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The Birth of
Integrative Medicine
"The utmost in the art of healing can be achieved when there is unity. When the minds of the people are closed and wisdom is locked out, they remain tied to disease. Yet their feelings and desires should be investigated and made known, their wishes and ideas should be followed, and then it becomes apparent that those who have attained spirit and energy are flourishing and prosperous, while those perish who lose their spirit and energy."
—From the Nei Ching Su Wen
CENTURIES OF HEALING WISDOM
We are certain the cure will be in the next pill, the next prayer, the next visit to the doctor. And in many ways we are not alone. The search for a cure has led even the crustiest of souls to the far reaches of the earth—to the healing waters of Lourdes, to an appointment with the surgeon's scalpel, to the shaman's medicine bag, to the acupuncturist's needles, to taking transfusions of another person's blood, to exposing ourselves to deadly gamma rays, or to taking addicting pain deadeners. Sometimes it seems we would do just about anything to find the golden cure.
Ancient cultures were no exception. People in the earliest civilizations suffered from chronic and life-threatening conditions—very similar to today's ills—and they, too, searched for remedies to stop the pain and extend life. Those ancient peoples knew much more about tending each other, the living and the dying. Their connection to the heavens and the earth wasn't complicated by 156 selections on satellite television or the horrors of the evening news, and, while they often faced the harsh realities of nature's elements with fewer protections, their essence was not lost in a lonely world where everything happens too fast. They listened to themselves, to their neighbors, and to the hearts of their ancestors.
In their less complicated lives, they were not spared the pain of living—the grieving, the loss, the sickness. And as primitive scratchings on dampened cave walls indicate, even in the earliest of times man suffered from headaches, chronic conditions, and sexually transmitted diseases. Archeological digs have revealed prehistoric art showing that holes were bored through human skulls to relieve pressure. Neolithic man endured the daily pain of osteoarthritis. There are the calcified remains of parasitic eggs known to cause the tropical disease schistosomiasis in Egyptian mummies.1 And petrified syphilitic skulls, dating back prior to Columbus's historic journey to the New World, have been uncovered in North America.2
Just like the diseases and the physical and mental ills that existed long before us, the natural impulse to stop the suffering, to find a better way, is nothing new, even though some try to lay claim to this innovative thinking. Today bulletin boards at trendy health food stores contain messages of healing—the new blue-green algae, the latest inner child healing workshop, or the spiritually centered ads about reconnecting with nature—tacked to their cork surfaces with multicolored pushpins. Or better yet, there are tear-off phone numbers so that the desperate can call for help twenty-four hours a day. Hip, pop-culture magazines are filled with the claims of new life from New Age healers. On the Internet you can get a reiki consultation, and herbs to kill your bad breath and the dog's at the same time. The secrets behind these dramatic breakthroughs and discoveries about stopping the pain and healing our bodies, our odors, our relationships, as well as the universe around us, can be ours with just a credit card number.
What we often don't realize in our search for healing is that many of the concepts and theories that are being touted these days have been around since a time when it was OK to believe in myth, a time when legend was passed from generation to generation. Finding a way to wellness dates back to an era when legend could become reality. Today we have come to a threshold in which we understand what our ancestors perhaps took for granted—that healing is everyone's business and responsibility, and that it is something that involves our understanding and active participation.
The healing traditions of our neighbors in the East, which go back centuries of generations, are steeped in parables and evidence a connection between health, spirituality, and the cosmos. In China, Han dynasty tombs preserved fragments of exemplary medical information, which, according to legend and generations of believers, were first penned by the mythical Yellow Emperor, who is said to have reigned from 2696 B.C. to 2598 B.C. Beginning with conversations between the emperor and his physician, the Nei Ching Su Wen, or The Yellow Emperor's Classic of Internal Medicine, establishes the concept that supports the need for a positive doctor-patient relationship. With information on drugs, surgery, medical theory, spirituality, life force, the balance of yin and yang, the five elements (wood, fire, metal, air, and water), and the four seasons of healing, this comprehensive record remains a main source of guidance for many Eastern cultures and health practitioners today.3
Sumerian cuneiform clay tablets, dating from somewhere around 2500 B.C., tell tales of illness and list the details of medicinal plants and animal parts prescribed for treating the ills of the time. Historians are unable to determine whether the Sumerians actually discovered these healing arts or whether the concepts were borrowed from other cultures. Many of these medicinal remedies were divided into organic and inorganic categories, with plant remedies such as figs, dates, anise, jasmine, juniper, coriander, caraway and willow.4 Passing this legacy of knowledge and healing on to the Babylonians, the Sumerians set in motion a generational chain of curative information that formed the rudimentary foundations of Western medicine. The embryonic Sumerian teachings traveled history's course, crossing lands and time. Eventually uncovered by Egypt's Pharaohs, these healing arts evolved to yet another level. And as writings preserved in papyrus tell us, elaborate theories explaining the cause of physical ills took on dramatic proportions. The Egyptians believed that sickness originated in the supernatural realm, and that healing took place on the physical and spiritual planes.
As the discoveries of healers became paradigms for their culture, the integral rhythm of contrasting internal and external forces was seen as reigning over the body. Chinese healers set forth the delicate balance of yin and yang: yin, the feminine force of darkness, night, moon, moistness, quiet, and earth; yang, the masculine force of light, sun, day, dryness, fire, heat, heaven, noise, and function. Yin, representing the internal, descends; yang, the external, ascends. It was believed, and is still believed today, that each of the body's organs has an element of yin and yang, and that health is achieved by keeping the two in balance.
