Ancient wisdom, modern science: Integrative medicine blends the best of both worlds

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Ancient wisdom, modern scienceIntegrative medicine blends the best of both worldsBy Julie DeardorffTribune staff reporterPublished February 15, 2004http://www.chicagotribune.com/features/lifestyle/q/chi-0402150288feb15,1,6535190.story?coll=chi-leisureq-hedTwo weeks after discovering she was pregnant, 34-year-old LynetteBisconti was diagnosed with breast cancer. Six doctors across thecountry advised her to end the pregnancy so she could beginchemotherapy. Six times Bisconti said no.Bisconti, a Rockford native, wanted natural options. She wantednutritional advice. And she wanted a voice in her health caredecisions. It wasn't until she walked into an unusual cancer center inZion that she found the answer to her prayers: integrative medicine.A controversial medical practice that is changing the face of healthcare, integrative medicine melds modern science with ancient wisdom.Cancer, for example, might be treated by blending the best of theWestern medicine--chemotherapy, radiation and stem celltransplants--with complementary approaches that could includemind-body therapies, acupuncture, nutrition, herbs and massage.This best-of-both-worlds approach is still criticized by mainstreamphysicians who argue that most complementary therapies have noscientific basis. Some call them a waste of money; others say they canactually cause harm, especially if patients use alternative methods inplace of conventional care--which is not what integrative medicineadvocates."It's contributing to the public confusion about health, disease andhow it should be approached," said longtime critic Arnold Relman,professor emeritus at Harvard Medical School and former editor of theNew England Journal of Medicine. "The main thrust of complementary andalternative medicine is to soften the brain, confuse logic, denyscientific evidence and encourage people to turn away fromconventional medicine. Unfortunately, it's making a lot of money."For Bisconti, however, the integrated approach offered by the CancerTreatment Centers of America (CTCA) at Midwestern Regional Hospital inZion--one of the pioneering integrative medicine centers--was worthrisking her life."I believed if I didn't change everything, I wouldn't make it," saidBisconti, now 40, free of disease and the mother of a 5-year-old son,Frank.The movement, popularized by Harvard-trained physician Andrew Weil,has gained unprecedented support during the last five years. Consumersnow can find integrative practitioners at hospitals, clinics andprivate practices. Several of the nation's top medical institutionshave opened integrative care centers.Acceptance growsInsurance companies increasingly are covering complementary therapies.And in April, the University of Arizona will begin training 40 DefenseDepartment physicians in integrative medicine.Though skeptics say studies are poorly designed and there is noevidence that integrative medicine works, the federal government isfunding research through the National Center for Complementary andAlternative Medicine, which has a budget of $111.7 million for 2004.These developments alarm Donald Marcus, a professor of medicine andimmunology at the Baylor College of Medicine, who called integrativemedicine a "Trojan horse of belief-based medicine.""By having these things in academic centers, which ought to beupholding scholarly standards, they're legitimizing dangerous anduseless practices," Marcus said.With much of the science still evolving, claims are also a difficultissue for integrative medical centers. In 1996, the Cancer TreatmentCenters of America settled Federal Trade Commission allegations thatthey had made false and unsubstantiated claims while advertising andpromoting their treatments. The CTCA was not sanctioned and did notadmit any wrongdoing, said CEO Steve Bonner, but the FTC has sincemonitored the center's advertising.But Weil and others call integrative medicine the future of healthcare, thanks to a gulf between what consumers want from physicians andwhat medical schools are offering.Today's patients are looking for doctors who listen, won't just pushpharmaceuticals, can guide them through the maze of nutrition and canaddress chronic illnesses, not just crisis situations, Weil said."My motivation is to close that gap," Weil said. "But I can't do itmyself."Blazing a trailIn 1997, when his colleagues were just beginning to take himseriously, Weil created a two-year post-doctoral fellowship programfor integrative medicine at the University of Arizona. So far theprogram has trained 28 medical doctors, including at least four inIllinois.Another 160 physicians have enrolled in the distance learning program(84 have graduated), now the dominant training