Integrative Medicine for Nurse Practitioner

lhflanurseNP, APRN · Jan 2, 2016

Insurance does NOT pay for alternative medicine. I do bill for the patient encounter by time and education/consult. Some of the labs are covered through insurance (or at least a decent portion). Most of my patients do not mind paying for the additional nutraceuticals or the non-covered services. For some of these patients, these alternative approaches are costing less than what they are paying for some of their meds!

cayenne06, MSN, CNM · Jan 4, 2016

What are the major nutraceutical companies?

I am wary of any training provided by a company that wants me to use/promote their products.

I don't understand why so many "alternative" practitioners have a problem with Big pHARMa, but seem to have no problem support Big Supplement- and even SELLING the very same products they recommend to their patients!

I agree with the previous poster who said that nursing is, by definition, an integrative practice. Practicing holistic health care does not mean recommending non-standardized dosing of (potentially) pharmaceutically active compounds (while it has been shown that many supplements contain no actual active ingredients, many herbs are medicinally active and it is dangerous to give medicine in a form that prevents accurate dosing of active ingredients. There is a reason we give penicillin instead of moldy bread).

Practicing holistic health care does not mean recommending treatments that a) are not backed up by even basic science (um, homeopathy anyone?) b) often have potential for harm (cervical chiropractic manipulation), and/or c) cost patients precious time/money for no therapeutic return. That is unethical.

cayenne06, MSN, CNM · Jan 4, 2016

Believing in homeopathy requires a suspension of the basic laws of physics. It cannot be reconciled with science based medicine.

Acupuncture has been shown, time and again, to work only insofar as the "placebo effect" allows.

Yoga is great exercise and stress relief. Very effective, probably comparable to some good hiking.

Traditional chiropractic is based on the subluxation theory (not to be confused with actual subluxations)- no basis in actual physiology/anatomy (there are awesome chiros who specialize in science based back care, but unfortunately the chiropractic profession clings tightly to the subluxation thing.)

Functional neurology- https://www.sciencebasedmedicine.org/chiropractic-neurology/

Nothing alternative about omegas. The problem is that supplements vary dramatically in the actual omega content of their oil. Hence the push for pharmaceutical grade, standardized products. Another problem is the ethical one of profiting from a product you recommend to a patient. Conflict of interest right there.

momrn5 · Jan 4, 2016

Yes :)

Psychcns · Jan 4, 2016

For myself, I find alternative medicine interesting in how it influenced mainstream practices. For example, mindfulness is now common in psychiatry. 20 years ago it was simply meditation. Someone was able to do

The studies to give it legitimacy. I think patients interested in alternative approaches tend to be more self-interested in their own health and well being--more "empowered". This is my observation. We need to at least know what they are finding out. For myself, when I am sick, I dabble with both. For serious things, I go mainstream-at least so far.

twozer0, NP · Jan 4, 2016

While I'm not yet in practice I've always been an advocate of balance. Will using essential oils and taking supplements save your life or fix your strep throat? No. The idea of alternative medicine should be used as an adjunct to mainstream therapy. I don't think its good for patients to rely upon medication to solve a problem that could be managed another way. Sure they might need the statin for a while but the goal shouldnt be statin therapy for the rest of their life (which is what happens a lot of the time). Diet modification and exercise is the true solution. The problem is that the culture we have created revolves around a "pill for every ill" and that most people don't want to alter their lifestyles.

I think the placebo effect of some alternative therapies can be as strong as actual treatments pending the person and what they believe. What works for one person, might not work for another. If a person perceives a benefit from an otherwise "unbeneficial" modality, why not if it does no harm?

My personal opinion is because of this terrible culture and eating habbits, I truly feel a lot of health issues could be evaded with proper diet modification. Nobody is saying you cant have a 5 guys bacon cheeseburger, but you cant have one everyday (or weekly at that!) and expect not to eventually have some issues.

cayenne06, MSN, CNM · Jan 5, 2016

While I'm not yet in practice I've always been an advocate of balance. Will using essential oils and taking supplements save your life or fix your strep throat? No. The idea of alternative medicine should be used as an adjunct to mainstream therapy. I don't think its good for patients to rely upon medication to solve a problem that could be managed another way. Sure they might need the statin for a while but the goal shouldnt be statin therapy for the rest of their life (which is what happens a lot of the time). Diet modification and exercise is the true solution. The problem is that the culture we have created revolves around a "pill for every ill" and that most people don't want to alter their lifestyles.

Diet and exercise are not alternative, though. No cardiologist would disagree that lifestyle modification is of the utmost importance in promoting heart health.

I think the placebo effect of some alternative therapies can be as strong as actual treatments pending the person and what they believe. What works for one person, might not work for another. If a person perceives a benefit from an otherwise "unbeneficial" modality, why not if it does no harm?

