Integrating Medicine and Minds

A woman drawn in shades of pink is practicing aromatherapy, as she holds a scent in one hand to her nose. Above her head, a jar of the same scent particles are depicted as pouring into her brain and lighting it up.

When I was fourteen years old, my friend’s mother had a severe form of cancer and was prescribed oxycodone, an opioid. My friend became his mother’s primary caretaker, granting him access to her medications. After a minor bike accident one day, he decided to take one of her painkillers. Due to its severe addictive side effects, the dependence he soon acquired for the drug was unbearable to watch. I--a pre-med student who’d wanted to become a physician for as long as I could remember--felt completely blindsided by this experience. This, on top of the deaths of numerous people close to me at the hands of our current healthcare system and modern medicine, otherwise known as allopathic medicine, led me to question its efficacy.

Cancer and opioid abuse are categories where aggressive allopathic intervention can oftentimes be inadequate or even detrimental. In 2019 alone, there were 49,860 overdose deaths involving opioid use. Of these, over 14,000 resulted from prescriptions of opioids for those people who died [1]. Mainstream medicinal practices rely heavily on pharmaceuticals, and the United States is currently a contender for the top drug-dependent country in the world [2]. But what if I told you that there are ways we can alleviate these issues, and your future doctors actually want to implement them?

Too often, physicians do not take into account the whole of a person in their evaluation, frequently ignoring the patient’s sociocultural-economic background or their mental health and instead focusing solely on their physiology. Through many sleepless nights of doubt and research, I rediscovered the beauty of medicine through integrative medicine, a treatment technique that introduces “alternative” medicine into “mainstream” medicine. For our healthcare system to function with efficiency, equality, and efficacy, we need to integrate these methods and philosophies. I am not suggesting we disregard “mainstream” medicine, but that we reduce its exclusive predominance in our daily medical practices. By utilizing common scientific rationale and our understanding of the nervous system used in many allopathic therapies, we can actually unveil evidence that supports integrative approaches to medicine.

BACKGROUND

There are numerous philosophies regarding medicine and healthcare. The current consensus in the US medical community is that allopathy prevails. Allopathy is a system of medicine in which healthcare professionals use intrusive treatments including biosynthetic drugs, surgery, or radiation for diseases and symptoms. It’s also often called Western, Modern, or Bio-Medicine, though these titles perpetuate common misconceptions including the modernity, infallibility, and superiority of allopathy [3]. These names give insight to the stigma and suspicion surrounding other medicinal philosophies like homeopathy and osteopathy, which lead to their exclusion from medical literature, education, and practice.

Integrative, or “holistic,” medicine, refers to practices that emphasize not only physical, but mental, emotional, and nature-based aspects of health [4]. Such practices promote the belief that the body, mind, and spirit are deeply interconnected, as is one’s self with the surrounding culture and nature. Therefore, when one of these dimensions is affected, the entire self is affected and sickness results [5]. Integrative care usually includes therapies under non-allopathic philosophies that we deem “complementary” or “alternative” such as acupuncture, biofeedback, and aromatherapy. Integrative practices utilize complementary and alternative medicine (CAM) to create personalized, holistic care which is currently missing from orthodox practices. Integrative treatment can include allopathic practices, but the colloquial usage of the term “integrative” or “holistic” has come to mean treatments outside mainstream medicine [6].

Non-allopathic philosophies of healthcare have been at odds with mainstream allopathy for quite some time, as biases towards these other philosophies have created stigma or suspicion around their practices. Many scientists suggest such practices aren’t evidence-based since most allopathic research utilizes double-blind randomized, controlled trials, and they incorrectly assume this isn’t the case for CAM therapies [4]. However, there are a multitude of barriers for researchers pursuing such studies, thereby limiting their ability to study CAM [7]. For instance, the National Institutes of Health (NIH), the primary source of research grants in the US, only allocates 0.3% of its funds towards the National Center for Complementary and Integrative Health [8]. Other potential biases that lead to the favoritism of allopathy, scholars suggest, result from Western Exceptionalism and racism. As the Pew Research Center highlights, Americans tend to believe that the West (particularly, the US) has a distinctive ability and responsibility to “enlighten” the rest of the world, especially developing or Eastern countries. This ambition has infiltrated the scientific and medical community into believing that Western, allopathic medicine reigns supreme and other forms of medical intervention must be witchery or quackery [9]. Many practices, such as Ayurveda or acupuncture, emerged in Indian and Chinese cultures. Others have roots in various Native American, Tibetan, African, or Central-and-South American cultures [10]. Thus, these medicinal methods have been largely excluded from “Western medicine”.

