I recently caught up with my old friend, Richard Nahas, an M.D. practicing alternative and integrative medicine in Ottawa. Since embarking on his career in 1994 Richard has accrued a panoply of fascinating work-related experiences and travels: from challenging tenures treating the downtrodden in Cairo and Johannesburg, to being a frontline physician during the SARS outbreak in Toronto in 2003, to training in old school therapies with traditional healers in Latin America and Asia. At the end of 2006, he returned to his home in Ottawa and established the Seekers Centre for Integrative Medicine as a non-profit initiative to practice and promote alternative and integrative medicine. He continues to add to his knowledge through frequent travels and seminars that connect him with new ideas and approaches. Richard and I had a chat in which he discussed his approach and philosophy to practicing his brand of medicine.
ZADA: What’s meant by the terms “alternative” and “integrative” medicine?
NAHAS: “Alternative medicine” or “complimentary medicine” describe therapies that are outside the established western medical paradigm. That paradigm is defined by what’s taught in medical schools, what appears in textbooks and what’s enforced by official guidelines. Everything that falls outside of that: whether it’s acupuncture, meditation, herbal medicine and even exercise – the things that tend to get neglected – are considered “alternative medicine”.
“Integrative medicine” is a new approach to healthcare that doesn’t throw away western medicine. It’s the method of using standard medical care plus these other therapies. But those of us that do integrative medicine see it as more than that. We see it as an opportunity to integrate different parts of the body into a holistic understanding of how people get sick and how people heal.
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ZADA: How did you get interested in this field of medicine?
NAHAS: I’ve always been interested in what you might call the study of human potential and the difference between “average” and “optimal” as it relates to things like nutrition, athletic performance and psychology.
When I went to medical school, I struggled with what I perceived to be a lack of rational thinking about what was causing disease. I saw a dogmatic approach to describing dysfunction and prescribing palliative remedies. Soon after, I went into emergency medicine because I saw it as an area where that paradigm works well. You can have a lifesaving measure that is not necessarily treating the cause, but is preventing people from dying.
It never occurred to me to practice alternative medicine until a few years later. Shortly after the SARS crisis I decided to take a hiatus from medicine and went traveling. It was supposed to be a six-month trip that turned into a two-year odyssey. During my travels I became interested in shamanism and had the good fortune to meet healers who work with plants or acupuncture and I got a chance to study in South America, India and Europe. When I came back to Canada I decided it was important for me to pursue this professionally.
I’ve been practicing alternative and integrative medicine for about five or six years here in Ottawa. During this time my understanding of how we get sick and how we heal continues to evolve. And my observations continue to amaze me.
ZADA: What do you see as the current problems facing western medicine?
NAHAS: The first problem is that medicine is based on a diagnosis. The diagnosis is a description of what’s wrong with the person. But it doesn’t necessarily correlate with what’s causing the problem. So, the first issue facing western medicine is that, in general, its not actually striving to make people healthier. It’s simply trying to treat any particular diagnosis.
The second problem is that there’s a huge industry involved in the treatment of disease. There’s far greater incentive to find and deliver treatments that people must rely on for the rest of their lives, rather than finding methods of healing people so that they’re no longer ill.
This means we have a huge challenge ahead of us. As a society we’re getting sicker. The kinds of chronic illnesses that we all struggle with – including headaches, stress related disorders, digestive problems, allergies, inflammation, high-blood pressure and cholesterol – are not the kinds of problems that Western medicine developed to treat. Western medicine evolved to treat diseases of the 19th century, which were mostly infections, physical traumas and other acute illnesses.
Lastly, our whole system of healthcare is still largely based on per patient remuneration. It’s like an assembly line approach to medicine. There really isn’t a built-in incentive for doctors, nurses, hospitals, clinics and healthcare programs to actually make people healthier in the long run. Although, there are some signs that this is beginning to change.
ZADA: What are some of the pillars of alternative medicine?
NAHAS: The thing that most alternative medicine approaches and philosophies have in common is that they are primarily focused on the body’s ability to heal itself. When you recognize that a person who suffers from a chronic illness is sick because the body’s self-healing tendency has been obstructed for some reason, the idea is to search for the best method to eliminate that blockage. And you know that you’ve found it when the person starts to heal and no longer needs the treatment they had in the first place.
