Monday, February 02, 2009
BY JULIE DEARDORFF
For years, Dr. Ali Keshavarzian ignored "alternative" therapies because his Western-trained brain wanted more evidence that they actually worked.
But Keshavarzian also knew conventional medicine often needed some assistance. And when he learned his patients were seeking out natural products, acupuncture, meditation and massage, he took a deep breath and dived in.
Ten years later, Keshavarzian straddles both worlds, using Western treatments along with a variety of alternative approaches, a combination known as complementary and alternative medicine, or CAM. "CAM is looking at a patient as a human being, rather than a disease," said Keshavarzian, a gastroenterologist at Rush University Medical Center. "Instead of treating 'ulcerative colitis,' I treat 'Mr. Jones."'
The future success of the holistic CAM movement in the U.S. hinges on the very people who once viewed alternative medicine with cold skepticism: mainstream, conventionally trained doctors. Though many, such as Keshavarzian, still believe medical treatments should be backed by rigorous scientific data, they will not rule out adding into the treatment mix mind-body therapies that have been used for centuries in other cultures. Keshavarzian, for example, might suggest relaxation techniques when he thinks stress is a factor, acupuncture for pain or probiotics for acute diarrhea.
"The public has been on board for some time," said physician Andrew Weil, founder of the University of Arizona's School of Integrative Medicine, which has trained more than 350 physician fellows. "The professionals are harder to win over."
Five chronic conditions -- mood disorders, diabetes, heart disease, asthma and high blood pressure -- account for more than half of all U.S. health expenditures, according to the Institute of Medicine, part of the National Academy of Sciences, which advises the federal government on health issues. But these are the disorders that conventional medicine struggles to treat, according to the institute.
"Studies show that $2.5 trillion is being spent in a system that is not improving the overall health of our citizens," according to the institute. "Incidents of chronic disease are on a sharp rise and by 2023 will cost our nation $4.3 trillion."
Proponents say CAM, which is also called "integrative medicine," is a cost-effective solution.
Integrative treatments fall into four main categories: natural products (vitamins and supplements), energy medicine (acupuncture), manipulative practices (chiropractic work) and mind-body medicine (meditation or deep breathing).
For instance, if a patient needs bypass surgery, an integrative doctor would recommend it. But afterward, he or she might suggest fish oil, exercise or nutritional changes to aid healing.
Laura Restaino of Wheaton, Ill., tried an integrative physician, Charles Dumont, a Loyola University pediatric gastroenterologist, after prescription drugs, creams, steroids and lotions prescribed by conventional doctors failed to treat her daughter Alex's severe eczema. After receiving hand acupuncture (using pellets in place of needles) from Dumont, the condition cleared up almost instantly, Restaino said.
Alex, now 12, sees Dumont every six to eight weeks for maintenance acupuncture. "He's kind, he listens and he doesn't rush," her mom said.
Though primarily driven by patient demand, the integrative medicine movement recently has received a boost from the conservative medical establishment, including the American Academy of Pediatrics, which has a CAM task force.
An increasing number of prestigious medical schools are teaching integrative practices. Since 1999, the Consortium of Academic Health Centers for Integrative Medicine, a group that includes Duke University, Harvard and Northwestern, has grown from 8 to 43 members. With more traditional medical schools focusing on health care that addresses the mental, emotional and physical aspects of healing, the use of CAM by the nation's future physicians is expected to grow.
Meanwhile, it's getting easier for practicing physicians to find CAM training. In early December, the University of Chicago and the Mayo Clinic co-sponsored the ninth annual two-day CAM conference for medical professionals. And the 2009 Integrate Chicago Conference on Jan. 17 at Loyola is being organized by, and for, medical students interested in integrative medicine.
Nearly 40 percent of adults used integrative therapies last year, according to a new government report, most often to treat chronic back, neck and joint pain, arthritis, anxiety, high cholesterol and head or chest colds.
And 12 percent of U.S. children have used an alternative therapy.
"Early in my career I felt like we (doctors) were missing the boat because we weren't addressing underlying problems," said integrative physician Steve Devries, a preventive cardiologist at Northwestern Memorial Hospital. "We'd often tell patients after angioplasty that they 'had the heart of a teenager again.' But it was completely untrue. We'd bought them time to correct the underlying problem, but if we didn't fix that then we'd see them again and again."
Now Devries focuses on prevention; his aftercare includes addressing factors that influence heart disease, including stress and nutrition. He'll find a therapy that fits a person -- meditation, yoga, biofeedback or talk therapy -- as part of an overall treatment plan. "The modality is not as important as the awareness of a mind-body connection," he said.
One of the challenges of integrative medicine, however, is that it requires more of a doctor's time. Critics say it also has a relatively small evidence base, but that, too, is changing. Though research funding pales in comparison to pharmaceutical drug trials, the National Institutes of Health's National Center for Complementary and Alternative Medicine has been increasing its pace of granting funds for CAM research. It has funded more than 2,200 research studies since 1999.
"The difference is that 50 years ago Western medicine began to examine its practice more vigorously; the other methods have begun to do it more recently," said Keshavarzian. "You can't dismiss CAM; it's the result of 1,000 years of experience. But we can vigorously study