Let’s start with two eyes before we open the third
We are living in a time of mass consumption and as more people take ownership of their health, we are venturing outside what’s considered “the usual” in search of a more balanced life. If you’ve been paying attention to health trends then you have heard of the term holistic, a debated term. Holistic medicine incorporates more of a philosophical and attitudinal approach to health and wellness. There has been an increase in people’s awareness of holistic medication and some will need guidance on their journey.
Complementary and alternative medicine or CAM for short is guided by the holistic approach. For those of you who believe this is “hippie-dippy” science, you are greatly mistaken. The National Institute of Health created the National Center for Complementary and Integrative Health which is solely dedicated to the research and information dissemination of CAM. In 2012, the Centers for Disease Control published a statistical report displaying upward trends in CAM. Americans spent $30.2 billion out-of-pocket on complementary health approaches — $28.3 billion for adults and $1.9 billion for children during the year 2011. This out-of-pocket healthcare spending included healthcare providers such as chiropractors, acupuncturists, and massage therapists.(1) Approximately half of you reading this have already started a complementary therapy. Be it an herb, oil, tea, or yoga/meditation (or all of the above), people have been searching for natural and organic methods to improve their health.
Cynic or Seeker
Due to the Covid-19 pandemic, people are taking a greater interest in boosting their immunity with heavier influence on oral supplements and vitamins. Another aspect to consider is the spiritual view in that as a society, our focus has been centered around productivity and technology and further away from Mother Nature. The ramifications of isolation and distancing have impacted overall mental health as well. This unfortunate situation further escalated a transition towards the holistic approach. Before this transition, a broadening occurred in the number of practitioners and counselors within this space. Another added source of material stems from influencers on social media platforms. Social media can be a tricky or beneficial platform by either adding skepticism and confusion or the polar opposite, an introduction into a beneficial possibility, especially for those of us who have experienced therapy failure with conventional treatment.
Part of the confusion can be due to terminologies used and skepticism stems from lack of formal regulation and guidance within the holistic space. Although foreign countries have extensive clinical data supporting the science behind Ayurveda and Traditional Chinese Medicine, for instance, the US is lagging. Ironically, there is a populace in the US that practices holistic medicine legally, along with funding backed by the CDC, the American Indian and Alaskan Native communities.(2) Irrespective of funding and regulation, the demand for holistic interventions is present and growing, a force our government will have to take into consideration, simultaneously protecting the public’s safety whilst allowing freedom of choice.
Beyond what information is available online, through social media, and from Deepak Chopra, checking in with a pharmacist can guide consumers to find tailored products and practices complimenting treatment regimens. The primary duty of a pharmacist is to ensure the safety and efficacy of medication therapy of the public. Besides dispensing medications, providing immunizations, and preventing adverse reactions, we are counselors first and foremost. It’s in our professional DNA and now is the best time to expand our education and training to holistic therapies. Retail pharmacists are easily accessible healthcare professionals and now beyond the traditional chain pharmacy model is another, the integrative pharmacy. These pharmacies contain a traditional pharmacy, a storefront full of holistic products, and referrals to both conventional and holistic practitioners. These convenient one-stop-shop establishments will further peak the public’s intrigue into holistic medicine.
As pharmacists, we are constantly interacting with people of varying demographics and disease states. We are accustomed to making suggestions on vitamins and supplements and understand the importance of evaluating the risk and benefit of adjunct therapy. With the increased use of bio-hacking and self-diagnostics along with health/fitness apps, patients have data outside of lab tests requiring analysis and interpretation. Those of you who are health professionals have already been advising on lifestyle modifications however it is best to familiarize yourself with the available holistic methodologies patients might request your advice on. These categories include mind-body interventions such as yoga and meditation, biologically-based such as aromatherapy and herbal medicine, manipulative and body-based such as massage and chiropractic, and energy-based such as reiki.
Some traditionalists feel that eastern medicine has been diluted to fit the western way of life. For instance, the use of mediation apps is debated within holistic communities. Some feel it’s best to start something versus nothing in hopes the meditator will weed through the commercialism and seek a practice leading to a greater intrinsic value beyond stress reduction. Others feel the philosophy is lost and people remain stagnant in the surface layers and don’t truly dive inward reaching transcendence. The Ayurvedic science of yoga and meditation is quite vast and detailed, it’s roots are deep-seated in sacred texts written in the Sanskrit language. To receive the benefits these texts encompass doesn’t require you to quit your job, pack your bags, and live in an ashram in India. What is vital is choosing a master/guru/teacher/trainer who understands the philosophy and can introduce it safely and effectively into a patient’s daily practice.
