Dr. Robert McCarthy is the author of the new Integrative Medicine software suite published by the BFE. We recently had a chance to ask him a few questions about his approach to Integrative Medicine. This is part two of a three part series.
Click here to read Part 1.
How does an integrative medicine approach benefit your patients? I think you touched on it a little bit already in the case of Attention-Deficit\Hyperactivity Disorder.
ADHD is only one area, but we work with the full range of medical disorders. For example, we work with people who have multiple sclerosis, hypertension, gastroesophageal reflux, ulcers, tinnitus, migraine headaches, tension headaches, panic attacks, cancer, and the list really goes on to eventually cover about 80% of medical disorders. Roughly 80% of all medical disorders are considered psychophysiological in origin.
So, the mind-body connection is all about how emotional well-being affects one’s health and vice versa?
Integrative medicine really means working with the patient as a whole system and various aspects or parts of that person. If you can conceive of a pie with a lot of slices each representing an aspect of an individual, and, yet all the slices collectively comprise the pie or bigger picture. Most medical or psychiatric disorders come about as a result of the multi-factorial influences of numerous slices from that pie. All these slices contribute in some meaningful way to the bigger picture, or who and what we are, and how we are affected by certain aspects of ourselves. What we try to do in our practice is to address as many of these “slices” as we can, without prioritizing their importance or potential significance. Genetic predisposition may be one slice, diet another slice, exercise yet another slice, personality another slice, mental status another slice, etc. Diet seems to represent an extremely importance “slice”, and potential contribution to our health and well-being, virtually ignored by the entire medical field, despite knowing that our chance of developing some form of cancer is directly proportionate to the volume of meat we consume.
How does biofeedback enhance your integrative medicine practice?
In order to work with patients as a whole system, one must be able to evaluate and treat various dimensions of neurological, somatic, and emotional issues. Otherwise, you are too limited in your usefulness to patients and the many ways they can potentially recover and heal. When patients come for their initial diagnostic interview, rarely do they not describe a matrix of neurological, psychiatric and physical complaints that need to be addressed. By understanding psychophysiology, we're able to provide a comprehensive integrative medicine treatment approach that enables people to achieve therapeutic goals not possible within a uni-dimensional therapeutic framework. In essence, we are teaching patients how to develop healthier, happier and more fulfilling, meaningful lives.
How do clients find out about your practice?
The majority of patient referrals are received from primary care physicians (Family physicians, internists, pediatricians, Obstetricians, Gynecologists), then neurologists. Many patients committed to a holistic health orientation also find us on the internet. So they might have been searching for a significant period of time, looking for some treatment other than drugs or surgery that was going to provide them relief. Many psychophysiological disorders are complicated by what is called secondary gain. In other words, sometimes we derive gratification or benefit from remaining symptomatic. It is quite common to work with patients and have their psychophysiological disorder go into remission, but, in doing so, realize all the major changes they need to make in their life. When patients are unwilling to make those major life changes, symptoms can rapidly return and keep the patient immobilized.
One woman I recently worked with had literally been all over the world seeking out specialized migraine headache clinics, without relief. When we started focusing on diaphragmatic breathing, she suddenly noticed her migraine and intra-cranial discomfort disappear. So, her diaphragmatic breathing, progressed to heart rate variability training and eventually hemoencephalography (HEG). Within two to three month, this patient’s migraines were gone.
Unfortunately, she remained married to an alcoholic man who continued to binge drink. Eventually, she came to the conclusion that a lot of her stress and headaches had to do with conflicted feelings about her spouse’s drinking, and unhappiness surrounding her marriage. She came from an extremely religious family that pressured her to remain married to this man. Within a short time, her migraine headaches returned to pre-treatment levels.
Hence, we see these scenarios in the lives of patients a great deal when working with psychophysiological disorders, where something else in their life is stressful and they refuse to address the conflict that would require major changes and disruption in lifestyle. Dr. Erik Peper emphasizes in his new book the commitment we as individuals must take to “Make Health Happen”. The reality is most patients want to get better but they sometimes don't want to invest the time and effort to do the necessary work to bring this about, even terminal cancer patients.
Do you think we rely too much on prescription drugs?
