Collaboration and Co-Management

The optimal health care system is one which fully embraces basic sciences’ remarkable advancements in understanding human physiology and pathology; conventional medicine's incredible diagnostics and, at times miraculous, ability to cure many types of disease; natural medicine's vitalizing healing wisdom and health promoting therapies; and public health's considerable effectiveness in fundamentally improving the environment and decreasing disease risk of populations. Great idea, how do we do it?

 

Obviously, advancement of all the healing arts is highly dependent on continuing investment in human biological research. This area appears well funded and continues to evolve in significant ways, especially genomics/proteomics. How well this rapidly evolving body of knowledge is accessed and utilized to improve clinical practice by both conventional and CAM professions is, however, of concern.

 

Public health, though well documented to have done more to improve the health of population the past century than all the health professions combined continues to be under-funded and under appreciated. Equally important has been the failure of conventional and CAM practitioners to fully embrace and engage with public health. Sadly, the current healthcare reform initiatives do not appear in place to resolve this lack of collaboration.

 

The aspect of the emerging healthcare system currently most in play is the interaction between conventional (CM) and CAM providers and their therapies. The success or failure of this interaction appears to depend on two factors: technical and interpersonal. The technical side—how to co-manage patients and recognize both desirable and undesirable interactions of drugs and natural medicines, is finally beginning to be researched. Thinking through how to integrate patient care when both conventional drugs and natural medicine therapies are being used at the same time is challenging and, while holding great potential of substantially improved patient outcomes, is fraught with significant risk of undesirable interactions. These can range from increased toxicity of a drug, such as when liver Phase I detoxification is slowed by an herb such as capsicum so the drug reaches higher blood levels than expected, to direct interference with the mechanism of action such as see with the chemotherapy agent cyclophosphamide and the herb curcumin. The other, perhaps more challenging, aspect is the interpersonal. We need to address such issues as "Why bother?" "Why is it so difficult?" and "How to do it."