The twain is meeting, but just barely.
Once there was standard, establishment medicine on one side, with its arsenal of high-tech equipment, potent drugs and invasive procedures. And on the other side was holistic health or alternative medicine, practices that focus on the low-tech, the natural and the mind-over-matter.
But today, some physicians are becoming more open to some alternative treatments -- such as acupuncture, biofeedback, meditation and vitamin therapy -- as possible adjuncts to the mainstream medicine they practice. Still, the gulf remains, and most doctors who even consider alternative treatments will consider them only in limited cases.
"To me it's a question of what's going to work best for an individual," said Dr. Warren Ross, a Columbia internist. "What I basically do is regular medicine. But what I've always thought is we need to place more emphasis on diet, nutrition and exercise when appropriate. ... And I do acupuncture. I think it can help with something like chronic pain, but it's not like you can do acupuncture for cancer."
Even the American Medical Association, the bastion of all that is conservative in medicine, has given the subject of alternative health care a look. Earlier this year, the AMA decided to investigate the use of psychological methods -- such as biofeedback, hypnosis and relaxation -- in the care of physical problems.
The AMA's conclusion? There may be something to this, but it has yet to be proven.
"There is not a lot of scientific evidence that these things work," said Dr. Sally Kess, an AMA science fellow who studied the available literature on these alternative treatments. "But I think there is some merit to them."
Dr. Kess said people may be deriving benefits from these practices because it gives them a sense that they, rather than the disease or the physician, are in control of their health. Dr. xTC Kess likens this to the effect exercise can have on health and well-being.
"The repetition of performing these techniques on a long-term basis might affect their self-esteem, and their sense of control, and that may affect their outcomes," Dr. Kess said.
Indeed, the wellness and fitness movement has contributed to the alternative health field in that both focus on preventive care -- and the importance of diet and nutrition.
And that, more than alternative health care, has made its way into the medical profession.
"When I was in medical school, prevention was not a major issue; mainly, we were taught diagnosis and treatment," said Murray Kappelman, associate dean for education and special programs at the University of Maryland School of Medicine. "But then, we didn't know that much about prevention before. It's been a very gradual evolution."
With the proliferation of consumer health information -- magazines, television and other media all seem to have jumped on the health bandwagon -- doctors are no longer the sole purveyors of medical information.
"A lot of patients would say, 'I've heard about this and this and this as a cure,' and I'd say, 'Nonsense. If that was true they would have taught me that in medical school,'" said Dr. Jacob Teitelbaum, an Annapolis general practitioner.
Dr. Teitelbaum, however, said he has since found scientific support for treatments that some might consider "alternative" and uses them regularly on patients.
He has used wrist splints and vitamin B6, for example, rather than surgery on people who have carpal tunnel syndrome, a nerve disorder that comes from repetitive motions. In some people, the theory goes, a lack of enough B6 can lead to swelling, and that can contribute to problems in the very narrow carpal tunnel, Dr. Teitelbaum said.
He has also used magnesium on patients who have just had a heart attack because it can prevent abnormal heart rhythms, the leading cause of death from heart attack, and herbal treatments on people with enlarged prostates to decrease the effect testosterone has on enlarging the gland, he said.
"They're not publicized because these are things that aren't patentable," Dr. Teitelbaum said of vitamin and natural therapies.
Dr. Teitelbaum doesn't see a total split between practicing conventional medicine and practicing alternative medicine. "I see as what any good doctor would do. I just take care of people," he said. "I go with the risk-benefit ratio, what is most likely to help and least likely to hurt."
Doctors, however, say that not all alternative treatments are equal. Many doctors who refer patients to biofeedback clinics, for example, wouldn't similarly advocate other alternative techniques that are considered more fringe and less proven.
"Biofeedback is much more scientifically based," said Dr. Howard Moses, a neurologist whose migraine patients sometimes use the technique. "I still feel I have to justify it, and say it's not yoga, or Transcendental Meditation."