Ian Gawler Blog: Key medical terms - What is in a name?

When I began one of the world's first cancer self help groups in 1981, what I was doing was often described as "Alternative Medicine". Back in those early days, this seemed fair enough.

What I was teaching was new and it was different to what the mainstream doctors were doing. However, it was not meant to involve a choice as in "do one alternative or the other; do the medical stuff or the self help stuff". It was just different.

But then things began too shift. Somehow, some key people in mainstream medicine decided there was a conflict between what the doctors could do for people with cancer and what those people could do for themselves. Perhaps they were worried people would make the choice to not go with the medical stuff.

Whatever the thinking, instead of seeking to combine the best of what the doctors could do with the best of what the patients could do for themselves, they adopted a combative, exclusive view. They began to strongly express that when it came to recovery from cancer, the only hope lay in what the medical system could do for its patients. The self help options were denigrated.

While this always struck me as a weird and most unfortunate misunderstanding, it sadly led to what some now interpret as a very unhelpful turf war, initiated by those same medical authorities. To be clear about this, I have done all possible to avoid such a conflict. I have maintained constantly since 1981 that in my view the best results for people with cancer will always be achieved by a collaborative approach that combines the best of what is available. However, it is also true that I regard the contribution of the patient, their families and friends as crucial and I have no doubt that frequently this combined contribution has made the difference between life and death.

One way that the self help movement was put down was to brand the word "alternative" as a pejorative. That means "alternative" become a term of medical derision, and all too frequently it is still used as such. The way the word "Alternative" is used these days, it  smacks of quackery and danger.

To attempt to brand people working hard to help themselves as being involved in "quack alternatives" is clearly very unhelpful. In my view it is actually irresponsible as well as being an extremely inaccurate way to describe what I advocate and teach.

In response to all this, more balanced doctors and self help advocates use far more constructive terminology. So we have moved on to "Holistic Medicine", "Complementary Medicine" and "Integrative Medicine". Currently, the best and most accurate way to describe what I advocate and teach - the self help approach - is "Lifestyle Medicine".

However, it seems to me we are now in a position where all of these medical words tend to be bandied about a bit recklessly - in the media, amongst the professions and privately. So this week it seems useful to clarify the definitions. But first

Thought for the day
A joyful heart is good medicine
But a broken spirit dries up the bones
              Proverbs 17:22









1. MEDICAL DEFINITIONS
Currently there are many terms used to describe different ways of offering healing and wellbeing: Conventional Medicine, Traditional Medicine, Complementary and Alternative Medicine, Lifestyle Factors and so on. Often these words are used in a loose way that can be confusing.

What follows is an attempt to draw together the best and most widely accepted working definitions for these different modalities. The hope in that this may bring more understanding and help with the words being used more accurately and more clearly.

1. Orthodox or Conventional Medicine and/or therapies1
Orthodox or conventional medicine generally describes medical interventions taught at medical schools, generally provided at hospitals, and meeting the requirement of peer accepted mainstream medicine and standards of care.

2. Evidence Based Medicine2
The conscientious and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. By individual clinical expertise is meant the proficiency and judgement that individual clinicians acquire through clinical experience and clinical practice.

3. Allopathic Medicine3
The system of medical practice that treats disease by the use of remedies that produce effects different from those produced by the disease under treatment.

The term ‘allopathy’ was coined in 1842 by CFS Hahnemann to designate the usual practice of medicine (allopathy) as opposed to homeopathy, the system of therapy that he founded based on the concept that disease can be treated with drugs (in minute doses) thought capable of producing the same symptoms in healthy people as the disease itself.

4. Integrative Medicine4
The blending of conventional and natural/complementary medicines and/or therapies with the aim of using the most appropriate of either or both modalities to care for the patient as a whole.

Integrative Medicine considers the person’s body, emotions, mind and spirit. Integrative Medicine is open to integrating the services of a wide range of health practitioners and modalities in a way that is often described as Holistic Medicine.

5. Holistic Medicine and/or therapies5
These combine complementary and conventional approaches that support the physical, social, psychological, emotional and spiritual wellbeing to help achieve optimal health. The holistic or health model looks at maximising or supporting all aspects of a person’s health that may lead to the disease being healed by the body. Health promoting and lifestyle advice, such as advice in dietary changes, stress management, exercise, and the environment, are integral to holistic medicine.

