The case for acupuncture and integrative health
It’s not all that long ago that the health treatment choices available to us were more or less binary: you either opted to go the conventional clinical medicine route, or you took the road less travelled and decided on alternative or complementary medicine.
Even if you elected to receive both conventional and alternative/complementary care, your treatment was likely to be delivered in isolation.
Clinical health practitioners had no great interest in collaborating with their counterparts in alternative treatments, and so your care existed on parallel yet separate paths – both working toward the same end (prevention or cure) but each largely uninformed by the other.
Whether that was down to ignorance, snobbery or the mixture of the two, who knows? But it’s fair to say that even two decades ago the world was a less enlightened place with regard to treatment that fell outside the sphere of the conventional.
Words like ‘alternative’, though accurate in the context of medical treatment, didn’t exactly help, either. In medical terms it indicated a different choice; but it is a word that carries other connotations that are, or were, less desirable, and so alternative medicine became dogged by misplaced perceptions.
Perhaps inevitably, this became a brush that to some extent also tarred complementary medicine. There is a tendency – and certainly has been a tendency in the past – to lump alternative and conventional medicine together and see them as the same thing.
Yet they are fundamentally different both in approach and philosophy.
Complementary medicine, such as acupuncture, can – and very often does – work as a standalone treatment (acupuncture, for example, is often used in isolation for pain management).
But crucially, in the context of integrated and integrative health, it is also highly effective when used to support the work of clinical practitioners.
Quite simply, alternative medicine plays no complementary role in healthcare. It is specifically designed to act as a standalone approach to health management – meaning that patients either choose alternative treatment or conventional clinical treatment, but not both at the same time.
However, I believe there are two fundamental flaws in the standard approach to health management that prevent typical care strategies from being truly effective on their own:
The first is that although lifestyle choices inform diagnoses and are often integral to cure and recovery – for example, obesity is a factor in cardiovascular conditions and weight loss and exercise contribute to better long-term outcomes in heart health – they are often not a core consideration in an overarching strategy to treatment.
Consider neck or back pain as an example. In clinical medicine a patient presenting with general musculoskeletal pain that is not indicative of a more serious underlying condition is most likely to be prescribed painkillers or anti-inflammatory medication and told to come back if there’s no improvement. In more acute cases, they may be referred for out-patient physiotherapy.
The first-call treatment in this case is designed to reduce or eliminate pain and/or inflammation. This may lead to cure – reducing inflammation, for example, can allow damaged ligaments, muscles and tendons to repair; but it doesn’t necessarily take account of cause.
Perhaps the patient spends their day hunched over a computer screen, sitting in a poorly-designed chair; maybe their work involves regularly contorting themselves into unnatural positions (e.g. a plumber or electrician); maybe they do a lot of manual lifting; or perhaps they play sport with a poor technique.
This is information that is often not explored at a GP consultation, and so the advice that is given on lifestyle changes that may facilitate long-term recovery is often found wanting.
None of which is to suggest that GPs – or any other health practitioners – are less than professional or competent. It is merely the case that our health system is not resourced well enough to allow extended diagnosis.
The second flaw is that clinical medicine is geared to treat symptoms and does not take an holistic view of individual health.
Acupuncture recognises that patients are often unaware that the symptoms they experience may be related to a condition that is present in a different part of the body. Headaches, for example, may be an indicator of high blood pressure, musculoskeletal issues or an intolerance to food or the environment.
Therefore, acupuncture treats the whole body in order to resolve underlying issues. In doing that, acupuncture also treats and mitigates the presenting symptom, but with a better likelihood of a positive long-term outcome.
I am a big advocate of integrative health (this is different to integrative medicine, and I’ll deal with that distinction in a moment) and that means I believe there are three key elements in effective healthcare management that are equally important and which all need to be part of any comprehensive treatment or care strategy.
It’s also important here to understand the difference between integrative and integrated care. Though many people use these terms interchangeably, I believe they are fundamentally different.
In my view, integrated care recognises that non-conventional treatment has a part to play in an individual’s health and utilises that resource if it’s in the best interests of the patient. In other words, if you have musculoskeletal pain, a GP might refer you to an acupuncturist or physiotherapist as a first step before prescribing analgesia.
Integrative health, however, recognises that the three core elements of healthcare – complementary medicine, alternative and/or conventional medicine, and self-care – must play a collaborative role in order to provide holistic support.
Only when each of these elements forms a fundamental plank in a person’s care strategy can we able to achieve an approach to wellbeing management that’s based on integrative health.
And the difference between integrative health and integrative medicine? Well, to me health and medicine are two different things because health goes beyond the practical business of treating a patient.
When we look at overall (integrative) health, that simply must include elements for which the patient themselves is responsible and which they control – the self-care element of the integrative health model.
Exercise, nutrition, sleep, alcohol intake and stress management are all examples of areas where the patient should be collaborating with healthcare providers in the management of their wellbeing.
If we accept this as a sound definition of health, then it also stands that when self-care is excluded from the equation and only complementary medicine (such as acupuncture) and conventional and/or alternative medicine forms the care approach, then this is integrated medicine rather than integrated health.
Similarly, if only self-care and conventional/alternative medicine (or only complementary medicine and self-care) are provided in someone’s care, then this might reasonably be described as lifestyle medicine or integrated health.
Integrative health is achieved when all three key elements are present in the management of any given individual’s health – and because it takes a holistic view of someone’s wellbeing that is monitored 24 hours a day (through appointments with and guidance from health providers and by ongoing awareness and practise by the patient) it is an extraordinarily powerful way to achieve effective ongoing results.
It means both symptoms and their underlying causes are treated in a coordinated way and it gives patients ownership and control over the health outcomes – and in the end, as all health practitioners know, it is only when patients buy into the role they play in their own health that real results can be achieved
That is why I’m committed to helping to promote and foster change in the private and public health systems to ensure integrative health can become a key principle in the delivery of healthcare in the UK in the future.
Next month, Archna will be exploring how the health system can break down barriers to a truly integrative health service