Similar to Chinese healers, Greek physicians looked at the nature of disease as sets of opposites: hot and cold; moist and dry. They also described and diagnosed illness based on the four humours—blood, phlegm, and black and yellow bile. The thread that binds these ancient beliefs is the theory that a vital life force, when kept in balance, can ward off disease. And whether it is called qi (Chinese, pronounced chee), lung (Tibetan, pronounced loong), or prana, meaning breath, maintaining or restoring balance was the physician's secret for preventing disease.5
Ancient healers developed an intimate bond with their patients; they believed, above all, that nothing must be done to injure the patient. Whether taking a history, feeling the pulse, or gauging the heat of the body, each practiced the gentle art of his or her respective beliefs. Medical advice, even in more primitive times, paralleled much of what the adventurous preach today—diet, exercise, prevention. The Chinese, much like the Tibetans, talked openly about combining tranquil, moderate exercise with seasonal diets, stressing the importance of a serene mind. They believed that it is better to prevent illness than to try to cure it once it occurs—a concept we're just getting around to understanding in this modern age of Western medicine. We've certainly made a lot of progress in the last two thousand years!
The use of plants and herbs was already highly developed in many cultures many centuries ago. Thriving pharmacopoeias were produced in China, Egypt, and Greece. The Chinese, who were using acupuncture in addition to herbs, massage, and gentle exercise, had delineated points on the body that could be needled or cauterized to cure or alleviate pain associated with most ailments. Historians indicate that the Chinese may have filtered water and prescribed boiling water and eating hot dishes as a means of avoiding infection.6 Because Egyptians actively engaged in embalming the dead, they began to learn the delicate intricacies of the human anatomy. Egyptians and Greeks used herbs and foods to balance the humours, often using St. John's Wort, yarrow and plantain to heal wounds and ward off illness. And whether Chinese, Egyptian, or Greek, disease prevention teachings, along with suggestions for keeping the body in balance, were a major component of these early beliefs.
During medieval times and even later, setbacks were not uncommon. Wars, cultural revolutions, plagues, malnutrition, and rampant disease left many victims in their wake. Keeping pace with the turbulence and magnitude of disease and death was challenging for physicians, at best. And in the 1500s and early 1600s, when the ancestors of some of us first set off across the Atlantic in search of a better life, scurvy and rickets were taking thousands of lives before the historic ships ever reached America's shores. Unprepared for the primitive life of the New World, women and babies died in childbirth, and nature's bitter elements took many lives as well. Native American healers, familiar with the restorative powers of their lands, shared shamanic teachings about the healing properties of plants, grains, and community. Recognizing the value of these natural remedies, the earliest settlers continued the medical evolution by sending these ideas back to Europe to incorporate them with the European healing tradition.
As the oceans' waters ebb and flow across sand, pebbles, and jagged rocks, so has medical theory over the centuries. The eclectic blend of Native American, African, Eastern, and European traditions eventually evolved into the new medicine: the Western way—the path that continues to dominate our medical treatments today. Corresponding with the U.S. industrial revolution, the mid-1800s marked an end to the free-spirited, anything-goes medicine of earlier times. Just like factory managers, physicians began to value the importance of fixing parts and keeping our bodies working like finely oiled machines. This type of thinking, along with the concept that bacteria produce disease and that antitoxins could be used to ward off these bacteria, formed the early roots of biomedicine. The American Medical Association was formed in 1847, and by the end of the nineteenth century its members were lobbying for state licensing laws. In the twentieth century, Western biomedical theory, as the conventional route to caring for the sick, was designated the one true path to health. Virtually every state in the United States passed laws governing medicine and its practice.
Because the medical establishment was quick to label alternative approaches to the Western way as hocus-pocus and quackery, chiropractors, homeopaths, and practitioners from other schools of thought (often women) were pushed out of the mainstream medical arena. The Pure Food and Drug Act, regulating the prescription of medicinals, was passed by 1906. With the release of the Flexner Report, Medical Education in the United States and Canada, in 1910, competing forms of medicine were virtually obliterated. Abraham Flexner, a U.S. educator and founder of the Institute for Advanced
Study in Princeton, New Jersey, developed the report to set standards for American medical school education. In some instances the report helped regulate education, which in the 1800s had been far from adequate, ensuring that doctors were qualified to care for the ill and infirm.
But the Flexner Report certainly had its shortcomings: it was rigid, leaving little room for innovation and flexibility in medical education, and it never addressed the patient-doctor relationship. At the time that the Flexner Report was written, this relationship was taken for granted. Of course, the patient would always be considered above all else, Flexner reasoned. So he did not write that concept into the standards. As generations of doctors learned how to treat human bodies, that's all they learned. The importance of listening and staying connected to the patient was lost somewhere between anatomy and pharmacy. And even Flexner, who was not a physician, was eventually displeased with the rigid standards that he had originally helped create.
Within a few short years following Flexner's curricula guide, alternative medical schools—schools of homeopathy and osteopathy to name two—were left with little more than fringe status, and most were forced to close their doors. (Homeopathy is a school of treatment involving the administration of minute doses of remedies to increase the symptoms a patient is experiencing in an effort to spur the body's powers to restore harmony. Osteopathy is the science of manipulating the musculoskeletal system to restore health.) Biomedicine was the standard. Doctors and the powerful lobby of the AMA successfully kept the "charlatans," as they called them, out of the arena for nearly sixty years. It wasn't until consumer confidence in conventional medicine started to wane three decades ago that an opening appeared for alternative paths of healing. Many of the changes began to emerge in the sixties. Reports on the serious side effects of commonly used drugs like antibiotics started chipping away at consumer confidence. Coupled with a resurgence of more virulent strains of tuberculosis and deadly bacterial species like strep-A (the flesh-eater), not to mention new diseases like AIDS and Alzheimer's and cancer that traditional treatments could not cure, medical shoppers began looking for more. They wanted to find something to help them feel better, not necessarily get rid of the disease, just make them feel better. They wanted a more satisfying way of life.
