There are many different schools of medicine. For example, there are those who elect a long and tortuous course of surgery. Some eventuate in general surgery, others are in specialized areas, while others choose a more nonsurgical bent such as the chemotherapist, radiologist, oncologist. The major point of this story is that all of these practitioners have one thing in common... they all graduated from North American medical schools, and so, they share similar philosophies.

According to the United States Department of Commerce, in 1984 surgeons performed 25.6 million operations, an increase of 5.6 million since 1975.¹ As one might expect, some of these procedures (and the cost associated with them) are not justified as evidenced by second opinions and other defining measures. The extent of unnecessary surgery has been the object of considerable speculation and occasional wild accusation in recent years. Results from the few studies that have measured unnecessary surgery directly indicate that for some highly controversial operations the fraction that are unwarranted could be as high as 20 to 30%.² It is also a well-known fact that the number of operations performed in a community is directly related to the number of surgeons practicing in the same area. In other words, the more surgeons available, the more surgeries performed. This obviously plays an additional role in the cost factor.

In 1993, a very informative paper appeared in the New England Journal of Medicine.³ Eisenberg and his group conducted a national survey to determine the prevalence, costs and patterns of use of unconventional therapies. They found that one in three respondents reported using at least one alternative treatment in the past year. Expenditures associated with this type of therapy amounted to approximately $13.7 billion, three quarters of which ($10.3 billion) was paid out of pocket. Other reports underline the fact that more and more people are spending more and more money on complementary techniques.^4-9

It should be pointed out that the methods used were not those taught in medical schools. Unfortunately, they have many different designations. Some are called acupuncturists, acupressurists, herbologists, chiropractors, homeopaths, but the term most applied to this group as a group is naturopaths. The operative principal is that they believe in natural living which consists of the air they breathe, the water they drink and the food they eat.

While naturopaths and allopaths have many characteristics in common (the role of infections, immuncompetence and the Hippocratic oath, "first do no harm"), there are very distinct differences. For example, naturopaths cite frequently the quote from Thomas Edison, "The doctor of the future will give no medicine, but will interest his patient in the care of the human frame, in diet and in the cause and prevention of disease." So, diet and the role of infections become very important factors. Incidentally, even segments of the United States Government have pointed out that the average diet is Suboptimal. Not only does diet become more vital but natural ingredients gain in significance. Hence, the antioxidants in larger amounts, are more essential for the treatment of specific aging and nonaging diseases, such as Parkinson's, Alzheimer's, arthritis, cancer and heart disease.¹⁰"¹¹ This raises the point of interest in natural medicine in prevention and particularly prevention of occurence (primary prevention) versus recurrence (secondary prevention).

We have been studying naturopaths at the Clayton College of Natural Health (CCNH) in Birmingham, Alabama. This is a distance learning program inaugurated more than 15 years ago to provide training in naturopathy. Since they are concerned with lifestyle, we have examined physical activity and the use of vitamins as well as other characteristics. We found that 163 of the total sample we studied (n=244) exercise on a daily basis.¹² Smoking is found in only 19 of the entire sample. This is a very small number when compared with the 25% of known smokers in the United States population. Also, only 22 consume alcoholic drinks daily.

Our survey also revealed that 87% of the male naturopaths took a vitamin/mineral supplement on a daily basis.¹³ Interestingly, those taking the vitamins had fewer psychologic complaints, (3.1 versus 5.6).¹³ This is consistent with earlier data by Chandra who showed that days of infection could be halved (23 versus 48) in healthy elderly subjects by providing physiologic amounts of vitamins and trace elements.¹⁴

Recent figures derived from a survey of five United States sites and one Canadian show that the rate of chiropractic use is twice that of 15 years ago.¹⁵

There is a commonality between naturo-paths and allopaths, but, there are differences.¹⁶ A well-known octogenarian, on her recent 80th birthday, was asked the question, "What's your greatest accomplishment?" Abigail Van Buren, in her Dear Abby column, replied, "Surviving" (Ms. Van Buren, who works as long as 10 hours a day reviewing letters, at an age when most people have long since retired, says, "It's only work if you would rather be doing something else." It seems she has also provided us with a simple practical naturopathic solution for aging gracefully: "Fear less, hope more. Eat

less; chew more. Talk less; say more. Hat less, love more." And, she adds, "never un derestimate the power of forgiveness." And this inexpensive prescription could be heeded and may be just another reason ft change!

References

1.   United States Department of Commerce. Statis tical Abstract of the United States. Washington D.C., Government Printing Office, 1988; 100.

2.   LeapeLL: Unnecessary Surgery. Health Service Research, 1989:24/33; 351-407.

3. Eisenberg DM, Kessler RC, Foster C, Norlock FE

Calkins DR, Delbanco TL: Unconventional Meet cine in the United States: Prevalence, Costs, and Patterns of Use. NEJM, 1993:328; 246-252.

4.   Astin JA: Why Patients Use Alternative Medicine: Results of a National Study. JAMA, 1998 279/19; 1548-1553.

5.   Borkan J, Neher JO, Anson 0, Smoker B: Referrals for Alternative Therapies. / Famil Pract, 1994; 39/6:545-550.

6.   Neher JO, Borkan JM: A Clinical Approach to Alternative Medicine. Arch Famil Med 1994: 3.-/10; 859-861.

7.   Editors: Uncle Sam Gets Serious About Alternative Medicine. Med Econom, 1994: 1; 100-102,107-110.

8.   McGinnis LS: Alternative Therapies, 1990: An Overview. Cancer (suppl) 1991:67/6; 1788-1792.

9.   Feldman MK: Patients Who Seek Unorthodox Medical Treatment. Minnesota Med 1990: 73/ 6; 19-25.

10. Cheraskin E: Antioxidants in Health and Disease: The BigPictwceJOrthomolMed 1996:12; 89-96.

11. Cheraskin E: Antioxidants in Health and Disease. J Am Optometr Assoc, 1996:67; 50-57.

12. Cheraskin E: Clinical State of the Naturopath: A Self-Reported Analysis. Submitted for publication

13. Cheraskin E: The Health of the Naturopath: Vitamin Supplementation and Psychologic State. Submitted for publication

14. Chandra RK- Effect of Vitamin and Trace-Element Supplementation on Immune Responses and Infection in Elderly Subjects. The Lancet, 1992:340/8828; 1124-1127.

15. Hurwitz EL, et al: Use of Chiropractic Services from 1985 through 1991 in the United States and Canada. Am) Pub Health, 1998:88/12; 771-776.

16. Hoffer A: Playing with Statistics or Lies, Damn Lies and Statistics. JOrthomolMed 1998:13; 67-71.

17. Van Buren A: Dear Abby: Abby's Greatest Accomplishment: Surviving. The Birmingham News, 4 July 1998.