Integrative Medicine: a synergistic answer to Doctor-Patient rifts

Integrative Medicine: a synergistic answer to Doctor-Patient rifts Why integrative medicine should become more mainstream, examined through an acupuncture lens Michael C. Hoaglin mike@northwestern.edu & E. Charles Osterberg, III costerberg@northwestern.edu LING 325: Language & Medicine Northwestern University Professor Rae A. Moses, Ph.D June 9, 2004 Dedicated to Robert Mang, Marilyn Macevicz, and Deborah Lupton for their inspiration Table of Contents Introduction ............................................................................................. 1 East meets west ....................................................................................... 1 Acupuncture basics .................................... Error! Bookmark not defined.2 The mechanized body ............................................................................. 3 Acupuncture effectiveness and benefits ................................................. 4 Legitimacy without a scientific basis ..................................................... 6 The call for integration ............................................................................ 7 Medical expenses .................................................................................... 8 Subjective Impact .................................................................................... 9 A Self-Conducted Study of Integrative Medicine at NorthWestern .....10 Introduction ............................................................................................10 Methods ..................................................................................................10 Results..................................................................................................... 11 Discussion ..............................................................................................14 Conclusion ..............................................................................................15 Appendix A .............................................................................................16 Introduction The west has grown to accept the state of medicine as one that lacks sufficient doctor-patient communication. Unfortunately, the strengths of Western medical practices have led to this weakness. Science remains the decisive factor in Western medicine or ―biomedicine,‖ and developments in the 20th century brought forth life-saving techniques in understanding pathophysiology. With this profound biological understanding, the body could be cut into and surgically corrected, and synthetic drugs could be fabricated for the alleviation of symptoms. However, the experience of the patient has become of secondary importance, and his/her views hold very little power in the medical encounter. Today, health providers pressure physicians to spend less time with patients. Doctors order batteries of tests, and thus the patient becomes a chart full of lab results and counts. There are established protocols for treating particular abnormalities, so the individual subtle differences of each patient are often not considered. Doctor-patient communication is a critical link in resolving physical ailments, and any lapse in this communication can result in compromised treatment. The limitations of Western medicine stem from these communication rifts between the doctor and the patient‘s body, and here lies the strength of Eastern medicine. The strengths of both Eastern and Western medical practices should have a greater combined role in American healthcare as ―integrative medicine.‖ “It is more important to know what type of person has the disease than what type of disease the person has” Hippocrates East meets west Eastern medicine practices, which have thrived in China for centuries, were quickly rejected by the Europeans as early as the seventeenth century because ‗Chinese abstract knowledge‘ was denigrated as useless. The fact that the Chinese had a particular knowledge over the British was quickly dismissed, and the British shrugged off the Chinese as people who could only be taught to be proficient in the ‗mechanical arts.‘1 As missionary Louis LeComte wrote to the French Secretary of State: The Chinese that are mean proficients in the sciences, succeed much better in arts;. . .they [know] in this respect not only what is necessary for the common use of life . .2 1 Leung, P.-C., C. C. Xue, et al. (2003). A comprehensive guide to Chinese medicine. [River Edge] N.J., World Scientific. 2 Le Comte, L. (1739). A compleat history of the Empire of China…, and many other curious particulars. London,, Printed for J. Hodges. 