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How Many Varieties of Medical Practice Are There?by Rafael A. Rivera, M.D., FACP | |||
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Allopathic Medicine, also referred to as scientific medicine, is the type of medicine practiced in the US by physicians who have the initials MD after their name. The majority of medical schools in the US and Canada are allopathic medical schools, though the term allopathy (Gr. allos ~ against, and pathy ~ disease) is rarely used, only appearing in medical documents. The initials MD stand for the Latin Medicinae Doctoris, which appears on the diplomas of US medical (allopathic) schools. There are 129 accredited MD degree-granting medical schools in the US and 17 in Canada—all represented by the Association of American Medical Colleges (1). Osteopathic Medicine is the closest to allopathic medicine, though osteopathy is based on the belief of its founder, Andrew Taylor Still, that most diseases are related to problems in the musculoskeletal system (bones, muscles, and nerves). The founder of osteopathy devised and taught manual manipulations to restore proper musculoskeletal function that are still taught and used. Otherwise, MDs and DOs in the US practice medicine the same way. There are 24 osteopathic medical schools in the US (2) that grant a DO (Doctor of Osteopathy) degree. MDs and DOs are equally recognized by the various US certifying Boards of medical specialties and subspecialties upon successful completion of the appropriate examinations.
Homeopathic Medicine is the product of the observations and theories of the German physician Samuel Hahnemann (1755-1843), founder of homeopathy. Homeopathy is a method of treating diseases or symptoms by administering infinitely diluted natural compounds in the smallest amounts that would bring about or mimic the patient's symptoms. This is referred to as the Law of Similars ("like cures like"). Critical examination of homeopathic products finds that these infinite dilutions of the purported substances have no detectable active products. Advocates have proposed the "memory of water" theory, whereby, for example, the structure of a water-alcohol solution altered in the process of dilution still retains curative properties, even after none of the actual substance remains. All homeopathic remedies are made of naturally occurring plant, animal, or mineral substances. Homeopathy is practiced worldwide, including the US. (3), (4). Naturopathic Medicine, also called naturopathy, deals with nutrition, botanical medicine, hydrotherapy, psychology, and counseling (5). Traditional Chinese Medicine (TCM) relies primarily on the use of herbs and acupuncture. Acupuncture has gained full acceptance by the Western medical community, particularly the specialty of anesthesiology (6). In addition, trigger point therapy for relief of pain arising from specific definable musculo-skeletal areas has a correspondence of approximately 90% with classic acupuncture sites (J. of Alternative and Complementary Therapy, May 10, 2008, Mayo Clinic). Traditional Hindu Medicine (THM), also known as Ayurveda, is the ancient Hindu science of health and medicine in which diseases result from disharmony between the person and the environment (7). Beneficial effects of yoga and meditation are regularly reported by those who practice them regularly; both have become integral parts of most comprehensive rehabilitation programs. Chiropractic practitioners are not medical providers. Under current law, chiropractors are considered "limited providers" (8) (9) (10) who perform spinal "manipulations" and "adjustments" to correct vertebral column misalignments referred to as "subluxations." This is an area of controversy, since conventional medicine defines subluxation as a partial dislocation of a joint structure for which any "adjustment" or "manipulation" would be strictly contraindicated. In addition to "spinal manipulations", chiropractors prescribe nutritional products, homeopathic products, and various types of physical therapy. For an in-depth look at this practice, refer to (7) (8) (9).
The National Institutes of Health (NIH) maintains a National Center for Complementary and Alternative Medicine (11) that provides information on this subject. Mind-Body Medicine is associated with the pioneering work and the writings of Dr. Herbert Benson, a Harvard-trained American cardiologist who is currently the Director Emeritus of the Benson-Henry Institute (BHI), the Mind/Body Medical Institute at the Massachusetts General Hospital, Harvard Medical School. His early work was captured in the 1975 best-selling book, The Relaxation Response (15). The body's response to acute stress has been traditionally referred to as a "fight-or-flight response" which results in a cascade of biochemical events led by the release of adrenaline and a predictable cardiovascular response. The perception of chronic stress, however, is difficult to assess until some catastrophic event like a heart attack or cancer occurs. Through the process of rehabilitation one can learn to recognize stress and work through a relaxation response, where all systems reach a steady state that promotes healing and well-being (12). Dr. Benson's clinical research, (http://www.mbmi.org/benson/bio.asp) is extensive and crosses over into spirituality and mysticism, as his bibliography shows (13).
Personalized Medicine—also called genome-based or genomic medicine (16) (17) is the most recent healthcare concept being talked about in medical circles. The basic premise is that a person's genomic information can be used to determine the kinds of treatments most beneficial to a particular person—be they preventive measures before a disease presents or actual therapy for an existing condition. Genetics is the study of heredity and genetic medicine, it examines the role of individual genes as they relate to biology and medicine. Genomic medicine makes use of our own personal (thus the name, personalized medicine) genome, our individual genetic structure encoded by the nucleotide sequences, etc to determine individual vulnerability to disease and responsiveness to medication. Medications have traditionally been prescribed only after clinical trials show benefits. After that, individual physicians decide on the usefulness, or lack thereof, of the medication for their own patients. If a particular medication doesn't work, another will be tried. Via the use of genomic information, specific responses to treatment can be predicted by identifying the specific genomic information involved in the biology of the disease (see illustration below). 
There are still many ethical, legal, financial and social questions to be answered regarding genomic medicine. Concierge medicine—also known as boutique medicine, retainer medicine, platinum practice or executive health plans—is an arrangement between physicians and a limited group of patients wherein, for a fixed annual fee, these practices offer special amenities and services not now provided by most medical practices. These include nicer, less crowded reception areas, priority same day, guaranteed next day, extended appointments, home access, cell phone access and a 24-hr pager to the physician, Also, telephone and email consultations, free check ups, preventive care, weight loss, nutrition, wellness advice. It is possible to maintain coverage from Medicare and other third party payors while participating in these arrangements that do not include major diagnostic or interventional procedures as well as surgery(19).
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his question deserves revisiting and updating from time to time, particularly for those who are not familiar with the fundamental differences or the confusing terminology that seems to expand continuously.