The system ‘Conventional Medicine’ is ailing!
How the credibility of conventional medicine is diminishing and what conventional medicine can learn from CAM
What´s wrong with conventional medicine
Seeing a conventional health practitioner not infrequently follows the same old pattern, of having to wait for perceived ages until being admitted to the consultation room. Once face to face with the health provider, you hardly get to say what ails you, and before you know it, you´re out of the room, a prescription in hand. Very often the time spent waiting, exceeds by far the time spend in the consultation. An Australian appraisal has brought forth that the average time spent in the patient consultation is 14 minutes [1]. In the UK, this time was 9.36 minutes in 2004 [2]. This is hardly satisfactory for the ill patient.
Research has shown that patients are dissatisfied with the duration of time spend with their doctor, and with how this time is managed. Compliance with treatment regimens and overall satisfaction could be improved if doctors’ comportment demonstrated a higher attentiveness and comprehension of patient concerns [2]. A cross-sectional study of GPs consultation times in six European countries concluded that a patients time spend in the doctors´ appointment decreased with the doctors increasing workload [3].
Once a patient is admitted into the mainstream system then, he or she is subjected to inspection by the many diagnostic tools on offer, and in the consequence of findings needing treatment, the patient is then receiving access to the available interventions and the necessary medication.
In the event that patients enjoy good health and are unlikely to seek medical assistance, the system has developed a means of assuring that the healthy too, will regularly visit the doctors´ office and will maintain the diagnostic machinery running.
The main stream media, the health insurances, and health providers do not fail to inform on a regular basis that it is beneficial for us to attend regular health screenings. We are being told that the timely detection of cancer, diabetes, or high cholesterol can save our lives; that we are in a risk group, as overweight, nearing high blood pressure, or simply are of age 35+.
Naturally, if our GP tells us that the early detection of a potentially death bringing disease or illness improves the chances of recovery from such diagnosis, we will more than readily feel prepared to have tests undertaken to early diagnose, or give assurance we are not yet ill, or in the risk-group of falling ill of a disease. That is a natural behavior, considering that our GP told us that if it’s too late we can die. Our fear of dying, and the logic pronounced in the doctors statements substantiate the emerging decisiveness to be tested. Commonsense furthermore directs our thoughts to such arguments that it is too soon to leave loved ones behind, to be in pain, or to have to alter live plans that have not yet been fulfilled. It is most convenient then, if the national health insurances of, not all but many, countries disburse for such health screenings, or offer incentives for regular check-ups. They are after all concerned about our health and well-being! Are they really?
Screening / Over-diagnosing / Over-treating – are doctors making us sick?
Taking a closer look at some of the more common screenings recommended by doctors, lets us doubt in the efficacy of these, and the intent behind screenings in general.
Breast-cancer screening:
According to recent research, breast mammography screening saves one life and creates up to 10 women that are unnecessarily subjected to needless cancer treatment [4, 5]. A Cochrane review conducted in 2006 [5.1] and reappraised in 2013 [5] investigated the data of over 600 000 subjects, assessing the impact of mammography screening for breast cancer on mortality and morbidity. They concluded that there was extensive over-diagnosing and little to no alteration in the incidence of cancer [5]. On account of such discrepancy the Nordic Cochrane center has released an information leaflet explaining the benefits and harms of mammography screening (http://nordic.cochrane.org/mammography-screening-leaflet) [5.2].
Prostate-cancer screening:
For the Prostate screening test, PSA, a high risk of over-diagnosis has been identified [6]. Cancer treatment for prostate is viewed highly controversial in particular in high age [7]. The high incidence of side-effects and the consequential impact on quality of life following treatment, compared to the benefit of the actual screening, strongly tilt the risk/benefit ration in favor of a reservation from treatment where no specific symptomatology is present. Prostate cancer patients have a high likelihood of dying with the cancer rather than actually of the cancer [8, 9]. Older patients, above the age of 70 years, largely have a life expectancy that does not exceed the attempt of a treatment, and on top of that, subjects these men to the strain of the intervention and the numerous adverse effects [6, 9]. Two of the potential side-effects of surgery, beyond others, are incontinence and impotence [10].
