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Holistic Care in America The EDGE Interview with Mark
Hoch, M.D., incoming president of the American Holistic Medical Association MINNEAPOLIS -- Despite a growing public demand for more alternatives in health care, medical doctors and educators are slower to adopt holistic approaches to caring for people's mental and physical ills, said Mark Hoch, M.D., a Minneapolis physician and incoming president of the American Holistic Medical Association (AHMA). Dr. Hoch said schools that are charged with educating our future doctors are not in a rush to preach the gospel of holistic medicine. "It's very slow and they see it more as a curiosity," he says. "I've spent some time at the University of Minnesota. They invited me to help teach a course they were doing on back pain, which was for all the first-year students. But, it's still sort of more of a curiosity like, 'You need to know this because your patients or clients are going to be doing this,' or 'These are some of the other things out there.' It's more of an interest or curiosity as opposed to looking at health a different way." Dr. Hoch, who had served as lead physician at the Arizona Center for Health and Medicine, a multidisciplinary holistic center in Phoenix, is now practicing at the Wellness Center Etc. in Minneapolis. He has training and practice experience in osteopathy, Trager, mind-body approaches, herbal medicine, diet, nutritional therapies, qigong and spirituality. He is board certified in family medicine and is a founding diplomate of the American Board of Holistic Medicine. He has been a member of the American Holistic Medical Association since 1986, on its Board of Trustees since 1995 and will become president of the association at its annual meeting in Toronto May 15-18. A native of Long Island, N.Y., he tagged along with his father, a veterinarian, on Saturday trips to the clinic. In college, he majored in biology, specifically neurobiology, but realized that developmental research and genetics was not his path. "I really wanted to work a lot more with people," he said. "What I've found over time is that I've been much more drawn to the practical side and the spiritual side of health and healing, balancing that out with the scientific side, because I think they're both really important." He spoke with The EDGE from his office in Minneapolis about the state of holistic care in America. Tell me about the American Holistic Medical Association. Dr. Mark Hoch: We have about 1,000 members right now, which is steady growth. Our organization started out in 1978 and was more of a support group for people. The numbers were running between 300 and 400 people until the last maybe six or seven years. Membership has more than doubled in the last six years and it's steadily growing. There is now a wider array of people in the organization. In other words, there are a lot more people who are in academic medicine, either teaching or are on faculty at medical schools or residency programs. And there's a lot more emphasis on education. It's no longer just a group offering support to doctors who were really isolated and wanted somebody they could talk to or share ideas with. The association has had several courses that have been co-sponsored by medical schools. We've been getting more evolved in getting more people interested and giving them more skills and more information. A lot of doctors don't believe there is proof that holistic medicine works. Hoch: That attitude is based on what's now being called "evidence-based medicine." One of the knocks on holistic or complementary medicine has been, "Where's the data?" Bob Anderson, a family physician out of Washington state, put together a database that contains more than 4,000 abstracts. He has published the abstracts and has cross-referenced the information. You can look up nutrition and then find the data that supports all the things that nutrition has shown to be good for. Bob has been successful at getting the courses put on by medical schools because when they say, "Show me the data," then he says, "Here are 4,000 abstracts." That's really helped people look at it and take it much more seriously. One of my goals is to continue to improve the education process and to help the American Board of Holistic Medicine, which has now certified about 500 doctors. To be certified, there's course work to complete and an exam that must be taken. Doctors need to have a letter of recommendation and they need to write an essay about their own personal journey of healing and what that means to them. And they have to have an interview Doctors need to demonstrate more than just the information. Merely knowing a lot of information on herbs or on acupuncture does not make one holistic. They have to be able to demonstrate that they are on the path and that they are walking the talk. For somebody who is not familiar with holistic medicine, how would you define it? Hoch: Holistic medicine is a philosophy and a way of being, more than a modality. That's really important. It's health based and it looks at all the factors that affect health. It looks at the physical -- everything from genetics to biochemistry, diet and nutrition, and environmental factors, whether it be pollution or noise or things in the workplace, and body structure -- and it also looks at the emotional components of health, the