As respect for diversity becomes a recognized value in American public health, so does an understanding of community constructions of health and illness become an essential component of truly community oriented primary care (COPC). Alternative or complementary health practices (ACHP) are practices whose alternative origin comes from outside the mainstream biomedical culture of American medical schools, hospitals and research centers. While ACHP are occasionally integrated into this biomedical culture, they tend to require considerably more research evidence for their use to become widespread among MD's than do practices which originated from within the biomedical culture (and were not themselves necessarily based on evidence from randomized trials, such as the prescription of antibiotics for most upper respiratory infections, intrapartum fetal monitoring for low risk women in labor, or various surgical procedures). ACHP include traditional healing practices from other (often non-English speaking) cultures and are often based on concepts of health and illness that seem foreign to American MD's, who are therefore likely to attribute a much lower Bayesian prior probability to the possible effectiveness of ACHP. From this office, we seek TO CREATE an environment for health care in the US that places the needs of the patient and of the community at the center of the health care equation, with health professionals ready, willing and able to learn as much from their patients as from their professors. At the same time, in those unfortunately rare instances when truly definitive data ARE available to guide the provision of health care, they should be pursued with all possible vigor. Sometimes this will mean insisting on treatment of the community's outcast with a new respect, treating them as sick, rather than "bad." The use of Methadone and LAAM to treat patients with heroin addiction is such a case in point. This is a treatment with some of the most definitive supporting data of any common treatment in American medicine. Opioid agonist treatment (OAT) reduces the patient's risk of death to less than a fifth of the death rate without such treatment, yet it remains politically (and tragically) controversial. At TO CREATE, we do not merely navigate these waves of controversy and change; we seek to surf them.
Surf's up!
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