President's Message The Challenge Of Dealing With Alternative Medicine Mike F. Mass, M.D., President

A heterogeneous group of methods has become increasingly popular recently. This group is most often referred to as alternative medicine and has its own web site. The practices vary from traditional acupuncture and herbal therapies to more bizarre theories, such as therapeutic touch. It has become clear that this group cannot be dealt with as a single unit, as some of these remedies are finding their way into mainstream practice.

It really wasn't that long ago that physicians had to be convinced that, in general, deductions based on the scientific method should replace long held empirical views. Tension still exists as we now struggle with various practice parameters. Therefore, from a historical perspective scientific medicine could be viewed as "alternative." Now that a new orthodoxy has been established, we must be open to change — hopefully, supported by good science. There has been a fair amount of work done with alternative remedies. From a scientific standpoint the results thus far are disappointing. Nevertheless, it seems clear that as healers we must make some of these modalities available to our patients who seek comfort from us.

In the rheumatologic side of my practice I see a lot of patients complaining of chronic pain. My patients and I both know that pharmacologic analgesia is not always satisfactory in relieving pain. There is a whole group of soft tissue pain syndromes, once called "psychogenic rheumatism" by my professors, that is termed "fibromyalgia" or "myofascial pain syndrome." The physiologic cause for these is still poorly understood, but we do recognize certain similarities in the presentation of symptoms that cause us to believe that there is, at least in part, a physiologic basis for the pain. As my patients and I struggle to deal with this, alternative (i.e., non-pharmacologic) methods of pain control become of greater interest. I would like to see some pain centers more willing to explore these methods, even if it means accepting some empiricism.

It is not just because the public is clamoring for this (witness the billions spent on unproven and unregulated therapies); we as physicians should be proactive in understanding and using those therapies that are promising. This becomes even more difficult to do when third party payors will only cover FDA approved therapies. It is precisely for this reason that we as scientists and healers must be willing to take a larger role in evaluating the various methods presented to us. We must find a way to fund research in areas that do not get traditional pharmaceutical support. It is my hope that the 21^st century will see physicians who use molecular biology and genetics as well as "alternative" therapies to cure and bring comfort to their patients.

November, 1998/ Jacksonville Medicine

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