medical components of health, the social components of health and the spiritual components of health. And it looks at all those together as one whole. That's the biggest difference, as opposed to conventional medicine, which is really focused on disease management. I can say that, having gone through seven years of training, plus all the pre-requisites and having taught in residency programs and having taught medical students. Holistic medicine is focused on health. There is a much greater emphasis on promoting health and preventing problems, as opposed to waiting for them to manifest and then trying to manage them. It's also about getting at the roots of problems. The closer you get to the root, the easier it is to solve the problem, and then you don't have to spend the rest of your life trying to manage it. I also think practitioners of holistic medicine are really focused on health -- and they are living their lives that way. What they are recommending to people, they are doing for themselves. It's not just, "Do as I say." We like people to be able to set an example, and I think it's very powerful for people coming to the office if they see that you've actually been able to do it and it's working for you. It helps them get motivated and see the benefits. There's a big emphasis also on really getting to know the unique individual who comes in, as opposed to saying, "This person has this disease, so let's work with the disease." The same disease or problem can have many different causes, and there are unique solutions for each individual. We can help individuals much faster by following their own unique lifestream and story. One of the most obvious differences between your practice and somebody who's working in an HMO clinic would be time. You would spend more time with your patients, getting to know them? Hoch: Time is a big factor. What I always teach my students is that if you want to help the story end well, it's really important to know the beginning and the middle. I spend at least an hour on the first visit and often more than that. Instead of me being a primary care doctor, I'm more of what I call the ultimate care doctor. I see a lot of patients around here whom I'd call the post-Mayo Clinic crowd. They've been to the Mayo Clinic and come in with a stack of records, or they've been to three or four doctors with a stack of records. Then I have to figure out what's happening and why they are not well. Most of my patients come from this group. So you're seen people who have not been helped? Hoch: It's either people who haven't been helped or people who are concerned about the toxicity of the therapies they're getting or that their treatment is not addressing the root cause of the problem. I happen to see a lot of people with pain issues, partly because I had some injuries in my life and I've studied a lot of things like Osteopathic medicine, Trager, t'ai chi and qigong. I have a lot of skills in those areas and some of my teachers have been in those areas. But, I have been seeing everything, including chronic diseases, diabetes, heart disease and arthritis. I'm seeing more people with cancer. It's not a specialty of mine, but I am seeing that also. Are you seeing a shift in public perception of holistic medicine? Hoch: I think public perception is shifting dramatically. Probably the majority of people are more just looking at what's been called complementary therapies. Let me define some terms. In our society, we use what I call conventional, rather than traditional, medicine, in the sense in that it's just that that's what the mainstream is doing and that's what is taught in mainstream institutions. Whereas in some other traditional medicines, for example Native American medicine, are centuries to millennia old. Look at Chinese medicine: acupuncture was standardized around the year 1100 and there are textbooks that go back 3,000 years -- and their tradition goes back about 5,000 years. If you look at Ayurvedic medicine from India, again there are texts that are well over 3,000 years old, and there's evidence of Ayurvedic Medicine being at least 5,000 years old. So there's a big difference between something that's been around for 5,000 years and something that's just been around for 100 years. We sort of lose sight of that, because that's all we've been raised on and are used to. What is called alternative medicine is that which is not taught in mainstream institutions. I'm not really fond of that term partly because it doesn't make a lot of sense, because even if you went to a mainstream cardiologist and you had high blood pressure, the doctor has about 50 different medications -- 50 different alternatives -- to choose from there. I don't think "alternative" is a very useful term, and I also find it somewhat divisive. It's sort of like, "It's either this or it's that." And you see that both in conventional doctors, if anything is not conventional it's bad. Or you see people who are in the complementary world and they say, "This is good. Only Chinese Medicine is good, and Western herbs are bad and Western medicine is bad." So, I like the term "complementary" better, where things complement each other. And you're hearing the words "integrative medicine" a little more, where people are putting all those things together. The difference, again, between complementary and integrative approaches and a holistic