MEDICINE AMERICAN-STYLE
Western Miracles and the Deification of Doctors
Many of this country's medical breakthroughs have had some basis in ancient Eastern wisdom. Drawing on an eleventh-century Chinese practice of using a powder derived from aging smallpox scabs to prevent disease, English country doctor Edward Jenner further evolved this Asian discovery into a vaccine for smallpox. Jenner scratched eight-year-old James Phipps's arm with the cowpox virus. It was this simple experiment that, several generations later, led to the eradication of smallpox in America and most of the world.7 Although it was the Chinese who first used this technique, Jenner was named the Father of Vaccinology.
By the first half of this century, new medical discoveries had dramatically altered the face of Western medicine. Soaring past ancient horizons, medicine's innovations unveiled frontiers never before explored by even the most adventurous of healers. British bacteriologist Alexander Fleming was one such pathfinder. Returning from vacation in 1928, the pioneering scientist was cleaning up his laboratory and discarding used culture plates, when he observed something new: a fungus that had been flourishing on the culture plates in his absence was destroying the fringes of the deadly staphylococcus bacteria that had been smeared on the plates. His observations, although not fully appreciated and developed into penicillin until the 1940s, gave rise to a new era of treatment.8
At the same time government, academia, medical science, and the private sector, namely, drug companies with big dollars, formed previously unheard of alliances. Vast sums of government dollars were poured into medical research at medical schools and universities, and this powerful partnership9 began a miraculous wave of invention that launched Western medical care into an age of wondrous findings and technological advances. Smallpox and polio were virtually eradicated in the Western hemisphere; human eggs could be fertilized in test tubes instead of in the mother's womb; surgery and medical imaging, enhanced by computers and robotics, became commonplace; body organs could be transplanted from dead patients into living ones, from pigs to humans; and through innovations in communication, and remote surgery techniques, surgeons and patients could remain on opposite sides of the country during surgical procedures.
As we approach the end of this millennium, technology is advancing more rapidly than even such sci-fi legends as Robert Heinlein or Isaac Asimov could predict. We're entering the twenty-first century with people living well into their eighties and nineties; forty- and fifty-year-old women (an age that once marked the end of life) are giving birth; aging, withered bodies are being sustained by transplants, respirators, and feeding tubes, while women and men voluntarily hook themselves up to the Kevorkian death machine when they can no longer tolerate the pain of living with debilitating diseases.
It's no wonder that we've been misguided into thinking that our doctors, our external healers, are deities capable of performing the greatest of miracles. We don't just pray for such miracles; we expect them. When a doctor fails to meet our ever increasing demands for youth and immortality, we sue. We scream malpractice. Doctors work in fear of litigation, often feeling it necessary to order a battery of unnecessary and expensive tests.10
An Era of Alienation
For the first time in history, we're a generation for the most part sadly lacking the wisdom of those who went before us. We've abdicated responsibility for our health and turned our health problems to teams of specialists. And these doctors, not being generalists, are not in a position to see us as whole human beings. The result is alienation of the doctor and the patient.
We seem to have lost touch with common sense, that inner knowing that tells us the baby's cold needs to run its course, or you should elevate your foot and stay off it if you've twisted your ankle—the doctor would say the same thing. There was a time when cultures relied on this most valuable resource, common sense.
We have lost sight of the fact that healing messages are as individual as the beings searching for a cure. Because of medical progress, it has become easier to view the human body as a machine: take a number, line up, cut it out, cut it off; get the broken or diseased part fixed; forget about it. We have become faceless body parts in the medical maze. Doctors admit that it's easy to forget there is a person attached to the gallbladder, the lung, the breast.
One surgeon shared a story with me. He had recently done a routine gallbladder surgery on an older woman. Returning to his office for the postoperative exam, she stood clutching her fine leather bag as he breezed in to check her progress. He started talking, asking her questions. He didn't recognize her, but that was a pretty common thing since he had gotten so busy. He didn't recognize lots of patients. But the woman had this puzzled look on her face. "Who are you?" she asked indignantly, stopping him dead. Momentarily he thought, "Who am I? I'm the surgeon." He realized that he had never examined this woman while she was conscious, and that through arrogance he assumed all his patients knew him; after all, he was the doctor. This was a defining moment for him, and he actually left his group practice shortly after this seemingly benign encounter. The little woman, the gallbladder, clutching her bag, brought this well-known surgeon to his knees.
Dare or Death: It's A Game of Life Roulette
Life Roulette. The stakes soar faster than the wheel can turn. As we throw down a growing stack of cash for one more try in the game, pieces of doctors and patients dissipate among the ashes of malpractice, managed care, dwindling resources, and the needless, violent deaths. Children. Old people. No one is spared the pain of a medical system crying out for change. Perhaps it's the dwindling financial and human resources, or the mutant bacterial strains that antibiotics will no longer heal. Or is it cancer? AIDS? Violence? Guns? Gangs? Our inner city emergency rooms are turning thousands of patients away. Lined-up in halls, in waiting rooms, on park benches, their plea becomes a whisper lost in the murky residue of noise, cars, sirens and too many others. Quiet moments at any emergency room are rare, and they come suddenly, like the yellow-green stillness that falls over the trees, streets, and trailers just before the tornado's black funnel sweeps victims in its wake. While some patients are fortunate enough to have family or insurance to care for their needs, others are forced to seek solace in shelters rather than in the arms of a loved one. Others die, unnoticed, under bridges, near trash cans, in back alleys, in their cardboard beds.
Are We Managing Care, or Is It Managing Us?
