The ginkgo's branches spread behind a low concrete wall. As a small group of students and faculty gathered around the tree, Adriane Fugh-Berman described how, over the centuries, its leaves have been used in various preparations intended to aid memory and blood circulation.
She then led the group around the corner, stopping at a small juniper tree.
"Can anyone tell me what juniper is used for?" Murmurs but no answers. She looked disappointed. "What? No alcoholics in the group?" She laughed and passed juniper berries around to smell. Faces brightened. Gin. "Yes, but juniper has also been used as a diuretic and for indigestion," Fugh-Berman said.
It is a sunny spring day, and this "herb walk" is an epilogue for the first graduating class in Georgetown University's master's program in Complementary and Alternative Medicine (CAM). Unlike other academic endeavors devoted to alternative medicine, it's devoted less to teaching clinical applications and more to training researchers to subject complementary treatments to scientific scrutiny.
The year-long master's degree program, the first of its kind in the United States, is offered by Georgetown's Department of Physiology and Biochemistry. The herb walk was one the last times the 10 students -- who entered the program last September -- would be together before they scatter to complete their required internships.
Next up: the Pharmaceutical Garden, planted in 2000, a long narrow strip of earth next to Georgetown's Basic Sciences Building. But it's not a working garden; it's an ornamental lesson.
The group passed lilies-of-the-valley ("toxic," said Fugh-Berman, "but once used as a wash for gout"), rosemary ("for baldness and gastrointestinal disorders"), foxglove ("ground up by drug companies for its digitoxin, for congestive heart disease").
It's when the group talks about the dandelions that the focus of the CAM program becomes apparent. "Dandelions are purported to have diuretic effects, but from our findings, that hasn't been fully determined," announced student Dia Wirsing, who, with fellow student Mary Saphyakajon, studied dandelions' effects on laboratory rats.
"The fundamental idea [behind the program]," explained professor and program co-director Adam Myers, "is teaching them to think scientifically and critically about [CAM]."
People today are spending more money out-of-pocket for complementary and alternative therapies than they pay for all hospitalizations, Myers said, yet conventional doctors remain largely ignorant of CAM practices. Doctors, Myers said, "need to understand what their patients might be taking." This can't happen unless someone does the research into what works, what doesn't and other essential details like interactions, side effects, contraindications and so on.
"When my aunt had cancer, a lot of the treatments she took were CAM," said Roger Alvarez, 23, who came to the Georgetown program with a degree in biology from the University of Miami. "Her oncologist . . . was clueless" about the remedies she was taking on her own.
Andy Jou, also 23, often encountered similar ignorance during the year he worked in a Champaign, Ill., emergency room after graduating from the University of Illinois in 2002.
"Every time someone came to the ER, we had to surf the Web" for information on the herbal medicines and dietary supplements the patient reported taking. The situation left Jou confused and concerned: "What do we do if we don't know what the interactions will be?"
A Federal Matter
In 2001, Georgetown's medical school received a $1.7 million federal grant to integrate CAM into its curriculum. The master's program is an offshoot of that grant, which came from the National Center for Complementary and Alternative Medicine (NCCAM), part of the National Institutes of Health. The program was developed in large part as a revenue builder: The $23,000 annual tuition of the 20 hoped-for students will help maintain the larger CAM program after the five-year grant ends.
"Virtually all medical schools recognize that they need to grapple with CAM," said Aviad Haramati, a Georgetown professor of medicine and director of the medical school's CAM initiative. Seventy-five to 90 percent of medical schools, he said, do have some basic CAM courses. But they are frequently segregated from the rest of the curriculum and offered as electives.
That, he said, is not good enough. "We have to ask what does every student need to know, not what do some students want to know," and integrate those essentials into the curriculum.
"Georgetown is correct and exemplifying a trend across the nation," said David Eisenberg, director of Harvard Medical School's Osher Institute and chief of the school's division of research and education in complementary and integrative medicine.
While Harvard's month-long course in CAM is an elective, aspects of CAM have been introduced into certain required courses. For example, herbs are now studied in pharmacology classes. Of the 120 medical schools in the United States, said Eisenberg, "at a minimum, 20 schools are [integrating CAM] proactively. . . . That's what we'll be seeing over the next decade."
This increase in the academic is not universally welcomed.
"We're off to the races with something that hasn't been conceptualized as a discipline. It's a hodgepodge of quackery taken to a new level," said Robert Baratz, president of the National Council Against Health Fraud.
Baratz, a practicing physician in the Boston area, deplores what he believes is the squandering of research dollars on studying CAM. He also disputes the statistics claiming large numbers of CAM users -- statistics that are often cited to defend the need to study CAM.
According to an NCCAM survey published in May, more than 60 percent of Americans use some form of CAM. That figure, however, drops by almost half when prayer is excluded.
"Lots of people pray," Baratz said, "but [NCCAM] calls it CAM. . . . We call it SCAM."
Joseph J. Fins, director of medical ethics at Cornell Medical School, shares Baratz's concerns about CAM statistics.
