Mainstream Alternative: Medical community warming to alternative care [The Journal]
by Hope Katz Gibbs
July 26, 1998
A small revolution is taking place on the
second floor of the Ambulatory Care Center on the campus of the George Washington
University Medical Center in Washington.
Down the hall from the Department psychiatry, four examination rooms and a reception area have been set aside for the George Washington Center for Integrative Medicine. Since April, an acupuncturist, chiropractor and massage therapist have been aligning chakras and soothing sore muscles, as well as using guided imagery, nutrition counseling, meditation and spirituality to help heal patients. About 60 people have used the center’s services, so far.
The Center for Integrative Medicine may be a small step for George Washington, but its mere existence represents a big change in the attitude toward unconventional medical therapies.
For years, the mainstream medical community snubbed alternative methods of care. Only two decades ago, the American Medical Association declared it “unethical” for its members to associate with chiropractors.
In 1992, the ANU changed its position. According to the industry guidebook, AMA Current Ethical Opinions, “It is ethical for a physician to associate professionally with chiropractors providing the physician believes that such association is in the best interest of his or her patient.
The change in attitude has rippled through the medical community.
“My experience in creating this center is that there has been very little resistance,” says Dr. John Pan, the obstetrician-gynecologist and medical school professor who heads the George Washington Center for Integrative Medicine. “I can say I’ve never gotten any negative feedback. It’s more that I’ve experienced different degrees of enthusiasm. But nobody is attacking me. No one is against having the integrative therapy center here,” he says.
Ironically, for most of his career Pan, 54, thought prescribing acupuncture and herbs was a lot of hocus-pocus. Only in recent years did the George Washington-trained physician, who was born in Shanghai and raised in Hong Kong realize that acupuncture relieved aches and pains associated with gynecological problems. Slowly, he became a believer.
In early 1997, he approached the medical schools vice president about opening a center offering non-traditional treatments. He felt a clinic that integrated traditional therapies with alternatives, such as acupuncture, chiropractic and massage, would be a benefit to the patients of his hospital’s 250 physicians. The university thought the idea was sound enough to fund the center. The goal, Pan says, is to break even on the $600,000 investment.
In addition to focusing on women’s health issues, oncology, back pain and wellness, an educational component is planned. Starting this fall, conferences will be hosted and the school’s medical students will be trained there, too.
The program is part of a trend among medical schools. According to The Association of American Medical Colleges 1997-‘98 curriculum directory, almost half (60) of the 127 medical schools in the nation—including Harvard, Yale and Johns Hopkins universities—offer courses in alternative medicine.
Susan Silver, program director for the George Washington Center, says the reason for the increasing interest in alternative medicine is that patients are demanding it.
“The alternative medicine movement is a consumer-driven business,” Silver says. “Many people are using alternatives. Many are not telling their doctors and are spending a lot of money to do it. There’s going to be a lot more of pressure on the medical establishment, providers and payers included, to incorporate these kinds of services because consumers are going to demand it.”
A 1990 nationwide study in the New England Journal of Medicine showed that the number of visits to providers of unconventional therapy was 425 million, compared to 388 million visits to primary care physicians.
The study’s author, Dr. David Eisenberg, also found Americans was willing to pay for the extra care not covered by health insurance. Eight years ago, Americans spent $13.7 billion on unconventional therapy and most of it, $10.3 billion, was paid out of pocket.
Since Gary Kaplan, a doctor of osteopath opened his practice in 1985, about 3,000 patients have sought out the services of staff, which includes two osteopaths, a medical doctor, four registered nurses, a psychologist, two physical therapists, including on who uses a movement therapy called Feldenkrais, and a massage therapist who practices a massage technique called Shiatsu.
“The combination of western medicine an alternative therapies is the key,” Kaplan says. “We use the methods we know will help the patient. It is essential to have the correct diagnosis, however. If someone has cancer for instance, chemotherapy, rather than acupuncture, is probably the best course of treatment. But we may use acupuncture to he with some of the symptoms.”
Combining western medicine with alternative modalities is the medical model American Whole Health Inc., a Reston-based company founded in 1993 in Chicago board-certified internist and gerontologist Dr. David Edelberg.
Throughout the early 1990s, he heard his patients talk about the success they had with alternative therapies. So he combined alternative therapies with standard medical protocols.
Business began to boom. By 1994, he had move to a bigger office in Chicago. In 1996,
he opened a second clinic in Denver, Colo., and a third in Bethesda, Md., last year. There is also a center in Boston and 2004, the privately held company expects to have enough funding to open 54 more centers at a cost about $1 million each.
Within the next five years, six clinics scheduled to open in the Washington and the first is slated to open in Alexandria, VA. A site has not been selected, but like other centers that have been set up, American Whole Health is most likely looking to buy an existing medical practice where the physician has a compatible outlook on medicine.
In Bethesda, American Whole Health bought out the 20-year-old practice of Leonard Wisnesky, an internist and endocrinologist who performed acupuncture on some patients. He’s now the medical director of the Bethesda center, which in May moved into a new 13,000 square-foot two-story building on Wisconsin Avenue in Washington. His center employs five medical doctors and about 15 alternative practitioners who administer a variety of services from regular check-ups to acupuncture.
Before long, it is likely even more integrated medical companies will begin dotting the health care landscape, says Bill Eggbeer, vice president of marketing and product development for American Whole Health.
“We are breaking new ground in the health care community,” Eggbeer says. “But I know of several single-center projects in the works and I expect to see more. There is a lot of room for development in this arena. A lot of doctors are interested in bringing integrated medicine to more people.”
In the region, most of the large health care systems are only now considering tapping into the trend.
At Inova Fairfax Hospital in Falls Church, VA for instance, there is no alternative medicine program scheduled but classes that focus on the mind-body connection are offered in its community education programs. Courses include prenatal yoga, yoga for stress management, massage for couples and Tai Chi for seniors.
“We recognize the importance of the mind-body connection,” says hospital spokeswoman Lisa Wolfington. “We are in the process of looking at implementing some types of alternative medicine. Therapy, which enhances treatment and healing of the whole patient, is something Inova is interested in,” she says.
Interest in alternative therapies have also been piqued at Suburban Hospital in Bethesda where incorporating alternative therapies is in the talking stage. “Patients are looking
for physicians who have experience in alternative therapies,” spokeswoman Rona Borenstein-Levy says. “We constantly monitor the marketplace to see what other health care facilities are offering. Integrative medicine is gaining in popularity and demand, so we’re researching the possibility.”
Not everyone is jumping on the alternative medicine bandwagon. At Washington Hospital Center, alternative therapies are not likely to find their way into the large cardiology hospital.
‘Me concern many physicians here have is that patients will see alternative medicine as true alternatives and not as adjuncts to their therapy, I says invasive cardiologist Dr. Ramin Osxoui. ‘Mat’s a great worry, especially for cancer and heart disease patients, because over the years, thousands of people have died because they have scorned traditional therapy.
“Most physicians I know are open to the potential benefits some patients may receive
from alternative therapy, but only as an adjunct,” he says.