Blood-pressure:
The threshold values for blood-pressure have constantly been altered in the past years, and individuals that were previously considered to have a perfectly healthy BP, have with the introduction of new guideline values, been made patients. While, for many years a rule of thumb was followed that stated the systolic blood pressure should not exceed a measured value of 100 plus the respective age of the individual, this was continually reduced. In the 1980’s a general healthy blood pressure was one of systolic pressure below 160mmHg, and diastolic pressure below 100mmHg.
According to the WHO guidelines the current parameters for a risk of hypertension is a measurement up to 140 / 90 mmHg [11], and generally speaking a blood pressure of above 120 / 80 mmHg is considered as pre-hypertensive [12]. The most recent European guidelines follow along these lines [13]. With such reduction of parameters, a large number of new patients is created, that according to the threshold measurements, requires medical treatment.
While a prolonged high blood pressure is commonly associated with severe health impacts, the benefit of such drastic reduction of threshold values, is questionable for those ‘new patients’ now required to be ‘made fit’ into the reference measurement values. This is in particular disputable in the light of research confirming that individuals considered as pre-hypertensive, are at no greater risk of dying prematurely than persons with the markedly lower, ‘normal’ blood pressure [14]. Another study exploring the efficacy of treatment, to reduce systolic blood pressure, of high risk cardiovascular patients, below 120mmHg, provided evidence that such lower blood pressure indeed reduced rates of fatal and nonfatal major cardiovascular events, yet at the same time provided evidence of significantly elevated rates of serious adverse effects in these patients [15].
Similarly to blood pressure, the guidelines for diabetes and cholesterol are subjected to such adjustments, and these are no lesser controversial. The blood sugar measurement threshold has as such been reduced from 110mg/dl to 100mg/dl in 2003, increasing the number of diabetics in the US of A, instantly, from 4 to 30 Million [16].
Generally speaking, the idea of conducting screenings in order to identify disease early on in its development, and as such be able to maximize treatment success, is not faulty. To many people, seeing doctors for regular screenings as such makes perfect sense. Yet, health checks are commonly undertaken in the trusting belief that they are beneficial and not associated with greater harm.
Research though, in terms of general health checks, of which screenings are a part, has shown that mortality and morbidity are unaltered, since their introduction [17]. The same research has also highlighted that new diagnoses have since increased [17.1].
What must not be ignored in the screening for cancer is the extent by which so called ‘pseudo-disease’ forms are identified. ‘Pseudo-cancer’ forms are tissue anomalies that by the definition of cancer meet the pathological criteria, yet will never break out to provide the cancer specific symptomatology [18, 4].
Yet, in particular in oncology, health screenings have frequently detected such tissue alterations that would potentially never have created symptoms, and the individuals screened have as a consequence become unsettled by the findings, and have subsequently been admitted into medical care. What this means to the individuals and their environment is dramatic.
Such over-diagnosing and the consequential over-treatment are common adverse effects of many cancers such as prostate, breast, colorectal and cervical cancer [6].
It is somewhat bewildering that most of the common health screenings have been implemented and recommended to extensive groups of the population in the absence of prior trials of usefulness and efficacy [19, 17], and their harm/benefit ratio is thereby drastically tilted.
The economic orientation of medicine – the creation of an industry
The medical market has and is continually expanding; healthcare has become a managed industry largely dominated by the economic goals imposed by the profit oriented organizations, enterprises and companies. Clinic federations, pharmaceutical companies, doctor associations and insurances dictate the direction that the industry has to evolve in [20], and in the consequence, the aims and purposes of the health care industry, are not necessarily, primarily the patients’ well-being. The focus on healing and recovery is immensely distorted by the monetary factor.