229. Hoaglin & Osterberg 2 Clearly the condescension of the Chinese as practitioners of a type of healing has early roots. Today, integration of Chinese medicine still faces challenges in the west due to historical tensions and its lack of scientific basis. This study will examine Eastern medicine from the perspective lens of acupuncture in hopes of understanding the hindrances associated with a new form of medicine: integrative medicine. Acupuncture basics Acupuncture is a system of healing—originating 2,500 years ago in China—that activates the body‘s ability to strengthen and regulate itself. The theory states that there are a series of meridians, or pathways, traversing the body in which the life force or Qi (pronounced ―chi‖) flows continuously. Any time there is a blockage or congestion in these meridians—each of which is connected to an organ or organ system—a physical disturbance or disease can result. The acupuncture treatment is intended to remove blockages and restore balance between the Yin and the Yang. Some meridians are designated Yin and others Yang, which constitute the fundamental dialectic ideology of the Orient. This restores circulation and balance in the system. The diagnosis and practice are holistic. That is, the patient‘s whole person: symptoms, history, life situations and environmental context are considered. Because each person is viewed as an individual and the patient‘s ―story‖ is a major part of diagnosis, there is no clear-cut formula to treating any one disease as in Western medicine. Some of the topical evaluations the acupuncturist makes to determine inner vitality include tongue inspection and pulse quality. By observing the level of adherence and spread of the tongue coating, the healer can determine a great deal about the GI tract health. One of our authors experienced this first-hand during his recent acupuncture visit. The intake form and initial interview included several qualitative questions such as diet and sleep patterns. When taking the pulse, both wrists are used, and instead of a mere pulse rate, . Figure 1 - Flow of Qi Hoaglin & Osterberg 3 the quality of pulse is noted. For example, the healer we visited noted that the pulse was ―wiry: like a guitar string.‖3 He was able to actually feel the energy by lightly palpating the patient. Following treatment, the acupuncturist felt the pulse considerably soften. It is believed from a somewhat physical standpoint that acupuncture points are near areas of low electrical resistance in the skin. Inserting the hair-thin needles into points along appropriate meridians activates Qi flow redirection, amplification or diminution, bringing the body back into balance. In emergency cases where the needles are not readily available, knowledge of acupuncture treatment can be used with similar effects via pressure points with fingers in a Japanese healing method known as Shiatsu. Indian Ayurvedic medicine also utilizes pressure points in a similar fashion. The mechanized body While the Chinese emphasize keeping the mind and body as one—allies that together promote wellness—the post scientific revolutionary West brought about the mind-body separation. René Descarte championed the separation of the mind and body and avidly modeled the ―mechanized body.‖ The mechanized body metaphor thrives in modern medicine and contributes to the limitations of Western medicine. According to Descarte, matter was inert, and the human body contained no ―vital spirits.‖4 Before and during his time, doctors had few tools with which to alter disease effectively. Up until the end of the 18th century, medical practice was related more toward the patient‘s lifestyle and general functioning. The patient‘s condition was compared against himself rather than an accepted metric. By the early 20th century, applied science began transforming medicine and medicine became concerned with the extent patients deviated from the accepted norm.5 Labeling and surveillance have been sustained metaphors in modern medicine, and the disease has become more important to medicine than the person afflicted Figure 2 – A view of the meridians8 by it.6 Jordanova wrote in 1989 that biomedical sciences in 18th and 19th century France and Britain characterized nature with women and culture 3 Acupuncture treatment by Dr. Frank Scott, D.Ac., Pacific College. Muir, E. (2004). The West: Encounters & Transformations. New York, Pearson Longman. 5 Foucault, M. (1975). The birth of the clinic; an archaeology of medical perception. New York,, Vintage Books. 6 Doyal, L. and I. Pennell (1979). The political economy of health. London, Pluto Press. 4 Hoaglin & Osterberg 4 with men. Upon the Enlightenment, she portrayed nature as women being penetrated by masculine science7. The Flexner report changed the way medicine was taught in 1910, and in response, the AMA began to insist that health education, research and practice become inseparable, and medical school admission standards quickly rose. The scientific model of medicine has brought about enhanced ability to detect the pathophysiological basis of infectious disease and to understand biology and human physiology. However, the flourishing medical knowledge led to the creation of medical bureaucracy, hierarchy and specialty. All of these are necessary in percolating today‘s medical world, but the specialists focus their attention on often small parts of the body. This creates