Most of the methods that are used by alternative practitioners have been used for centuries, if not thousands of years. So their safety record is often very reliable. We know that adverse drug reactions, or other complications of conventional health care are the third leading cause of death in the United States. So that’s another important factor.
ZADA: Tell me about some of the treatments you employ?
NAHAS: There’s a wide range of therapies you can employ. For instance, something as simple as breathing exercises have been demonstrated in clinical studies to lower blood pressure and address anxiety and insomnia. And although it hasn’t been rigorously tested, the ancient discipline of pranayama, which is a system of breathing exercises developed in India, can help shift the state of the nervous system.
Therapeutic fasting has been used for millennia in many cultural traditions. Beyond the religious motivations for these practices, there appear to be a lot of benefits on a physical level. Studies involving people with auto-immune diseases and other problems of chronic inflammation show that regular, medically supervised fasting can actually give the body a rest from the stress of digesting and processing food and allow it to repair damage in the body.
I use a therapy in my practice, which is at the other end of the spectrum. It’s more of a medical treatment called “chelation therapy”. It’s basically about taking toxic metals out of the body. There’s good evidence that it can prevent kidney failure and it’s been used for decades to treat heart disease.
Acupuncture is a very simple way of waking up the nervous system and stimulating the healing response in places where, according to the Chinese, there are blockages of what they see as energy flow. By restoring the normal flow of energy in the body, you help the healing process resume.
Those are just a few examples. And there are many more – from herbs, to guided imagery and homeopathy – that represent a wealth of wisdom developed by different cultures and traditions throughout history. For some reason our modern health care system has systematically ignored most of them and is really focused on pursuing the next blockbuster drug.
ZADA: With so many possible treatments available, how do you decide what to prescribe for a patient?
NAHAS: Patient input, cost of the treatment and my experience with those treatments is important. The other aspect of choice which is not commonly discussed, but which is a strong factor in most of the decisions we make as alternative practitioners, is intuition.
But it’s important to recognize that there’s not always just one right answer. There are many ways to help the body heal. It’s not always the case that of all the options available, only one will far outweigh the others. There’s always a certain degree of educated guessing and some trial and error involved. And that’s part of the process we call “The Art of Medicine.”
ZADA: Some doctors have said that every system of medicine, whether ancient or modern, works through our beliefs. One book entitled The Healing Brain by Robert Ornstein and David Sobel argues compellingly that the history of medical treatment is largely a history of how a sense of positive expectancy in the patient about a therapy helps the mind heal the body. In other words: every treatment has a placebo value built into it. What are your thoughts on that?
NAHAS: The way I see it is that every treatment works, in part, by harnessing the body’s ability to heal itself. So what some people have called the placebo effect, we prefer to call the healing response. It’s not a question of whether a treatment is working through the placebo effect – or whether it’s truly working on its own merits. It’s a question of the combination of the two.
If I prescribe a treatment after building a strong connection with the patient, having given them the impression that I’m competent, that I’m skilled, that I’m listening to them and that I care, and having told them that this treatment will be effective, then that treatment is more likely to work – whether it’s a homeopathic remedy or an antibiotic.
Expectation and the body being ready and willing to heal itself is part of the overall healing process. But I think it’s also unfair to say that because we don’t understand how a medicine works that it must always be acting on the placebo response.
ZADA: Where has alternative medicine reached here in Canada and, by comparison, abroad?
NAHAS: In Canada there are obviously a number of people who are looking for this kind of medicine because the Internet is a global phenomenon and people can find answers on their own. About 40% of people have reported seeing an alternative practitioner in the last year. And around 70% have reported using some kind of natural health product like a vitamin or a herb.
Different Canadian provinces are at different stages in terms of regulating their professionals. Naturopathic doctors and chiropractors are the most regulated. Acupuncturists, osteopaths, homeopaths and massage therapists are becoming increasingly so.
In terms of medical doctors embracing integrative medicine, it’s been a very slow uptake in Canada because health care is free when provided by a medical doctor. The colleges of medicine that regulate doctors in all the various provinces have a record of frowning on physicians who practice this kind of medicine. So that’s a major disincentive for people to step outside the box, so to speak.