approach is that the previous still focus on the modality as opposed to the focus on the health and the whole being. Some modalities, like Chinese medicine, happen to be very holistic, but I've seen it practiced in a very narrow way. It's more likely you'll find a holistic practitioner who's trained in traditional Chinese Medicine than conventional Western medicine. So, what I find in watching what's been happening with the public in the last 15 years is that there's a great interest in complementary and integrative medicine, and there's also a great interest in holistic medicine. Health food stores have so many more things on the shelves than they did long time ago. Even with conservative estimates, there are more visits to complementary/alternative/holistic practitioners every year than there are to primary care physicians every year in the United States. That says a lot. And, I don't know what the exact number is, but a very conservative estimate, probably with five-year-old data, is that there's probably at least $45 billion a year spent on this sort of thing, and probably half of that is going to visits and half is going to supplements and therapies and herbs and things like that. The vast majority of that $45 billion is out-of-pocket expense, compared to insurance where people pay into the system. It's really interesting, because a very large percentage of people have a sense of entitlement because they're spending hundreds of thousands of dollars a month on their insurance, so they want to do what's on the insurance plan because it's covered. People who say, "I'll do this, because it's covered. I know it's not as good, or it's more toxic, but it's not costing me anything." There's been a big change in that now. A lot of people are just spending the money because they know that's what they really want and really need, and it's not covered by their insurance plans. And there's the frustration that they can't spend their insurance money on what they choose to. Hoch: I think the medical savings account idea is going to be helpful with that. That's what I've chosen to do. So you can take pre-tax dollars. You have a wider choice of what you can spend it on. You can go out of the network of your health insurance and see another doctor if one is more in tune with what you need. Are you concerned about the number of advertisements on TV selling new drugs? I see more and more of it. They tell you about new drugs and say, "Ask your doctor about it." Hoch: Yes. It's been a major trend for the last several years. Having lived in New York, it's amazing that almost every single subway car has a prescription drug advertisement in it. Some of them take up an entire side of a car. I have seen studies in medical journals looking at that issue, and about 40 percent people in a given year will ask their doctor about an ad they've seen -- and almost half of those people, I think about 18 percent, will actually get a medication that may or may not be appropriate to them. The more educated you are about prescriptions, the better. But, often there a new drug will cost five to 10 times as much as an old drug or a nutritional supplement. The new drug of the month is always out there. That drives costs up tremendously. Even if there's no philosophical problem, I think it's really causing costs to go through the roof. Part of my concern is how these commercials for prescriptions reinforce the mindset of treating symptoms with drugs. Hoch: Exactly. Especially the drugs for depression. It's like, "If you only took this drug, you'll feel better." It's as if the only problem with America is that we have a Prozac deficiency and if we just put it in the water supply, then everybody would be happy. And that's a big problem. It's easy for people, especially if your insurance plan is paying for it, to take drugs instead of taking responsibility. And that's another big difference between conventional and holistic medicine. Part of the reason I think the results I get with patients are so much dramatically better than let's say 10 years ago is due to all the extra training I've had in other modalities and the skills I have. Part of it has to do just the fact I'm listening. We get the story and then figure out what's going on. People also are taking an active role in their health, which is so critical. People who take the most active role in their health are the ones who get better, even from disease that are seemingly incurable or impossible to get better from. The problem I have with the pharmaceutical industry and their ads -- and how we're trained not just in medical school, but in our whole society -- is it's always the quick fix and nobody's responsible for anything. If you've got a problem, you can always sue somebody. Look at Enron, "It's not our fault. It's this person's fault. It's the accounting company's fault." If it's not that, with Ford and Firestone, "No, it was the tires." "No, it was the car." Everybody knew there was a problem, but nobody would take responsibility. Look at all the things in government. Nobody will take responsibility. If all the adults are doing that, where are the children going to learn to do that? Tell me about trends in holistic medicine internationally. Hoch: Most countries are ahead of America, especially many of the developed countries. Europe has always been much more open to things. Homeopathic medicine is very