here are two great neglected areas in the treatment and prevention of disease: lifestyle changes and so-called complementary medicine. Lifestyle changes involve using diet, exercise, stress control and the like to treat and prevent disease. Unfortunately, too many doctors are too busy prescribing drugs and surgeries when lifestyle changes might be even more effective and safer.
The other neglected area is sometimes called alternative medicine, but now the preferred term is complementary medicine: treatments used in addition to conventional medicine such as acupuncture and spinal manipulation. It is intended to complement conventional medicine rather than being an alternative.
As most of the health care delivery system is on the medication/surgery merry-go-round, some doctors neglect or ignore altogether lifestyle treatment and complementary medicine. The neglect is so great that it is difficult to get good information, especially on complementary medicine.
One of the leaders in the use of complementary medicine is the Mayo Clinic College of Medicine, universally considered to be at the top of medical rankings.
I've written about a book Mayo published on the subject and was delighted to find an article (Bottom Line Health, August 2007) in which the director of research at the Complementary and Integrative Medicine Program of Mayo, Dr. Amit Sood, sets out the top complementary treatments and their supporting research.
Mayo uses four criteria in recommending complementary medicine treatments.
1. Safety. If the treatment is safe, it will sometimes be recommended even lacking ideal evidence of effectiveness on the theory that it won't hurt to try - it might help and it won't hurt.
2. Standardization. Dietary supplements is an area of virtually no regulation and no product standardization. You often can't be sure if you are getting what is on the label. To be on the safe side, Mayo recommends working with a knowledgeable doctor in using these supplements.
3. A need that conventional medicine can't meet. Consider the options when treating stress. You can use a long list of medications, many with serious side effects and some with hazardous ones. So it makes sense to consider options such as meditation, massage and yoga to escape the side effects of medicine. It should be noted that almost any treatment could pose danger in the hands of an unqualified practitioner.
4. Does it help patients and others as well? Mayo notes that treatments such as music therapy and meditation help not only patients but all the people with whom they interact. In my view, you could say that about all the therapies. If you improve a patient's health, then you're probably improving his relationships with everyone he has contact with.
Here are Mayo's top 10:
1. Acupuncture. Most people have probably seen acupuncture in action, with thin needles being inserted into what are thought to be "strategic, energy-balancing points of the body." Acupuncture is an ancient art practiced by the Chinese, one that now has a significant foothold in the U.S.
According to Mayo, "acupuncture can prevent and treat nausea and vomiting and help relieve many types of pain, including that from osteoarthritis, low back pain, neck pain, headaches and postsurgical pain." Patients are ordinarily given one or two treatments a week, up to a total of 12 treatments.
The most important evidence involved a German study of 3,000 patients with hip or knee osteoarthritis. It found that those receiving acupuncture had more pain relief than those who did not.
2. Guided imagery. Also called visualization, this treatment involves imagining a soothing environment, such as a beautiful warm beach or blue and sunny skies. According to Mayo, guided imagery "helps reduce anxiety in patients who become claustrophobic during magnetic resonance imaging (MRI) scans, who are having outpatient surgery without general anesthesia or who have been diagnosed with a life-threatening disease, such as cancer."
A study at the University of Akron found that women receiving radiation therapy who listened to guided imagery tapes once a day were more comfortable and less anxious compared to those who did not.
3. Hypnosis. The patient can be put into a state of deep relaxation or focused attention by a hypnotherapist or an instructional audio (self-hypnosis). Then verbal suggestions are made to relieve anxiety, pain, tension headaches and insomnia.
The doctors at Mount Sinai School of Medicine in New York City looked at 20 studies. In 80 percent of the cases, patients who were hypnotized had less pain, used less pain medication and recovered faster.
4. Massage. Massage of the skin, muscles and tendons with fingertips, hands and fists has been used to treat lower back pain and improve postsurgical healing.
Studies conducted at the University of Miami's Touch Research Institute found that massage can relieve back pain and strengthen the immune system in women treated for breast cancer. It does so by increasing levels of disease fighting cells.
5. Meditation. Meditation focuses on breathing and on a word such as "peace," "love" or "life." The word, repeated with each breath, is called the mantra. Mayo has used meditation to treat anxiety and high blood pressure and to help people quit smoking without medication.
An analysis of 20 studies found that meditation helped patients cope with epilepsy, premenstrual syndrome, menopausal symptoms, autoimmune disease and anxiety during cancer treatment.
6. Music therapy. This has become one of the most popular forms of complementary therapy. For some reason, this is the first time Mayo suggests you can use one of these therapies "on your own." I would think most could be used on your own, just as easily and just as obviously. Take guided imagery and meditation as two examples.
At Abbott Northwestern Hospital in Minneapolis, a study found that patients recovering from heart surgery who received music therapy experienced less anxiety and pain.
7. Spinal manipulation. This therapy is usually associated with chiropractors, but it is also practiced by osteopaths and physical therapists. Mayo writes, "Spinal manipulation is an accepted medical practice for low back pain, but the evidence supporting its use for other medical problems has been somewhat conflicting."
The UCLA School of Public Health did a study that found chiropractic care as effective as medical care, including painkilling drugs, in relieving discomfort.
8. Spirituality. This treatment is given a broad definition that includes prayer, faith in a higher being, deep appreciation of nature or art or even participation in a secular community.
In 16 studies of religious intervention (praying and attending religious services), researchers in Virginia found that "spirituality can decrease the length of hospital stays and fever in patients with severe infections ... increase immune function ... help relieve rheumatoid arthritis symptoms ... reduce anxiety ... and improve outcomes in people with heart disease."
9. Tai chi. This is a gentle exercise that is derived from Chinese martial arts. It involves a series of postures and movements performed slowly and gracefully. It is recommended to improve balance in older people to prevent their falling.
A study conducted in the Netherlands found those who practiced tai chi had 50 percent fewer falls and fewer injury-causing falls than those who did not.
10. Yoga. This involves stretching and breathing exercises derived from India. It is said to help body and mind. It is especially effective for stress relief, lower back pain, carpal tunnel syndrome, osteoarthritis, anxiety and depression.
A study out of New Delhi, India, found that 98 people with heart disease and diabetes who practiced yoga breathing techniques and postures had significant improvement in total cholesterol and blood sugar.
I found it remarkable that not a single food or dietary supplement made the top ten list of Mayo. Perhaps they involve matters too mundane for the doctors, who have always had an allergy to recommending good diet, good nutrition and related therapy. For starters, Mayo might have included some of the spices and herbs useful in treating and preventing disease such as cinnamon (lowers blood sugar in type 2 diabetes) and fennel seed (relieves GI cramping). These healing herbs and spices will be the subject of a future column.
Herb Denenberg, a former Pennsylvania insurance commissioner and professor at the Wharton School, is a longtime Philadelphia journalist and consumer advocate. He is also a member of the National?Academy of Arts and Sciences. His column appears daily in The Bulletin. You can reach him at advocate@thebulletin.us.
?The Evening Bulletin 2007