The physical and mental health benefits of yoga have been established but there is a lack of more clinical research in disease-specific states, specifically randomized control trials. The majority of data results are derived from patients diagnosed with mood and mental health disorders. For example, patients suffering from Post-Traumatic Stress Disorder or PTSD had symptom improvement when yoga and meditation practices were added to conventional therapy.(3) Another study which was a randomized control trial reflected positive clinical outcomes in patients diagnosed with Major Depressive Disorder, MDD. After 12 weeks of yoga and meditation interventions, patients self-reported stress reduction which was clinically visible in the decreased circulation of a cortisol biomarker.(4)
Encouragingly, cardiovascular monitoring parameters from such studies promoted the execution of trials in other settings such as cancer, metabolic syndrome, and critical care. In the US, only 1 in 4 adult patients diagnosed with hypertension is controlled on medication, leaving the remainder at a higher risk of complications such as stroke or cardiovascular disease.(5) In 2019, the Mayo Clinic published a review reporting yoga eliciting a positive response with an overall blood pressure reduction of 11/6 mmHg versus the non-treatment group, designating yoga to be a viable antihypertensive lifestyle therapy.(6)
A benefit was also reported in a study of patients diagnosed with breast cancer. Findings included a reduction in insomnia and depressive symptoms, an increase in participants’ physical and mental endurance to withstand cancer treatment, as well as overall improvement of mental health-related quality of life.(7) The favorable effects of aromatherapy were reported in ICU patients experiencing anxiety, trouble relaxing, and sleep disturbances. The use of essential lavender oil helped reduce anxiety and increased quality of sleep in ICU patients diagnosed with coronary heart disease.(8) Essential oils are cost-effective and non-invasive, making them suitable adjunct therapy in most settings. Clinical trials are reporting positive effects yoga has on smoking cessation, self-control in adolescents coping with substance use, as well as alcohol and substance use in adults undergoing psychotherapy.(9,10,11)
Similar trials like these warrant further study of these interventions in both an inpatient and outpatient setting. Evidence-based research outcomes enable governmental bodies to regulate health practices and guidelines. In 2016, the NCCIH outlined a strategic plan supporting further clinical research on holistic therapies. Although this is a great start, it is pertinent these trials have inclusion criteria of different age groups, races, gender identities, disabilities, and socioeconomic statuses.
Despite the well-known benefits, there have been drawbacks as to why holistic interventions are not incorporated as complementary therapy on a larger scale. Two major culprits are the lack of legal regulation and health insurance companies’ willingness to cover the expense. Without legal regulation and the push for insurance carriers to cover holistic programs, the less likely it is for people, especially marginalized communities, to adopt these valuable modifications.
In 2010, Congress approved the Ornish Program as a component of the Center of Medicare and Medicaid Services’ intensive cardiac rehabilitation program to incorporate lifestyle modifications in at-risk patients to prevent cardiovascular events. The Ornish program contains 4 main components: plant-based nutrition, stress management, moderate exercise, and group support, of which the stress management component consists of meditative yoga practices. Currently, private or employer-sponsored health plans fully or partially cover alternative therapies such as chiropractic, acupuncture, and massage therapy. Although this is a beneficial policy, insurance companies do not umbrella complementary therapies under preventative health services, which could further reduce the cost for the public.
Companies such as Google, provide mind-body therapies at a discount and/or at no cost for their employees. If more companies understood the value of mental and physical wellness, there would be a reduction in burnout and turnover, as well as increased job satisfaction. Another concept is authorizing the use of Flex-Spending and Health-Savings Accounts to pay for complementary therapies. Until these changes happen, pharmacists should collaborate with providers to connect patients to local businesses such as yoga studios and mediation centers, as well as quality apps, benefiting patients in the interim. Community institutions are another valuable source and do not charge for services or accept donations, how much ever a person can give.
Many highly qualified professionals in all holistic fields continue to practice without standardization, erring on the side of caution. However, with governmental influence, companies will be more likely to utilize this pool as a component of wellness programs. There needs to be a structured process of licensing teachers and practitioners, along with guidelines and protocols otherwise all these wellness benefits will be at a loss.
Just as a single drug doesn’t benefit all patients, the same goes for holistic treatments. Preventing injury and harm, averting deception of consumers with ineffective products, avoiding confusion with misguidance and misinformation, and educated patients on false health claims are daily tasks pharmacists are charged with. These challenging tasks apply to holistic medicine as well. Mitigating this burden on health professionals requires a multi-disciplinary approach. Adding qualified holistic providers such as Naturopaths, Ayurvedic doctors (practitioners/counselors), and Integrative physicians to conventional institutions will require rewiring of our current health system but it isn’t impossible. Incorporating holistic studies into undergraduate and graduate programs at universities can pave the path for a more open mindset within medical practices.
The future outlook of holistic medicine is a bright and effective one. Understanding its value will prepare healthcare teams to have constructive conversations regarding complementary and alternative therapies with patients. By guiding patients, pharmacists are supporting the public’s path to better wellbeing. If you are a pharmacist and are unfamiliar with holistic practices, procuring local and national resources for the public is essential. Having websites readily available such as the National Center for Complementary and Integrative Health, National Ayurvedic Medical Association, American Holistic Health Association, provides people with access to more information.
Keep in mind, therapy protocols need to be individualized to the patient’s priorities and requests. Many varieties of yoga and meditation exist and must be tailored to each patient. Another example is if a patient has an allergy or intolerance to a certain fragrance, one has to be knowledgeable to provide alternate options (e.g. allergic to lavender, substitute with vetiver). Remind your patients to always share details of your consultation with their medical provider. It is not uncommon for patients to not fully disclose details with their provider due to poor communication or fear of dissuasion. Most providers will support the addition of complementary therapy willing there are no contraindications present.
My final note to all healthcare professionals: people reach out to us not only seeking our medical expertise and healing capabilities but to treat them with compassion and empathy. Accept their health goals, including connecting mind, body, and spirit, and provide them with tools and knowledge to set them up for success on their path of health self-advocacy.
Dr. Anjali Udhwani is a pharmacist with over 13 years experience in community healthcare. Her main interests include holistic and health sciences and practical spirituality. Please subscribe to the publication for future articles on Ayurveda and Holistic practices.