common in Europe. Even though Osteopathic medicine came form America, it's in France and there's actually an Osteopathic Medical school in England now. Herbal medicine is much more popular, though It's actually more regulated in many countries. In Germany it's not unusual for doctors to prescribe for somebody to go to the spa for a week for their health. That would be just totally outrageous here. Only the rich and famous go to the spas. There has been a longstanding tradition for that in many European countries. In the former Soviet Union, there is a greater openness to energetic approaches of healing and medicine, particularly in Russia and the Ukraine. One of the problems I see with this argument of "show me the research, show me the data" related to the effectiveness of complementary modalities is that doctors do a search on the computer for two Western medical journals for the last five years and they say, "There's only three articles, so there's nothing in there." Well, if you take Coenzyme Q10, which is a nutrient, there are books of research, not articles, but books, published in Japan, and you can find them in some hospital libraries. None of the doctors know that they're there, but they're actually in the library. There are thousands of articles published in England, Germany, Italy, France and Sweden and other countries and they ignore them. Research is from another country so it doesn't exist. They discount international studies? Hoch: They don't even care to look there. They don't even know other countries are doing research. If you look back at some of the nutritional research that was done in this country, most of it is from the 1940s and 1950s, before the pharmaceuticals were really big. That gets completely ignored also. The classic example is niacinimide for arthritis. There were great studies done in the 1940s that were dismissed, and they were repeated in the 1990s with the same results. Somehow the literature from the 1940s was thought of as completely invalid, because it was done 50 years ago, so therefore it has no value. That doesn't make sense. Yes, I'm a very strong supporter of evidence-based medicine, but can't be selective about what evidence you look at. You have to look at all the evidence. And we also have to realize that they're trying to hold complementary medicine/holistic medicine to a much higher standard often than Western medicine is held to. Look at how many surgical interventions there evidence-based medicine for? Very few. The appendix operation is one of the most common operations. How many scientific studies show that's better than antibiotics? There may be one, there may be none. I don't know. And how many hundreds of thousands of heart bypass operations were done before anybody scientifically studied it? It's good to review the evidence, but I'm gong to teach the students that you also have to hold the pharmaceuticals and the surgery to the same high standard. Speaking of nutrition, there are new studies about children and obesity. Is the solution to this problem putting more emphasis on nutrition? Hoch: Absolutely. In one of the Family Practice journals I was reading yesterday, it said 60 percent of the American population is overweight. That is just astounding. The vast majority of that is due to our nutrition. I'm very concerned about the diets recommended by mainstream medicine and the American Dietetic Association. I question the idea of the food pyramid that's been promoted and the diets for diabetes. Why have we seen obesity and diabetes dramatically increase since that diet was recommended? There's something wrong. You can cut fat out of the diet, but to some degree it's healthy. But, if you just eat sugar and refined carbohydrates...that's what this epidemic of obesity is all about. People often blame it on fat, but if you eat a high-fat diet, it's really hard to overeat because your body gets satisfied quickly. If you eat a high-carbohydrate diet, you can just sit there and eat and eat. People can eat a whole box of cookies. You're not going to eat five pounds of meat or cheese or fish or something like that, or soy, or high-fat foods. Your body will just be satisfied. Whereas the sugar has this addictive quality to it. Almost every low-fat food you can see is not necessarily low calorie, and it is usually very empty in nutrition. There's very little vitamins, very little minerals, very little fiber. All of which are important. They're usually high in sugar, high in salt, high in refined carbohydrates. And that's a big problem with this obesity epidemic. Not only are people eating foods that are not necessarily nutritious, but they tend to make us want to eat more. You get into the cycle. Is the American Holistic Medcical Association going to come out on some of these issues in a strong public way? Hoch: Yes. We had a nice strategic planning meeting about two and a half years ago and we've met about 90 percent of our goals in that time. We're in our new phase now, which means we will be continuing the education, building the infrastructure of the organization and then getting out more in the public and the media, even if it's just to explain these things to more people so people can really understand what's happening. Copyright (c) 2002 Tim Miejan |
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May 2002 |
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