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Developing a Sustainable and Functional Medical System

If we truly want to develop a sustainable and functional medical system in this country, we are going to need to redefine what constitutes evidence. We need to open our minds and expand out of the box we have sealed ourselves into.
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The "status quo" has never been the driver of progress. Progress only comes through the work of visionaries, of pioneers who are not afraid to step outside of the "status quo" so that society can benefit from expanding knowledge in new and more efficient ways. It's interesting, though, that pioneers always seem to take a lot of heat from those who have a vested interest in keeping the status quo for their own selfish interests. Those who attack and offend pioneers are thorns in the side of progress. Fortunately, visionaries and pioneers are not the type of people who are easily thwarted. They are not the type of people who can easily be prevented from following their dreams, their visions and their passions.

Those who wish to keep the status quo often go on the offense and wage a war of intimidation, legal wrangling and economics against those who they feel jeopardize their coveted status quo.

In essence, this is what has happened to medicine in this country. There are many doctors out there working hard to improve the care of their patients and improve the health of their patients. But there are those out there who have a vested interest in keeping the status quo. Who, might you ask, would want to keep things as they are and interfere with progress in this direction? The answer to this is obvious, but not simply overcome by the obvious.

For starters, we have the pharmaceutical industry. Their vested interest is in selling drugs. Drugs are needed by those who are sick, not those who are well. So drug companies do not have much to gain if our health care paradigm became more health optimization-oriented and less symptom management-oriented. I am referencing the millions of patients who are suffering with lifestyle diseases that require chronic drug therapy. I am not referencing those patients whose lives are being saved by drugs. This is not an anti-drug tirade on my part. It is, however, a position paper with one issue being our over-dependence on drugs. If doctors were inclined to spend the time it takes to make a more mechanistic diagnosis (identifying the underlying causes of their patients' medical conditions), then far less people would be depending on drugs, and this would hit the drug industry in the pocketbook. So these very same drug companies work hard to sabotage integrative medicine, which is a paradigm of health care designed to optimize the health of the patient as naturally as possible.

How do they do this? By making "donations" to the Federation of State Medical Boards (FSMB), for one thing. It was reported by the Alliance for Natural Health that in mid-May:

"... the Senate Finance Committee launched an investigation into the close ties between pharmaceutical companies, the FSMB, and "nonprofit pain groups" like the American Pain Foundation. The foundation received 90 percent of its $5 million in funding in 2010 from the drug and medical device industry, and its guides for patients, journalists, and policymakers downplay the risks associated with opioid painkillers while exaggerating the benefits from the drugs" [...] "the US Centers for Disease Control and Prevention report that opioids were involved in 14,800 overdose deaths in 2008, more than cocaine and heroin combined. So much for 'safe use.'"

The report also says that recently:

"... two senators from the Finance Committee sent letters to the American Pain Foundation and four other pain non-profits, three drug companies, and the FSMB, expressing concern about their relationship with each other. Tuesday evening, the Foundation announced that it would 'cease to exist, effective immediately.' Coincidence?"

Clearly, if there are any ties at all, in any way, between drug companies and the FSMB, we no longer have a fairly functioning system. These state boards have prosecuted doctors and stripped some of them of their licenses simply because they were treating their patients holistically. Does this make sense? Should a doctor who has taken an oath to do no harm be prosecuted for doing just that?

Integrative doctors are not killing patients. They are working protocols that are helping many patients to improve their health, get off of drugs and live a more vital and successful life. The worst that happens for some patients is that they are not helped. Is that reason enough to prosecute? Please understand that I am speaking about responsibly-implemented medical protocols. I am not speaking about irresponsible medicine. For that, we can see both traditional and integrative doctors at fault. Those doctors aside, the paradigm of integrative medicine seeks to heal mechanisms rather than treat symptoms. This approach is a win/win for everyone who complies.

Next, we have the health insurance companies. They have a vested interest in keeping as much of their premium collections as is possible. To that end, they have limited their coverage to those treatment protocols that have "evidence" to support their use. What constitutes evidence? Evidence that is obtained from random controlled trials (RCTs) seems to be their preference. It is not coincidental that drugs are approved by the FDA based on RCTs and therefore, by definition, hold a high level of "evidence." It is also not coincidental that the least expensive form of "medical care" is drug therapy, not medical therapy. So insurance companies will not pay for many forms of natural medicine because there is no "evidence" and reject these therapies as "investigational/experimental" in nature. It is important to note that the FDA does not oversee RCTs on natural therapies and therefore the FDA cannot approve these therapies and therefore there is no "evidence" for their use.

The other issue here is that integrative medicine, because it deals with underlying mechanisms, is implemented as protocols that address numerous issues simultaneously. It is protocol-based medicine, not single agent (drug) medicine. So it is not possible to perform RCTs on protocols that may include dietary improvements, exercise programs, yoga and meditation, nutritional, herbal and/or homeopathic medicines, etc., because there can be no "placebo" group to prove the "evidence." However, it is anecdotal science at its best. If we are able to move a patient from illness to health, is that not evidence enough? Drug RCTs may imply "evidence-based medicine" to some, but we also know that every year in this country, more than 100,000 people die from appropriately-prescribed prescription drugs. What does this evidence tell us about our "evidence" model?

The beauty of integrative medicine is that it combines all the best of traditional medicine with the best of holistic medicine and seeks to create a medical paradigm based on salutogenesis (the optimization of health), so that whatever caused the patient to cross the morbidity threshold can be identified and corrected. If we insist on treating symptoms with medications, the patient will remain on the wrong side of the morbidity threshold and will surely develop other co-morbidities in time, requiring more "evidence-based" drug therapy.

If we truly want to develop a sustainable and functional medical system in this country, we are going to need to redefine what constitutes evidence. We need to open our minds and expand out of the box we have sealed ourselves into. We need to overcome those whose vested interest is in keeping the status quo and who sabotage progress by labeling it investigational/experimental.

For more by Dr. Robert A. Kornfeld, click here.

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