Delving into alternative care (Milwaukee Journal Sentinel)

Susanne Quick, Journal Sentinal, Milwaukee: Johnnie Thomas spent 22 years trying to get teenagers to behave.

As a building superintendent for a dormitory first run by the YMCA, now by Marquette University, he saw more than his share of late-night shenanigans.

It took a toll, and in 1994, he underwent open-heart surgery. While recovering from the triple bypass, he re-evaluated his lifestyle – his food choices, his exercise regimen. But with an aloof doctor, and little in the way of support from home, he didn’t make much headway.

Then, two years ago, Thomas saw a late-night advertisement on TV – an ad that called for African-Americans with cardiovascular trouble to participate in a study at the Medical College of Wisconsin. The idea was to test the cardiovascular effects of Transcendental Meditation – a patented form of meditation owned and promoted by Maharishi Mahesh Yogi, the Indian guru made popular during the 1960s by the Beatles.

Thomas figured, “Why not?”

He has been meditating every day since then, and according to Thomas, his new doctors – those not involved in the study – are thrilled with the results.

“They say, keep doing whatever it is you are doing,” he said. “And I do.”

A generation ago, even a few years ago, a heart patient learning about meditation from a leading medical center would have been unthinkable.

No more.

More than a third of Americans use some form of complementary or alternative medicine – treatments or regimens used in conjunction with, or as an alternative to, standard Western medicine.

The number of people using these non-standard treatments almost doubles if prayer is included, according to the National Center for Complementary and Alternative Medicine – a branch of the National Institutes of Health. And even though many treatments haven’t had much scientific testing, doctors, insurance companies and health centers are paying attention.

The Medical College’s meditation study, which has been funded for four years by NIH’s Complementary and Alternative Medicine center, has recently been extended for another four years. And it is similar to many others being conducted across the country.

The center has a 2004 budget of $117.7 million, double what it was just five years ago. And that’s less than half of NIH’s total annual spending on complementary and alternative medicine. Other money goes to agencies such as the National Institute on Aging and the National Cancer Institute. It funds such research as Transcendental Meditation and distance healing – defined as a “mental intention on behalf of one person, to benefit another at a distance” – as well as more “conventional” alternative treatments such as acupuncture and massage.

“Our goal is to find out what works, what doesn’t work, and what is safe and is not safe, and to share that information with consumers, practitioners, and policy-makers,” said Margaret Chesney, deputy director of the center. If the center finds something valid, doctors can start using it.

The result is that traditional research centers such as the University of Wisconsin-Madison, Johns Hopkins and Columbia University are competing for federal grants to study alternative medicine with places such as Maharishi University of Management in Fairfield, Iowa. To date, Maharishi University has received more than $20 million in government support.

Beyond the government investment, alternative medicine centers have started appearing in mainstream medical centers and managed care facilities across the country.

In the Milwaukee area, Aurora, Covenant and Columbia St. Mary’s all have supported and managed “complementary care” facilities in their health systems. Covenant’s Center for Complementary Medicine in Mequon, for example, offers acupuncture and massage, as well as a full-time trainer who advises patients on a more balanced and holistic lifestyle.

“We knew patients were seeing chiropractors as well as their surgeons and physicians,” said Nancy Conway, director of complementary medicine at Aurora, which has similar centers.

What better way to manage their patients’ care than to get both types of practitioners under the same roof, she said.

Where is this headed?

The question no one has been able to answer is where all this is headed.

Government-funded health agencies would like to systematically either legitimize or debunk the numerous alternative treatments available. Chesney said the center reviews every proposal with the same scientific and critical rigor – irrespective of the politics, religion or spiritual practice associated with it.

But to conventional Western doctors, it’s one thing if a mainstream research center such as UW-Madison or Johns Hopkins says an alternative practice such as acupuncture is valid. It’s another if the research is from Maharishi University.Will family doctors really feel comfortable referring patients with high blood pressure to the nearest Transcendental Meditation clinic – where they will be asked to write a $2,500 check?

What is more likely – and what is already happening, regardless of the NIH studies – is that some doctors are referring patients to alternative practitioners within their own medical facilities.

And then there’s the question of insurance. So far, insurance companies have been reluctant to cover many alternative and complementary treatments, said Aurora’s Conway.

Some insurers will cover visits to chiropractors or offer discounts for acupuncture and chiropractic care. But for other kinds of complementary and alternative care – the more fringe practices such as homeopathy and chelation therapy- there is little in the way of coverage, Conway said.

“With the rising costs of health care,” both insurance companies and consumers are finding themselves on the same side of the table, said Sam Benjamin, corporate medical director for integrative health strategies at Humana. They both want cost-effective medicine.

Indeed, if insurance companies can inform and educate people about complementary medicine – a lot of it low-cost with few side effects – then both parties will be better off, Benjamin said.

There just isn’t a lot of incentive right now for insurance companies to pay for alternative medicine, he said. The last thing they want to do is cover more kinds of medical treatments. And again, there’s the question of endorsing fringe organizations. If insurance companies started paying for Transcendental Meditation, for instance, would they unwittingly be promoting Maharishi’s program for achieving world peace through yogic flying?