It is an evident fact that the conventional health care system has over the past years detected and, in fact ‘created’ new diseases [20]. This discrepancy clearly reflects from the multiplicity of unnecessary interventions and surgeries that are being conducted [21]. At the same time the health industry has massively promoted health screenings and has as such confronted healthy individuals with the potentiality of contracting or falling ill to one of the new diseases [20, 21].
In an industry where bonuses are paid out, to doctors and clinics, in the event that preset quotas are reached [21], the patient has become a commodity. A health system where economy is placed before ethics is one that is fundamentally ailing [21].
It is not astonishing that patient trust in conventional medicine has diminished since economic consideration has come to the foreground of doctors’ treatment recommendations [20].
Patient uncertainty due to adverse effects
Where medication and mainstream interventions are concerned, an investigation by Clinical Evidence has brought to light that for the state of evidence for orthodoxy not all is as it seems. The provision of an evidence-based practice has left much to wish for.
The appraisal of 3000 trials and studies has brought forth that 50% of conventional medical interventions trialed were of unknown effectiveness, while 3% were likely to be ineffective or even harmful, and 5% unlikely to be beneficial [22]. Such figures are, in the least, somewhat unsettling.
The US based Agency for Healthcare, Research and Quality highlighted in its statistical brief #109 in 2011 that for the year 2008 adverse effects from in-hospital treatments amounted to 1.9 million. Reported negative impacts from out-patients summed up to 838,000. Within just 5 years from 2004 to 2008 drug-related side-effects had increased by 52% [23].
Playing into the arms of CAM?
In the light of such discrepancies in the system, one might think it not astonishing that patients are increasingly turning to CAM therapies. Yet, according to a survey conducted in 2011, patients are increasingly dissatisfied with conventional medicine on account of a lack of clear communication, and on account of feeling disrespected by the mainstream health provider [24]. Further outcomes showed that 1/4th of the surveyed participants, exclaimed that their GPs´ did not respond satisfactorily to questions, used medical terminology without explaining it, and did not involve the patient in treatment decisions. 1/3rd of participants stressed that doctors were unpunctual and disrespectful [24].
This assessment also concluded that 44% of participants disliked of conventional medicine that doctors did not spend enough time with them as patients. 46% criticized the lack of explanation, given by doctors, of the treatment and its potential side effects. 37% criticized the lack of attentiveness and listening, and 32% mention the lack of time spend on evaluating potential treatment options [24].
From further research it has been reported that the users of CAM have a perceived efficacy of the treatment, and that they consider this to be the main benefit of seeing alternative therapists. Both users and non-users of CAM, are not generally dissatisfied with, or lack trust in orthodox medicine, yet CAM users are generally dissatisfied with orthodox medicine on account of it being incongruent with their beliefs, values, world views and philosophies [25].
Conclusion
Much of the above mentioned discrepancies and failures of conventional medicine are not broadly highlighted in the awareness of consumers and patients. Perhaps they should be, such that the orthodox medical sphere will become sensitized and will strive to become more refined and patient-centered. Yet, for this to happen, the system has to distance itself from its economic orientation, and must return to a position where caring comes before profit. It is time to listen to the patients, to what ails them and what they want and expect of the interaction with their healthcare provider. It is time to speak their language such that they can make informed choices about all the aspects of their health care, and to provide them with treatments that heal, without giving rise to other ailments and diseases.
It is unlikely that this will happen anytime soon. All the better for the CAM approaches that are filling a gap, where beliefs, worldviews, holism, patient-centeredness and patient respect come together with effective, non-invasive, gentle treatment.
Great advancement has come with the establishment of orthodox medicine. Gradually though, its priorities have shifted, and its treatments, increasingly, are not solely establishers of cure. Its tools of diagnosing and investigating disease appearance in patients have been extended to investigate the healthy. Its medicines are not infrequently associated with questionable efficacy, and not few are on the market that are of an unknown effectiveness [22].
What has become prioritized is not what should be the first and foremost aim of the health care practices, and as such the conventional medical system is, ailing.
References:
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