Every one of us suffers for the needless excesses of our health care system. When most of our grandfathers, fathers, sons, or lovers were across the ocean fighting in World War II and women were working in factories, national health care dollars spent were about $4 billion. Half a century later, in 1992, the money spent on health care each year had soared to $800 billion, and conservative estimates indicate that number will soon exceed a trillion dollars.11
Back in 1940, most health care costs for doctors and hospitals went to cover the most serious, acute conditions. Today the situation seems to have flipped: the seriously ill are forced home in two or three days, no longer able to get well in a hospital setting. These are stays that in the past were treated in hospital settings for eight to ten days. Now, thanks to the health insurance industry, major surgical procedures for things such as mastectomies warrant a twenty-four-hour stay, while treatments for chronic conditions such as arthritis, pain, depression, and high blood pressure eat up about 70 percent of the current health care budget. According to the U.S. Department of Health and Human Services publication Healthy People 2000, more than 33 million Americans are functionally restricted from daily activities because of such chronic conditions.
Managed care has become our solution to the rising costs of health care. But insurers further muddy the waters by insisting that our care be dictated by the dollar and the day. Too many days, too much money equals time to go home. You're still sick, you say? The ever-tightening noose of managed care and its capitation system have become part of medical treatment delivery, while patients, doctors, families, government leaders—everyone—is asking, why? We are told that because as a nation we shell out $950 billion annually to care for our sick, we need to find ways to cut costs, so that everyone can be served. We can no longer afford to pay for everyone to be treated for every ailment.
We are the only industrialized nation with no comprehensive system of health care delivery. More than 37 million Americans have no health insurance, and 22 million working poor go untreated because they cannot afford adequate coverage. Others, with the right amount of money, the right job, and the best insurance, continue to enjoy the luxury of being covered for elective procedures. The health care controversy even took over the 1992 presidential campaign, placing First Lady Hillary Rodham Clinton under a microscope of public scrutiny. There were focus groups. There was testimony. There was posturing and grandstanding. And everybody was trying to get on the list of speakers: the special interests, the hospital administrators, the business leaders, the doctors, the patients, the insurers. Everybody had to have his or her story heard. But try as the First Lady might, she could not make the pieces of the puzzle fit. And now that the dust has settled after the whirlwind of a failed attempt, it's clear that no winners emerged from this damaging battle. Some favored a national health care plan. Some were vehemently opposed. Some only cared about protecting their niche in the health care arena. The patients—and when you think about it, we're all patients at some point—wanted affordable, accessible, quality care. To make matters worse, the golden crescent of scientific evidence that's all wrapped up in the double-blind bind of clinical trials and proof, kept raising its ugly head, as a few brave souls tried to consider alternative options to conventional care. And now, several years later, we're still puzzled. We ask, How did this happen? What role did we play? Many are quick to blame the other guy: the hospitals; the doctors; the insurance companies; the uninsured; the government; the gangs; the guns; the immigrants; the homosexuals. No matter who gets saddled with the blame, the questions remain: Who will pay? Who will get care, and who will die without it?
The answer may not be the cure. Perhaps the simple truth of healing is connecting or reconnecting to the inner healer within each of us. Maybe it's learning to live with grace and ease, with or without cancer, AIDS, or addiction. Or could it be that we have to unleash the power of centuries of knowledge, taking a little wisdom and a little loving and mixing it up with a lot of common sense? Many doctors today think that we have lost touch with our generational wisdom. Generations before us knew the answer. They had a special tea for this and an herb or poultice for that. Only when things seemed fairly grim was the doctor summoned. Some feel that doctors didn't always know the answers anyway. And that was OK. They, too, relied on an invisible force for the answers. But today, the practice of Western medicine has far surpassed such folksy remedies. It took the doctor out of the village and threw this once familiar healer into the vast hive of buzzing competition and technology. Our grandmothers easily diagnosed the difference between croup and pneumonia. But the post-World War II era tossed common sense out the window. And we lost a sense of generational wisdom. We invalidated the lessons of generations before us. Old people were old, not smart. We were young, hip, and strong. Times were good. We had jobs, money, and education. We had color television, and the world got smaller as technology progressed. Our families split: a brother in California; his wife and children in Indiana; a sister in Florida; parents up North. We kept moving so fast that no one from the class reunion committee would ever be able to find us again. We were lost in the blur of express living and fun times. And now we're all alone.
A MEETING OF THE MINDS:
A NEW APPROACH TO HEALING
For thousands of years, healers have been trying to uncover the ever changing mysteries of the human body. Both the Eastern and Western traditions go back many centuries. The Eastern tradition is steeped in philosophy and spirituality, and, in its approach to healing, the body is seen as a microcosm of nature, a landscape of the seen and the unseen, whose seasons and temperatures, deficiencies and excesses need to be gauged and understood in order to promote health. At one time the Western tradition had some similar beliefs, the Greeks, for example, seeing disease as an imbalance in the four humours, but since the 1800s, a lot of that tradition has been overshadowed by the Cartesian thinking of modern medicine, which views the body as a machine, a mechanical structure that can be diagnosed based on cause-and-effect thinking, and whose parts can be removed and replaced or molded or zapped into shape; and which views disease as a separate entity with its own patterns and cycles that are to be disrupted and put out of commission through drugs or surgery. The healing wisdom of centuries in the West was overshadowed by this approach to medicine. But practitioners and patients are now regaining a sense that the systems and organs of the human body are interdependent parts of an organic whole, and that curing what ails us involves encouraging the body to fight for wholeness rather than target and destroy symptoms. Medicine is so intriguing today because the West is continuing to learn more about cells, immunity, disease, and genetics, while it eagerly explores Eastern medicine, tapping into the wealth of wisdom it offers. The prospect of our getting the benefit of all these systems, practices, and wisdom bodes well for our general health and well-being.