The placebo effect (better called the contextual effect) is real and powerful. But a sugar pill or sham treatment is not necessary to elicit this effect- it is the act of feeling CARED for, the idea that you are receiving effective treatment, that elicits this effect.

And the problem is, many alternative treatments do have the potential for harm. Chiropractic cervical spine manipulation has been linked to stroke. "Herbal" supplements, produced by hugely profitable and unregulated Big Supplement, contain widely variable amounts of active ingredients, ranging from none to potentially toxic doses. "Traditional" (in quotes because it is anything BUT traditional) Chinese Medicine supplements have been shown to soometimes be laced with actual pharmaceuticals, and some contain high levels of lead. There have been more than a few cases of infection caused by acupuncture done without proper technique. No treatment should be given if the benefits do not outweigh the risk to the patient.

And to be clear, the problem is not exactly with patients deciding to use alternative medicine. The problem is with health care providers using their position of authority to recommend treatments that have no proven efficacy- and even worse, profiting off the sale of these treatments. I think it is roundly unethical for a health care provider to provide and charge for things like acupuncture, reiki, dubious IV "vitamin cocktails," etc.

And even worse- it is often the most vulnerable patients who fall victim to this kind of thing. Cancer patients with a terminal diagnosis will spend tens of thousands, and the last months of their lives, pursuing "alternative" cancer treatments.

My personal opinion is because of this terrible culture and eating habbits, I truly feel a lot of health issues could be evaded with proper diet modification. Nobody is saying you cant have a 5 guys bacon cheeseburger, but you cant have one everyday (or weekly at that!) and expect not to eventually have some issues.

But again, that is not alternative medicine.

lhflanurseNP, APRN · Jan 5, 2016

I am wary of any training provided by a company that wants me to use/promote their products.

So I guess you do not listen to any "Big PHARMa" education or "use" their products?

Goldenfox · Jan 5, 2016

So I guess you do not listen to any "Big PHARMa" education or "use" their products?

A reasonable argument. Everybody is trying to sell something.

There is also some truth to the placebo argument. The mind is a very powerful thing. It can will a person who wants to live to survive extreme adversity, and it can will a person who is discouraged or depressed to give up and let go. I've seen this more than enough times to convince me that it's more than just facile interpretation or luck. But although pills and injections have their place they don't always work for everybody. For some people with chronic conditions, traditional medicine alone doesn't always control their symptoms well, no matter what you do or which specialist you send them to...but for some people the symptoms go away when they drink their bush teas, or apply their body salve, or oils from wherever. As long as homeopathic treatments don't clash with traditional medicine in ways that may be dangerous and the regimen is working for them then my philosophy is to let it be.

Nutraceuticals and naturaceuticals therapies aren't all just feel good placebo stuff or quackery (i.e. treatments that claim to burn fat off in a week, or to enlarge certain male body parts). In many cases, the products are much milder organic versions of similar products produced by Big Pharma, and without many of the toxic chemical ingredients. And, some of them do work---without nasty side effects. I have some books on the topic but haven't really read them in depth.

twozer0, NP · Jan 5, 2016

A reasonable argument. Everybody is trying to sell something.
There is also some truth to the placebo argument. The mind is a very powerful thing. It can will a person who wants to live to survive extreme adversity, and it can will a person who is discouraged or depressed to give up and let go. I've seen this more than enough times to convince me that it's more than just facile interpretation or luck. But although pills and injections have their place they don't always work for everybody. For some people with chronic conditions, traditional medicine alone doesn't always control their symptoms well, no matter what you do or which specialist you send them to...but for some people the symptoms go away when they drink their bush teas, or apply their body salve, or oils from wherever. As long as homeopathic treatments don't clash with traditional medicine in ways that may be dangerous and the regimen is working for them then my philosophy is to let it be.
Nutraceuticals and naturaceuticals therapies aren't all just feel good placebo stuff or quackery (i.e. treatments that claim to burn fat off in a week, or to enlarge certain male body parts). In many cases, the products are much milder organic versions of similar products produced by Big Pharma, and without many of the toxic chemical ingredients. And, some of them do work---without nasty side effects. I have some books on the topic but haven't really read them in depth.

You bring up something that I think a lot of people forget in that all drugs came from a natural source at some point. Even those synthetically created have natural roots. Willow Bark (aspirin), Poppy Seeds (Opiates), Foxglove (digoxin), even the greatest drug of the 20th century Penicillin came from Mold. High dose vitamin C effectively being used to treat cancer (High-Dose Vitamin C (PDQ)Ã¢Â€Â”Health Professional Version - National Cancer Institute). But my post above mentions balance. Will the high dose vitamin C completely put the person in remission? No, they will still likely require chemo/radiation/surg/etc but the studies that are out there point to vitamin C being effective in certain cancers. If those bush teas and natural therapies seem to work for a person, why stop them!

