Alternatices Enter the Mainstream - Unconventional Care Wins some converts

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Surprised the Hopkins is collaborating

Alternatives Enter the Mainstream

Unconventional Care Wins Some Converts

By Sindya N. Bhanoo

Washington Post Staff Writer

Tuesday, September 16, 2008; HE01

http://www.washingtonpost.com/wp-

dyn/content/article/2008/09/12/AR2008091203012.html

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, Lee, dressed in a

white lab coat, used the tools of conventional medicine to treat a

patient for digestive problems.

The s 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 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 i 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 ls 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.

* * *

A lack of research has not stopped a few alternative practices from

becoming standard treatments in some high-tech settings.

At the University of land 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 land 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 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.

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. "

* * *

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

land'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? "

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