Medicine's emerging heroes—Bernie Siegel, Andrew Weil, Larry Dossey, Deepak Chopra, Dean Ornish, Christiane Northrup, Sandra McLanahan, to name a few—have, through experimentation, new findings, and ancient teachings extracted the prime nectar of all the available medical worlds. The pilgrimage to integrative medicine, to wellness, has just begun.
"There are some very good things about Western medicine, but many times it is used to treat patients across the board. Everybody gets the same treatment. Healing depends on the person, and everyone needs custom-designed health care. I let patients talk for the first hour or so, so they can unload and get it all out. They talk, they cry, and from that point on I go into my complete physical, which combines Eastern and Western diagnostic tools. Using Eastern principles in treatment is not some fly-by-night, silly little therapy. It's not New Agey; it's Old Agey. It's been around for more than 2,500 years."
—Carolyn Jaffe, nationally certified acupuncturist,
registered with the Pennsylvania State Department of
Osteopathic Medicine, Diplomat of acupuncture.
The birth of integrative medicine will force the medical establishment to form previously unheard of alliances with practitioners once shunned by Western medicine. Transforming the course of our nation's curative path, our sick care system will become obsolete. New strategies, blending the spiritual, emotional, and natural with hightech procedures, will evolve. Although it may seem overwhelming, this change is close at hand.
OUR HEALTH CARE SYSTEM IS NOT EMULATED THROUGHOUT THE WORLD
People in the U.S. think of Western medicine as the standard method of care, often assuming that the rest of the world practices medicine as we do. In actuality, estimates reveal that only 10 to 30 percent of the world's health care is delivered by conventional Western methods; the remaining 70 to 90 percent is rendered by alternative modes of treatment.12
THE BIRTH OF INTEGRATIVE MEDICINE:
GESTATION, TWENTY-SEVEN YEARS
"Most of the people who come to me are ready for something different because they have tried what doesn't work. We don't have a health care system; we have an illness system. One thing integrative medicine can do is teach people. And that will begin to provide the tools for change."—Sandra McLanahan, M.D., executive medical director of the Integral Health Center in Buckingham, Virginia, and physician to the world-renowned spiritual healer Reverend Sri Swami Satchidananda
1971 New York Times columnist James Reston brings the concept of acupuncture and Chinese herbs to America's shores.
1983 The Alternative Health Plan is established in California by Steve and Sherry Gorman. The company's goal is to provide medical plans offering freedom of choice and including coverage for alternative and complementary medicine such as acupuncture, massage, and herbal remedies.
1986 The Oriental Medical Center in Los Angeles studies the efficacy of Chinese herbs and acupuncture in treating ARC and AIDS.
1992 The nation's first federally funded alternative medicine HIV public health clinic project gets underway in San Francisco.
The Office of Alternative Medicine, part of the National Institutes of Health, is created by Congress. This is the first federal agency focusing on alternative treatments.
1993 Harvard University researcher Dr. David Eisenberg releases findings in the New England Journal of Medicine on Americans' use of alternative therapies. This landmark study reports that one in three Americans used at least one form of unconventional therapy.
American Western Life Insurance Company offers its first wellness plan, which promotes self-care and reimbursements for visits to alternative practitioners.
1994 A Gallup poll finds that 17 percent of Americans use herbal supplements, a 14 percent increase over the previous year.
The Dietary Supplement Health and Education Act is passed by Congress, deregulating herbal remedies.
The first two specialty research centers—Bastyr University AIDS Research Center, Seattle, and Minneapolis Medical Research Center for Addictions Study—are established by the NIH to study the effects of alternative therapies.
Health insurance giant Blue Cross and Blue Shield of Washington and Alaska launches a yearlong pilot program, Alterna Path, which provides coverage for alternative treatments.
1995 Kaiser Permanente, the country's largest health maintenance organization, opens the doors of its first alternative medicine clinic in Vallejo, California.
Harvard Medical School hosts the first-of-its-kind mind/body conference for doctors, who can receive continuing education credits for attending.
Eight specialty research centers have now joined the NIH Office of Alternative Medicine in its efforts to study alternative medicine.
The State of Washington passes a law requiring all insurance companies to cover the services of licensed alternative practitioners.
1996 The State of Oregon follows Washington's lead and presents voters with the Healthcare Freedom Initiative, a plan similar to that of Washington State, but it fails at the polls because of a technicality.
The first-of-its-kind nationwide study of patient perceptions of Chinese medicine treatments is conducted under the direction of the Traditional Acupuncture Institute in Columbia, Maryland.
The first clinical study of the effects of the Chinese herb dong quai on postmenopausal women is conducted by Kaiser Permanente's Division of Research. A record number of volunteers express interest in participating.
Acupuncture needles are removed from the FDA's list of investigational devices, making them accepted treatment devices, no longer considered experimental.
One of the first undergraduate courses in unconventional medicine is offered at the University of California, Davis.
The Asian Diet Pyramid is released.
1997 National Institutes of Health Office of Alternative Medicine and the Office of Dietary Supplements are collaborating to fund research on the benefits of the herb commonly known as St. John's Wort as a potential treatment for depression.
National Institutes of Health panel endorses acupuncture therapy as an effective treatment for certain types of pain, nausea, as a surgical anesthesia, for pregnancy, and to relieve the side effects of chemotherapy. The panel also says that there is evidence that acupuncture may be effective for menstrual cramps, tennis elbow, drug addiction, stroke, and fibromyalgia.
Teaching Alternative Treatments at
Traditional Medical Schools
Eastern applications and Western alternatives have been quietly creeping into the mainstream Western medical practices. Hospitals around the country now offer some form of alternative (the term used to define anything unproven in Western medical terms) choice for patients. Western medical schools are adding integrative medicine courses, for example, blending Chinese medicine with Western therapies, to their once conservative curricula. Therapies until recently considered offbeat and unproven—such as acupuncture, meditation, herbology, energy balancing, spirituality, and various cultural traditions—now complement traditional training. Conservative Columbia University has created the Richard and Hinda Rosenthal Center for Alternative/Complementary Medicine. Harvard Medical School offers students an intensive course on alternative medical practices.