challenges facing many ―multi-disciplinary‖ diseases, since the whole-being approach is not emphasized, and this is evident when specialists are faced with more of a systemic problem. Acupuncture effectiveness and benefits Acupuncture has significant success in treating systemic and multi-disciplinary ailments. While Western medicine excels in trauma, acute infectious disease and life-threatening situations requiring immediate medical intervention, Eastern medicine has enjoyed centuries of success in healing and preventing chronic conditions. Western practices involve dispensing medication in response to symptoms, and this can be effective for clearing up a condition such as a one-time bacterial disease. However, consider living with chronic migraine headaches: for many, the unbearable sensations can only be masked by continuously taking medication. Unfortunately, steroidal drugs can have scores of harmful side effects, but with acupuncture treatment, patients may receive long term or semi permanent relief from their migraines without side effects. Some relief is immediate and often felt within 15 minutes following treatment, while more relief is cumulatively experienced upon return visits. Recent studies have also indicated that microcirculation in the brain can be increased, which parallels with the integration of mind and body. Increasing blood flow to the brain has shown to reduce general irritability, short-term memory loss and insomnia in elderly (see Subjective Impact). Increased circulation also is associated with heightened alertness and lowered blood pressure. Acupuncture can also begin a series of 7 Jordanova, L. J. (1989). Sexual visions : images of gender in science and medicine between the eighteenth and twentieth centuries. Madison, Wis., University of Wisconsin Press. Hoaglin & Osterberg 5 blood chemistry changes including decreases in blood lipids (slightly decreasing cholesterol), increases in cortisol (a hormone required for life that makes more glucose available) and normalizing the number and quality of erythrocytes (red blood cells) and leukocytes (white blood cells). On the other hand, drugs in Western medicine with indications to reduce serum cholesterol levels include clofibrate, which has shown to increase the death rate in gall bladder cancer patients.8 In fact, this medication is regularly used in laboratory settings to induce cancer in rodents. 9 However, improving these same blood chemistries with acupuncture has reported no serious side effects. Other common ailments that may baffle biomedicine, from severe constipation to acute stomach pain have been treated by the insertion of needles at the proper locations on the body. The WHO has cited acupuncture as an appropriate treatment for more than 43 conditions. Baffling diseases for the west may be readily treated by acupuncture. For example, a gastroenterologist can be expected to be more effective and able in treating peptic ulcer disease (PUD) rather than irritable bowel syndrome (IBS). PUD can be treated locally with medication to slow acid production and kill any suspect bacteria such as H. Pylori. IBS, however, does not have treatment that is clear cut. It is currently thought that IBS has psychosomatic origins, but this is still not well-understood.10 Clearly, treatment would require a great deal of communication with the patient. So, who do you visit: your gastroenterologist or your psychiatrist? According to recent studies, acupuncture may be an effective answer, as it has been successful in treating a variety of GI disorders including IBS—long term.11 There are several meridians dedicated to the GI tract. However, acupuncturists do not isolate parts of the body as a specialist does but rather understand the various bodily connections via meridians. According to Frank Scott, Professor of Oriental Medicine at Pacific College in Chicago, IBS is quite treatable by acupuncture and Chinese herbalism. Scott has had such a successful healing practice in this specialty, that local gastroenterologists have consistently referred IBS presenting patients to him. Countless 8 9 Omura, Y. (2003). Acupuncture medicine : its historical and clinical background. Mineola, N.Y., Dover. Mizumoto, K., S. Kitazawa, et al. (1988). "Modulation of N-nitrosobis(2-hydroxypropyl)amine-induced carcinogenesis by clofibrate in hamsters." Carcinogenesis 9(8): 1421-5. 10 Folks, D. G. (2004). "The interface of psychiatry and irritable bowel syndrome." Curr Psychiatry Rep 6(3): 210-5. 