A photo of pills on a shelf.

Broken Medicine

Can the “Wellness” Industry Solve Our Healthcare Crisis?

Women frustrated by conventional medicine’s failures are turning to alternative therapies, with varying results. But if regulated and supported by physicians, an integrated approach could cure our broken system.

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This feature is part of our ongoing series looking at the inequities in healthcare.

Penelope DeMeerleer was born with hydrocephalus, a rare brain disease that causes grand mal seizures. Throughout her youth, surgeons performed 57 innovative surgeries to save her life. When she was 16, doctors prescribed an anti-seizure medication called Keppra. No one mentioned the side effects, which included depression and headaches, or that sugar and high-carb foods can trigger seizures. For ten years, DeMeerleer struggled with her mood, “I used to be a happy person, and now I was feeling numb and down.”

Cannabis-derived CBD oil is showing clinical promise as an anti-seizure treatment. DeMeerleer posed the idea of modifying her diet and implementing supervised CBD use so she could take herself off Keppra. “My doctor won’t have any of that,” DeMeerleer said. “Trying other options would be going against my doctor’s advice,” so she keeps taking the drug. Without her physicians, she would be dead, and yet, she would like to live the rest of her life free of a medication that gives her headaches and makes her depressed. She receives free therapy through a Native American clinic in her community.

For all the benefits medical technology and research have to offer, conventional health care is a rigid, transactional system anemic of empathy; it’s excellent at damage control for illness and injury, with little to no emphasis on quality of life. The current medical model where the patient is assessed, tested, diagnosed, and prescribed (all at dizzying speeds) feels like a machine.

The negative side of conventional medicine is magnified for women. Statistically speaking, they are understudied compared with men, misdiagnosed more than men, and our pain is often underestimated. Multiple studies found doctors interrupt their female patients within the first 11 seconds of a visit.

Outcomes in women’s health reflect those inequities: Pregnancy-related maternal mortality rates have climbed steadily since the 1980s, and we are twice as likely as men to experience depression and suicidal ideation. Naturally, women who can afford it are venturing outside conventional medicine.

The promise of Eastern, alternative, and holistic approaches is twofold: One, understanding of the mind-body means our thoughts, our stories matter to our physical health and, two, this knowledge is a form of taking back control.

According to the National Institute of Health, 38 percent of Americans pay out of pocket for some type of alternative medicine at a cost of approximately $33 billion per year. Of that segment, 59 percent are women.

Many of these practices and techniques are preventive, affordable, and often lack negative side effects associated with drugs, particularly for pain management. Neuroscience and psychology provide startling evidence that ancient practices like yoga and acupuncture work for a wide swath of conditions, and offer a range of health benefits. HMOs are slowly adapting evidence-based CAM (Complementary and Alternative Medicine) and seeing results. However, there is plenty of resistance to this substantiated data within the medical community, and very little research attention paid to CAM.

In the vacuum of compassionate care, the mind-body revolution exploded and the multi-billion-dollar wellness industry formed, largely unchecked by science.

Recognize the phrase: “This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease”?  That’s a result of Congress passing the “Dietary Supplement and Education Act” in 1994, which divests the FDA of having to test these products before they hit the shelves. The legislation states that commonly used vitamins have benefits and very few negatives. The sheer volume of new products was overwhelming the FDA, so this allowed supplement companies to go to market and possibly get tested according to the claims on the label down the line.

In the last 20 years, the e-commerce supernova dispersed a new “green purity” culture. Middle-class women were the target market for this enhanced set of lifestyle goals that refashioned success and beauty around enlightenment. It’s no accident that these products, services, and practices speak deeply to women’s existential dread. We are disconnected from our bodies and our doctors don’t listen to us.

To reconnect, we have to get back to the Earth through “mindful detoxification.” The Goop lifestyle brand is the perfect encapsulation of pseudo-scientific enlightenment in a bottle. Gwyneth Paltrow could not strike a deal with Condé Nast because so many of the claims in her content could not be substantiated. Professional alternative practitioners contend that any merit to Goop’s offerings is negated by the excessive pricing. Goop’s main value proposition (currently worth $250 million) is a way of being in the world.

U.S. profits on meditation apps, vitamins, fitness clothing, essential oils, health tourism, and plant-based anti-aging products soared by 12.8 percent from 2015 to 2017. Current estimates put the global wellness market at $4.2 trillion.