According to information from the Office of Alternative Medicine at the National Institutes of Health, there are more than twenty-six prominent medical schools now offering courses in alternative medicine. Yale School of Medicine, Temple University, Johns Hopkins School of Medicine, Stanford University School of Medicine, Mount Sinai School of Medicine, Harvard Medical School, Columbia University College of Physicians, Emory University School of Medicine, and the University of Virginia Medical School are among them.
FELLOWSHIP PROGRAM AT THE UNIVERSITY OF ARIZONA
The University of Arizona College of Medicine developed the nation's first postgraduate fellowship program in integrative medicine. Under the direction of best-selling author Dr. Andrew Weil, the Arizona program accepts board-certified physicians to a course of study that includes acupuncture, herbology, visualization, mind/body techniques, Chinese medicine, and Native American medicine, to name a few. According to materials developed for the program, it was created in response to a growing demand from physicians for instruction in alternative healing practices.
"It is anticipated that this pioneer program in integrative medicine will help document which of the alternative medical approaches to include in standard allopathic practice.... I am personally convinced that many of the interventions studied and used in this innovative program will find their way into future daily allopathic practice. At that time, the term alternative will no longer be appropriate for these techniques and agents. Indeed they will have become mainstream therapy."13
—Joseph S. Alpert, M.D., head of the Department
of Medicine, Arizona Health Sciences Center,
University of Arizona College of Medicine
Goals of the University of Arizona Program in Integrative Medicine
• To train doctors to combine the best ideas and practices of conventional and alternative medicine into new cost-effective treatments.
• To encourage doctors to research theories and methods of alternative systems of treatment.
• To encourage doctors to be role models of healthy living.
• To provide integrative medical care for a selected group of patients coming to the university health center.
• To develop a model of training that can be used by other medical institutions.
• To produce leaders for this new discipline of medicine who will establish similar programs at other institutions and set policy and direction for health care in the twenty-first century.14
HEALING OPTIONS COURSE AT
UNIVERSITY OF VIRGINIA MEDICAL SCHOOL
About seven years ago a group of medical students approached Pali DeLevitt, Ph.D., saying they needed her to teach a course at the medical school. A cancer survivor who had found healing through her own disease and the use of alternative methods, DeLevitt was known for her strong spirituality and her understanding of the healing process. Teaching a course at the medical school wasn't exactly what she saw in her future, but after giving it some thought she developed a curriculum and approached the head of the medical school with her concepts for an alternative healing course. DeLevitt recalls that there was surprisingly little resistance to what she was proposing, so she began teaching what has become an extremely popular elective for fourth-year medical students.
At a healing space she has created in the woods just behind her Charlottesville, Virginia, home, DeLevitt introduces students to drug and surgical alternative options for treating patients and spends a great deal of time helping them get in touch with their own healing and spirituality. As part of the intensive monthlong course, the medical students are required to participate in group meditation as well as commit to make lifestyle changes at least for the duration of the course. They go out in the field and learn from alternative practitioners, where they discover that there are nonharmful herbal remedies that in some instances can take the place of most prescription drugs; that acupuncture, massage, and energy healing can be very effective in relieving pain; and that the relationship between the doctor and patient needs to be very intimate. She says that the students are amazed, often asking, "How come in four years of medical school no one told us about these things?"
"Medical school students get indoctrinated into drug and surgical management," she says. "But rarely do they hear about healing; everything is disease symptom oriented."
Because she requires that students take a Western diagnosis and research how that particular ailment might be treated with alternative methods, the students leave the course knowing that there are treatment options for various disorders. "If a patient comes to you with asthma, it is your role to inform them that they have alternatives to drug therapy," she tells the students. She told me, "These medical students are the vanguard of new healers. A doctor should be able to look at the many possibilities of the human experience and be able to discuss these things with their patients."
"This course changed my life. I will never look at things the same way again. It not only changed the way I will practice medicine; it changed the way I will live."
—a fourth-year University of Virginia medical student
referring to DeLevitt's alternative medicine course,
Healing Options, offered at the medical school
The National Institutes of Health Joins the Act
What some have called unorthodox therapies are gaining even more credibility, or at least a second look, even from the harshest critics. The creation of the National Institutes of Health's (NIH) Office of Alternative Medicine (OAM) has spurred this growth. In 1996 the OAM, under the direction of Wayne Jonas, M.D., a family physician with a background in many alternative therapies including homeopathy, bioenergy, and spiritual healing, awarded nearly $9.7 million in grants to ten institutions to conduct research on the therapeutic merits of Chinese herbs, acupuncture, massage, and other alternatives to conventional Western medical treatment. In a hearing before the Senate Labor and Human Resources Committee regarding the Access to Medical Treatment Act, Jonas testified that the OAM is committed to accelerating public access to potentially useful complementary and alternative therapies.
The OAM's leader reports that his office is exploring methods to assess and monitor the results of individual practices of complementary and alternative health practitioners, including practice-based research networks. Jonas has recommended a three-tiered review process specifically tailored to judge the level of risk of particular treatments. He states, "If such developments were accompanied by systematic data collection of selected unapproved therapies, a situation allowing access, assuring public safety, and furthering research could be accomplished."15
The following is a list of NIH Office of Alternative Medicine initial grant awards. Although research in these directions is improving, it is clear how comparatively little is spent on research in alternative therapies.
