Mehmet Oz, MD

Newark, Delaware

The rapid rise of visibility of complementary (also called alternative, integrative or unconventional) medicine over the past decade is an understandable response to the evolution of biomedicine in this country. At the turn of the last century, medicine was a poorly regulated enterprise with medical education often provided by diploma mill medical schools followed by a brief period of preceptorship with clinicians of variable quality. The trainee was unleashed on society and took with him/her many of the biases and shortcomings of his limited education. The same misconceptions regarding patient care were propagated between generations with this system and organized efforts to improve the quality of provided care were thwarted by the for-profit nature of many schools and the lack of scientific underpinnings in many of the endeavors.

In this environment, attempts to license providers of healthcare centered on state medical society certification and/or graduation from an approved medical school. Often these regulatory mechanisms failed, especially since the quality of a medical school education was variable. The release of the Flexner report (1) by the Carnegie Foundation in 1910 condemned the existing educational system for physicians and resulted in the closure of many second-tier facilities. By the end of the first World War, every remaining medical school had partnered with a university. This merging of allopathic medicine into science departments around the country resulted in rapid standardization of the educational process and facilitated the expeditious maturation of biomedicine.

More importantly, especially in the public’s eye, conventional medicine benefited from this close affiliation with science by continually working wonders. Antibodies were developed that reproducibly killed bacteria with predictable reversal of infectious ailments. Even when resistant strains appeared, newer antibiotics appeared to meet the challenge. Mechanical support of the heart was developed in a consortium between physicians and bioengineers. Medicine cured polio, eradicated small pox and became able to keep 22-week-old fetuses alive.

The continued progress of biomedicine made alternative approaches appear limited and representative of the work of charlatans. But, these advances cam at a price. With standardization, we also flirted with stagnation. Allopathic practitioners understandable felt an intellectual superiority over healers who had not passed the gauntlet of medical school acceptance or residency. Alternative paradigms explaining bodily function and disease treatment were understood to reflect the attempts of primitive societies to grapple with the complexities of the body, which we are now able to understand with modern biomedicine. In particular, the organ-based approach to healing focused on the culprit disease within an ailment. Physicians specialized in a particular organ or system, and few were interested in the less-lucrative and often less intelliecutally challenging generalist practice.

As the baton was passed to newer generations of physicians, the model of the body composed of independent organs that were interrelated but could by studied independent of each other and the mind became accepted. Confidence that science-based medicine would continue to close the loopholes in our understanding of the human body allowed us to ignore alternative approaches since they would be at best redundant and more likely misleading when the real truth was finally uncovered. Yet, as biomedicine improved, the complexities of the human body, and our limitations in fully comprehending subtleties of its function became clearer. We could understand how the eye detects shapes, light and movement; but how do we recognize that the figure detected is your grandmother? Patients and physicians hoped that biomedicine would provide a rational and comprehensive system of understanding the body, but despite the magnificent advances, we are still far from a comprehensive paradigm. More importantly, a clearer understanding of disease processes, such a myocardial infarctions, forced us to address the pathophysiology rather than solely the anatomy of disease. In this transition, the impact of the mind on bodily functions became clearer, and a rationale for addressing these sometime "nonscientific" approaches became more defensible.

In fact, busy clinicians have long realized that the model of organ-based biomedicine is limited. After completing the intense boot camp of medical school, many of us realized that patients often had not read the same texts as we had during our basic medical school education, and we were presented with symptom complexes which did not fit neatly into our pathophysiology textbooks. The art of medical practice, as opposed to the scientific understanding of biochemical phenomenon governing bodily processes, mandates that we remember that our medical school education was based on a model of how the body functions independently of the mind. We have to learn to integrate the patient’s will into the healing process if we are going to mature from trouble-shooting medical technicians to healers.

Accelerating this increasing interest of physicians in complementary medicine is the public’s embrace of many of these practices, with an estimated $27 billion being spent out of pocket for these therapies in 1997 (2). Surveys of patients admitted to our cardiothoracic healthcare system have already made forays into complementary medicine (3). Attempts to integrate complementary medicine into the western healthcare system have been slowed by difficulties in study design, logistical constraints on implementation of modalities in a hospital setting and a language and philosophical barrier between practitioners in the two camps.

We have made progress sorting through the three aforementioned obstacles by assessing as precisely as possible the effects of complementary medicine using hypnosis (4), audiotapes (5), massage, energy therapies and guided imagery as initial models (6). End points include heart rate variability, quality of life assays, acousticly evoked potentials, pain scales and pain medication utilization, exercise studies and basic science research. These efforts have been facilitated by the creation of a dedicated center with an administration and outreach effort dedicated to the process.

Treatments are chosen on the basis of their applicability to this population and on the promise of clinical efficacy based on prior pilot experience. Although each modality can be offered in multiple variations, we have standardized protocols in order to achieve a reproducible effect that can be studied prospectively with the hope of statistical validity. Nevertheless, the advance of complementary medicine research is hindered by the lack of an adequate financial infrastructure (7), making the adoption of this effort by conventional medicine imperative.