ONLY THE OVAL
Alternative Medicine for Ailing Hospitals
by Richard P. Huemer, M.D. © 1995
The future isn't what it used to be, at least where medicine is concerned. The vision of a brave army in white coats, using every weapon of science to conquer disease, is tarnished by the unintended effects of new drugs and the rising incidence of chronic degenerative diseases.
Even infectious diseases are staging a comeback, as proliferating antibiotic-resistant strains threaten to end the miracle of "miracle drugs." New viruses arise --AIDS and Ebola, for example--to threaten our people and defy our science.
Medicine isn't the same, either. Once a cottage industry dominated by doctors, it's a now a monster enterprise that gobbles an ever-greater share of the gross national product. Those visionary men in white coats gave us some very fine and costly technology, and with third parties footing the bill, the costs of high-tech medicine had nowhere to go but up.
Just now, medicine is undergoing a phase of industrialization, and all that implies --interchangeable parts, the assembly line, standardization of quality, cost-cutting, sophisticated marketing, and finding ways to produce the product more cheaply.
Your doctor is one of the interchangeable parts. In principle, one doctor is as skilled and efficient as any other. That doesn't leave much room for Marcus Welby, M.D., but then he wasn't notoriously efficient anyway.
Impact on Hospitals
All of a sudden, the financial future of many hospitals has begun to look anemic. So, some of them have been taking a hard look at health and wellness as a new way to serve their communities and incidentally to green-up their financial corpuscles.
The relevance of health (as opposed to conquest of disease) is easy to understand within the hospital's walls. People tend to get well faster in a cheerful, friendly environment, and it costs relatively little to implement such patient-centered care. Well-nourished patients recover sooner, too, so nutritional support is receiving renewed interest. The DRGs work in a hospital's favor when a patient spends less time there.
Understanding the potential importance of extramural health programs requires an appreciation of the public's attitude. The public is not happy with the health care system. Unfortunately, the public is about to get even bigger doses of what it doesn't like, owing to the accelerating industrialization of medicine.
Here's what Consumer Reports found in a survey of 70,000 readers, published this past February: 29% said their doctors didn't seek their opinion about their medical condition. An equal number noted that the doctor did not explain how they might improve their health with lifestyle changes. 26% said the doctor didn't explain possible side effects of medication, and 22% complained that the doctor never took a through medical history. 15% said the doctor rushed through visits, and the same number felt the doctor didn't care about their emotional well-being.
The people are voting with their feet; they're taking their business elsewhere. Over a third of the people surveyed by Dr. David M. Eisenberg and his colleagues at Harvard used at least one form of unconventional medicine in 1990, as reported in The New England Journal of Medicine. (Many also saw regular M.D.'s.)
Most of those people had sought treatment for chronic problems such as backaches, anxiety and arthritis, and most were Caucasian, educated, aged 25 to 49, and living in the West. If the figures hold for the entire U.S. population, they are nothing short of astounding: more people visit providers of unconventional therapy than see primary-care physicians, and about the same amount of money is spent on such therapy as on hospitalizations--over $10 billion annually!
It has not escaped the attention of some hospital administrators that there is a sizeable group of potential clients out there whose needs they have not been addressing. Moreover, since insurance does not usually cover alternative services, these are customers who pay cash for what they want.
Here is part of the motivation for hospital-based outpatient programs in alternative health care: the chance to serve more people in the community, and a way to help reverse declining fortunes. An additional motivation is to paint the hospital in a favorable new light. However much we appreciate our community hospitals, they are also associated in our minds with sickness and pain, which are negatives. By identifying itself with health and wellness, which are positive concepts, the hospital engenders warm feelings among the people it seeks to serve.
Community outreach programs can take several forms. I have grouped them into three major categories: educational activities, wellness programs, and complementary medical practice.