Dartmouth-Hitchcock Medical Center $29,901
Massage Therapy for Bone Marrow Transplant
University of Arizona $29,585
Acupuncture, Unipolar Depression
University of Maryland Pain Center $30,000
Acupuncture, Osteoarthritis
Medical College of Ohio $26,405
Massage Therapy, HIV-1
City of Hope National Medical Center $30,000
Electrochemical DC Current, Cancer
American Health Foundation $30,000
Pancreatic Enzyme Therapy, Cancer
Virginia Polytechnic Institute and State University $30,000
Hypnosis, Low Back Pain
University of Virginia School of Medicine $28,919
Massage Therapy, Post-Surgical Outcomes
Pacific College of Oriental Medicine $30,000
Chinese Herbal Medicine, PMS
Washington University $30,000
Anti-Hepatitis Plants, Therapeutic Evaluation
Pennsylvania State University $30,000
Music Therapy, Psychosocial Adjustment after Brain Injury
Menninger Clinic $30,000
Energetic Therapy Basal Cell Carcinoma
University of Miami School of Medicine $30,000
Massage Therapy, HIV-Exposed Infants
Harvard Medical School $30,000
Hypnosis, Accelerated Bone Fracture Healing
University of California $30,000
Classical Homeopathy, Health Status
Hahnemann Universit, $18,420
Dance/Movement Therapy, Cystic Fibrosis
Emory University $30,000
Chinese Herbal Therapy, Common Warts
George Washington University $29,985
Imagery and Relaxation, Immunity Control
Northwestern University $29,985
T'ai-Chi, Mild Balance Disorders
Lenox Hill Hospital $30,000
Guided Imagery, Asthma
University of Texas Health Science Center $30,000
Imagery and Relaxation, Breast Cancer
University of Vermont $30,000
Manual Palpation, Lumbar Spine
Columbia University $30,000
Chinese Herbs, Hot Flashes
University of Minnesota $29,964
Macrobiotic Diet, Cancer
Alternative Treatments Gaining Popularity among
Doctors and Consumers
Alternative therapy is fast becoming a $15 billion industry in this country. And many of the nearly 670,000 Western conventional, or allopathic, medical doctors in this nation have demonstrated an increasing openness to the possibility that alternative therapies may have merit. The first original published research, led by David Blumberg, M.D., of the department of psychiatry at the State University of New York Health Science Center at Syracuse, reported that over 90 percent of the doctors responding to survey questions said that they were willing to refer their patients for an alternative form of treatment. These findings were based on 572 responses to 2,000 questionnaires that were mailed to conventionally trained and board-certified internists and family physicians.
In late 1995, the results of a study published in the Archives of Internal Medicine stated that "on average physicians perceive complementary medicine as moderately effective, with younger physicians more receptive than their older counterparts." Nonetheless, the study concluded by saying that these alternative therapies "urgently need to be tested in randomized controlled trials." Proponents of alternative therapies say that such testing won't work because of the unquantifiable components of many alternative therapies, including spirituality, energy, human interaction, and placebo effects. And in symposia and medical conferences around the nation during 1996, that point continued to be debated among the nation's top healers.
"It's an enormous problem. They are stalled around the methodological issue, how do you research this? And right now the methodological issues are virtually insurmountable. I think they're missing the point. They are always looking for the control group. Researching common sense gets very expensive."
—Robert Duggan, president of the Traditional Acupuncture
Institute, Columbia, Maryland, and former chair of the
Maryland State Board of Acupuncture
Back in 1993 David Eisenberg, M.D., and a group of researchers from Harvard reported in the New England Journal of Medicine on their findings from a telephone survey of 1,539 respondents. The team discovered that in 1990 one in three American adults relied on an unconventional treatment for a health problem. Unconventional, for this study, was defined as meaning medical interventions not taught widely at U.S. medical schools or available at U.S. hospitals. The study also reported that Americans had made more visits to alternative practitioners—425 million—than to primary care doctors— 388 million—during that year. Amazingly, these same adults shelled out more than $13.7 billion for unconventional care, three-fourths of which came from their own pockets.
This past year, a Harvard-based study of medical directors of Health Maintenance Organizations (HMOs) in thirteen states found that chiropractic and acupuncture are the top two alternative therapies that HMOs plan to offer their members within the next one to two years.
Here are some other survey highlights:
• 58 percent of the respondents indicated that they plan to offer alternative care therapies to members in the next two years;
• 70 percent reported an increase in requests for alternative care therapies from members;
• acupuncture, massage, and chiropractic were the top three therapies of interest to HMO members.
OTHER TRENDS IN ALTERNATIVE MEDICINE
• Insurers are loosening the noose around the necks of alternative practitioners, and one of the first to change was the once conservative Blue Cross of Washington and Alaska. After conducting a series of town meetings across the state, Blue Cross launched AlternaPath, a pilot program covering naturopathy, homeopathy, and acupuncture. Enrollees paid $171 for up to $1,000 of treatment, and the pilot was limited to 1,000 subscribers. The program was filled to capacity within three months.
• American Western Life of Foster City, California is another insurance company at the forefront with regard to alternative medicine. The company's wellness plan, available to individuals in Arizona, California, New Mexico, and Colorado, is one of the first to offer coverage for alternative and traditional treatments.
• State of Washington lawmakers passed legislation that mandated that all insurers and managed care organizations make the coverage of services for licensed alternative health care providers available to subscribers. Taking effect in January 1996, the ground-breaking Washington law set the stage for an Oregon proposal, the Healthcare Freedom Initiative, which failed on a technicality in the November 1996 elections.
• Oxford Health Plans, a managed care company based in Norwalk, Connecticut, announced plans in late 1996 to become the first large medical insurer to offer a network of alternative care providers. Starting in early 1997, the Oxford Health options became available to individuals and employers in Connecticut, New Jersey, Pennsylvania, and New York. For employers adding the alternative option to their benefits packages, premiums will increase by about $5 to $6 a member per year.