At medical schools there are steps to start teaching doctors about alternative medicine. I myself teach such courses at Ottawa University. And there are similar courses for medical students at a few other schools in Canada. The situation is further ahead in the United States mostly because wealthy individuals with a strong belief in integrative medicine have established philanthropic foundations to promote that kind of approach at different medical schools.
In other countries there are factors promoting the development of integrative medicine. Obviously, the long history of traditional Chinese medicine means that there is an inbuilt familiarity in China with those sorts of practices. There are hospitals in China devoted solely to either western or traditional medicines.
Cuba’s contemporary history of political and economic isolation has meant lack of access to modern technology, pharmaceuticals and proper surgical equipment. So they’ve had to draw on other resources. Because they are also a Communist country they’ve received considerable help from Chinese doctors, who helped teach about and provide herbal medicine in many of the community clinics in Cuba.
In Europe traditional medicine has a long history as well. Medical schools in Germany, Switzerland, England and France were established centuries ago, and their medicine was originally largely plant-based. As a result, they haven’t been so quick to dismiss some traditional medicine as we have in North America.
The general consensus is that Canada is in general lagging far behind the rest of the world in this area.
ZADA: Why the opposition within Canada?
NAHAS: Well, it’s really a global opposition we’re seeing. In one sense the concerns are legitimate. We are now as a profession practicing something called “evidence-based medicine”. That means we select medicines that have been studied and are proven to be effective. And that’s been a step forward in one sense because we are not using as many useless therapies anymore.
But the more problematic side of evidence-based medicine is that the kind of research that is required to satisfy the medical experts that a treatment is effective is prohibitively expensive. It costs between $10 to $50 million to conduct the kinds of clinical trials that would help a treatment make the grade in their eyes.
So the only medicines that make sense financially to invest in are the medicines that will generate huge revenues down the road. It’s a no-brainer to spend $50 million dollars on a treatment if there’s the potential to generate $50 billion dollars in revenues over the 20-year lifespan of a patent. You don’t have to believe in conspiracy theories to recognize that this creates a natural barrier to entry where treatments that aren’t patented don’t stand a chance when you’re judging them based on that standard of evidence.
That’s the most obvious reason for opposing alternative therapies. But there’s also a subtle – but undeniable – cultural disinterest in older, simpler, traditional healing approaches. Medicine is really focused on the new, the modern, the advanced, the sophisticated – the silver bullet approach. And that culture of medicine also has its own problems.
ZADA: Detractors will point to examples of charlatanism or doctors using dubious treatments to take financial advantage of people in desperate situations. I recently saw a documentary about cancer clinics in Tijuana, Mexico – across the border from the United States – where this seems to be happening. What’s your reaction to these examples?
NAHAS: I can’t speak for other members of the alterative medicine community. Having said that, my first response is that the threat posed by the pharmaceutical industry can be, in my opinion, far greater than the damage done by a few individual charlatans. We have examples of drug companies systematically lying about research that they knew showed that their drugs were harmful or useless.
The most egregious example of how far this can go was in the early 1980s with Bayer, the makers of Aspirin. They were selling contaminated blood that was HIV-positive to hemophiliacs in the developing world – when they knew it was contaminated – because they had to get rid of old stock. So, that would be one response.
The other is aspect, is yes, there are charlatans out there. There are people who want to take advantage of patients in need. And yes, patients are certainly vulnerable when they’re sick. But I don’t think the answer is to systematically try to discredit the entire field. I don’t have the answer, but I don’t think it’s fair to take the entire field to task because of a few bad apples. If that was the case we would have no medical doctors because there have been examples of allopathic physicians who abused their privilege of trust.
ZADA: What advice would you give someone who’s looking for an alternative medicine practitioner, with an eye to avoiding those “bad apples”?
NAHAS: The first thing I would suggest is to trust your intuition because there are no hard or fast rules about what courses a practitioner should have taken, or what designation they should have. If someone wants to sell you something that’s very expensive, or if someone is promising you a miraculous cure, you should obviously think twice before believing that.
In my experience, the vast majority of practitioners who are seeing patients one at a time – not big operations that are recruiting patients from all over the world, but instead your neighbourhood acupuncturist or local naturopath – have good intentions and they’re in this field to help people. Just like many doctors are.
It shouldn’t require a huge stretch of the imagination to realize that knowledge evolves and that there are, in fact, other ways of doing things beyond what’s rigidly defined and accepted by the official gatekeepers.
