Today's Daily Tip
Peaceful, Easy Healing
Joanne Perron, M.D., spent five years practicing medicine in a busy OB/GYN office, where the patients trundled through as if on an assembly line—in and out in 10 minutes. "I was frazzled," she recalls by phone from her home in Monterey, California. "By the end of the day, I felt disconnected and stressed. Eventually, I got very frustrated and disillusioned and began to ask myself, 'Is that all there is?'"
Perron had to face the fact that she wasn't the healer she had set out to become. "Conventional medicine is like a religion," she says. "You get indoctrinated at an early age, and then sometimes you start to question your belief system. You start to ask, 'Why?'—or, more important, 'Why not?'"
The questioning began as she realized that the things conventional medicine had taught her didn't often cure her patients. And some of those patients came back to tell her they'd gotten better after trying alternative therapies—for example, botanical remedies for menopausal symptoms, Chinese herbs for uterine bleeding, or acupuncture for pain. In Georgia, where she was then practicing medicine, prayer is commonly employed to help healing as well. "I felt there was a gap in my knowledge. My patients were pursuing things I knew nothing about," she says. "I had learned all that I could, but I knew I needed to learn more." Perron cut back her hours at work and started taking yoga classes; in time, she enrolled in a 200-hour yoga teacher certification program.
Perron's patients are part of the growing group of Americans turning toward complementary and alternative medicine to cure their ills and improve their quality of life. A national survey released last May by the National Center for Complementary and Alternative Medicine (NCCAM) and the National Center for Health Statistics found that 36 percent of U.S. adults use complementary and alternative medicine. That number jumps to 62 percent when prayer used specifically for health reasons is included in the definition. The reasons for alternative medicine's popularity go beyond the practical, according to a 1998 Journal of the American Medical Association article authored by John A. Astin, Ph.D., titled "Why Patients Use Alternative Medicine." Astin wrote that people seeking alternative medicine aren't necessarily dissatisfied with conventional medicine, but they find "these health care alternatives to be more congruent with their own values, beliefs, and philosophical orientations toward health and life." It's true; there has been a significant evolution in our time toward a more proactive, holistic view of well-being.
Conventional medicine has a lopsided view of the physical, mental, and spiritual body," surmises Andrew Weil, M.D. By now a cultural icon with his friendly smile and oversize gray beard, Weil has long been willing to take on the medical mainstream and advocate what he calls integrative medicine. His definition of the term is very straightforward: healing-oriented medicine that takes into account the whole person (body, mind, and spirit), including all aspects of lifestyle. It emphasizes the therapeutic partnership between consumer and healer and makes use of all appropriate therapies, both conventional and alternative.
In 1994, Weil was instrumental in creating the University of Arizona medical school's Program in Integrative Medicine, the first comprehensive, continuing-education fellowship to give physicians the chance to learn about alternative therapies such as botanicals, acupuncture, Reiki, massage, diet, and meditation—and how they can be used to enhance medical care, prevent illness, and improve quality of life. But more important, this program encourages a philosophical shift in the practice of the healing arts. "Rather than just bringing these therapies in with a focus on disease, we're looking at the whole body, at lifestyle, at the relationship between the practitioner and the patient," Weil explains. "Not only is this the kind of medicine patients want, but it has the potential to restore the core values of medicine in an age of managed care."
Perron enrolled in the University of Arizona's Integrative Medicine program precisely to return to a path more aligned with her original motives for becoming a doctor. "I wanted to feel more like I was participating in healing," she explains.
Perron was in the second graduating class of an associate fellowship program that requires 1,000 hours of course work (mostly online) over a two-year period and three on-site workshops. So far, the University of Arizona's Program in Integrative Medicine has turned out 151 physicians who have learned how to integrate the best of the East and the West into their medical practices—and into their own lives.
Yet, how far have we really come since Weil started his program, considering there are more than 800,000 doctors in the country? Medical schools are loath to require an integrative curriculum. Even the University of Arizona medical school does not require an integrative course; integrative medicine remains an elective. Under these circumstances, what kind of impact can 150 or so physicians make?
Even though some people in the medical establishment refer patients to therapies like acupuncture or massage, there still exists a bias toward allopathic (that is, conventional) medicine. Perron has experienced this resistance from medical colleagues who are skeptical of her integrative approach. "There is this suspicion that what I'm trying to do is too 'woo-woo,' too far out in left field," she says.
Weil has certainly stood up to his fair share of flak, some of it virulent. For example, in a 1998 New Republic article, Weil gadfly Arnold S. Relman, M.D., former editor-in-chief of the New England Journal of Medicine and professor emeritus of medicine and social medicine at Harvard Medical School, opined, "'Breathing' is an important and recurring theme in Weil's prescriptions for health and healing, and it holds a prominent place in [Weil's book] Eight Weeks to Optimum Health, which appeared in 1997. As far as I can see, his opinions on this subject are largely nonsense." Relman, apparently unfamiliar with the yogic arts, added, "In the absence of supporting evidence...skepticism is surely in order, particularly since belief in much of what Weil is saying about mind and body, and the ability of consciousness to operate in the physical world, requires a rejection of the fundamental physical laws upon which our current views of nature and the human body are based." Weil dismisses these comments as a tirade from "the quackbuster crowd. They'll pass from the scene. They're ideologues claiming to be skeptics."
