What prompted me to write this article was a repeated experience that I was having in practice... while questioning my patients during their intake, I would often find out that their primary concerns(s) began around the time that they started using a certain medication. And when I would look up the side effects of the medication, that the most common "side effects" of the medication would be exactly the exact same issues that they were coming in seeking help with. What I also noticed, to my dismay, is that these patients also did not respond well to acupuncture treatment, at least in a way that was lasting or making real headway with improving their chief complaint. I finally put the pieces together and realized that I could not out-acupuncture a pharmaceutical side effect. I'm just not that powerful.
This kind of pissed me off, because I know how amazing and potentially life changing acupuncture is, and I felt like my hands were tied. And it was especially disheartening knowing that often the patients I would see were prescribed medications for things that most likely would have been preventable or remedied another way, but the option wasn't investigated.
At this point, I should offer the obligatory note that my frustration arises from the grey areas of pharmaceutical intervention, medications prescribed for symptoms and conditions that can be safely addressed with alternatives in a way that supports the long-term health and vitality of the person. I'm not talking about the unavoidable side effects that are acceptable with necessary, life-saving pharmaceutical interventions for which there are no safe alternatives.
People are often left on medications seemingly forever because of the liability that can arise if a practitioner ventures out on a limb to take them off of them. This is just one of many reasons why we as Americans spend more money on healthcare than any country in the world, yet have some of the worst health outcomes, and most importantly in my opinion, a paucity of real health. And, by "real health" I mean an inherent vitality and resiliency of the body to respond to stressors and health challenges on its own or with minimal intervention.
Overcoming divisive health narratives
This is where it's important to note the difference between symptom management and health promotion... two entirely different things that are often conflated in our culture. Now, this isn't to say that natural medicine is good and pharmaceuticals are bad, but it is to say that in my opinion, pharmaceuticals should not be the first line of defense. I think there should be a hierarchy to interventions starting with the safest options that will likely result in long-term remediation of conditions.
That's why this is more of a "yes, and..." article, rather than a contrarian piece---we have enough divisive thinking in this country, another thing we collectively need to change. Often people think that pharmaceuticals are better because they are scientific and natural medicine is not. This is partially true, but there is also a ton of science at this point on natural medicine, and with respect to East Asian Medicine specifically (my scope), there are thousands of years of experiential knowledge and practice validating how it works and its effectiveness. Not all science is laboratories and petri dishes. For most of history good science has been observing things, watching what happens, and then testing the possible reasons to figure out what consistently works and what doesn't by process of elimination---this is the science of traditional medicine, even though it was never termed as such.
But natural medicine is not a panacea for everything. It works best for prevention and for promoting lasting health and vitality over the long term, not for emergencies or life-threatening situations. Measuring things like overall health and vitality over a long period of time is not something that our current scientific model supports, as there are typically too many variables, it takes too much time to do this type of research, and most importantly, there isn't much money in it, so there's no one to fund the research anyway. You can read more on the current problems with the culture of scientific research here from the perspective of some of the scientific research community itself. Personally, my undergraduate degree was in science and I grew up loving science (still do), but I'm also very aware of the limitations and current challenges.
I say these things knowing that people love to create dualistic narratives, it's ego enlivening and gets us all charged up on perceived righteousness and better-than-ness. However, this is the problem... in creating an "us versus them" mindset in healthcare, we have become really bad at knowing how to work together or how to address health in a truly cooperative way. And, while we glorify science, we are also really bad as humans at approaching things scientifically, which means looking at all of the data objectively, with as little bias as possible.
The little piece of paper
Relative to the content of this article, being a supporter of good science means taking a good hard look at that little piece of paper that comes along with any prescription medication. You know the one that often gets deposited directly into the trash, or that people read and then think that the long list of side effects listed on there are just things that happen to other people? That paper is the science, so if you love science, you should love that paper. You should be informed to be able to have the conversations with your physician to determine if your medication is truly necessary, how long you will need to take it, if there are risks with discontinuing its use, and if exploring an alternative treatment would be safe and advisable.
When side effects do come up as symptoms or conditions, the connection is rarely speculated. This is also because people assume that side effects are apparent right away, but this is not true; many side effects are insidious. Weight gain is one example (there are many others). So folks go back to see their medical doctor complaining of what is likely a side effect, and often the solution is another medication to address those symptoms, and this cycle repeats. I see people on upwards of six medications, and when I apply my critical thinking and reasoning skills to their presentation and timing, the dots are easily connected as to how one thing led to another. Sometimes the patients have connected the dots themselves, but feel helpless to find a way out or to initiate a conversation with their primary care provider. The most difficult aspect of all of this, is that there is absolutely no way to definitively determine if a symptom, or health condition, is independently emergent or the result of a "side effect." So, all any of us can do is look at the probability based on the presented facts and apply our critical thinking skills.
"Natural" is not always safe or better
Also, important to note is that "natural" remedies are not necessarily safe or innocuous either. That's why I went to graduate school for six years to learn how to use herbs and supplements naturally and safely. I had to get licensed with my state medical board and pass absolutely grueling board exams to be able to become a certified "woo-woo" practitioner (humor intended). So, when I see people self treating with natural medicines, such as herbs or supplements, without having really been trained in the nuances of using them, it concerns me. There is absolutely no question about the fact that there can be iatrogenic effects of natural medicines, some of which are very serious (i.e. liver failure). This is especially true if used for an extended length of time, used in combination with pharmaceutical medications, or more generally used without a real understanding of how they are working. There is a ton of misinformation on herbs and supplements available on the internet. I would go so far as to say that there is more misinformation than truth. So, even for my physician/PA/NP folks who are also Google searching for journal articles (often limited) or general information on herbs and/or supplements, please make friends with someone who has formal education in natural medicine. We would love to feel included and acknowledged for our area of expertise. Research data is limited, especially RCTs, and information online is presented in a way that is misleading, highly biased, or often with the conflict of interest inherent in trying to sell you something. There's no substitute for the wisdom earned through clinical experience.
Middle ground
As a practitioner, I try to be aware of my own biases and to take a middle ground with people in the recognition that there are absolutely cases where long-term pharmaceutical use is life saving and necessary. But, there are also a lot of health conditions that would be better addressed early with prevention or through another route, so that the need for pharmaceuticals is avoided. It's a difficult conversation to have because the tendency is to throw out the baby with the bathwater---to think that one school of thought is preeminent or always better in any given situation. Physicians are reluctant to talk about these things, as they want to make the patient happy, and our culture loves quick fix solutions, so mediating the patient's symptoms quickly makes them happy. Win-win right? Well, unfortunately the idea of the quick fix is most often an illusion; there are often downsides. Some of the downsides are not overt, yet they can have long-term negative impacts to health that can lead to other more serious conditions requiring more serious interventions over time. This is why it's really importance to discern and illuminate the difference between the suppression of symptoms and the proliferation of health. And, that's the difference that I really wanted to drive home with this article.
For more info, check out this related article in US News.
With sincerity,
Ev
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