Advocating for Wellness in the Age of Skepticism
A growing body of evidence supports an integrative approach to wellness.
Posted August 18, 2018
A recent article that appeared in the New York Times utilized colorful metaphors and flowery hyperbole in an attack on the wellness industry. Comparing wellness practices as a “spell from the local witch,” “faux religion,” and “expensive magic,” the article took a reductionist approach in undermining an industry that has captivated the attention of millions who are simply seeking to live a healthier life.
I appreciate that the nature of medicine is progressive, evolving, and complex. As doctors, patients offer us the greatest gift; access to their life. And while it is true that “wellness is not the same as medicine,” it is also true that in many ways, wellness is so much more important than medicine. Medicine focuses on the eradication of disease, while wellness supports recovery. In fact, the World Health Organization defines health as, “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
A patient of mine with PTSD recently confessed that he had tossed his SSRI in the trash because he did not like the way it made him feel. "My faith is helping me through this," he quipped. He then turned to me and said, "but I still want to come see you, because talking to you helps me, too." Studies, in fact, support that incorporating cognitive processing therapy with trauma patients is useful for reducing PTSD scores. According to studies, there is also a therapeutic role for spirituality and religion in a trauma-recovery model. When patients veer away from medications, it is important to understand why, and when reasonable, work within alternative evidence-based models, understanding that some forms of mental illness will simply require strict adherence to a longterm medication regimen. As my patient continues to see me in clinic and continues to improve, I would argue that an integrative approach is actually helping him get better.
While there are many areas of disagreement with those who argue against wellness, I do agree we should challenge unfounded ideas and medical hoaxes. One does not have to look too far to understand the fallacy of antibiotic over-prescription for the common cold. There is no evidence to support this practice, and supportive care wins in this case, yet every day patients are written prescriptions for antibiotics that may actually be causing more longterm harm than good.
When well intentioned and reputable leaders in medicine stray from the evidence, it smears innovative ideas that could actually help our patients recover. I offer here an evidence-based alternative and counterargument against the ideas of those misrepresenting wellness.
Evidence shows that there are indeed some cases where conventional medicine alone falls short. In the mental health care profession, therapeutic alliance has been shown to improve outcomes in psychotherapy and pharmacotherapy cases. There is solid evidence to support the use of ginseng in the treatment of cancer-related fatigue. Preliminary evidence supports that Ginko biloba, the oldest medicinal plant, has benefits for tinnitus, cebrovascular disorders, and improving tardive dyskinesia in patients with schizophrenia. A recent article published in the American Journal of Psychiatry, a meta-analysis of 49 studies, supports the role of physical activity in preventing major depressive disorder regardless of age or geographic region. A 2017 Australian-based study commonly referred to as the SMILES trial, supports that incorporating a Mediterranean diet can help treat depression. Finally, yet another meta-analysis supports the benefit of yoga for patients who suffer from chronic low back pain (Holtzman). This is evidence-based wellness at its finest.
Wellness is not “potions in beautiful jars with untested ingredients.” It is not advocating for charcoal detoxes, and it is definitely not a practice based in conspiracy theories; most reasonable wellness advocates would dismiss such conspiracies as nonsense. Wellness is not the supplement industry, which I agree is a big business that markets products with questionable promises of vitality and longevity. Wellness is a philosophy that appreciates the importance of nutrition, physical activity, spirituality, community, and mind-body connection. These important areas should not be devalued.
When we patently and publicly disavow patients’ attempts to live healthier and cleaner lives by slinging mud at wellness, we discourage patients who would likely benefit from our guidance from seeking our encouragement and professional advice.
Integrative medicine does not eschew conventional medicine, but allows for evidence-based alternative practices which serve to embody wellness. I believe we are moving away from an age of cynicism and towards allowing ourselves the academic freedom to critically examine the evidence, regardless of whether or not it is yet the current standard of care. Rather than attacking wellness, let us focus on being more comprehensive doctors who practice the healing arts with an open mind and with compassion.
Holtzman, S. et. al. Yoga for chronic low back pain: A meta-analysis of randomized controlled trials. Pain Res Manag. 2013 Sep-Oct; 18(5): 267–272.