With or without Weil, the medical establishment cannot ignore the trend toward integrative medicine, especially considering the economics. In 1998, Americans spent $23.7 billion on alternative health care providers; in 1999, they spent $4.4 billion on herbs, up from $2.5 billion in 1995. Additionally, the proportion of hospitals offering complementary and alternative medicine has doubled, from 8 percent in 1998 to 16.7 percent in 2002, according to the American Hospital Association. Medical schools have taken note: nearly two-thirds now offer some kind of elective integrative medicine curriculum.
Tracy Gaudet, M.D., director of Duke University's Center for Integrative Medicine (she was formerly the executive director of the University of Arizona's integrative medicine program), has given herself and her cohorts a big charge. "Our goal is to change the whole approach to health care in this country," she explains. "We realize that it's not just about using botanicals or getting acupuncture. People are saying they want the whole paradigm of treatment to shift toward a more proactive concept. People want to plan for their health and not wait for something bad to happen. That way we're looking at the whole scope of a person—mind, body, and spirit, not just the body."
To that end, Gaudet and her colleagues at Duke have designed what they're calling a "prospective" health care model, one that provides patients with individualized health care planning and goals utilizing a range of modalities outside the medical mainstream—practices and resources like yoga, mindfulness, meditation, and nutrition. Perhaps the most innovative component of the Duke model is the concept of a "health coach," someone trained to motivate behavior change. Initial results from a 10-month pilot study, presented at an American Heart Association meeting last year, indicate that participants in the intervention group significantly reduced their risk of developing heart disease. And this year, Duke will publish results showing that this group exercised more frequently and ate more healthful meals than the control group.
Renée Halberg, a licensed clinical social worker at the Duke University Eye Center, enrolled in the study to help deal with stress and menopausal weight gain. At her intake interview, she learned that her family history of adult-onset diabetes and hypertension, coupled with her being overweight, greatly increased her risk for those diseases. "I learned how much I could change that bad outcome," she says. "It was alarming when they presented me with these risk factors articulated in lab results. It was also very motivating."
The most valuable skill Halberg learned was the ability to change her behavior toward the stress in her life. "Like thousands of other people, I substituted food for the things I lost: I was depressed. I was grieving over not having had a child. I went through a divorce. And I gained 60 pounds," she recalls. "That was horrifying, especially since I didn't have any tools to do anything about it."
The program, especially the mindfulness and meditation training, helped her find her inner strength and motivation.
So far, she has lost about 25 pounds and changed her diet to incorporate whole grains, seeds, vegetables, and low-fat foods and to eliminate fats and processed carbohydrates. Her blood pressure went from 150/90 to 120/80, and her cholesterol levels are stable. But the breathwork and relaxation skills are what have helped her the most. "Every time I have the impulse to eat something like a candy bar, I do deep breathing or progressive muscle relaxation," she says. "It takes my mind off it, and by the time I'm finished, I lose the desire. I feel centered and refreshed, and I realize I can depend on myself instead of just reacting to the stresses of the external world."
Research like Duke University's is key to effecting change within the medical establishment. Without it, it's very hard for the scientifically minded to accept a more integrative approach to medicine. The good news is that funding for alternative therapy research has grown tremendously, driven mostly by the creation of the NCCAM. From an initial annual budget of $2 million in 1993, the center has grown to a projected 2005 budget exceeding $121 million, and today it is funding groundbreaking research.
Memorial Sloan-Kettering Cancer Center in New York is one of the institutions taking advantage of NCCAM's grant money. Having opened an integrative medicine center in 1999 both to treat patients and to further scientific evaluation of complementary therapies, the research hospital has several studies under way. One is looking at the effects of acupuncture on breast cancer patients suffering from chemotherapy-induced hot flashes, another is investigating massage therapy, and a third is exploring whether specific Asian herbs can reduce or kill off tumors. The center's therapeutic and research work is nicely interwoven and accessible—for example, its Web site (www.mskcc.org) includes an "About Herbs" database of herbs, botanicals, vitamins, and supplements that is analyzed and monitored by an oncology-trained pharmacist and a botanicals expert. It provides overviews of research, interaction information, and adverse effects, and cites the benefits of herbal medicine—all in all, a tremendous resource.
But even the world-renowned cancer center encountered resistance when it first opened its integrative center. "It definitely took baby steps," says Simone Zappa, the center's program director. Once the doctors saw that alternative medicine was effective at managing symptoms like pain, nausea, and fatigue, however, things got easier. "I think I can say that we're 90 percent there now. But there are still certain things we have to be aware of. Doctors aren't going to take us seriously if we start talking about chakras and energy. No matter what our belief is, we have to maintain credibility in the doctors' eyes."