method.Like foot soldiers, they have fanned out across the country, openingcenters from Maine to California."Integrative medicine stresses the belief of the body to heal itself,with some facilitation," said Karen Koffler, director of theIntegrative Medicine Program at Evanston Northwestern Healthcare and amember of the program's first graduating class.Opened in 2001, Evanston Northwestern's center initially treatedcancer patients. Today 350 people come each month with problems frominfertility and headaches to heart disease and anxiety. In addition toKoffler, a critical-care specialist, the staff has 13 practitionerswho offer Chinese medicine and acupuncture, body work such as massage,nutrition, yoga, meditation and mind-body therapies.A massage therapist might treat patients and family members waitingfor a loved one.Koffler, like many conventionally trained physicians, turned tointegrative medicine when she realized she was treating the samepatients again and again. "I saw we were never taught how to keeppeople well or prevent disease in the first place," she said.Though Americans have been treating themselves using alternativemethods for years, a 1998 study by David Eisenberg, an assistantprofessor of medicine at Harvard, found that 42 percent of Americansused some combination of complementary or alternative therapies inconjunction with conventional medicine--today's integrative medicine.But patients weren't telling their doctors what herbs and supplementsthey were taking, putting them at risk for adverse herb-druginteractions. Meanwhile, armed with more information than ever,patients began demanding a different relationship--a partnership--withtheir doctors."It's causing a certain kind of revolution," said Victoria Maizes,executive director of the Program in Integrative Medicine at theUniversity of Arizona.Looking for magicRelman acknowledges that integrative medicine could be correctingflaws in the medical system, including impersonality and a focus ondrugs, procedures and expensive tests. But he also believes itspopularity stems from a yearning for magic, miracles and a belief inthe supernatural."There's no way to solve [life's problems] through faith, mysticism,supernatural belief and prayer," he said.Often lost in the debate is that integrative medicine differs from"alternative" medicine because it embraces Western techniques.Proponents would not treat cancer with acupuncture alone. But doctorsmight use acupuncture to relieve post-operative pain or nausea afterchemotherapy, an approach endorsed by the National Institutes ofHealth.For Bisconti, now living in Menomonee Falls, Wis., the frank talk shehad with her surgeon at the Cancer Treatment Centers of America madeall the difference in the world. She agreed to monthly chemotherapysessions during her second trimester, but instead of two-hourtreatments, they were spread over three days--a controversial approachknown as fractionated dose--and her body was immediately flushed withwater.Bisconti breast-fed her son for six months and then agreed toradiation, almost a year and a half after her original diagnosis."What turned for me was when my surgeon said, `I know you don'tbelieve in chemotherapy, but unfortunately, it's the best and onlything we have. It won't ultimately be the cure for cancer.'"When he respected me enough to tell the truth, relief washed overme," she said. "I knew it. But no one would say it. He respected meenough to tell me."Healing treatment begins with tea and sympathyIntegrative medical centers are intended to look, smell and feelradically different from traditional hospitals.Often designed using feng shui, the Chinese art of placement, toharmonize the flow of energy, many offices incorporate plants, naturallight, wood floors, aromatherapy, tea, soothing music and, in somecases, non-toxic building materials.A first visit is lengthy and intended to assess the state of the mind,body and spirit of a person, not just the physical ailment.Integrative medicine believes the body has an innate ability to healitself with as little intervention as possible.Wanted: Good listeners"Every integrative physician will say that just giving a person spaceand time to tell their story and having a doctor who won't laugh andwill listen is vital to the healing process," said James Nicolai,medical director for the Franciscan Center for Integrative Health inIndianapolis.Although conventional medicine shines during a crisis or problems withvital organs, integrative medicine targets life's chronic maladies,including allergies, anxiety, insomnia and gastrointestinal disorders."About 75 to 90 percent of all visits to primary care doctors are fora stress-related disease," Nicolai said. "Not just ulcers, headachesand migraines but also insomnia, panic attacks, depression, anxiety orjust feeling discontent. So