• A hotline for health care practitioners—Natural Healthcare Hotline, a service developed by the Natural Healthcare Institute—has been established to provide access to research-based information on alternative health care products.
NATION'S FIRST PUBLICLY FUNDED NATURAL
MEDICINE CLINIC: COMMUNITY HEALTH CENTERS
OF KING COUNTY AND BASTYR
The Community Health Centers, a national nonprofit agency that provides care for underserved populations, will house one of the nation's first publicly funded natural medicine clinics in its Kent, Washington, center. In conjunction with Bastyr University and the Statistics and Epidemiology Research Corporation, Community Health Centers plans to offer natural medicine treatment to low-income, immigrant, and refugee populations in the Seattle area.
Natural medicine involves restoring health through encouraging the elimination of toxins. Practitioners of naturopathy believe that health is maintained by avoiding unnatural or artificial products in the environment and diet. Poor lifestyle habits are often corrected through adopting new behaviors in terms of eating, exercising, attitude, and self-care.
Alternative therapies will be available to these populations in addition to conventional treatment already available at the center. The clinic has $750,000 in funding, approved by the Washington State Legislature, which is provided by a State Legalization and Immigration Assistance grant. The research corporation will conduct studies evaluating patient satisfaction, cost-effectiveness, and health outcomes, and these findings will be compared to results for conventional therapies for the following health conditions: migraine headaches, high blood pressure, chronic ear infections, and asthma. Bastyr, an accredited natural medicine school and an OAM-funded specialty research center investigating alternative therapies for HIV/AIDS, will manage the clinic.
OUR LEGACY
The medical revolution is at hand. And perhaps the most active rebels will be you and me, those of us looking for a better way to wellness. As we evaluate our own desires, examine our beliefs, we will uncover the healing powers stored within our bodies. Many—from all over the globe—will walk beside us on this journey. Even Western practitioners, who once thought that the Western way was the only way, will join us as we discover an elegant route to wellness—a route that integrates the natural, the spiritual, the personal, with the technological advances of our modern world. Through integrative medicine, we begin our journey together. This is the legacy we will leave for future generations.
"I had been feeling unhappy. I was offered a trial of Prozac by my medical doctor; I compared the cost of Prozac (100% out-of-pocket) and that of psychotherapy and acupuncture (receiving 40% and 75% reimbursement respectively) and though it's about half the cost to use Prozac, I decided I wanted human contact and an opportunity to be coached and educated into how to grasp my struggles in life better. Also, I quit my job . . . for one that is much less stressful. I feel less depressed and a whole lot smarter. I care about the people I work with, too."
—Male, 21-30 age group, survey respondent
WESTERN MEDICINE'S FIRSTS
1796 Edward Jenner first inoculates against smallpox
1847 The American Medical Association is formed
1892 The American Medicinal Plants is compiled. It is the first American-based herbal medicinal, containing information on the healing properties of 180 plants.
1928 The first antibiotic is discovered by Alexander Fleming.
1938 The first cardiac catheterization is performed in New York by George Peter Robb and Israel Steinberg.
1953 DNA's double-helix structure is discovered by Francis Crick and James Watson.
1955 There is a major public health effort to inoculate children with the polio vaccine discovered by Jonas Salk.
1957 Oral polio vaccine is formulated by Jonas Salk.
1957 Fiber optic endoscopy is pioneered by Basil Hirschowtiz at the University of Michigan.
1967 The first human heart transplant is carried out by Christian Barnard.
1972 Computed tomography, CAT scans, are devised by British engineers.
1978 First test-tube baby is born in England.
1979 The World Health Organization declares that smallpox has been eradicated.
1981 The Centers for Disease Control is alerted to the first reported cases of AIDS, occurring in Los Angeles and New York.
1981 The MRI scanner is developed by scientists at Nottingham University and Thorn-EMI Laboratories in England.
1985 The first PET scanner is developed by researchers at the University of California, a technique that enables organ functioning to be studied in color.
EASTERN MEDICINE'S FIRSTS
2700 B.C. The legendary emperor Shen-nung is credited with writing the first recorded history of medicinal herbs and plants. This pharmacopoeia has been called the PenTsao. As legend has it, Shen-nung tasted all the herbs to test their value and use. He lived for 123 years.
2600 B.C. The first written presentation of comprehensive medical theory is produced, The Nei Ching Su Wen or The Yellow Emperor's Classic of Internal Medicine.
300 B.C. The first anesthetic powder is developed for surgical procedures such as laparotomies and wound expansions by Hua Tuo, Chinese physician.
1066-225 B.C. Environmental hygiene, personal hygiene, boiling water, and the elimination of rats and rabid dogs to prevent disease are espoused by Zhou dynasty, China.
1000-221 B.C. The first integrated system of medicinal classification (for herbs) is created in China.
320 A. D. The first study of pharmaceutical chemistry is developed by Ge Hong, a Chinese physician in the Jin dynasty.
Eleventh Century People are inoculated with the serum of human smallpox in China.
618-1279 Medicine is divided into branches in China relating to the treatment of diseases and bodily functions—orthopedics, laryngology, wounds, acupuncture, gynecology, ophthalmology, and stomatology.
1247 The first book of forensic medicine is written by Song Ci in China.
1949 After the 1949 revolution, the People's Republic of China brings Chinese medicine back into prominence, establishing organized training for practitioners.
1971 New York Times reporter James Reston is taken to Chinese hospital for emergency appendectomy. He later writes of the benefits of acupuncture and Chinese herbal medicine.
1976 Chinese gynecologists develop chorionic villus sampling, an aid to early diagnosis of genetic disorders.