An equally grim explanation for bias against non-allopathic medicine is the commodification of the healthcare industry and the profits of major pharmaceutical corporations. For instance, the US healthcare and pharmaceutical industry in the early 2000s were characterized by an emphasis on prescription opioids and information dissemination tactics that falsely persuaded care providers into believing that medicinal strategies were always more effective. In reality, they simply fed dollars into a system profiting off of cycles of addiction [11].

Through the same scientific reasoning used by the healthcare industry in support of current orthodox remedies, we can uncover rationale behind alternative, holistic remedies [12]. I will now focus on three modes of integrative care that display such evidence.

ACUPUNCTURE

Currently, pain relief costs the US healthcare system and general economy $560 to 635 billion annually [13]. Acupuncture, a traditional Chinese medicine, can instead be employed to relieve or prevent this pain along with many other beneficial applications, without the potentially harmful side effects of its allopathic counterparts. This technique involves the flow of “Qi,” energy, through “meridians,” channels throughout our body. When our energies become imbalanced, resulting in pain or discomfort, acupuncture is utilized to restore bodily harmony [14]. Acupoints lie along meridians, and either needles, pressure, or heat is used to stimulate responses [15].

One way acupuncture leads to analgesia (relief from pain) and other physiological effects is through the release of endogenous, or natural, opioids and endorphins to relieve stress and pain [13]. Acupuncture activates sympathetic nerve fibers, nerves that aid in involuntary, reflexive reactions, which leads to a downstream effect of increased β-endorphin release in the inflamed tissue. Opioid-activated receptors on the corresponding peripheral nerve then suppress nociception—the process by which we encode painful stimuli. Interestingly, acupuncture causes additional upregulation of opioids in targeted tissues through the increase of endogenous cannabinoid CB2 receptors. This blocks cytokine release (that normally facilitates nociception), inhibiting pain. Furthermore, stimulation of acupoints leads to increased secretion of anandamide, a neurotransmitter associated with pleasure and happiness. Then, the hypothalamus-pituitary-adrenal (HPA) axis, which normally controls our stress response, further suppresses cyclooxygenase-2 and increases opioid release [13].

This image shows a doctor's hands on a person's shoulders (both in hues of blue), practicing a version of osteopathy. The spine is included in pink down the person's back to anatomically and aesthetically display muscle relief.

These effects, though, aren’t merely due to tissue and nerve stimulation in general. The “Neural Hypothesis” and correlating evidence can be used to map out this effective localization of acupoints and meridians. When acupoints are stimulated, patients experience analgesia, but stimulation of non-acupoints on the back or arms doesn’t yield this same effect. For instance, acupoints LI-10 to LI-11 along the arm are situated over the deep radial nerve which projects to the pain-processing regions of the brain. Lesions to this nerve prevented analgesia by acupuncture, highlighting this critical mechanism. The stimulation of these deep nerves accounts for some of acupuncture’s other benefits such as lowered blood pressure due to their extensive connections to regions of the brainstem like the medulla, which regulates such processes [15].

The meridians also represent metaphysical organs in Chinese medicine, different from biomedical organs. Additional evidence supports this meridian localization in conjunction with “organ” representations. Although the meridian that corresponds to the “heart” actually runs along the back-medial sides of the arms and the fingertips, when researchers used an electrocardiogram, a technology used to compute the heart’s electrical impulses and activity, in conjunction with acupuncture stimulation at the heart meridian, they saw cardiovascular inhibition and increased cardiac neurons’ responses in the brain (specifically in the nucleus tractus solitarius). These physiological responses generated by acupuncture help regulate blood pressure, heart rate, and circulation of blood flow throughout the body [14].

Many studies have shown beneficial effects of acupuncture not only in treating muscular and mental health disorders, but neurological, respiratory, gastrointestinal, and gynecological disorders as well [12]. Think about the strides we could make in medicine if we utilized techniques like acupuncture to stimulate natural biochemical pathways to enhance the effects of and thus prescribe less synthetic, toxic, and addictive products like prescription opioids.

NEUROFEEDBACK

Neurofeedback, a type of biofeedback and CAM technique, can actually directly target and defuse drug addiction, thus proving to be a beneficial response to opioid overprescription. Like acupuncture, biofeedback stresses the need for the maintenance of homeostasis and therefore learning to perceive our own internal cues [12]. This method enhances the interconnectedness and communication between the brain and the body by controlling involuntary bodily responses like our heart rate, brain activity, and muscle tension [10].