In 2015, Walmart, Target, Walgreens, and CVS pulled supplements labeled Ginko Biloba (taken for mental concentration) and St. John’s Wort (used for mood-boosting) from the shelves when a lab found “80 percent of the pills officials tested did not contain the key plant ingredient listed on the label, and included fillers like rice and beans, and additional ingredients such as wheat, mustard or radish,” reported NPR.

Sometimes the consequences of under-regulation are life-threatening. The CDC issued a warning recently on kratom, a plant derived from Southeast Asia touted as a natural alternative to opioids that can be purchased online. Toxicology reports revealed the presence of kratom in 91 overdose deaths in the U.S. 2017 along with other addictive substances. These overdose deaths indicate that people struggling with substance abuse attempted to use kratom to withdraw but accidentally overmedicated. Some states have already banned the sale of kratom, but one extensive survey undertaken at the University of Rochester School of Medicine looked at dozens of international studies on kratom and indicated that, taken in its natural form with supervision, the plant has significant benefits, including mitigating harm associated with opioid addiction. So it appears the problem with these types of deaths has more to do with purity, dosage, and lack of professional support than inherent danger in the plant itself. Even with non-lethal, regulated CBD, ER visits associated with overconsumption have shot up.

For people who work with herbs, misuse is wrong for spiritual reasons as well as moral and medical ones. Lola Venado practices ancient Mexican and Native American plant medicine and ritual healing. For her, this massive commodification of plant-based medicine is “colonization at work,” a form of cultural appropriation where the product is stripped of multi-generational knowledge, and therefore its efficacy. Just like with pharmaceuticals, these powerful compounds must be administered properly by someone who knows what they’re doing.

Instead, doctor-patient culture sets us up to pop “high potency” pills to address symptoms, not the root cause of the illness or condition. Venado argues that it’s the consultation between patient and healer that enables the medicine to work. The medicine sets the stage for the mental-emotional work to begin. “Being heard is a huge part of the healing process,” says Venado. A crude equivalent in conventional medicine would be administering anti-depressants without cognitive behavioral therapy.

In a recent lecture at UC-Davis, Venado talked about  “wellness sovereignty,” by which she meant that “healing is not something that happens outside of us, or to us. The support has to be there, the relationships have to be there, but we are in charge of it.”

Women don’t have wellness sovereignty when big box stores sell them rice pills, and they don’t have wellness sovereignty when their doctors only offer them drugs and surgery.

“I learned early on in my career that healing is about relationships,” echoes Dr. Barbara Cordell, a licensed nurse practitioner with a Ph.D. in health counseling and education, and certification in several CAM therapies. She is the author of an upcoming book about Auto-Brewery Syndrome (ABS), a rare GI condition where the gut spontaneously produces excesses of ethanol. ABS has been systematically written off by doctors as closet alcoholism, even when presented with the data. Cordell has successfully treated patients with an integrative approach utilizing both conventional anti-fungals and probiotics.

Because each patient’s needs are unique, she says a collaborative team effort with medical doctors and alternative therapists is optimal. “We should be using every beneficial resource we have available.” This approach would enable someone like DeMeerleer to explore non-pharmaceutical options safely.

All the women interviewed for this story already take what you might call a DIY approach to integrative care, seeing a doctor for diagnosis and addressing mental health, bodywork, and pain management elsewhere.

The CDC, the NIH, and the National Center for Complementary and Integrative Medicine (NCCIH) all repeat the need for more integration like a mantra: Prevention, mental health, and lifestyle agency need to be woven into the fabric of health care.

The other compelling argument in favor of integrating evidence-based alternative medicine is money. The U.S. spent $3.5 trillion on health care in 2017, which equals roughly $10,000 per person and we have some of the worst health outcomes among industrialized nations. Part of the reason that HMOs started to institute evidence-based CAM in the early 2000s was that utilized along with conventional medicine, doctors could draw down expensive late-stage treatments and surgeries by way of prevention. Patients who receive a combination of CAM and conventional medicine are more satisfied with their care.

Now is the time to think boldly. There are few issues more critical to address in the next election cycle than health care, and while all the Democratic candidates are making the issue central, the women running for president have spoken concretely and personally about the life-and-death consequences of our current failed system.

If we are to create a public option, it must have at its core a soft revolution that re-humanizes patients and gives doctors more flexibility with time and treatment options. We need to de-stigmatize proven modalities and invest in research beyond drugs. This includes reexamining the methodologies with which traditional healing practices are studied.

Holistic medicine acknowledges the whole person and the body’s extraordinary aptitude for self-healing, which is why women gravitate to it. But if doctors, alternative practitioners, and patients work together, it will be far easier to distinguish science from snake oil.

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