"A lack of demographic knowledge has contributed to a disproportionate interest in the field . . . given other funding priorities," said Fins, who was a member of the White House Commission on Complementary and Alternative Medicine Policy.
In fact, he said, the most commonly used statistics showing great numbers of visits to CAM practitioners misrepresent the reality. He cites a 2002 Archives of Internal Medicine report that concluded that around 9 percent of the U.S. adult population accounted for more than 75 percent of the 629 million annual visits to CAM providers. "A small minority [of CAM users] accounts for the majority of expenditures," Fins said.
And prayer? "Questions of faith and healing should not be the purview of science. And it degrades prayer to try to define it in a way it wasn't meant to be defined."
Unlike Baratz, Fins supports some integration of CAM into the medical curriculum. After all, a doctor needs to know enough about supplements and other therapies to know when they may do more harm than good. For example, an HIV-positive patient taking protease inhibitors should be told not to take the herb St. John's wort -- sometimes used to treat depression -- which decreases the AIDS drug's effectiveness.
But the doctor's office and the laboratory are worlds apart, and for Fins the question is whether CAM's efficacy be measured objectively.
Fugh-Berman said part of the problem is getting medical professionals acquainted with the high-quality research that has already been done, much of it in other countries.
"There are more studies on herbs and dietary supplements than people know about," said Fugh-Berman, sweeping her arm across her Dupont Circle office. "I collect those studies, which is why my office is such a mess."
Fugh-Berman is an associate professor in Georgetown's CAM program and the author of "The 5-Minute Herb and Dietary Supplement Clinical Consult" (Lippincott, Williams and Williams, 2003) and "Alternative Medicine: What Works" (Odonian Press, 1996). For her, an essential element of the program is teaching students the mechanics of clinical trials -- how to design them, how to analyze their results.
"Some herbs and supplements fit really well into [conventionally modeled] studies," she said. But therapies like imagery and aromatherapy can be harder to measure.
Student Mary Saphyakajon's family is Thai-Chinese. Growing up in Los Angeles, Saphyakajon, 23, didn't know that the ginger tea her mother gave her for upset stomach was considered either complementary or alternative. In her house, it was medicine.
When she first learned of the Georgetown program, she said, "I was worried it would be all pro-herbs and whatnot, but it was very objective. . . . They give facts, they give evidence."
Like the rest of the students, Saphyakajon spent a semester in a CAM survey course and two semesters studying and critiquing CAM literature, as well as taking courses in physiology, nutrition, statistics and mind/body medicine.
A pre-med/mass communications major from the University of California, Los Angeles, she described herself as very realistic and objective. So why study CAM? "I want to have the knowledge of it for my patients. . . . [and] I like to challenge myself to think more grandly."
That kind of grand thinking is taking her to San Francisco this summer, where, as an intern, she will assist an NCCAM-funded study of distance healing.
That's the kind of treatment modality that inflames CAM opponents like Baratz. In distance healing, or intercessory prayer, faith healers send "positive energy" toward sick people. As Saphyakajon explained, terminally ill brain cancer patients participating in the study will, in addition to their normal treatment, each be prayed for by six people for a total of 60 hours, to see what benefits, if any, such prayer has.
"It boggles my mind that we are wasting government dollars on that," said Baratz. "Just because people are doing aberrant behavior and calling it CAM, we have to study it? That's wrong. . . . Let them take care of somebody who is really sick with their so-called CAM. Let's go toe to toe in the ICU, me [with conventional medicine] against them, and see what happens."
Some faculty members at Georgetown are also skeptical of researching such practices.
"My personal opinion?" said Michael Lumpkin, a neuroendocrinologist and chairman of Georgetown's Physiology and Biochemistry Department. "Waving hands over my body -- energy medicine -- that doesn't do anything for me." Nor do crystals or homeopathy, said Lumpkin, but "acupuncture is logical to me, [because it] affects nerves' activity, which affect musculoskeletal activity. [It] has been proven to have real effectiveness in reducing [some kinds of] pain."
Lumpkin has what he calls a "purely scientific interest" in CAM: "If the facts say something is worthless, that's what we teach. Let the facts fall where they will."
The CAM program's faculty and students say that facts are what they are after. They do not promote the use of CAM, they said. They simply want to know what works and what doesn't and to bring that knowledge to others who can use it.
The immediate futures of the students on the herb walk, most of whom plan to attend medical school, are as diverse as the herbs on the Georgetown campus. Jou and Alvarez will intern at the Federal Trade Commission, working on policy issues concerning the marketing of dietary supplements. Ketzela Jacobowitz will be researching the steroid DHEA as an intern at NCCAM. And Dia Wirsing will fly to Bhopal, India, where she will observe the work of two hospitals -- one focused on techniques of Western medicine, the other on Hindu-based Ayurvedic medicine.
"It's an opportunity to integrate some of these ideas of healing and holism into my own training," Wirsing said. "I'm excited to have my world turned upside down."
Matt McMillen is a regular contributor to Health.