Through measuring brain waves with an electroencephalogram (EEG) and providing feedback signals to patients, neurofeedback helps teach self-control of brain functions, especially to combat major brain dysfunctions [16]. Electrodes are put onto the skull cap and record cortical activity of regions near them. Therapists determine where to record from to invoke certain responses, and the patient is provided a feedback signal (either sound or visuals) corresponding positively and negatively with desirable or undesirable physiological responses, respectively. With this training, the patient slowly learns means to control these physiological responses for desirable outcomes. For instance, training along the left hemisphere sensorimotor cortex (SMC) can help patients with logic and cognition, as the motor cortex, a part of the cerebral cortex, helps the brain encode cognitive tasks. As the cerebral cortex encodes physical information, the SMC can be targeted to treat patients with stroke, epilepsy, ADHD, paralysis, and other sensory and motor disorders. This is just one example of a targeted region and its beneficial effects for the patient [16].

This image displays a woman in hues of blue with pink pins in her facial muscles, illustrating an example of acupuncture.

In order to truly understand the intricate workings and benefits of neurofeedback, I want to highlight a study that utilized these methods in children with Autism Spectrum Disorder (ASD) and explored the response of the mirror neurons system (MNS) [17]. Mirror neurons help us imitate our surroundings. For example, if you’re watching someone swim, the same neurons fire as those that fire when you, yourself, are swimming. The MNS is also crucial to the formation of social representations of ourselves and others. As ASD patients have difficulties doing so, the MNS has been studied and shown to underlie complications of this disorder. Through the self-regulation of brain waves and rhythms, scientists were able to reduce ASD symptoms. They designed an interactive brain computer interface (BCI) game with social interactions and provided corresponding neurofeedback to both the trained signals and reinforced behavior exhibited. BCIs are technologies that allow our brain to connect to computer systems and modulate their activity based on our processing. This enables patients to control and operate natural brain rhythms in real time.

Previous research has shown neurofeedback training (NFT) to aid in reducing “hyperconnectivity in posterior-frontal to anterior-temporal regions” of the brain. Friedrich et al. studied NFT in respect to the modulation of children’s mu rhythm, brain waves arising from sensorimotor areas. Mu suppression had been seen to correlate with improvements in autism symptoms as well as MNS activity. In children with ASD, mu rhythm suppression is absent, signifying an altered MNS. Through training children to control their mu rhythm by controlling their behavior during reinforced NFT game tasks, they could improve imitation behavior (associated with MNS) by linking children’s anticipated behavior and brain activation. Children with ASD exhibited improvements in behavior, emotion, and cognition [17]. This is just one example of how neurofeedback has made extremely positive, scientifically-sound impacts in disorders or atypicalities where allopathy has lacked.

Once deemed completely experimental, biofeedback has gained traction, become more “mainstream,” and been approved by the FDA. It can be employed to treat a variety of disorders such as asthma, migraines, elevated blood pressure, Raynaud’s disease, irritable bowel syndrome, cardiac arrhythmias, and epilepsy [10]. The integration of this method can help foster a less drug-dependent healthcare system [16].

AROMATHERAPY

Aromatherapy is a homeopathic CAM method originally from Egypt that uses essential oils and their pharmacological characteristics for therapeutic purposes. Essential Oils (EOs) are “concentrated hydrophobic liquid-containing volatile aroma compounds which are extracted from herbs, flowers, and other plant parts” [18]. Aromatherapy is largely used for treating anxiety, pain, convulsions, and cognitive deficit symptoms. EOs can be administered in several ways including inhalation, oral administration, baths, diffusers, and massages. Aromatherapy, like other homeopathic remedies, can help address the inaccessibility of healthcare by providing cheaper, shorter-term therapies [18].

There is extensive literature on aromatherapy, and studies mostly focus on various ways EOs activate neurotransmitter and ion-channel systems in our brains [19]. Specifically, the GABAergic system and sodium ion-channels in our brains, whose activation and inhibition, respectively, are essential to neuronal homeostasis, are greatly affected by EOs and thus help treat central nervous system (CNS) disorders. For instance, GABA dysfunction has been implicated in epilepsy, anxiety, and pain. Voltage-gated sodium channels have been implicated in inflammatory and general pain sensations, and they are hypothesized to be the targets of antiseizure drugs. A perfect example of EOs targeting such mechanisms is Rhizoma from the plant Acorus gramineus, which causes increased GABA activity and decreased GABA transaminase, an enzyme that breaks down GABA. This has sedative as well as general CNS inhibitory effects, as GABA is an inhibitory neurotransmitter [19].