11 Pang, H. (1999). "[Progress of clinical basic study of acupuncture in the treatment of gastrointestinal diseases]." Zhongguo Zhong Xi Yi Jie He Za Zhi 19(3): 188-91. Hoaglin & Osterberg 6 other systemic diseases fit this very profile, and acupuncture can prove beneficial for ailments in any or all parts of the human body and mind. A fascinating modern application of managing the flow of Qi has been in the treatment of addictive disorders. By focusing on the auricular (ear) acupoints, the kidney meridian can be tapped into, which is associated with addiction (and insomnia). Alcohol and drug disorders treated by acupuncture have shown success rates upwards of 50-80%, even for people who have had these disorders for years. This form of treatment is also associated with very low rates of recurrence. The success of this treatment has been so profound that Florida‘s Miami-Dade county has made drug addicts choose acupuncture or jail.12 Acupuncture was first popularized in the US in 1971 with journalist James Reston‘s visit to China with Henry Kissinger. Upon appendicitis attack while abroad, Reston underwent emergency surgery and the Chinese used acupuncture as the only anesthesia. Reston‘s writings about the experience captivated the nation, and acupuncture popularity has increased since, but it has still always been an alternative option to Western medicine. Legitimacy without a scientific basis Acupuncture‘s critics often focus on its lack of scientific basis and the difficulty in describing the exact mechanics of how it works. Western medicine struggles with this issue because it is wrapped up in the mechanized body, scientific measurements, and surveillance. As Harvard Chemistry Professor Rustom Roy said, ―Americans can't handle abstract science because it is not conceivable and not touchable.‖13 Although a number of pilot studies and small-scale clinical trials have taken place with acupuncture, it is likely that science should not be completely carried over to acupuncture. The WHCCAMP Final Report says that conventional and CAM (Complementary and Alternative Medicine) systems of health should be held to the same rigorous standards of good science. Good science, though, is not subjective, and Eastern modalities thrive on the subjective experience of the patient. Larry Dossey, a pioneer in integrative medicine once said ‗‖In clinical medicine we would do well to focus mainly on whether a therapy works, instead of being paralyzed by whether or not it should work. To do 12 Faass, N. (2001). Integrating complementary medicine into health systems. Gaithersburg, Md., Aspen Publishers. 13 Williams, J. (1999). ―Weil: alternative medicine growing in popularity.‖ Arizona Daily Wildcat. Tucson, AZ. 2004. Hoaglin & Osterberg 7 otherwise is to elevate intellectual tidiness over saving lives.‘‖14 Patients need to be the center of medicine, not science, because pain is an individual experience, difficult to quantify. Acupoints, meridians and energy flows can be slightly different for each patient—hindrances to scientific studies. More research is needed in the area, and there are a great number of pilot studies that necessitate follow-up. A common limitation though is funding and publicity. Federal support for research is essential for development of health care, but developing patents in natural medicine is more difficult, because the constituents, especially herbs are largely the public domain.15 The American media also worships science and are slow to cover alternative therapies. Without capitalism driving competition, new developments are slow. The call for integration The new health care design must integrate compassion and actively seek the involvement of the patient in his/her care. The center of health care should not be a cookie-cutter approach to disease treatment, but rather the patient-physician relationship, since every patient has a story. As the well-known champion of natural healing, Dr. Andrew Weil once said ―I have a strong commitment to gathering data, but I also feel that one's life is evidence.‖16 Integrative medicine emphasizes preventative medicine by invoking a healthy lifestyle, which includes diet, stress management, exercise and emotional well-being. The physician views the patient as a whole person—mind, body, community member and spiritual being. Most Americans who would turn to alternative treatment would be thrilled to consult a physician well-brained in science and open-minded to the body‘s innate ability to heal. These doctors practicing integrative medicine (―the new model‖) would provide synergistic results as the scientific understanding of biology and close communication with the patient and his/her body create a patient-centered approach to medicine and healing. The appropriate use of Chinese/Ayurvedic medicine, dietary supplements and herbs would be an individualized plan for healing and would take into account the patient‘s spiritual well-being. In the new model, patients would desire competent help in navigating the vast treatment choices, especially for chronic conditions, ineffectively treated by conventional methods.5 Even those patients with a fear of 14 Schrodt, C. J. (2004). "Reflections on complementary and alternative medicine." J Ky Med Assoc 102(3): 123-4. 