Poly-pharmacology represents a growing social problem. It's not unusual today for us to see patients on ten, twelve or fifteen medicines, prescribed by different practitioners. Some of the medicines may be redundant. Our universal therapeutic goal with all patients is to help them get down to the minimum amount of medications absolutely necessary. I think people really have to be more honest and truthful about the unknowns involved when we mix several medicines in our body. We only do research in the field of medicine by testing a new drug and its relative efficacy in comparison to a placebo. I know of no research whatsoever that helps us understand the intricacies of how people and their bodies may be potentially impacted when given prescriptive “cocktails” involving three, four, five, ten or twelve medicines. Therefore, it is important to streamline as much as we can by using integrative medicine treatment options which most people and practitioners have still not heard about.
Biofeedback, neurofeedback, cranial electrical stimulation, audiovisual entrainment and computerized cognitive training are almost as foreign today to most patients and physicians as they were years ago during development. Drug companies obviously have a vested interest in this information not getting out. So we constantly strive to expand the awareness of our patients and exert their right to choose from a comprehensive list of treatment options. Our position is that all health care providers should be educators, and not try and impose their personal belief system on others. We educate patients about all their options and then it's up to the individual patient within their belief system to use whatever available techniques or treatments they, ultimately, choose. It is quite interesting to note that in Suzanne Sommers’ recent book and review of cutting edge cancer treatment, many oncologists stated they would not undergo chemotherapy if diagnosed with cancer.
On the topic of educating clients about the various treatment options that exist, how do they react to this approach?
When we introduce patients to the field of integrative medicine and all their scientifically-based treatment options, their first question is usually, “Why did my physician never tell me about this stuff?” Or, in many cases, physicians make critical comments or totally dismiss these techniques. Here are two funny patient stories. Quite a few years ago, a Myrtle Beach internist returned after attending a medical conference at Harvard. He told our patient that if qEEGs and neurofeedback were any good, they would be doing it at Harvard and he would have certainly heard a lecture about it during his Harvard Conference. When we provided that physician information about Dr. Frank Duffy and his work with qEEG and neurofeedback at Harvard, we never heard from him again. Similarly, a patient came to us after relocating from Los Angeles, California. In the twelve years prior to relocating, he received various medications and treatments for an intractable depression at UCLA. When I suggested he complete a quantitative electroencephalogram, and had never heard of the technique before during his twelve years of treatment at UCLA, I was quite surprised. Out of curiosity, he contacted his old psychiatrist and inquired as to where on the UCLA campus quantitative electroencephalograms were given. The psychiatrist told him in the building right across the walkway from my office. We can all still be close, yet so far away.
Once we get past a patient’s initial skepticism, they usually become curious. In most patients, that curiosity gives rise to further interest and integrative medicine treatment involvement. Once they start benefiting, then these procedures develop a momentum of their own. I once had a migraine patient who we helped a great deal refer fifteen other patients plagued by the same problem.
So, we still have a lot of work to do to educate communities about the benefits using an integrative approach including biofeedback and neurofeedback.
I don't know if you are aware that in the United States there are a lot of primary care physicians restructuring their practices. Instead of requiring the traditional fee for service all of us are familiar with, these physicians now charge an annual fee of several thousand dollars. However, as a result, they are now able to spend forty-five minutes with you each and every time you come to them with a problem. This extended examination period permits in-depth discussion and a more comprehensive evaluation. Unfortunately, due to the annual fees involved, it isn't accessible to lower socio-economic segments in the population, but does represent the rebellious idea that superficially “windmilling”patients in and out of exam rooms after just fifteen minutes has its drawbacks and may not be the ideal way to practice medicine.
President Obama actually came out a few weeks ago and said that “brain mapping” would now be required and routinely used for certain medical disorders like asperger’s, autism, etc. under his new National healthcare system. Texas is the only State in this country that for years has had a law requiring insurance companies to reimburse neurofeedback services for certain medical conditions such as head injury, stroke, ADHD, etc. So, regardless of one’s political affiliation, President Obama is getting some sound scientific input from health care professionals on the need for specific changes.
In a May 2013 post on the American Psychological Association website, Washington, DC writer Rebecca A. Clay talks about the importance on integrating physical and behavioral health.
Treating Mind and Body
“A Sixty-eight percent of adults with mental health conditions also have medical conditions, and 29 percent of adults with medical conditions have mental health conditions. "If that's not a reason to integrate mental and behavioral health care into primary care, I don't know what is," said Rebecca B. Chickey, MPH, director of the American Hospital Association's section for psychiatric and substance abuse services.”
In Part 3 of this series, Dr. McCarthy will talk about some of the features of his new Integrative Medicine Software Suite and will present a couple case studies.