A preliminary first step is to expand existing services such as a monthly newsletter to the community, a speaker's bureau, and a dial-in telephone information center. The emphasis of the education should be progressively shifted toward self-care and disease prevention. Hospital personnel can be made available to go out into the community, for instance to teach CPR to service clubs and basic health science to school children.
A more ambitious project is the establishment of a community resource center, with books, articles and audio-visual materials about all manner of health problems and the many ways they can be dealt with. The Planetree organization, a nonprofit consumer-based health alliance, has an excellent track record of fostering such centers. A sterling example is the Planetree Health Resource Center of Mid-Columbia Medical Center, located in a Victorian house downtown in The Dalles, Oregon.
These can take various forms, but the basic requirement is to have trained professional staff, such as nurse practitioners, dieticians and physician assistants, available to counsel mainly healthy individuals on health-related issues. The scope of a wellness program might include weight management, exercise programs, sports nutrition, cholesterol control, smoking cessation, stress reduction, and classes on preparing natural foods.
The program generates both good will and revenue, the latter arising through services (including those of other hospital departments, e.g. cholesterol screening) and the sale of products (mainly nutritional supplements). Some progressive-marketing companies have begun pitching their products to doctors, recognizing the potential market. Interior Design Nutrilionals, for example, sells a half dozen nutritional "systems" that come with educational videos and booklets to meet most common needs. This sort of product is easy to integrate into a wellness program.
I much prefer this term to "alternative medicine," which implies fragmentation of medicine and an either/or choice. Complementarity implies fitting together and working in harmony, and that's what the best complementary medicine does: it adds to, and extends, the capabilities of a medical practitioner, rather than competing for patients. (This is an important point to emphasize when selling a complementary medicine program to the hospital's staff doctors.)
Complementary medicine is not the same as a wellness program; rather, it is treatment for people who have lost their wellness. It comes in various forms: naturopathy, chiropractic, acupuncture, herbalism, homeopathy, ayurvedic medicine, mind-body medicine, and more. Nearly all of these systems are labor-intensive, Marcus Welby style.
My personal involvement for the past 20 years has been with orthomolecular medicine, a discipline that rests on the same scientific principles as "mainstream" medicine. It embodies the idea of using biochemical substances normal to the body, in optimal amounts, for treating and preventing disease. it assumes that most diseases arise from inherited and acquired imbalances in the body's chemistry.
A complementary-medicine program requires the services of licensed professionals, preferably from more than one discipline. Properly structured, it can be a resource to community doctors both for referrals and as a way to help "problem patients" who haven't gotten well with conventional techniques.
A complementary-medicine program can more fully utilize laboratory services (which are quite an important part of the orthomolecular approach). It can generate income for the hospital pharmacy through prescriptions of nutrient substances, herbs, biologicals, and intravenous solutions, such as those used in chelation therapy . It can extend the scope and capabilities of the dietary department in new ways.
The Time Is Now
When I first started practicing nutritional and metabolic medicine, there wasn't much interest in it. You rarely found healthy food in the supermarket, back then. My colleagues were suspicious of me, too, and they didn't like vitamins much. For two years, as a member of the Pharmacy, Dietary and Lab Committee of our local hospital, I tried without avail to get a nutrition support service established. (Then the JCAH mandated it and they had to get one.)
Things are different now. Whole grains and organic foods abound, and food products are labelled with nutrition information. Even the fast-food chains tell you what's in their burgers. Doctors are popping vitamins and telling their patients to take them, too. People are actively trying to control coronary risk factors instead of just assuming that "cholesterol happens."
Hospitals have been losing revenues and market share because of the industrialization of modern medicine. They might do well to look beyond the conventional medical paradigm that has supported them, and explore other approaches to healing-- approaches that an aware and restless public is increasingly seeking out.
Website Design, Hosting and Maintenance by User-Friendly Computing
505 River Street, Santa Cruz, CA 95060 • Tel: (831) 423-9653
Copyright (C) 2008. All Rights Reserved.