By Audrey Goldfarb
As one of the world’s leading biomedical research communities, members of the Tri-I appreciate the volume and rigor of research done to seek and support new medical advances. In the U.S., overall life expectancy and survival rates of many diseases have steadily increased thanks to modern medicine. Paradoxically, the general well-being and healthspan of these populations has stagnated, in part due to side effects of the very treatments used to fight disease. We currently face an increased rate of mortality in individuals with a history of disease, and institutions are investing in research to address the growing gap between healthspan and lifespan. However, there are alternative healthcare systems that have existed for thousands of years to treat and prevent disease and preserve healthspan. These alternative systems are not yet integrated into Western medicine, but many are entering the mainstream of health and wellness, in large part due to promotion on social media platforms like Instagram and TikTok. While these platforms are effective in raising awareness, they’re also susceptible to overhype and misinformation, especially as rigorous research is lacking. The potential benefits and risks of alternative medicine remain unclear. Efforts to increase knowledge, awareness, and accessibility of all forms of healthcare will be key to improving health and well-being.
What is complementary and alternative medicine, and how is it used?
Complementary and alternative healthcare and medical practices (CAM) encompasses any medical and healthcare system and practice that doesn’t fall under the umbrella of conventional medicine. Because the practices included in CAM are constantly changing as mainstream medical practices evolve, it’s difficult to accurately define it as anything other than *not* modern, conventional medicine.
For example, traditional medicine, encompassed by CAM, is defined by the WHO as “the sum total of the knowledge, skills, and practices based on the theories, beliefs, and experiences indigenous to different cultures, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness.” CAM extends far beyond the resources we access through modern healthcare systems. As research bolsters our appreciation for personalized medicine, access to more diverse healthcare may be key in advancing individual and community well-being.
According to WHO, about 80% of the population in developing countries relies on nonconventional medicines as healthcare. CAM practices that originated in developing countries reflect limited local resources; therefore, many CAM treatments and remedies are produced at a lower cost than conventional Western medicine. However, the use of CAM practices does not correlate with socioeconomic status in the way one might expect and varies by country. For example, one study in Sub-Saharan Africa suggests that lower socioeconomic status correlates with CAM usage, while another in Iran indicates the opposite. In a 2008 study, the use of CAM in the U.S. was associated with higher socioeconomic status and education, but the degree of association varies among different ethnic groups.
The dose makes the antidote
One benefit of alternative medicine, especially to treat chronic conditions, is that it’s often administered in small, innocuous doses. Many of these treatments are designed to be integrated into a long and healthy life, which requires a higher level of commitment and participation from patients. Accordingly, when compared to modern medicine, CAM patients have more agency in decisions concerning their treatment.
Chemotherapy, for example, is prescribed by an oncologist and administered in a hospital, not at home. The patient is generally expected to be passive throughout the decision-making process, and any at-home complementary treatments are secondary. Chemotherapy is administered at a high dosage, which is generally calculated from the body surface area of the patient and doesn’t consider other factors that could help minimize the side effects of these drugs. Such an approach may be essential for acute injuries and illnesses but becomes a problem when treating chronic conditions.
Dr. Helene M. Langevin, director of the National Center for Complementary and Integrative Health (NCCIH), discussed different forms of complementary medicine in conversation with Neil deGrasse Tyson on an episode of StarTalk. Langevin argued that the high dosage of modern medications and treatments influences cultural beliefs about proper doses of substances used over longer periods of time, such as vitamins and supplements. This could be harmful, as most drugs and vitamins have off-target effects. For example, large doses of Vitamin E have been linked to cancer. Langevin recommended taking substances in the context of one’s diet rather than in pill form. “Correcting deficiency is important, but adding to that is not that beneficial,” she said. “Nonpharmacological treatments, when done right, can be very effective and useful without needing drugs.”
Work by Langevin and others suggests that in many situations, low-dose CAM may be more effective than high-dose modern medicine. “More is better is the mantra of our society, but what we’re finding out is actually the opposite,” Langevin said. “Research is starting to show that taking large amounts of anything is not a great idea.”