6. Lifestyle Medicine6

The application of environmental, behavioural, medical and motivation principles to the
management of lifestyle related health problems in the clinical setting.

7. Lifestyle Factors7
These come under the umbrella of Integrative Medicine and are concerned with what a person can do for themselves in the context of their daily life. Lifestyle factors contrast with complementary therapies which better describe a therapy provided by a therapist, or a compound taken by the patient. (eg. Supplements/herbs)

Lifestyle factors or therapies include physical factors such as nutrition (food/juices), exercise, exposure to sunlight and creative activities.

They also utilize Mind-Body Interventions which can include psychosocial activities, group therapy, mind training (positive thinking, affirmation, imagery etc), meditation, Yoga, Chi Gong, Tai Chi, healthy emotions: (relationships, communication, laughter, forgiveness, etc) personal development and transformation.

Lifestyle factors also encompass spiritual pursuits such as exploring meaning and purpose in life, prayer, spiritual healing, religious practice and spiritual development.

8. Complementary & Alternative Medicine8
In the United States, the National Centre for Complementary and Alternative Medicine (NCCAM), defines CAM as a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine, as defined by our medical peers.

Unlike in America, in Australia, Complementary Medicine and Alternative Medicine tend to be spoken of quite separately.

9. Complementary Medicine9
Any therapeutic practice that does not satisfy the standards of the majority of the orthodox medical community in Australia, that is not taught widely at Australian medical schools and that is not generally available at Australian hospitals.

According to Dr Vicki Kotsirilos10 this definition varies cross culturally with more medical schools – both in Australia and overseas – offering courses in complementary medicine.

Dr Kotsirilos goes on to say that the diversity of these therapies makes them difficult to categorise as a group, yet they are often collectively referred to as ‘complementary’, ‘alternative’, ‘integrative’, ‘unorthodox’, ‘unconventional’, ‘unproven’, ‘natural’, ‘traditional’ and ‘holistic’ medicine, and are contrasted with ‘conventional’, ‘mainstream’, ‘allopathic’, ‘orthodox’, ‘conventional’ and ‘scientific’ medicine.

According to the NCCAM, CAM can be grouped as:

i. Alternative Medical Systems: include naturopathy, Traditional Chinese Medicine, Ayurveda and homeopathy.

ii. Mind-Body Interventions: include patient support groups, cognitive-behavioural therapy, meditation, prayer, mental healing, and therapies that use creative outlets such as art, music, or dance.

iii. Biologically Based Therapies: include herbs, foods, vitamins, minerals, and dietary supplements.

iv. Manipulative and Body-Based methods: include therapeutic massage, shiatsu, chiropractic, and osteopathy.

v. Energy Therapies: include acupuncture, therapeutic touch, reiki, Chi Gong, electromagnetic fields, magnetic fields, kinesiology.

10. Alternative Medicine11
Alternative medicine has two aspects:
i) Proven Alternative Medicine which includes alternative medical systems such as Traditional Chinese Medicine and Ayurveda. These alternative medical systems represent a different paradigm of health care when compared to Conventional Western Medicine.

ii) Unproven Alternative Medicine – sometimes described as Unorthodox or Unconventional or Unproven Medicine and or therapies. This generally describes medical interventions that are not widely taught at medical school, not generally provided at hospitals, and are outside peer accepted mainstream medicine and standards of care. Examples include aromatherapy, intravenous chelation and ozone therapy.

11. Traditional Medicine or therapies12
Well documented or otherwise established medicine or therapies according to the accumulated experience of many traditional health care practitioners over an extended period of time.

The Therapeutic Goods Administration (TGA) provides a specific definition: ‘traditional use refers to documentary evidence that a substance has been used over three or more generations of recorded use for a specific health related or medicinal purpose’.
Traditional therapies include traditional Chinese medicine, traditional Ayurvedic medicine, western herbal medicine, homeopathic medicine, indigenous medicines, and aromatherapy.

12. Natural Medicine or therapies13
Substances or therapies that work with the natural processes of the body by restoring or correcting organic functions; or modifying organic functions such as modifying those functions in a manner that maintains or promotes health. They generally support the body’s healing mechanisms rather than taking over the body’s processes.
Examples of pharmaceutical medication originally derived from natural medicine include digitalis from the herb foxglove (Digitalis purpurea), and asprin(salicylate) from willowbark (Salix alba), which contains that active ingredient salicin.