15 Faas. 16 Williams. Hoaglin & Osterberg 8 needles could be calmed with hypnosis17. Integrative medicine would provide a doctor with a balanced knowledge of avenues to well-being and guide the patient through the decision-making process to wellness. Western patients hold the potential inner strength necessary to utilize Eastern medicine; it is simply not invoked as often as in the east, where acupuncture aids the body in healing itself. The best known situation of Western medicine calling on inner strength and spirituality is in the midst of a terminal illness. Australian singer Olivia Newton-John was interviewed about her battle with breast cancer and described the success as a result of her personal courage and constant maintenance of a positive attitude.18 This conveys that the west holds the capacity to give the mind a larger role in bodily health. Integrative medicine can provide the necessary guidance in finding the happy medium between biomedicine and Eastern modalities. Both have their strengths, but it is when the two are combined that we have an extremely powerful healthcare program. Medical expenses Acupuncture has great potential in lowering national medical costs. Consider someone with chronic shoulder or migraine pain. The patient may have to visit a biomedical doctor for the rest of his/her life; however acupuncture may eliminate some of these expenses either by just a few treatments or a series of treatments over a few months. Coverage for migraine headaches by insurers can average as much as $6,500 per year. Migraine patients utilizing biomedicine may be in and out of the emergency department, take a variety of narcotic medications, make frequent office visits and may require CT scans. The disappointing fact is that the $6,500 mainly targets pain and symptom management, and the headaches may never be resolved in this fashion. Acupuncture has shown to eliminate migraines after one to several regular visits. Controlled clinical trials have shown in a different paralysis study to save an average of $26,000 per patient19. In a 1992 study, randomized patients with severe knee osteoarthritis and awaiting surgery received acupuncture; 7 out of 29 patients were able to cancel their arthroplasty, a savings of $9,000 for each patient. In Asia, Oriental medicine has led to lowered national health care costs, making it possible for every individual in Japan and China to have medical insurance. 17 Lu, D. P. and G. P. Lu (1999). "Clinical management of needle-phobia patients requiring acupuncture therapy." Acupunct Electrother Res 24(3-4): 189-201. 18 Olicar, J. (1993) ―My fight for life‖ (interview eith Olivia Newton-John)‘. Australian Women‘s Weekly. February, 4-9. 19 Faas. Hoaglin & Osterberg 9 Interest for CAM is evidenced by the mandate of CAM insurance coverage in Washington state. Socioeconomic barriers have kept Western medicine out of the reach of many in the East. Alternative modalities provide a less-expensive alternative to the magnanimous costs of visiting a Western hospital. Subjective Impact We interviewed two individuals who visit acupuncturists regularly in order to see what motivations existed for leaving Western medicine either partially or completely. One woman we spoke with visits her acupuncturist weekly for insomnia. After years of taking Ambien, a prescription sleep aid, she felt it was time to stop masking the physiological problem. Her acupuncture treatments last about fifty minutes and always involve auricular acupoints and almost always result in her becoming so relaxed that she falls asleep on the table. She reports that her sleeping patterns have markedly improved and now spends much fewer sleepless nights forced to take Ambien. She has since convinced her spouse to try acupuncture for a similar problem. Another gentleman we interviewed tried acupuncture due to lack of satisfactory results with allopathic medicine. After the death of a daughter to bone cancer and trying everything he could in Western medicine, he and his wife have since completely switched to Eastern medicine after realizing the limitations of Western medicine. For several years he also experienced recurring walking pneumonia and respiratory weakness of various origins (viral, fungal, bacterial), and grew tired of taking antibiotics constantly. When he turned to Eastern medicine, he had a different way of looking at health. A diet change including the largely vegetarian Japanese Macrobiotic diet consisting mostly of whole grains, teas and herbs made him feel more healthy and energetic. His respiratory problem has been successfully treated by visits to his acupuncturist. In addition, some digestive issues have been cleared up by several visits. His spouse, also only utilizing Eastern modalities now, had chronic sinus infection treated successfully, but he mentioned that sinus infections are more difficult to treat than most other commonly treated ailments, so many visit are required. The interviewee summed up acupuncture as a means to enable the body rather than treating symptoms and creating unwanted side effects. We also spoke with a non-user of Eastern practices to see what kept them with Western medicine. She said the main reason was that she had not been educated about its benefits and did not know enough about how to begin a treatment. In addition, she has excellent coverage for Hoaglin & Osterberg 10 Western medicine doctors through her HMO. She mentioned though that she does take Kava Kava root occasionally to help sleep. A Non-scientific Study of Eastern & Western medical knowledge at Northwestern University Introduction To expand our knowledge from the realm of literature regarding the integration of Eastern and Western modalities, we evaluated the Northwestern community‘s perceptions of and familiarity with Eastern and Western ideologies through a subjective survey. Our research question that provided the basis for a campus wide survey was: Why have Eastern modalities, like acupuncture, not integrated into Western medical culture? Justification for this research stems from the notion that Eastern medicine has yet to be fully consolidated into Western culture, permitting doctor-patient rifts, as discussed earlier. Acupuncture‘s ability to treat many syndromes without referring to biomedical science further asserts that the integration of Western and Eastern ideologies is warranted. This study attempts to draw conclusions as to why such integration has not occurred by circumscribing some issues that may account for the impedance of Eastern and Western unions. The hypothesis for our research was: Northwestern students are aware of Eastern modalities, but fail to integrate them into their culture because of hindrances attributed to other factors such as race, gender and culture. Methods The method by which we studied why integrative medicine has or has not been incorporated the Northwestern community‘s ideology was in the form of a questionnaire/survey. The subjects of this survey were thirty random undergraduates who would take the time to fill it out. The survey design revolved around three parts: First, the subjects were asked to fill in demographic information which included: gender, race, and age. Second, the survey design tested the subject‘s propensity to associate Eastern medicine with more passive adjectives/nouns and Western medicine with more aggressive adjective/nouns in a multiple choice format. Two examples are as follows: Hoaglin & Osterberg 11 1. Acupuncture a. aggressive b. machine c. full body d. preventative 2. Naturalistic a. beach b. preventative c. fought d. reactive The adjectives/nouns chosen for the second part of the survey design were chosen at random from a word bank of passive and aggressive overtones. Reasoning behind the two polar forms of overtones stems from the previous research conducted above that referred to Western medicine as mechanized. The third part of the survey design provided the subjects with seven different scenarios in which he/she would choose from a variety of treatments, according to personal preference. This allowed us to gauge whether the subject was predominately focused medically toward Western or Eastern ideologies and preferences. Two examples are as follows: 1. Shortness of breath a. perform relaxation exercises such as yoga or meditation b. call 911 c. take anti-anxiety or bronchodilator (inhaler) medication given to you by your doctor d. take kava root, an herbal remedy sold in grocery stores said to naturally reduce tension 2. Chronic lower back pain a. seek acupuncture or massage treatment b. look into what orthopedic surgical procedures may alleviate the pain c. take non-steroidal anti-inflammatory medication given by your doctor d. work on posture techniques on your own or with a program such as Pilates (Refer to Appendix A for the full survey design) Results The results we obtained from our survey design provided the information we needed to ascertain whether the Northwestern Community has integrated Eastern and Western ideologies to hinder doctor-patient rifts in a synergistic manner. The results were examined by demographics, namely race and gender, and correlations were then drawn: Hoaglin & Osterberg 12 Gender: Percentage associating an Eastern treatment with a passive overtone Men Women 72.86 % 87.14 % Percentage associating a Western treatment with an aggressive overtone 80 % 82 % 60 % 55.71 % Percentage preferring a Western treatment for the given scenario Figure 3 Correlation between gender and Eastern medicine descriptors with passive overtones, Western medicine descriptors with aggressive overtones, and the preference of each for Western medicine treatments when presented with various symptoms. Comparrison by Gender 100 90 80 70 Percentage 60 50 40 30 20 10 0 Eastern Q Assoc Western Q Assoc Age West Pref Males Females Figure 4 Graph showing the correlation between gender and Eastern medicine descriptors with passive overtones, Western medicine descriptors with aggressive overtones, and the preference of each for Western medicine treatments when presented with various symptoms. To ensure that race was not affecting the gender distribution results, the breakdown is as follows: For males- 60% Caucasian, 25 % Indian, 15 % Asian. For female- 70 % Caucasian, 10 % Indian, Hoaglin & Osterberg 13 20 % Asian. As seen, a fairly weighted distribution between the races accounts for minimal effect on