Bridging CAM with modern science
Ayurveda, one of the world’s oldest medical systems, uses natural and holistic approaches to prevent and treat illness. It originated in India over 5000 years ago and is practiced all over the world today. Ayurveda focuses both on preventing and treating disease by maintaining balance in one’s body, mind, and consciousness. It is commonly used in conjunction with conventional medicine—for example, to mitigate side effects of chemotherapy. MSKCC provides information on Ayurveda for patients and caregivers dealing with the side effects of cancer and cancer treatments.
Ayurvedic treatments are generally accepted by the medical community as highly effective, but because the pharmacology, pharmacokinetics, and pharmacovigilance of Ayurvedic medicines are largely unknown, they have not been integrated into our modern healthcare system.
Dr. Vikas Singh, a research associate in the Tarakhovsky Lab at Rockefeller, grew up in a village in North India where Ayurveda was the predominant form of healthcare. As a teenager and young adult, Singh was inspired by the remarkable recoveries he witnessed in family members treated with Ayurvedic medicines. “It’s more customized to your body than common drugs,” Singh said. “Taking an integrative approach could be more preventative for chronic pain and inflammation.”
When Singh was thirteen, his older brother was electrocuted by a wire carrying 11,000 volts of electricity. He had three-millimeter-deep wounds on both hands. “You could see the bones,” Singh said. The recommended medication was prohibitively expensive in the quantity Singh’s brother needed. However, his uncle connected them to a family who brought them a homemade Ayurvedic salve to treat the wounds. Within a week, Singh’s brother saw a remarkable improvement. “He was healing with no scarring,” Singh said. “I was inspired.”
“I think we should be talking more about it, and discussing how and why this is more effective than any advanced medicine,” Singh said. These conversations could motivate biomedical researchers to study Ayurveda, improve the research methodology used to do so, and identify the active ingredients in Ayurvedic drugs. This, Singh says, would provide the deeper understanding necessary for acceptance by the scientific community.
“To integrate it into the healthcare system, you have to know the active ingredient,” Singh said. “It’s in the philosophical state now, and I want it to be in the scientific state. It’s not yet accepted by the scientific community.”
The placebo effect: good for patients, bad for pharma
Though a strong advocate for Ayurveda, Singh is open-minded to the possibility that the benefits could be largely psychosomatic. “When you go to the Ayurvedic doctor’s house, you are assured that the doctor will take care of you,” he said. “It could be completely placebo.”
However, many practitioners argue that the placebo effect is a valid form of healthcare. The placebo effect activates the body’s ability to heal itself, one of the central tenets of Ayurveda. Clinical trials with open-label placebos have shown promising results in both adults and children. Research using fMRI and PET scans show that placebos work by acting on pathways in the brain that respond to pain. “The placebo effect is a self-healing response,” said Langevin. “It’s not just about how you see the pain, but also in how you respond to the pain.”
By leveraging the body’s ability to heal itself, placebos and many CAM treatments are generally inexpensive to produce and create few negative side effects. On their surface, these characteristics appear to support the integration of these treatments into our healthcare system. However, considering the stronghold the pharmaceutical industry has on healthcare and biomedical research, it’s difficult to make progress on preventative treatments that would be less lucrative and diminish the need for other prescription medications.
Sleeping on preventative healthcare
The marketization of healthcare is a systemic obstacle that disincentivizes treatments that are inexpensive and preventative. Lifestyle interventions like improvements to one’s diet and sleep schedule can be equally or more effective than prescription drugs but are devalued in comparison to modern medicine and overshadowed by patients’ desire for a “magic pill.” It might not be obvious to compare sleep with medicine, but as with our diet, the quality and dosage of sleep is one of the most impactful factors to our health.
Dr. Sofia Axelrod is a research associate at Rockefeller in the Laboratory of Genetics, headed by Nobel Laureate Dr. Michael Young. Her research investigates the biological and environmental determinants of sleep and circadian rhythms, as well as the consequences of their dysregulation. Work by Young, Axelrod, and others has shown that circadian clock disruption can have profound effects on human health. Dysregulation of these processes and pathways is associated with metabolic, cardiovascular, and mental disorders and cancer. Sleep experts argue that this research warrants the modernization of medical care to incorporate the importance of sleep into standard advice and treatments administered by healthcare professionals.
As someone who formerly struggled with sleep dysregulation, Axelrod experienced the shortcomings of our healthcare system firsthand. In college and graduate school, Axelrod was prescribed many different types of hypnotics to help her sleep. “They knock you out so you can sleep, but you feel really groggy the next day and it doesn’t solve the fatigue,” Axelrod said. “I tried all the hypnotics there are. None of them give you restorative sleep.”
