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Daily Archives: January 27, 2010

Haus LebensWert is a philanthropically developed and supported facility in Cologne, Germany where patients may receive oncology services free of charge.  An integral part of Haus LebensWert’s vision and mission is to vigorously help cancer patients cope with life both during treatment and afterwards.  Another key component is the use of alternative and complimentary therapies.  These therapies are made available to patients in addition to traditional measures as part of a seamless whole.   Examples include psycho-oncology, art & music therapy, gymnastics and other exercise, voice instruction, Feldenkrais training, Nordic walking, dance therapy, massage and aroma massage, Tai-Qi, Qi-gong and acupuncture.   The Haus LebensWert, which complements a more traditional hospice, has been well received by both patients and practitioners, including those who refer their patients from outside (Hematology Am Soc Hematol Educ Program. 2009:320-5).

Critics of “complimentary and alternative medicine” (CAM) frequently complain of a double standard, and a lack of rigor in its evaluation.  Some feel this looseness encourages bloat and charlatanism, and risks distracting patients and practitioners from the path to “good outcome.”

“Academic medicine integrates three of the most honorable human activities: treating the ill, teaching, and research. The quality that all three share is persistent quest for truth. However, there is reluctance of academic medicine today to openly defend scientific truth by challenging the arguments and the very existence of “complementary and alternative medicine” (CAM). There is no sound proof of CAM effectiveness, no hypotheses on the mechanisms of their action, nor scientific reports testing them. The fact that patients are charged for these “healing” activities makes CAM a plain fraud. With these facts in mind, the name “complementary and alternative medicine” is undeserved and misleading. CAM advocates maintain that CAM should be recognized precisely because it is widely practiced and very promising, that it has a special holistic/human approach, and works at least as a placebo in situations where medicine can do nothing more. As it seems that the public interest in paramedicine will only grow stronger before it grows weaker, scientists must raise their voice and question the truthfulness of CAM more openly.”
Croat Med J. 2004 Dec;45(6):684-8.

While a truth-centered paradigm is difficult to dispute, there is more than scientific truth at stake in the quest for human understanding.  There is also existential truth.  While physician-scientists optimize therapeutic regimens by evaluating their effects on controlled trial populations, each individual patient attempts to grapple with his or her radically changed reality both in terms of life, and death.  Quantity—be it months of survival, tumor size, or fraction cured—can be measured with increasing accuracy and predictive value.  Quality can’t be so easily parameterized.  Moreover, even attempts made to evaluate “quality of life” tend to fall short because experience transcends subjective criteria when they are too rigidly circumscribed.  Patients exist within the larger communities of other patients, clinicians, family, and the omnibus of culture.  If society views the sick as mechanisms in need of repair, and devalues anything regarded as “touchy feely,” then those in charge will cut the funds that allow physicians to spend time talking with patients or considering the larger life outside the body, while adding to the already glutted ranks of surgi-centers and MRI scanners.  Certainly the possible advantages of reinvigorating the art of medicine, or even expanding it to include real art, such as expressive writing, or speaking, as therapy,will be viewed as unworthy of “serious” exploration.  This is what has happened so far.  The impersonal and alienating experience of illness is nearly a truism, at least in the U.S.

Hospitals, especially large referral centers, can be daunting and soulless places.  As we move necessarily towards more “cost-effective” healthcare it will be important not to lose sight of the fact that quality and quantity exist to a large degree as orthogonal axes.  Designing healthcare to have a more empirical and inclusive approach to alternative healing strategies assures a better chance at quality of life, and should be encouraged as long as these don’t induce patients to forego proven treatment.   A life of fear and despair may be nearly as much a lost life as for the patient who dies of his or her disease.

Haus LebensWert, by the way, means House for a Life Worth Living.

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