Mixed reactions in doctors

All this interest in new forms of health care – and the money following it – has drawn a mixed reaction from doctors on the front lines.

Many physicians say they embrace alternative and complementary approaches to medical care, or at least don’t reject them. Steven Pinzer, a spokesman for Aurora Health Care, contended that skeptical primary care physicians, at least at Aurora, don’t exist.

But others said doctors are choosing not to speak out for fear of appearing close-minded, or inviting disfavor from their health care network.

And then there is Stephen Barrett, a retired Allentown, Pa., psychiatrist and director of Quackwatch Inc. – a medical fraud watchdog group. Barrett calls alternative medicine “rubbish.”

Barrett said that while it may sound as if a lot of people are using non-traditional forms of medicine, it’s just not true. Remove prayer and the use of herbal supplements, and the number drops to about 18%. Practices such as biofeedback and Ayurveda, which is a form of holistic medicine, have received a fair amount of publicity but attract only 0.1% of the American population, he said.

“The fringe stuff is just not being used all that widely,” he said.

Barrett also wonders whether more physicians are not voicing their skepticism because they don’t know much about what’s going on outside their own specific fields and have enough on their plates without inviting conflict.

Benjamin agreed.

“Believe me, I don’t mean to criticize doctors – I am one,” he said. But they are so overworked and have so little time, most are unable to keep on top of the latest research in their own field, much less the latest on massage therapy and acupuncture.

“This is a failure on the part of medical schools” and health care organizations, which should be training their physicians in these methods and giving them the time to learn, he said.

Barrett was a little more critical: “They don’t know enough. They don’t want to get caught in a fix. And they are afraid of getting sued.”

Gaining acceptance

Nevertheless, there does seem to be a level of acceptance in the medical world.

Many specialists, such as heart doctors and cancer physicians, appear to be relatively open to newfangled (or very old-fangled, depending upon how you see it) treatments.

This is particularly true for cancer doctors, who for years have incorporated an array of treatments to help their patients.

“I think oncologists are an interesting group,” said James Stewart, a medical oncologist at UW Hospital. “We take a multidisciplinary approach to disease, a holistic approach, which is pretty traditional in cancer clinics.”

From diet and exercise to psychological care, oncologists have been aware that a patient who feels better about herself – who feels she has some control in the outcome of her care – will have a better experience.

“If I had my wishes, all my patients wouldn’t smoke. They’d exercise. And they’d be an ideal body weight,” he said. “I guarantee they’d feel better.”

But when he can’t get them to follow this advice – and they show interest in other treatments – he’s willing to refer them.

He’s quick to point out these treatments are complementary – not alternatives to the standard front lines of chemotherapy, surgery and radiation. And, he reiterated, the patient has to ask for it.

“There are definitely charlatans out there, people who take advantage of those with chronic, life-threatening diseases for which there are no easy cures,” he said. “And it’s those few who can give everybody a bad name.”

What Stewart and Ellen Hartenbach, another oncologist at UW, try to do is make sure they and their patients keep talking to each other.

Others hesitate

For doctors such as Jon Keevil, a cardiologist at UW, the open approach that his oncology colleagues have shown is not entirely comfortable.

He thinks heart specialists may be a bit less holistic than oncologists and primary care physicians – although he does have a dietitian in his clinic and regularly discusses the benefits of exercise and a good diet with his patients.

“When it comes right down to it, when a person suffers a heart attack, we don’t take over everything else” in the body, he said.

Indeed, discussing alternative and complementary approaches may be somewhat inappropriate coming from a specialist such as himself, he said. “That’s really what their primary care doctor is there for.”

That where David Rakel comes in.

Rakel is a primary care physician in Madison, and director of UW’s Integrative Medicine clinic, so he’s open – almost by the definition of his job – to new methods of health care.

But he thinks “adding more tools to the tool bag” is not the answer.

Instead, he said, there needs to be “a change in the way we approach the patient.”

From the minute patients walk into the room, the focus should be on listening to their story, and hearing what the patients have to say – instead of peppering them with questions to cram them into a preconceived diagnostic box.

Studies have shown that within 18 seconds of patients’ descriptions of their ailments, they are interrupted. And other research has indicated that only a handful of patients actually understand what their doctors tell them, or know what to do when they leave their doctor’s office.

“We really need to match a therapy to an individual,” said Rakel, taking into account that individual’s “biopsychosocial and spiritual influences.”

That means spending time with patients.

If adding 15 more minutes to a patient’s visit is what’s required, than that’s what should happen, Rakel said. And if that’s considered complementary or alternative, then so be it, he said.

“Integrative medicine encourages empowerment. It facilitates the body in a way that it is best able to heal itself,” he said.

So where does acupuncture, massage therapy and Maharishi Mahesh Yogi come in?

With any treatment, he said, “you have to take into account the potential harm, cost, the patient’s belief system and the evidence-based science,” he said.

“What’s legitimate for one person may not be for another,” he said. “The goal is how we can help a human being.”

Original article no longer available…

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