It is when conventional medicine fails that the effectiveness of lifestyle interventions and CAM reveals itself. Changes to one’s diet and routine, such as controlling light exposure and exercising, can help regulate sleep sustainably and without the side effects of hypnotics. Axelrod found success when she treated her own light exposure and sleep schedule with the same rigorous regularity that she did with the fruit flies she studies in the lab. She also started practicing yoga, which positively impacted her physical and mental health. Yoga is also included in many Ayurvedic treatments aimed at improving sleep quality and regularity.
“I think generally speaking, going to the doctor is often not satisfactory,” Axelrod said. “The way medicine is done doesn’t consider how someone actually feels.”
An estimated 50 to 70 million Americans have chronic sleep disorders, but healthcare institutions haven’t adapted their practices to reflect the current research. Patients struggling with these and other disorders aren’t always aware of the options available to them, even after seeking help from healthcare professionals. Science communication is key in raising awareness of advances that are supported by research but not yet integrated into the healthcare system.
Science communication is key to an informed discourse about CAM
Axelrod’s 2020 sleep-help book, How Babies Sleep: The Gentle, Science-Based Method to Help Your Baby Sleep Through the Night, has helped thousands of parents sleep train their children using scientifically sound methods that aren’t yet common practice. Science communication that covers potentially beneficial subsects of CAM, such as Ayurveda, acupuncture, psychedelic therapy, and TCM, can improve public knowledge and make these alternative treatments more accessible to those who might benefit from them.
Many biomedical researchers like Singh and Axelrod use their scientific training to investigate and responsibly spread knowledge of alternative and complementary medicine and beneficial lifestyle interventions. With advances in personalized medicine increasing, individuals and healthcare practitioners may begin to integrate CAM into their wellness toolkits.
Current applications of CAM in biomedical spaces
As awareness continues to improve, some alternative routes to supporting health and wellness are present on biomedical campuses. Alongside skin cancer and cholesterol screenings, Rockefeller’s University Health and Wellness (UHW) center offers occasional sound bath meditations, Reike, and neck and back massages.
Caroline Nestro, Associate Professor of Clinical Nursing at the University of Rochester School of Nursing, focuses on the wellness of students, staff, and faculty. She works with nursing students as a wellness coach and strengths-based therapist, meaning that she capitalizes on a person’s strengths—strategies that have helped them through tough times in the past—to address current obstacles. This principle, that one’s body and mind possess the ability to heal oneself, is common across many CAM systems like Ayurveda.
Nestro uses mindfulness, art and music therapy, and community engagement to support the mental health of nursing and medical students. “The arts and humanities are very helpful in liberating them from the stress they’re having and changing their focus,” she said.
In crisis situations, Nestro says that more often than not, employing art and music therapy prevents her patients from needing to go to the emergency psych department. Similar interventions for chronic conditions could diminish the need for people to take prescription medications with undesirable side effects. Every week, Nestro runs a drop-in wellness group for students, many of whom are coping with enormous amounts of stress, anxiety, and sleep deprivation. “They come, color, talk with one another, and support each other,” Nestro said. “Their sympathetic nervous system can take a rest.”
While conventional psychiatry is imperative in some situations, many people could benefit more from using CAM approaches. “I would see these as complementary to drugs like SSRIs,” Nestro said. “But I wish we would try some of these other things first before getting people on meds.”
The future of CAM
Unlike conventional medicine, support for CAM lacks organized research, clinical trials, and quantitative data. Although anecdotal evidence of the effectiveness of CAM is striking, the extent of potential benefits and risks of different forms of CAM are largely unknown.
Given these unknowns, many forms of CAM can still be practiced at low risk. Yoga, meditation, massage, and many dietary and lifestyle changes can decrease inflammation to improve mental and physical health. Engaging with one’s community, friends, and family also supports healthspan and happiness. These practices overlap with tenets of CAM systems, and many of the same benefits can be derived.
Members of the biomedical community are fortunate to have access to a wide range of healthcare options and possess the literacy and scientific reasoning to find an individualized balance between conventional medicine and CAM. Additionally, we can use our position to amplify legitimate data concerning CAM, advocate for future research, and do our part in supporting the healthspan of people in our community and beyond.
