Alternative medicine is making its way into Israeli medical practice, despite what the doctor ordered
A new book looks at why patients are interested in alternatives, and why doctors are against them.
In recent years more and more patients have turned to complementary and alternative medicine in an attempt to find succor for their bodily ills. Alternative care includes acupuncture and herbal medicine, while complementary care combines these types of therapies and philosophies with those of conventional medicine.
The layman's increasing access to conventional medical information, thanks to the Internet, and increasing skepticism about ties between doctors and pharmaceutical and medical supply companies, are leading many patients to try treatment methods that do not necessarily correspond with traditional Western medical practices.
Thus, complementary and alternative medicine, or CAM, is making its way into medical institutions, though their efficacy of these treatments has not been proven by supervised medical research, and even though many in the medical establishment remain suspicious of alternative therapists and healers who have not been through medical school, yet are managing to receive professional recognition from the general public.
A study examining the complementary and alternative medicine, or CAM, trend in Europe, published in the European Journal of Public Health in April 2010, estimated that 12 percent of adults in Europe had gone to an alternative healer at least once a year, as of 2007. That was twice the figure in a similar study conducted in 1993. Thirty-seven percent of those surveyed had consulted more than one alternative therapist. Sociologists are now studying the phenomenon, to see whether complementary medicine is indeed eroding the power of Western medicine.
Popularity of alternatives on the rise
Figures from Israel also indicate increasing use of CAM in recent years. During the past decade a comprehensive study was carried out here on the relationship between CAM and conventional medicine, known as biomedicine. The study was published recently in the book "Alternative and Biomedicine in Israel: Boundaries and Bridges." The book's co-editors are Prof. Judith Shuval - a pioneer in the sociological study of medicine in Israel and an Israel Prize laureate, as well as former chair of the Israeli Sociological Association and Israel's representative to the parallel European organization - and Dr. Emma Averbuch. More than 100 in-depth interviews were conducted with practitioners in order to look at their perspectives and their experiences regarding the process of combining CAM treatment methods with the more traditional practice of medicine.
The study suggests that the increasing popularity of alternative medicine in the West can be attributed to the increasingly challenging attitude toward authority that is characteristic of the post-modern era. Shuval explains that medicine as a profession is a product of the modern era, and that its power has been entrenched throughout the 20th century. This was a period characterized by hierarchies and clear centers of power, and a nearly total belief in science and progress. By way of contrast the post-modern era adopts varied ideals and has many sources of information, which translates into the dissolution of the unifying power of traditional medicine. These tendencies, says Shuval, enabled, and even supported, the development of alternative therapies.
One of the book's chapters discusses a study that examined how complementary medicine has entered Israeli labor rooms by means of nurse-midwives. The researchers conducted in-depth interviews with 13 nurse-midwives who work in labor rooms in Israeli hospitals and employ CAM methods, including natural childbirth without an epidural combined with practices such as reflexology, reiki, guided imagination, aromatherapy and touch therapy. All the nurses reported mixed attitudes from doctors and other midwives toward these alternative practices, ranging from supportive to acute hostility.
The study found that complementary medicine is penetrating into labor rooms at least partially as a result of a feminist ideology that opposes excessive medicalization in childbirth, and attempts to preserve women's bodily autonomy. This perspective perceives childbirth as a natural phenomenon that should be carried out with minimal intervention and the avoidance, as much as possible, of the use of chemicals such as the epidural. Instead, this philosophy believes that the woman's body should dictate the progress of the birth, without use of artificial means to accelerate it.
The midwives interviewed stressed the importance of the childbirth venue, in the empowerment of women and their ability to control their bodies. They expressed a feeling of nostalgia for the way childbirth used to be, more natural and with less intervention, sometimes taking place at home in a warm and supportive atmosphere. One of the interviewees claimed that a woman's connection to a monitor as the birth progresses leads to a search for pathologies that in most cases aren't there, or that pass of their own accord. She added that 85 percent of all births are completely normal and do not require any medical intervention.
Little integration in Israel
Another chapter, written in collaboration with Prof. Revital Gross, who passed away last year, describes the gradual entry of complementary medicine into the primary care clinics of health maintenance organizations in Israel. In many Western countries, such as Germany, Holland, France and New Zealand, models already exist for primary care clinics that successfully combine biomedical methods with CAM therapies. In Israel, however, very few primary care physicians, called family doctors here, try to integrate CAM methods into their daily clinical work. The study identified and interviewed 15 Israeli doctors who do this.
The findings show that alternative methods tend to be offered to patients only after the family doctor has carried out a thorough biomedical examination, and after he or she has given treatments included in the health basket - a list of subsidized treatments that does not include alternative treatments. For the most part, even family doctors who do offer additional therapies, if deemed appropriate, have difficulty achieving full integration of traditional and CAM methods. One physician interviewed said that doctors in a regular Israeli practice focus on the sickness rather than the patient. He said the medical system does not provide caring medicine that is concerned about the welfare of individuals and that it is the international pharmaceutical companies that determine how conventional medicine works.
The research finds that Israeli HMOs do not encourage an integrative approach, but instead urge physicians to employ methods that maintain the hegemony of the biomedical system and prevent full integration of CAM methods.
Kupat Holim Leumit is an exception. Established in April 2008, this HMO's primary care clinics includes rooms intended for alternative therapists. The country's three largest HMOs - Clalit, Maccabi and Meuhedet - operate separate networks for providing complementary treatments.
In fact, explains Shuval, there is no integration among CAM and conventional methods, and each of them is employed with no organic connection to the other. She adds that the national health system conforms to the demands of the medical doctors' regulations, which allow for alternative treatments only on condition that a biomedical doctor is present at the site.
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