By Lori Aratani
Washington Post Staff Writer
Tuesday, June 9, 2009
A patient who comes to Marie Steinmetz with clogged sinuses might be in for a surprise.
Instead of walking out of the Alexandria family physician's office with a prescription, he might find himself stretched out in a dim room on a massage table. With soft music playing in the background, Steinmetz might quickly -- and gently -- stick several needles into his head and hands to help clear his nasal passages. For a chronic sufferer, she might suggest the use of a neti pot, an ayurvedic treatment popular in India and parts of Southeast Asia that involves flushing out the nasal passages with a water-based solution.
After more than a decade of treating patients with conventional medicine, Steinmetz, a board-certified family physician, has embraced an approach that combines Western medicine with complementary and alternative treatments that have roots in Eastern, Native American and European cultures and that have been used for hundreds, even thousands of years.
Make no mistake: Steinmetz will still hand out a penicillin prescription to fight an infection, but she also looks to Eastern and Native American traditions for clues to how to treat her patients' ailments. For an upset stomach, it might be an herbal remedy; for menstrual cramps, a bit of cramp bark.
"It's about treating the whole patient in the best way,'' she said.
Steinmetz is among a growing number of traditionally trained physicians who practice "integrative medicine": conventional medical care that incorporates strategies such as acupuncture, reiki and herbal remedies.
It's not just family practitioners who are taking this approach. Reed Shnider is an Olney-based preventive cardiologist who works with patients to prevent heart disease and who, depending on the patient, encourages them to take up yoga or tai chi to ease stress after bypass surgery. Iona Razi, a board-certified pediatrician in the District, is also a homeopath; i.e., she treats illness with small doses of remedies that are thought to activate the body's "self-healing response." John Pan, a clinical professor in the department of obstetrics and gynecology at the George Washington University Medical Center, incorporates Eastern medicine into his practice. He is also the founder of the Center for Integrative Medicine at the medical center.
The shift in attitudes toward alternative and complementary medicine was very clear to Xiao Ming Tian, director of the Academy of Acupuncture and Chinese Medicine at the Wildwood Acupuncture Center in Bethesda. In the early 1990s, he received few inquires from local physicians seeking his services. Today, he said, he gets hundreds of referrals a year.
Studies also show that the number of Americans willing to try alternative treatments continues to increase. A 2007 survey by the federal government found that more than one-third of adults and nearly 12 percent of children in the United States used alternative therapies, including acupuncture and herbal supplements.
Many mainstream physicians continue to be skeptical of alternative therapies, saying their efficacy has not been proven and their successes may be nothing more than variations of the placebo effect. But increasing numbers of institutions, including Johns Hopkins Hospital and the R Adams Cowley Shock Trauma Center at the University of Maryland Medical Center, have established integrative medicine units that bring together conventional and alternative approaches to care.
Health insurers are also beginning to recognize and pay for some alternative therapies, including acupuncture and herbal remedies, although Medicaid and Medicare do not cover them.
"It's not as evidence-based, which is why doctors are somewhat averse to the practice,'' said Shnider, who is affiliated with Cardiology Associates. "But if [they] didn't work, why would we still be doing them thousands of years later?"
Shnider had studied martial arts and discovered that fighters developed a variety of healing strategies for injuries because they were often left to their own devices. He thought their practices could be applied successfully to his patients, and that led him to tai chi, a martial art based on slow, graceful movements. Practitioners believe it improves balance and digestion. Shnider said it helped his patients relax and be more in tune with their bodies. In Shnider's mind, it's not alternative medicine, but wellness.
"No tradition has all the answers,'' said Martha Calihan, a board-certified family physician in Leesburg, who incorporates acupuncture and herbal medicine into her practice. "I love the ability in integrated medicine to be able to pick and choose from among many traditions."
Vicki Shea believes those choices have benefited her. Shea suffers from fibromyalgia, an illness that causes pain and fatigue. An active mother of two who coached soccer, played golf and loved to hike, she says her condition left her too tired or in too much pain to do much more than routine tasks.
Shea had tried traditional treatments, mostly prescription medications, and visited at least half a dozen doctors when she decided last year to enroll in the Five Stones Program, a six-month health and wellness program offered by Calihan that combined traditional and alternative treatment strategies.
As part of the program, Shea had regular doctor's checkups, but she also met with a nutritionist and a personal trainer, and she took part in massage and meditation therapy. She began using digestive enzymes and slowly shifted to an organic diet.
Over the past few months, she began to feel better. Shea said she has been able to reduce the number of prescription medications she takes from six to two. She lost weight and has more energy. And although she still has pain, she is improving.
The key, she said, was Calihan's integrated approach: a willingness to look at all aspects of her life, not just her symptoms.
"It made a huge difference,'' she said. "All of these different [changes]."
Similarly, the experience of a former patient is what Steinmetz says transformed her from a "by-the-book physician."
While taking a break from practicing medicine several years ago, Steinmetz had a chance encounter at the supermarket with the former patient. The woman had suffered from horrible facial nerve pain, and nothing Steinmetz prescribed seemed to help. But the person Steinmetz encountered at the Safeway that day was a different woman: She was happy and smiling.
"Oh, I'm all better," Steinmetz recalled the woman's telling her. "I went to an acupuncturist."
Intrigued, Steinmetz enrolled in an acupuncture course at UCLA. That was followed by a botanical medicine course at Columbia University. Slowly, she began incorporating these and other alternative therapies once she returned to her family practice.
Now, one of Steinmetz's exam rooms is outfitted with a dimmer switch and furnished with a massage table. A poster on the wall illustrates acupuncture pressure points. Tongue depressors sit on the shelf above a silver cart holding acupuncture needles. Steinmetz's three associates are all board-certified family physicians who are trained in acupuncture.
Among the office's medical books is "Textbook of Natural Medicines," with detailed protocols for the use of various herbs and natural remedies as well as reports on available research.
"It's not just out-there stuff,'' she said, noting that Germany has a commission that approves herbs for physicians to use in treatment. "There is science behind this."
Steinmetz said there will always be doubters, but she can't imagine not offering her patients something beyond conventional treatments.
"I love what I do,'' Steinmetz said. "Every day I'm learning more ways of thinking of things. I can't imagine going back and practicing [only conventional medicine].''