked the the
presenting problem keep getting better.
Hard
evidence is building to support these claims of "positive side effects." Group
Health Research Institute senior research scientist Dan Cherkin, PhD, is a
specialist in complementary and alternative medicine treatments for back pain.
He has published randomized controlled trails on the effects of chiropractic,
acupuncture, massage, and other treatments. Often, but not always, these showed
better outcomes than usual care.
 Dan Cherkin, PhD
Cherkin
grew curious about what was going on between these practitioners and their
patients. These weren't, after all, merely disembodied therapies delivered as
impersonally as a pill. He examined what he called the "patient experience" of
this type of care. The team published their findings as: "Unanticipated
benefits of CAM therapies for back pain."
The
benefits were individualized and all over the map. They found for all the types
of treatment "increased options and hope, increased ability to relax, positive
changes in emotional states, increased body awareness, and changes in thinking
that increased the ability to cope with back pain." These themes, he wrote,
"were mentioned for all of the CAM treatments." More treatment-specific were
patient experiences such as "increased sense of well-being, improvement in
physical conditions unrelated to back pain, increased energy, increased patient
activation, and dramatic improvements in health or well-being."
 Dugald Seely, ND
Canadian
researcher Dugald Seely, ND, included patient self-reports in a study in the Canadian Medical Association Journal that
found lower cardiovascular risk via a population given whole person,
integrative care. Similarly diverse "secondary outcomes" emerged. Subjects
reported positive changes related to "fatigue,
sleep, weight, stress, allergic symptoms, hypertension, coffee consumption, and
musculoskeletal problems."
Ryan Bradley, ND, MPH, found similar
benefits among patients with type II diabetes who were participating in a
health maintenance organization. He and a group which included Cherkin, the
Group Health researcher, reported these in a study entitled Adjunctive Naturopathic Care in Type 2 Diabetes. On their primary
objective measure-the level of hemoglobin A1c - so for our purposes
read this as "condition X" - did not show improvement to the point of
"statistical significance." Then
consider Y, Q and H: Subjects reported that "mood, self-efficacy, and
motivation to change lifestyle" were all
bettered to statistically significant levels.
 Ryan Bradley, ND, MPH
The
hucksters would seem to have had a point about their positive side-effect
claims, at least in these examples.
When
I shared these studies, my spouse was not surprised. What to Cherkin was
"unexpected" to her was not. She anticipated the other outcomes based on the
health-oriented, whole-person philosophy organizing her practice.
Is
there something special in the type of treatment that engages patients?
An
article in an internal newsletter from Group Health Research Institute called
it a "secret sauce." The newsletter reported a follow-up study from the Cherkin
team. This one, led by Erica Oberg, ND, MPH dove more deeply into the patients'
experience of their care in they highlighted
three patient-reported characteristics: patient-centered, collaborative, and "holistic
health rather than diabetes focused."
 Erica Oberg, ND, MPH
The
interviews yielded additional characteristics. One was being counseled on an individualized
and detailed health-promotion plan.
Tactics viewed as "practical" enhanced engagement with self-care. They
liked that this patient education addressed not just diabetes self-care but
also general health issues. Finally, the "novel treatment options" of the
naturopathic doctors "fostered hopefulness."
These
data, these positive side-effects, and these patient experiences would seem a terrific
guide in this era in which the remedial banner of "patient-centered" flies from
nearly every hospital, medical group, and community clinic. Yet such evidence
of whole-person treatment is typically side-lined if considered at all.
One
begins to wonder, amidst present minimal regard, if it is time to level an
accusation of hucksterism not at the whole-person practitioners but at the
business entities flying those "patient-centered" banners.
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