Alternatives Enter the Mainstream
Tuesday, September 16, 2008
Jill Eisner lay still as an acupuncturist pushed thin needles into her face and feet, with soft music playing in the background. In another room, an herbologist studied his antidote for severe acne: a concoction of 12 ingredients, including dandelion roots, tangerine peel and dried raspberries. A few doors down, Linda Lee, dressed in a white lab coat, used the tools of conventional medicine to treat a patient for digestive problems.
The Johns Hopkins Integrative Medicine and Digestive Center, which opened Sept. 2, is the latest indication that alternative medicine is making its mark in mainstream health-care settings.
"We conventional doctors need to acknowledge that some of our therapies don't always work," said Lee, a gastroenterologist with 20 years of experience. In addition to Lee, the center has 12 specialists, including acupuncturists, nutritionists, massage therapists and a psychotherapist who uses hypnosis and touch therapy.
After spending four years together in private practice in the Baltimore region, Lee and her colleagues realized they needed more space, so they approached Hopkins. Housing the center under the umbrella of a prestigious institution will raise public awareness about complementary and alternative medicine (CAM), Eisner said. "The Hopkins name is important" to patients, she said. "People will be much more receptive to it."
For Hopkins, the center is a way to capitalize on a burgeoning patient base, Lee said. "I can't tell you the number of patients who come in and say they've been getting acupuncture for 10 years," she said.
The center's link with Hopkins is part of a trend toward integrating CAM with conventional medicine. In a survey of 1,400 hospitals, 27 percent offered some sort of alternative or complementary treatment, according to a 2006 American Hospital Association study, up from 8 percent in 1998. Last fall, Hopkins -- a bastion of mainstream medicine -- joined the Consortium of Academic Health Centers for Integrative Medicine. This group of 41 medical centers has pledged to invest in CAM research and to introduce integrative models of clinical care.
Investment in research is key to any true alliance between the two schools of care. Conventional practitioners often decry the subjective nature of many CAM treatments, which have not proved their worth through the controlled, randomized trials that are considered the gold standard of medical research.
"The kind of medical school training we get, we're taught to reject many other types of training," Lee said.
Efforts are underway to remedy the lack of solid research, according to Richard Nahin, a senior adviser to the director of the National Center for Complementary and Alternative Medicine, a branch of the National Institutes of Health.
The NIH will invest about $300 million in CAM research this year, up from about $50 million nine years ago. In addition, private organizations such as the Osher and Samueli foundations have injected funds into CAM research.
Acupuncture, now fairly widely used as a means of controlling pain, was said to be lacking evidence of effectiveness as recently as the late 1990s when the NIH called for more research, stating "overall, results were hard to interpret because of problems with the size and design of the studies." Today, "a number of large, pivotal clinical trials have either been completed or are nearing completion," Nahin said, "and more are in the planning stages."
An NIH study of 380 advanced cancer patients at 15 U.S. hospices published in today's issue of Annals of Internal Medicine finds that massage therapy may have immediate though short-term effects on pain and mood among patients with advanced cancer.
Some treatments, such as touch therapy, which is used to calm patients, are tough to measure. The Cleveland Clinic is currently studying how one form of touch therapy, reiki, affects anxiety levels and cancer progression in men with prostate cancer. Despite a lack of data on its effectiveness, many doctors are willing to give such treatments a shot, because gentle touching does no harm, Nahin said.
The same cannot be said of herbal supplements because of their potential to interact with conventional drugs. "Over the coming 10 years there is going to be substantial literature on the interaction of different herbal medicine and pharmaceutical drugs," Nahin said.
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A lack of research has not stopped a few alternative practices from becoming standard treatments in some high-tech settings.
At the University of Maryland Medical Center's Shock Trauma Center in Baltimore, nurse Donna Audia often gives patients and their families a bowl-shaped instrument called a crystal bell. When tapped, it produces soothing sounds that its proponents consider therapeutic.
Audia also offers reiki treatment. Though it is not a substitute for narcotics, reiki has become a critical component in patient care, said Audia, who has 11 years of nursing experience. She believes that it helps prevent such problems as post-traumatic stress disorder.
"These patients have emotional and spiritual pain," she said. "At some point they realize 'I could have died.' " Audia started performing reiki two years ago when a doctor in the center asked her to research techniques to calm traumatized patients. She found a course in reiki -- something she knew nothing about -- and trained to become a reiki master.
Now, as part of the pain control treatment that Shock Trauma patients routinely receive, Audia follows the Japanese practice of gently touching patients and moving her hands along their bodies while they keep their eyes closed. After a reiki session, Audia reports that patients' self-selected pain scores usually drop three or four points on a scale of 10.
News of Audia's skills spread through the center, and she soon had nurses and doctors across the hospital asking her to perform reiki on their patients. The response was so overwhelming that the University of Maryland School of Medicine's Center for Integrative Medicine is offering a new course for health-care professionals that includes training in reiki, yoga and meditation. Twenty nurses have signed up so far for the six-week course, which begins early next month.
"This is what Florence Nightingale would have wanted," Audia said, reflecting the view that as modern medicine has become more high-tech it has lost some of the personal touches that can promote healing. "When she talked about nursing," Audia said, "it was holistic care."
Last year, the George Washington University Medical Center launched a reiki program for patients as well as for their families and for staff members in need of stress relief. Dressed in neon-green jackets, reiki volunteers make daily rounds in the hospital, offering their services to all.
Joel Rosenberg, GWU's director of clinical cardiology, says he is not waiting around for a landmark study on reiki. He is already convinced that it works.
"The heart rate goes down. The respiratory rate goes down. The required sedation goes down. Inflammation goes down," Rosenberg said. "I've seen it in hundreds of patients. And, they are happier."
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At GWU, reiki is a free service. At Shock Trauma, the cost of a reiki session is bundled into the cost of pain control, which is usually covered by insurance, Audia said.
Elsewhere, the lack of insurance coverage for CAM treatments makes it prohibitively expensive for many. "One of the limitations of what we're doing is what insurance companies are paying for," Lee said.
Price and the lack of research are not the only concerns; conventional practitioners also worry that too much reliance on CAM could backfire.
"In some cases, it may reinforce the desire not to see a mainstream caregiver," Rosenberg said.
Insurance coverage and mainstream acceptance of CAM will come with time and research, said Margaret Chesney, associate director of Maryland's integrative medicine center.
"We will find out things we didn't anticipate," she said. "But that's part of what health and medical research is all about."
She sees the intersection of conventional and alternative medicine as an exciting new frontier.
"Three-thousand-year-old treatments are being brought into the most modern setting you can imagine, where people are flown to the hospital by helicopter," she said. "Why not?"