many people say, `I feel off.'"Dana Ryan, 40, had felt "off" for about a year, suffering from anxietyattacks, heart palpitations and muscle twitches before she foundNicolai. When X-rays and bloodwork showed nothing and the cardiologistfound her heart in good condition, Nicolai gave her breathingtechniques and sent her to an acupuncturist. He also gave her aguided-imagery technique to practice at home and a book thatillustrated the physical effect of stress on the heart."I noticed a difference within two weeks," said Ryan, a consultantwith the auto industry in Indianapolis. "I really liked that he waslooking into all aspects of my life. It just made a whole lot moresense."Patients suffering from chronic or acute pain resulting from surgery,cancer, fibromyalgia, headache, sinusitis or arthritis often turn tointegrative medicine.Even emotional issues such as depression and respiratory disorderssuch as asthma can be addressed with integrative medicine.Most centers are not high volume, and it can sometimes take weeks toget an appointment. Insurance generally doesn't cover the care. Butfor those who aren't having luck using traditional routes, integrativemedicine is an alternative."With conventional medicine, if you don't fit into an easily treatablesituation, doctors get frustrated," said Karen Koffler, director ofthe Integrative Medicine Program at Evanston Northwestern Healthcare."If you don't respond to chemotherapy, we say, `They failedchemotherapy,' rather than `The chemo failed them.' That kind ofmentality is woven into [conventional] medicine. With integrativemedicine, we believe that's inappropriate."A typical staff will have a conventionally trained medical doctor,like Koffler, working with experts from a host of complementaryfields, including massage therapy, nutrition, chiropractic,acupuncture, herbalism and meditation.Some centers incorporate fitness classes or healing movement forms,such as yoga, qigong, tai chi and craniosacral therapy.Team approachAfter the first visit, the doctors and complementary medicinepractitioners meet to discuss patient care. The team then creates acustomized treatment plan, which can include lifestyle changes andpreventive self-care.At Evanston, Koffler and six health practitioners, including amind-body therapist, a nutritionist and a Chinese medicine expert,also meet at least once a month to discuss the more difficult cases.Evanston's Integrative Medicine Center initially treated cancerpatients on an outpatient basis. The program was so successful,Koffler said, that it's now developing inpatient services and treatseverything from infertility to major illnesses that are exacerbated bystress.Crohn's disease, for example, gets worse with stress. But teachingpeople how to relax, whether by using breathwork or biofeedback, canhelp, said Koffler, one of the first four physicians in the U.S. totrain under Andrew Weil at the Integrative Medicine Program at theUniversity of Arizona."All of it relaxes the physiology and gets people in a calmer state,"she said. "In that state, the gut motility is calmer, the vasculartree dilates, there's better blood flow and the heart rate lowers."--Julie DeardorffWhere to find integrative centersThe following is a partial list of area integrative medical centers.- Advocate Good Shepherd Hospital Heath and Fitness Center, Departmentof Integrative Medicine, 1301 S. Barrington Rd.,Barrington;847-620-4560;www.advocatehealth.com/gshp/services/mind/integrative/index.html.- Advocate Illinois Masonic Integrative Medicine Center, 3000 N.Halsted St.; 773-296-8410; www.advocatehealth.com/immc.- ALT-MED Health and Wellness Center, 1544 Nerge Rd.,Elk Grove Village; 847-923-0046; www.alt-med.org.- Block Center for Integrative Cancer Care, 800 Sherman Ave., Suite515, Evanston; 847-492-3040; www.blockmd.com.- Cancer Treatment Centers of America at Midwestern Regional Hospital,2520 Elisha Ave., Zion; 800-615-3055, www.cancercenter.com.- Central DuPage Health--Integrative Medicine Centre, 10 W. State St.,Suite 100, Geneva; 630-232-7755; www.cdh.org.- Children's Memorial Hospital, 2300 Children's Plaza (Fullerton atLincoln), Chicago; 773-880-4000; www.childrensmemorial.org.- Integrative Medicine Program at Evanston Northwestern Healthcare,Park Center, 2400 Chestnut, Glenview; 847-657-3540;www.enh.org/integrativemedicine.- Northwestern Memorial Physicians Group Center for IntegrativeMedicine, 680 N. Lake Shore Drive, Suite 815,Chicago; 312-926-2224; www.nmh.org/services/outpatient(underscore)services/cim.html.- The Center for Integrated Health Care, 111 N. Wabash Ave., Suite1005, Chicago; 312-236-7010; www.cihci.net. Also: 400 Lake-Cook Rd.,Suite 200C Deerfield; 847-267-8780.For more information, check out the National Center for Complimentaryand Alternative Medicine on the Web at http://www.nccam.nih.gov/.