the gender distribution above. Race: Percentage associating an Eastern treatment with a passive overtone Caucasian Indian Asian 78.2% 83.33% 68.57% Percentage associating a Western treatment with an aggressive overtone 83.16 76.67% 76% Percentage preferring a Western treatment for the given scenario 60.86% 57.14% 51.42% Figure 5 Correlation between race and Eastern medicine descriptors with passive overtones, Western medicine descriptors with aggressive overtones, and the preference of each for Western medicine treatments when presented with various symptoms. Comparrison by Race 90 80 70 60 Percentage 50 White Asian Indian 40 30 20 10 0 Eastern Q Assoc. Western Q Assoc Age West Pref Figure 6 Graph showing the correlation between race and Eastern medicine descriptors with passive overtones, Western medicine descriptors with aggressive overtones, and the preference of each for Western medicine treatments when presented with various symptoms. Hoaglin & Osterberg 14 Discussion After obtaining this data, we affirm our hypothesis that cultural boundaries cause potential hindrances to the integration of Eastern and Western modalities, which mainly stem from race and gender. The first conclusion made is that females, more than males, have a greater propensity to associate Eastern medicine with passive overtones and Western medicine with aggressive overtones. In addition, females have a greater predisposition to chose Eastern medical treatments, slightly less than half of the time, when presented with a given ailment. This conclusion has led us to postulate that perhaps females, by nature, are more open minded toward the institution of integrative medicine into Western culture. From this, females acknowledge that the doctorpatient communication is of utmost importance to proper treatment. Males, on the other hand, are firm in nature and have a greater predisposition to choose Western medical treatments when presented with a given ailment. This suggests that males are more closed-minded toward the institution of integrative medicine in Western medical practices. Likewise, conclusions can be made from the various survey subjects‘ races, presenting evidence toward the impedance of integrative medicine. It is seen that Caucasians, more so than Indians and Asians, have a greater propensity to associate Western medicine with an aggressive overtone. A stark contrast to what we predicted was elucidated in how Caucasians, more so than Asians, have a greater propensity to associate Eastern medicine with a passive overtone. This conclusion suggests that Caucasians are well aware of Eastern ideology, perhaps more so than their Eastern counter parts. Not surprisingly, Indians, more so than Caucasians, have a greater propensity to associate Eastern medicine with a passive overtone, which makes sense due to their cultural influences. Likewise, the data suggests that Caucasians prefer Western medical treatments for various ailments over various Eastern options, which are namely preferred by Indians and Asians due to their cultural rearing. From these conclusions, one can claim that the impedance of integrative medicine to Western ideology exists because Caucasians, while informed of Eastern ideology, fail to accept its influences due to their preference of Western treatment that stems from cultural boundaries. Because Indians and Asians are accustomed to a cultural boundary that circumscribes treatments like acupuncture, they tend to have a greater preference for Eastern medicine. There are several postulates as to why integrative medicine, especially the union of acupuncture in the west, is not an amalgamated front. First, as discussed above, acupuncture and Eastern modalities are not scientifically based. Westerners are culturally bound by empirical data that results in a more ―observable‖ science. Because our study showed Caucasians choosing Western Hoaglin & Osterberg 15 treatments, one postulate is that Eastern medicine– specifically acupuncture– does not surpass the threshold of minimal scientific basis. In addition, we theorize that Eastern medicinal exposure is limited. This lack of education prevents the relay of knowledge regarding the benefits of Eastern medicine. Such exposure, which takes a form similar to the testimonials we received above, is a major component necessary toward the integration of Western and Eastern ideology. Finally, as one testimonial stated, the lack of consolidation of Eastern and Western medicine stems from an inability of insurance companies to accept Eastern practices. This notion is perhaps due to the lack of scientific basis, or could be attributed to a lack of demand of their use. The postulates presented only represent a few reasons why integrative medicine has not been adopted into Western culture. There are many more reasons that may branch far beyond cultural competencies to prevent this integration. Conclusion From our study, we have realized not only the importance of integrative medicine but also the hindrances that stem from its institution. Our self