Scott MacStravic, Ph.D.
What was once referred to mainly as “alternative medicine” has come to be labeled as “complementary and alternative medicine” (CAM), and is often part of “integrated” or “integrative” medicine. In most cases, the word “complementary” is used to indicate that other forms of medicine, i.e. non-allopathic, which presumably includes osteopathic, are used to add something of value to traditional medicine. When these additional approaches are included, they increase the range of “solutions” that healthcare providers may use in addressing patients’ problems. Combining CAM with traditional hospital services, with one-quarter of hospitals involved therein, has not been an overwhelming success, however, with few generating a profit thereby. [“Few Hospitals Profit from Complementary Care” Healthcare Strategist Trend Watch Aug 18, 2006 (www.hcpro.com)]
The true meaning of complementary is “making complete”, not merely “adding some value to”. What is deemed complementary medicine does not make allopathic or osteopathic medicine complete – it merely adds some concepts and tools -- such as acupuncture, massage therapy, and chiropractic manipulation – that a physician may choose to employ directly or refer patients to as part of treating a particular patient for a particular problem. When selected complementary treatments are employed in a truly coordinated fashion by or with physicians, they become part of an integrated solution, but not a complete medical package.
What is truly needed as to complete traditional medical care is not a modest set of selected non-traditional treatments, but a full set of proactive (also called prospective, preventive, even pre-emptive) health interventions. These should include:• Chronic disease management -- aimed at minimizing the crises, complications and worsening of the disease, itself, plus reducing the need for and use of reactive sickness care for such conditions, and their intrusiveness into patients’ lives• Risk condition management -- aimed at minimizing the extent to which conditions such as overweight/obesity, and “pre-disease” states -- such as high, but not-yet-disease levels of blood sugar, pressure and cholesterol; osteopenia; etc. – cause or become diseases or lead to injuries• Risk behavior management – aimed at preventing, ending, or reforming unhealthy and risky behaviors -- such as smoking, substance abuse, physical indolence, unbalanced and over-rich diets, ineffective stress management, and unsafe patterns of sexual behavior, driving, working, playing, etc.-- that significantly increase the risks of disease or injury• Health/wellness/fitness promotion – aimed at improving patients’ status beyond the mere “normal” level, to reduce their risks of disease and injury, improve their recovery therefrom, improve their “development” or reduce risks during normal life stages from birth to death, minimize risks or side effects from disease treatments or increase the success of rehabilitation
These categories of proactive health care are truly complementary in the sense that they complete the potential of medicine with respect to the health of patients. Modest efforts commonly applied and insurance-covered, such as once-a-year immunizations and physical exams may contribute to such completion, but don’t come close to achieving the full potential. Medicine might once have included more of these proactive elements, but third-party payers’ parsimony and short-term focus have greatly diminished their inclusion in practice, while the need for and value of proactive health has, if anything, increased.
And now third-party payers are promoting the proactive side of medicine, though mostly via non-traditional “health care organizations”. Specialized vendors, along with employers or commercial insurance plans (e.g. CIGNA, Aetna), themselves, are the dominant sources of proactive medicine today, not hospitals or physician practices. This has long been true, and worksite wellness among employers and disease management among insurers have both expanded to cover almost the full range of proactive medicine.
These are also “medical care” providers, at least in the sense that they have physicians as medical directors and nurses as coaches or case managers, for example. The relatively modest number of traditional providers, including hospitals and physician practices, that are significantly invested in proactive medicine tend to serve far narrower markets, offering limited services for limited conditions. Diabetes management and fitness centers, bariatric surgery and executive health programs operated by hospitals, or chronic care model programs, occupational and executive health services offered by physicians are examples of “toe-in-the-water” approaches by traditional providers.
At least in theory or rhetoric, hospitals are supposed to be in the health as well as sickness business. The American Hospital Association’s official vision is to see: “…a society of healthy communities where all individuals (emphasis mine) reach their highest potential for health.”[www.aha.org]. The American Medical Association officially consists of “Physicians Dedicated to the Health of America”, to: “…improving the public health through promoting healthy lifestyles.” (www.ama-assn.org)
But the reality is that both hospitals and physicians derive the vast majority of their income and devote the vast majority of their efforts to treating people who are sick, not to reducing the incidence and prevalence of disease and injury, or of crises, complications and worsening of chronic conditions. Indeed, when they have ventured into the proactive side of medicine as a business venture, they have as often failed as succeeded in making such businesses viable.
The other stakeholders in the ineptly labeled “healthcare system”, especially payers and patients, are increasingly seeing their own best interests as much or more in the proactive health as reactive sickness side of medicine. Providers may continue to devote the vast majority of their efforts and investments to reactive sickness side, though many, particularly physicians in “retainer practices” have found ways to combine these truly complementary dimensions of medical care successfully.
In the case of medicine, what “complements” its reactive sickness dimensions not only completes it, but competes and conflicts with these traditional dimensions. Proactive health is aimed at, evaluated on and paid for because of its success in reducing the need for, use of, and expenditures related to reactive sickness care. But despite this conflict, medicine can only be considered complete if it offers and delivers the full range of its potential with respect to the health, as well as sickness of patients. Nothing less truly reflects complete medicine and the complete, best interests of patients and society.
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