New Respect Between East, West
Tuesday, January 29, 2008
Peace. Love. Joy.
The dark months after the holidays leave many people returning unwanted gifts to store shelves and reaching instead for remedies to combat seasonal fatigue and midwinter blahs.
"Millions of people in this country take herbals of all kinds," said Rebecca Snow, an herbalist and nutritionist in Rockville, "often without understanding their effects or interactions. Some are beneficial, others are not."
That gap -- between the proliferating use of remedies such as herbals and the limited knowledge about their effects -- is a big part of the current debate about alternative medicine. There are no licensing requirements, for example, for people who dispense advice as herbalists, and Snow is a graduate of the only academic institution in the country to offer a master's degree in herbal medicine: the Tai Sophia Institute in Howard County.
Because alternative treatments are increasingly part of personal health choices (about 38.2 million adult Americans use herbal supplements, also called botanicals, for example, according to a 2002 survey by the Centers for Disease Control and Prevention), some doctors are taking steps to bridge the knowledge gap. Snow, for example, works in an integrative medical practice -- Optimal Health Physicians, which melds conventional and alternative medicine -- with two internal medicine doctors; and Tai Sophia itself has affiliations with several major medical institutions, among them the Morgan State University School of Public Health and Policy and the University of Pennsylvania School of Medicine.
"Students appreciate the emphasis on wellness and the exposure to unconventional aspects of medicine and healing," said Gail Morrison, a physician and vice dean of the Penn medical school.
Tai Sophia has grown in size and influence as interest in alternative therapies has increased. From a small healing-arts clinic founded in 1975, it has become an academic institution accredited by the Middle States Commission on Higher Education. The Maryland Higher Education Commission has endorsed all three of Tai Sophia's master's degree programs: acupuncture, started in 1981; herbal medicine, begun in 2002; and applied healing arts, a general wellness degree, opened to students in 2002. Its 100 graduates a year practice in 40 states and eight countries around the world.
The institute sees itself as a bridge. Tai Sophia's name represents the joining of two ancient healing traditions: the Chinese word "tai," meaning "great," and the Greek word "sophia," meaning "wisdom." Similarly, it views its mission as bringing together different approaches to health: "We're committed to reuniting the science of medicine and the art of healing," said Robert Duggan, the institute's president. "Herbal medicine, for example, has elements of both."
Although evidence-based medicine has brought advances in recent decades in the measurement of scientific success, many scientists say the art of healing remains a far more intuitive -- and less quantifiable -- process. Nonetheless, physicians such as Morrison have come to appreciate the healing potential of alternative therapies, including herbals.
Complementary medicine, she said, "can bring patients a lot of symptom relief. Acupuncture, for example, is well-validated for treating pain," she explained. "When it comes to herbals, many physicians would like to see more solid data on their effects. . . . The key is concerns about interactions: interactions between herbals, and interactions between herbals and prescription medicines."
Understanding those interactions is crucial, said Norton Fishman, one of the internists with whom Snow practices. "We're talking about complex biochemistry -- a link the general public, and many physicians, fail to make."
"It is this concern about the need for specialized knowledge that led to the creation of an herbal medicine degree program at Tai Sophia," Duggan said.
Herbals provide a case study in the complex questions surrounding alternative therapies and the challenges facing integrative medicine. The regulation of herbals, for example, which are designated as dietary supplements, is less stringent than that of drugs. The Food and Drug Administration prohibits retailers from making any statement that would make an herbal (or other dietary supplement) sound like a drug: Their labels cannot claim that they prevent, cure or treat diseases.
Last year, the FDA also established manufacturing standards for dietary supplements. Under this rule, makers of herbal supplements are required to evaluate the substances' purity, quality, strength and composition. Makers are also required to report any adverse effects from dietary supplements to the FDA.
However, the active ingredients in many herbals are still not understood, said Marguerite Klein, program director for biologically based practices at the National Institutes of Health's National Center for Complementary and Alternative Medicine. She said there may be dozens -- or hundreds -- of such compounds in an herbal supplement.
"Scientists are working to identify these ingredients," Klein said. "Rigorous research studies of herbals' effects, beneficial and not, are increasingly important."
NIH supports five botanical research centers investigating how certain botanicals might serve as treatments. Scientists at the Pennington Biomedical Research Center at Louisiana State University and the Rutgers University Biotech Center in New Brunswick, N.J., are studying Russian tarragon, for example. Extracts of this herb lower glucose levels in research on rats and mice. Russian tarragon may lead to a new therapy for metabolic syndrome, an increasingly common cluster of risk factors for heart disease and Type 2 diabetes.
If a botanical compound proves effective and a drug is made out of it -- as happened, for example, with one of the plants in the genus Artemisia, long used by Chinese herbalists, from which the antimalarial drug artemisinin was eventually made -- it is regulated as such.
Unless that happens, however, herbals remain dietary supplements, and physicians recommend caution: talking with a health-care provider before using them; knowing that some supplements may interact with prescription and over-the-counter medicines; and informing doctors about any supplements used, especially before surgery.
Another alternative therapy, acupuncture, is widely credited with combating pain, Penn's Morrison said. There are more than 22,500 acupuncture practitioners in the United States, according to the National Acupuncture Foundation, many of them graduates of Tai Sophia's program, the first accredited program in the country.
Tai Sophia's acupuncture graduates, like those in the herbal medicine program, work in hospitals, health centers, HMOs, integrated medical clinics, community service clinics and wellness programs. Many have independent practices; others maintain shared practices with physicians, chiropractors and other health professionals.
Acupuncture has been practiced in East Asian countries for thousands of years, and in recent decades, Duggan said, it "has skyrocketed in popularity in the U.S. as a complementary approach to disease management."
Colette McKie, owner of a hypnotherapy and acupuncture practice in Bowie and a 2000 graduate of Tai Sophia's program, said that for many people, acupuncture offers "a turning point in their lives."
Andrew McGlone of Annapolis, one of several area doctors who refers patients to McKie, said that "for problems like migraines, traditional medicine has few or no really good remedies." Acupuncture, he said, has worked well for his patients.
A Lifestyle Problem
It may be frustration that accounts for the popularity of alternative therapies. McKie said many of her patients "are 'doctored out,' having had little success with conventional medical therapies."
For anyone who has felt that frustration, Tai Sophia's philosophy and campus offer an undeniable allure, blended into woods and streams near Columbia. Its classrooms look out over quietly flowing fountains and marsh grasses. Above them is the clinic ("no cellphones, please"), where students are trained.
In addition to its degree programs, the institute offers community education classes and lectures in general wellness and understanding good nutrition, and exercise-based programs such as tai chi and qi gong.
Internist Michael Baime, who works with Tai Sophia students in Penn's cardiac wellness program, explained why so many patients who receive conventional treatment are also drawn to alternative therapies: "Most of the diseases we're now paying for -- physically, mentally, emotionally and financially -- are a result of our hectic lifestyles: running too much."