Integration or bust

Variations on the theme of medical crisis are reported persistently in the media: hospital waiting lists get longer; fewer psychiatric beds; life expectancy to decline due to obesity; more medication-related hospitalisations; more preventable deaths in hospital due to factors like medical error and overcrowding; hours worked by doctors unsustainable; one in four facing heart disease by 2051; spending on health 9.5 per cent of GDP and growing fast.

If no news is good news, medicine and the health system must be in dire straits.

The problem is real. There are too many patients, not enough beds, doctors or money. And the boomer bulge promises more chronic degenerative illness - that’s the type that’s hard to deal with, and expensive. It’s a bleak prospect.

Calls for more funding have been an inevitable response, but they miss the point, when the most efficient long-term solution must be to reduce demand. Other mooted solutions, like the use of nurse practitioners, promise to lighten the load on doctors, but still don’t go to the root of the problem.

One certain way to reduce demand on the medical system is still not being taken seriously enough: a shift towards a holistic, preventative model of integrative medicine (a coming together of conventional (or allopathic) medicine and complementary and alternative medicine (CAM).

Dr Marc Cohen, founding head of Complementary Medicine at RMIT and president of the AIMA (Australasian Integrative Medicine Association) says there is an “imperative for collaboration” between medical and CAM practitioners because of the improvement in patient care that it promises.

But there’s an economic imperative too. Proponents of integration see the current medical crisis as an inevitable product of the view that disease is best fought by (costly) technology. Modern medicine is not sustainable in the long term because it’s too expensive.

Many (some say most) patients visiting doctors don’t actually need allopathic medicine. They could be helped with much less expense.

In one example, the government spends hundreds of million dollars a year subsidising pharmaceutical treatments for osteoarthritis. But a recent large randomised controlled trial in the US found that acupuncture can be more effective. So can glucosomine, a cheaper natural substance.

Crucially, such remedies are less risky. Last year Vioxx, one of the top ten PBS (Pharmaceutical Benefits Scheme) drugs, was withdrawn after it was linked to thousands of heart attacks and deaths. In August last year a jury in the US awarded huge damages against the manufacturer, Merck, for one of those deaths. And a further 4,000 suits have been filed in the US alone.

The public attitude to the big pharmaceutical companies is changing. Consumers are starting to ask why they are paying so much for treatments that are more dangerous and often less effective. Specifically under attack are companies, like Merck, which have kept the lid on information about the risks associated with drugs. There’s a growing realisation that profit-making has been the priority, even at the expense of scientific review.

But still, there’s resistance from doctors to letting non-medical treatments in. Integration proponents have popular opinion on their side. For example, on the cover of Time magazine only last month was Dr Andrew Weil, US pioneer of integrative medicine and one of the country’s most popular and influential medical doctors. However integration proponents are still regarded at best as “alternative”, at worst as quacks, by diehards in the medical establishment.