COMMENT
Using these definitions, Integrative Medicine can be understood as an umbrella term which includes current Western Orthodox Medicine and Complementary Medicine. Alternative Medicine is posed as a choice to Conventional Western Medicine. This may be a well founded, proven alternative therapy such as whether to use Western Medicine or Traditional Chinese Medicine to treat a specific condition (where two quite different approaches are established as having good results) via different and therefore alternative methodologies; or an unproven alternative therapy such as using shark cartilage to treat primary cancer.

2. THE AIM OF TREATMENT 
Curative Treatment14
Aims to render the person clinically free of detectable cancer and to restore the person to their normal life expectancy.

Palliative Treatment15
Palliative care is an umbrella term for assisting those approaching death. It is a fundamental need and right. This term is generally used in the context that death is imminent and inevitable; and the application of palliative care aims to make dying as easy and comfortable as possible.

Palliative treatment is non curative by definition. It aims to extend life, eg. increase survival time, ameliorate symptoms, and increase quality of life.

REFERENCES
1. Medical Benefits Schedule, Item Statistics reports

2. Sackett DLR, Rosenberg WM. Gray JA, Haynes RB, Richardson WS. Evidence based
medicine: what it is and what it isn’t. BMJ 1996;312:71-2.

3. Webster’s New World Medical Dictionary

4. The RACGP-AIMA position paper on Complementary Medicine, available on www.racgp.org.au/advocacy/position-statements

5. Kotsirilos V Complementary Alternative Medicine AFP 2005;34: 1-3

6. Egges G North Ryde:McGraw Hill (2008) Lifestyle Medicine.

7. Gawler I.J. 2009 Presented at RACGP Annual Conference 2006.

8. National Center for Complementary and Alternative Medicine, National Institutes of Health,
Bethesda, Maryland 20892 USA. Available at: www.nccam.nih.gov

9. Easthope G Alternative, complementary, or integrative? Complement Ther Med 2003: 11:2-3C
10 Kotsirilos V. – ibid

11.Gawler I.J ibid

12.Therapeutic Goods Administration. Levels and kinds of evidence to support indication and
claims for non-registrable medicines including complementary medicines and other listable
medicines. TGA, October 2001

13.Kotsirilos V. – ibid.

14. Caociato DA. Manual of Clinical Oncology 5th Ed 2004
15.Gawler IJ ibid


Other Useful References:
1. Kotsirilos V. Complementary & Alternative Medicine – Part 2 AFP 2005; 34:689-691

2. Kotsirilos V. GP’s Attitude toward Complementary Medicine AFP 2007: 36: 1-2

3. Complementary Medicines Information Use and Needs of Health Professionals: General
Practitioners and Pharmacists December 2008 – National Prescribing Service Ltd.
4. Model guidelines for the use of complementary and alternative therapies in medical
practice. A Policy Document of the Federation of State Medical Boards of the United States. Dallas: Federation of State Medical Boards of the United States, Inc. 2002.
5. Marc S. Micozzi. Fundamentals of Complementary and Alternative Medicine. Churchill Livingstone Inc. 1996.

RESOURCES
1. Refer to my website where there is more related research and suggestions on how to manage a cancer diagnosis.

2. My book: You Can Conquer Cancer

3. My CDs (also available as downloads)
The Gawler Cancer Program
What to do when someone you love has cancer

RELATED BLOGS
The Cancer Council, the survivors and the book

Recovery from cancer is possible

NOTICEBOARD
Ruth and I will be presenting a range of public talks, workshops and retreats around New Zealand in November/December.

We start with an evening Public Talk in Auckland on Thursday November 14th (which will be followed up by a weekend in Auckland on November 30th and December 1st), then there are a range of other events.

We are delighted to be including our first meditation retreat in New Zealand (which quite a few Aussies have also booked for already!) - December 2 -8.

Please do let anyone you may know in NZ about the visit - a link to last week's blog gives all the details - Colour therapy and New Zealand - or go to my new public Facebook page: Dr Ian Gawler, or the website. So much technology!!!