Pugnacious Irishwoman that I am, I resolved to do just that. I ordered Dr. Eisenberg's 1985 book, Encounters With Qi, which detailed the two years he spent in China studying Traditional Chinese Medicine. I ordered every article of his in the indexed literature, using the online service "Grateful Med." He is one of the co-authors of the breakthrough NEJM article that let the orthodox medical community and the popular press finally catch on to the fact that a huge number of Americans frequently use some type of "alternative" care. Most of his publications were of this general genre: alerting the medical community that alternative care is out there, and that they should be non-judgmental about it.
Of particular interest to me was his April 1997 article in the Annals of Internal Medicine, in which he proposes an algorithm for MDs to use when confronted with a patient whom they believe might be using or considering using alternative healthcare. He advises that the doctor discuss it openly, get the patient to begin to journal his or her complaint, review the possible side effects of the treatment, meet with the patient after the initial evaluation to discuss the care proposed, and meet with the patient after several weeks or months of treatment to evaluate the effects of the treatment. What concerned me in his article was the assumption that the medical doctor knows enough about the treatment to discuss side effects, and the fact that the article made no mention of the doctor contacting the alternative provider.
This caused me great apprehension about the message he might present. When I attended his very crowded lecture, I had prepared a question for him as follows:
Good Evening. I am Peri Dwyer, president-elect of the North Central Florida Chiropractic Society. I have a rather lengthy question, so I beg your forbearance in allowing me to finish.After reviewing your publications, it appears that your main focus has been the prevalence of usage of alternative or complementary therapies, and your primary audience has been orthodox medical physicians. In many of your journal articles, you encourage orthodox physicians to monitor and maintain control of any complementary therapies used. You frequently allude to the unproven nature of many alternative therapies, without simultaneously making the point that many medical therapies in common, everyday use are also unproven, or even scientifically discredited (two examples being, the multiple prescriptions of antibiotics each primary-care MD writes daily for viral infections, and routine episiotomies for childbirth). At the same time, the public demand for unorthodox therapies has increased to the point that many orthodox physicians are feeling pressured to provide them. My questions has three parts:
- What do you believe qualifies medical physicians to supervise, or even undertake, the practice of therapies which are based on an unfamiliar paradigm? How does this differ in principle from the unqualified practice of prescribing drugs or surgery?
- Why do you advocate that medical physicians and HMOs perform the research on alternative therapies, when there are numerous PhD-qualified researchers, experienced in alternative health care and familiar with its common protocols, whose desire to perform basic research and clinical trials has been stymied by academic marginalization and lack of funding?
- Why is there a lack of emphasis in your more recent writings, as opposed to your 1985 book, on two-way communication between the primary-care medical doctor and the complementary practitioner? Particularly in your July 1997 Annals of Internal Medicine article, how can you justify having the patient be the primary conduit of information between the two clinicians?
In summary: what is the role of the alternative practitioner in the research and clinical practice future you envision? Is the knowledge we have chosen to acquire outside the field of orthodox medicine to be accorded appropriate respect and consultation? Or can we expect to be co-opted and patronized?
After his talk began, I heard a very different slant from what I'd read in his articles. It was more like the very open-minded discussions of collaboration and shared authority found in his 1985 book. He made the point in his lecture that many medical therapies are scientifically unproven, saying that MDs decide on therapies "by induction, deduction... and seduction." He advised the medical members of the audience that he was not an expert on many forms of healing and neither were they, but that they should share what knowledge they had with their patients. He also advised them to pick up the phone and call the alternative (he preferred the term "integrative") practitioner.
When his lecture was over, he called for questions. I was the first to jump (dry-mouthed and weak-kneed) from my seat while everyone else hesitated to speak up before a room full of 200-or-so professionals. I read my question, qualifying it with the comment that he had already answered parts of it. The question met with applause from about half those in the room.
Dr. Eisenberg was initially speechless, but his answer was interesting. He declared that it pained him that his message should be taken with suspicion. However, he also offered the comment that journal articles are quite heavily edited before being printed. He offered to supply the original draft of the Annals article for comparison. [note: as of January 29, his office has not responded to a written request for the draft] He conceded that chiropractors had been badly treated by medical doctors and that he hoped that grounds for cooperation could be found. I was for the most part placated. After the discussion ended, I walked out the front door of the auditorium with him and he mentioned some leaders in the chiropractic profession whom he had met. His parting words to me as we shook hands were, "Remember, I am your ally, not your enemy!" As I walked to my car, I did not doubt that he was sincere. Yet, the thought came unbidden to my mind:
Ally? Or Trojan Horse?
Peri L. Dwyer, DC
Editor's Note: Further information on Dr. Eisenberg can be found in the November 3, 1997 issue of Dynamic Chiropractic. Look at Nicolas Chamberlain's article, "Dr. Eisenberg addresses the `implications of alternative medicine'."