Not only do EOs utilize neuronal pathways to yield desired responses, but they also have neuroprotective properties. These properties have been studied particularly in patients with Alzheimer’s disease and dementia. They function by targeting common malfunctions in such diseases including cholinergic hypofunction, glutamatergic dysfunction, and oxidative stress. For instance, Alzheimer’s is characterized by “scarcity in cholinergic neurotransmission ” [20]. Cholinergic pathways refer to those of the neurotransmitter acetylcholine (ACh). Anti-Alzheimer’s drugs have thus tried inhibiting acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) enzyme activity, as these enzymes lead to the degradation of ACh and are implicated in Alzheimer’s. Interestingly, some EOs have similar effects! For instance, those from the flower Polygonum hydropiper have been shown to have this BChE inhibitory property and thus may be used as a natural treatment for Alzheimer’s.

EOs can also reduce oxidative stress which is very beneficial for patients with Alzheimer’s. Lavender, a popular EO, has neuroprotective, antioxidant, and antiapoptotic effects. Exposure to this EO caused increased antioxidant, oxidation-or-free-radicals-inhibiting, enzymes in the immune system such as superoxide dismutase. Radicals can “steal” electrons from lipids in a cell’s membranes and cause cell damage which can be detrimental to the brain [20]. This study also showed reduced degradation of lipids as a result of the radicals. Therefore, this antioxidant activity protected neurons and neuronal pathways in these subjects [20].

In addition, EOs are great for improving cognition including learning and memory, and fighting against amyloids. β-amyloid peptide, in particular, can build up to form cerebral plaques, often seen in Alzheimer’s patients, and EOs may be able to counter the severe injurious effects. Aromatherapy can also treat anxiety including cancer-induced anxiety, epilepsy, and convulsions [20]. There are a variety of critical effects and mechanisms driving EOs and their constituents, besides the few examples above.

CONCLUSION

I hope I have articulated the importance of broadening the medical canon and dismantling the stigma surrounding CAM. Our current healthcare system will suffer if we fail to incorporate such methods. Just as integrative medicine can reduce our reliance on opioids, it can reduce our overreliance on antibiotics, something that’s catastrophic due to the “development of antibiotic-resistant organisms… disruption of the gastrointestinal microbiome and sometimes serious drug-related side effects [18].” Furthermore, the consumerist character of the healthcare system and the inequality that results, including the barrier of entry into the field, are astounding and have led to the deterioration of often minority populations’ health [18]. CAM can actually help reduce these inequities and the cost of medicine by providing more routine, less invasive, and less monopolized products of care [4].

Why should research funds be spent on this, you may ask? The primary reason involves the opioid crisis, unjust biases surrounding alternative medicine, and areas of the current healthcare system where allopathy fails. A secondary reason is that medical students, your future doctors are onboard! In 2006, a Georgetown University survey found that 91% of their medical students believe mainstream medicine can truly benefit from CAM practices. Over 75% of them wanted these practices to be incorporated into the curriculum. A separate study in Singapore found that 91% planned on incorporating CAM into their future “conventional” medical practice [12]. A majority of medical schools are actually starting to incorporate CAM into their curriculum [21]. Columbia University is following suit [22].

One caveat is that we must remember and respect the origins of these diverse methods of care, as many thriving alternative medicinal practices used in the US today are exemplary gestures of cultural appropriation [18]. Many of these forms of medicine originated in Eastern countries and indigenous cultures. Due to their commercialization and exploitation by health tourism companies and other consumer products like tonics, health foods, and cosmetics, these practices are now becoming fashionable while ignoring their origins and legitimate medical value in their respective cultures [23]. Besides not giving due credit to the cultures that developed these methods, there is a threat of whitewashing them, as we’ve seen with many non-Western practices like yoga [24]. “The global wellness industry is now worth an insane $4.2 trillion,” which drives one to question their intent and regard for these practices’ geneses [25]. It is imperative that we maintain the integrity of CAM practices and their diverse cultures.

It is also important to recognize that while this article highlights the neurological and biomedicinal basis of integrative care, in order to truly understand these practices and their efficacy, we have to approach them through a holistic lens. In addition to viewing them through neuroscience, molecular and organismal biology, plant-sciences, physiology, chemistry, physics, and the material sciences, we must also acknowledge the significance of the ancient texts and cultures underlying these ideas [23].

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