Sloan-Kettering's integrative medicine center offers both in- and outpatient care. For patients in the hospital, therapists come to the bedside and offer massage, meditation, hypnotherapy, and yoga sessions—at no extra charge. Just three blocks away, in a spa-like setting, is the Bendheim Integrative Medicine Center, Sloan-Kettering's outpatient integrative medicine facility. Just inside the entrance is a gurgling fountain and muted, calming colors. Crystals and mandala art grace some of the walls. Herbal tea, fruit, or juice breaks and conversation take place in a small kitchen area. At this facility, patients and their families can take yoga classes, learn hypnotherapy or meditation, get a massage, see a nutritionist, receive acupuncture, or take qi gong. "We are very involved with the families too," Zappa explains. "Families are often forgotten in cancer situations, and we want to offer them meditation, counseling, massage, and anxiety management techniques."
About 60 percent of the 700 patients seen each month at Bendheim are from the cancer center; the rest are from the general New York City population. For many of these patients, insurance does not cover visits to the center or services provided. This is a problem at most integrative medicine centers. While some states require at least partial coverage for treatments like acupuncture or chiropractic care, and certain insurance plans cover some complementary and alternative medicine, most consumers have to pay for such services out of pocket. Until research shows that this kind of care is cost-effective, coverage (or the lack thereof) is likely to remain the same. According to Weil, this is the biggest obstacle to the growth of integrative medicine. "Unless this inequality of reimbursement changes, it will just be integrative medicine for the affluent," he says.
George DeVries, founder of American Specialty Health, has been trying for 18 years to broaden the coverage available to consumers. His firm works with employers in much the same way as a dental or vision benefit package works, only American Specialty Health provides coverage for services like massage therapy, chiropractic care, acupuncture, diet counseling, and naturopathy. (Employers generally offer it as an extra benefit, in addition to traditional health insurance.) It covers 9.4 million members in all 50 states and works with a wide range of employers and health plans. The good news, DeVries says, is that NCCAM funding is leading to the publication of good research demonstrating alternative medicine's safety and efficacy. But the big question, he says, is cost: "How can we keep health care costs down? Is complementary health care cost-effective? The problem is, nobody has been able to prove that yet."
For Anna (who asked to be identified by her first name only), visiting Andrew Weil's clinic in Tucson was worth every out-of-pocket penny. This 33-year-old struggled with severe PMS for years—and it was getting worse. "My husband used to say it was like an alien had invaded my body," she recalls with a wry chuckle. Unfortunately, her erratic behavior and irrational anger weren't funny at the time. She realized she was really out of control when she started taking it out on her dog. "I hated being in the victim role, but I couldn't control myself," she says. She had tried Prozac for a number of years, until it stopped working. Out of desperation, she called Weil's clinic and got an appointment with clinic director Victoria Maizes, M.D.
After two visits, and following Maizes's recommendations, Anna was able to control her symptoms. The regimen Maizes prescribed included both a nutritional plan—fish oil capsules, salmon (preferably wild) three times a week, seven servings of fruits and vegetables a day—and a plethora of physical disciplines and alternative therapies—breathing techniques, cardiovascular exercise, guided imagery, acupuncture, and Chinese herbs. Finally, Maizes asked Anna if she ever prayed for herself about her PMS. "I happen to be a Christian, yet this thought never crossed my mind," Anna says. "That really showed me that she was treating me as a whole person. You never hear that when you see a doctor." Now Anna's symptoms are virtually gone, and when they do flare up, she has mechanisms she can use to cope. "Before I saw Dr. Maizes, I felt I had no control," she says. "Now I realize I can help myself. I can do my breathing; I can go exercise."
Meanwhile, Perron graduated from Weil's integrative program and had some health challenges of her own. At 45, she was diagnosed with breast cancer. And while she did receive conventional treatment, including a mastectomy and chemotherapy, she also integrated some complementary therapies into her plan. She utilized guided imagery, Reiki, and healing touch right before surgery. Afterward, she practiced yoga to improve the range of motion in her arms. She also took nutritional supplements during chemotherapy and received acupuncture instead of taking narcotics for pain. "I think the reason I have done so well with my recovery," she says, "is that I used everything I knew. I didn't reject the conventional, and I educated my oncologist in the process."
Perron is now on her new path as a physician. And while it may not yet be possible to quantify the impact Perron and other physicians trained in integrative medicine are having on our health care system, the fact that even a few practitioners are out there aiming to heal the whole person, rather than the specific body part that's ailing, makes a hugely positive difference to the patients receiving their care.
Back at work in a conventional medical office, Perron joined a practice with two other doctors, in part so she could expose them to her newfound knowledge and create change from within the model of a traditional practice. "They're putting their toes in the water and getting more comfortable with some of the things I talk about," she says of her colleagues. Now, when patients get nervous during pelvic exams or procedures, she teaches them Ujjayi breathing instead of giving them a Valium. She talks with them about breath focus for anxiety attacks and recommends botanical and nutritional supplements. She also makes a point of spending at least half an hour with each patient. Recently, she's been asked to teach yoga to oncology patients at a nearby cancer center. "I'm not sure I would have made it through my cancer treatment without the skills I have learned from integrative medicine and yoga," she says. "But now I have firsthand knowledge, and I feel I have greater ability to heal my patients."