Integrative health clinics are appearing across Canada
Troy Media – by Rebecca Cheung
When he was starting out in medicine, Dr. Lawrence Cheng was hit with a realization about his patients.
“By the time they reached me it was too late,” Cheng said. “I didn’t feel like I had the correct tools and I didn’t feel like I could do the right thing for my patients.”
Cheng, who has practiced emergency medicine at St. Paul’s Hospital in Vancouver for over 15 years, explained that many of the cases he came across on the job were related to chronic health conditions – and that many of these illnesses were preventable. As waiting rooms continued to fill up every year, he became frustrated.
“There was a lot of symptomatic treatment and not getting to root causes,” said the UBC-trained doctor.
Together with Dr. Ashley Riskin, who was also trained at the UBC School of Medicine, Cheng launched the Vancouver-based integrative medicine clinic Connect Health in October.
Connect Health is among a handful of clinics popping up across the province that incorporate new approaches to health and health care delivery. The staff draws from complimentary and western approaches to healing. In addition to M.D.s and certified nutritionists, the clinic also offers naturopathic services, acupuncture and Chinese medicine.
It’s clear that increasing numbers of Canadians are beginning to rethink health and health care options.
But many patients are not only seeking guided advice – like Connect Health — but experimenting with alternative and unconventional medical approaches. Before making any major healthcare decision, important considerations, including safety, costs and personal comfort, need to be addressed.
Many Canadians turning to other options
Current criticisms regarding health care delivery in Canada are far from new.
According to critics, the same issues seem to come up again and again: The system is too focused on disease rather than prevention. Many Canadians don’t have family doctors. Wait times in emergency rooms are getting longer.
At the core, all of these criticisms are interrelated, says Dr. Alan Katz a public health researcher at the University of Manitoba, a family physician, and an expert advisor at EvidenceNetwork.ca, a comprehensive and non-partisan online resource designed to help journalists covering health policy issues in Canada.
“The system is very much disease-focused,“ says Katz. “You have a system that appears to be functioning at full capacity dealing with the current disease load.”
Primarily interested in ways of evaluating the efficacy of primary care, like family physicians, Katz says that the current system needs to be remodeled to be more patient-centred.
In fact, 4.1 million Canadians don’t have a family doctor, according to the Canadian Community Health Survey, which was published in 2007. And it’s not always an issue of access, but that patients might not see the importance of seeing a family physician regularly, Katz says.
Not surprisingly, many Canadians are turning to other approaches – including integrative health clinics that merge conventional MD services with complimentary and alternative medicine (CAM). CAM, which includes practices such as acupuncture, Chinese medicine therapy and mind/body healing, is known for focusing on spiritual and holistic health to treat conditions.
According to the World Health Organization’s Global Atlas of Traditional, Complementary and Alternative Medicine, in one year Canadians spent about $3.8 billion on CAM products and therapies. More than half of this total is invested towards practitioners and clinic visits.
And most patients are doing this on their own dime. In most provinces, like in B.C., CAM services aren’t fully subsidized by the provincial medical service plan. Patients with premium assistance benefits are partially covered for services like acupuncture, massage therapy and naturopathy.
As Canadians continue to invest in integrative or completely alternative health approaches, it’s important to take a closer look at the evidence backing up new healthcare movements.
Some proponents argue that complementary or alternative medicine incorporates spiritual practices and can’t be evaluated by conventional clinical studies. Still, there’s a danger in not taking a critical look at these procedures and blindly submitting to or ignoring alternative therapies.
And this can be dangerous.
Truant is a UBC graduate student and researcher with the Complementary Medicine Education and Outcomes (CAMEO) program, a Vancouver-based group that is currently collecting data on how cancer patients make treatment decisions. She’s interested in how to help patients make informed decisions based on evidence.
Though Truant can respect and sympathize with patients for choosing complimentary and alternative approaches, she cautions that health care decision-making comes back to being critical and looking at the evidence.
One issue “is combining common therapies. The idea that more is better,” she said.
Truant has seen one patient who blindly combined two dozen different natural health products with chemotherapy without consulting her physicians and healers.
“She was using the right doses but when she combined them, they all had this anti-platelet effect. She was covered in bruises,” Truant explained. “That is really a problem when you combine it with conventional chemo…it’s life threatening.”
In many cases, she’s seen patients mix and match therapies without telling their doctors or considering the risks.
“That’s the thing that people often forget – your oncologists and Chinese medicine doctors don’t always talk to each other,” Truant explains. “Sometimes treatment and healing programs might not mix very well. In terms of the herbs that are prescribed, there’s a lot of mushrooms that interact with cancer treatment.”
Negotiating your way to better health
There’s actually a lot that patients interested in non-western approaches can do to make wise decisions.
The first is to read up, says Truant. She refers patients who are interested in using herbs with their cancer therapy to reference materials that describe interactions and risk.
Additionally, there is on-going research aimed at confirming whether or not non-conventional therapies work. Last year, German scientists reported that acupuncture could ease nerve pain in cancer patients. But before that, British and South Korean researchers mined through hundreds of clinical studies and reported that placebos seemed just as effective.
Still, there’s also mounting evidence that alternative therapies might even induce harm in patients. Earlier this year, two different high-profile genetic studies suggested that some popular Chinese medicines contain toxic plants and animal products.
The key is to think rationally, sayConnect Health medical chairs Drs. Cheng and Riskin. The doctors spend over an hour with all new patients, reviewing their personal health issues.
“When you spend that time, that 60 to 90 minutes, you really do start getting the story, you start getting the narrative of the patient’s life,” Cheng said. “That’s just the beginning, then you can truly understand how to help that patient heal.”
Drs. Cheng and Riskin said that their staff – which includes a naturopath and a Chinese medicine healer – collaborate on medical cases and compare approaches to treatment and healing.
The clinic is currently using data collected on their patients as a way of evaluating whether their approaches are working. The doctors are also hoping to develop facilities so that young doctors and naturopaths can be trained.
Connect Health is one example among a number of integrative health centres, including the Burnaby-based clinic, Integrated Wellness, which are emerging in the Vancouver area. Questions regarding how these clinics should be funded and whether they will be accessible to the public remain.
“Health, it’s more than just the absence of disease, which is what we’ve been taught,” Dr. Riskin explained. “For me, health has to do with what the patients are seeking . . . and helping them get to a point where they wake up feeling good.”
Connect Health patient Karry Desmone agrees. Desmone has suffered from shoulder aches for over 20 years. She’s noticed a difference since she started taking supplements recommended by Connect Health.
Desmone has studied nutrition and worked in health food stores before. So she’s knowledgeable of what she’s putting into her body. And she knows the risks.
“I’ve never felt that safety with an MD like I do with Dr. Cheng,” she says. “What I feel is important, that I want to work with food and natural supplements, is important to him.”
Ultimately, whether patients seek solutions from integrative clinics, conventional medicine, or private complementary and alternative medicine clinics, they need to be prepared to do their research. And making informed decisions means including health care providers in decision-making processes.
Rebecca Cheung is a freelance writer. She is a former journalist intern atEvidenceNetwork.ca.