conducted study postulates that cultural barriers prevent said integration; however, there are many other potential factors that fashion such hindrances. More specifically, through the lens of acupuncture we found that something less scientific, and quasi-spiritual, can be misconstrued in Western culture as illegitimate, preventing the union of these Eastern and Western philosophies. But if this integration were possible, the health care system would be infinitely stronger. It would adhere more succinctly to its main purpose: to heal the mind, body, and spirit from energy imbalances. But it is not a question of whether the integration of Eastern and Western medicine is possible; some Westerners, as the testimonials demonstrate, supplement their allopathic medications with more naturalistic means. In fact, this integration is entirely plausible, but a full conversion toward the integration of Eastern and Western modalities must be delineated through a concerted effort by Western culture to adapt a more holistic approach to life and avoid compartmentalization. So while such a cultural conversion would be infinitely difficult, the integrative medicine approach allows for both firm believers in Western ideologies and Eastern ideologies to pull the assets from their own preferred health care approach, while at the same time assessing new alternative treatments. Through this integration of Eastern and Western modalities the basic health of our nation would be significantly improved while doctor-patient communication thrives. Hoaglin & Osterberg 16 Appendix A Date ___________________ Gender M F Race ___________________ Age ____________ Please circle the one answer that you most closely associate with the given word 1. Acupuncture a. aggressive b. machine c. full body d. preventative 2. Mammogram a. poked and prodded b. mother nature c. invasion d. pro active 3. Reflexology a. masculine b. feminine c. mind d. aroma 4. Sports physical exam a. surveillance b. business c. pleasure d. weapons 5. Inner strength a. rodeo b. intimacy c. siege d. technology 6. Homeopathic a. invisible enemy b. mist c. aroma d. bravery Please turn over 7. Naturalistic a. beach b. preventative c. fought d. reactive 8. Chemotherapy a. maintenance b. freedom c. meditation d. army 9. Aromatherapy a. blacksmith‘s bellows b. treating symptoms c. HIV/AIDS d. Enya 10. Angioplasty a. calm b. Easter bunny c. War d. peace time 11. Yoga/Meditation a. submerged anger b. laughter c. waterfall d. rebellion 12. Gastric Ulcer a. flowing b. defense c. cool d. Monday Night Football Hoaglin & Osterberg 17 What course of action do you think would seem most appealing to you if you experienced any of the following symptoms or diagnoses at some point in your lifetime? Assume all major procedures and office visits are covered by medical insurance. There is no right or wrong answer. 1. Shortness of breath a. perform relaxation exercises such as yoga or meditation b. call 911 c. take anti-anxiety or bronchodilator (inhaler) medication given to you by your doctor d. take kava root, an herbal remedy sold in grocery stores said to naturally reduce tension 2. Chronic lower back pain a. seek acupuncture or massage treatment b. look into what orthopedic surgical procedures may alleviate the pain c. take non-steroidal anti-inflammatory medication given by your doctor d. work on posture techniques on your own or with a program such as Pilates 4. One day of fever and nausea a. take OTC medications such as Tylenol (pain reliever) or Tums/Mylanta (antacid), etc. b. meditate to soothe the body and mind c. begin a daily herbal regimen said to prevent such upsets d. call your doctor 5. Common cold for five days a. begin a daily herbal regimen said to boost the immune system b. take OTC cold medicine or some of its constituents (decongestant, cough suppressant) c. call your doctor d. begin an acupuncture routine said to boost the immune system 6. High blood pressure (hypertension) a. perform yoga and other mind/body relaxation techniques b. take high blood pressure medication (vasodilator) prescribed by your doctor c. meditate regularly to relieve tension d. look into a surgical procedure on the kidney said to cure hypertension 7. High cholesterol a. consult a nutritionist to help improve your diet b. take cholesterol medications such as Lipitor prescribed by your doctor c. consult a personal trainer to help with an exercise regimen d. look into a vascular surgical procedure said to remove cholesterol from coronary artery 8. Stiff and painful knees at old age, diagnosed as osteoarthritis a. regularly take arthritis medication (COX-2 inhibitor) such as Celebrex b. begin an acupuncture regimen said to target joint inflammation c. look into possible joint replacement procedures d. perform daily exercises said to reduce joint inflammation Free response: Is there anything missing in your relationship with your doctor or with the American health care system as a whole? If so, please write it here: ______________________________________________________________