I do think there are a lot of products out there that just seem like a money grab, maybe these are the ones you are referring to? Remember Enzyte for male enhancement? Yeah they lost a pretty bad lawsuit because it did nothing! I also think these therapies are pretty easy to spot with all of the flashy advertising and outrageous claims.

Cayenne I wasnt referencing diet modification as an alternative therapy but more of a precursor that would reduce or eliminate the need for treatment. I agree with to a point about the clinician using authority to influence the patient on alternative therapies but when all other options are exhausted I dont see why it could not be pursued.

db2xs · Jan 9, 2016

Diet and exercise are not alternative, though. No cardiologist would disagree that lifestyle modification is of the utmost importance in promoting heart health.
The placebo effect (better called the contextual effect) is real and powerful. But a sugar pill or sham treatment is not necessary to elicit this effect- it is the act of feeling CARED for, the idea that you are receiving effective treatment, that elicits this effect.
And the problem is, many alternative treatments do have the potential for harm. Chiropractic cervical spine manipulation has been linked to stroke. "Herbal" supplements, produced by hugely profitable and unregulated Big Supplement, contain widely variable amounts of active ingredients, ranging from none to potentially toxic doses. "Traditional" (in quotes because it is anything BUT traditional) Chinese Medicine supplements have been shown to soometimes be laced with actual pharmaceuticals, and some contain high levels of lead. There have been more than a few cases of infection caused by acupuncture done without proper technique. No treatment should be given if the benefits do not outweigh the risk to the patient.
And to be clear, the problem is not exactly with patients deciding to use alternative medicine. The problem is with health care providers using their position of authority to recommend treatments that have no proven efficacy- and even worse, profiting off the sale of these treatments. I think it is roundly unethical for a health care provider to provide and charge for things like acupuncture, reiki, dubious IV "vitamin cocktails," etc.
And even worse- it is often the most vulnerable patients who fall victim to this kind of thing. Cancer patients with a terminal diagnosis will spend tens of thousands, and the last months of their lives, pursuing "alternative" cancer treatments.

"Traditional" means something that has been used for a long time. And Chinese medicine has been around a lot longer than Big Pharma.

Many pharmaceuticals also have the potential for harm. Anyone who thinks any treatment does not have any potential for some sort of possible side effect is fooling themselves.

Reminder: Many pharmaceuticals that have been created are based from the specific properties of plants.

Of my friends who have decided to incorporate integrative medicine into their cancer care, none of them were forced into it by a healthcare practitioner. And they are all well educated as well.

I don't think there is anything wrong with combining traditional and conventional. As with anything, be mindful of the contraindications. And remember that nothing is foolproof or the ultimate panacea--nothing.

cayenne06, MSN, CNM · Jan 10, 2016

"Traditional" means something that has been used for a long time. And Chinese medicine has been around a lot longer than Big Pharma.
Many pharmaceuticals also have the potential for harm. Anyone who thinks any treatment does not have any potential for some sort of possible side effect is fooling themselves.

Of course pharmaceuticals have potential for harm, as do pharmacologically active plants. That is why we standardize doses through purification, and insist on controlled clinical trials that show efficacy, and a favorable risk/benefit ratio. And this is why it is unethical to profit from a treatment that has no known benefit- because the risks automatically outweigh potential benefits in that situation.

Reminder: Many pharmaceuticals that have been created are based from the specific properties of plants.

Actually, I would say most, not many. Biologics are the main source of pharmaceutical compounds. But there is a reason we give ASA and not willow bark- because we want to control the dose and mitigate risk for harm.

Of my friends who have decided to incorporate integrative medicine into their cancer care, none of them were forced into it by a healthcare practitioner. And they are all well educated as well.
I don't think there is anything wrong with combining traditional and conventional. As with anything, be mindful of the contraindications. And remember that nothing is foolproof or the ultimate panacea--nothing.

Again, adults choosing to utilize alternative medicine is not the issue. And being educated is hardly protection against snake oil salesemen. I am highly educated, but that doesn't mean I can tell if my mechanic is swindling me. And we all know a little knowledge is a dangerous thing- dunning kruger affects ALL OF US.

The issue is health care providers using their position of authority to steer patients towards ineffective (and often dangerous) treatments. And even worse, steering patients toward dubious treatments that the practitioner themselves profits from. Unethical, morally wrong. I'm the first to point out the problems rife in the medical/pharm industries. That doesn't mean fake medicine is better. Science is practiced by humans, and humans make mistakes and act unethically. But the scientific process itself is what separates medicine from "alternative" remedies. It's not perfect, it's painfully slow, but it works.

Do you trust the science behind the plane you fly? Do you trust the science that makes the earth circle the sun? Then why not the science that has extended our lifespan and mitigated countless zillions of hours of human suffering? We can (and should) critique science and question results. That's not the same as dismissing science out of hand in favor of magical thinking.

Clearly this is an issue for me, lol. I spent many years steeped in this woo.