More than a decade after alternative therapies were exposed as a pillar of consumer preference, have doctors made significant changes in the way they practice medicine? Chicago physicians say "No."
There is good reason why U.S. healthcare consumers seek alternative therapies. Many of the treatments offered by conventional medicine — ranging from radical mastectomy for breast cancer, arthroscopic knee surgery, prostate removal, and estrogen replacement therapy — have recently been invalidated by scientific review. Millions of patients have undergone surgery or been administered medications that were never fully tested and upon examination were found to be scientifically baseless.
Patients recognized this and also realized that modern medicine often had no good answers for chronic health conditions like osteoarthritis, persistent headache, irritable bowel, allergies, fibromyalgia, and sinus conditions. In search of answers, they bolted and ran to alternative practitioners.
The continued dissatisfaction with modern medicine was trumpeted in 1993 when the New England Journal of Medicine published a landmark report indicating that more Americans visited the office of alternative medical practitioners than conventional physicians. The trend was confirmed in follow-up research in 1998.
But the figures were misunderstood. Patients hadn’t abandoned their family doctors who control access to most of their health insurance coverage. Consumers appeared to be straddling both sides of the fence — visiting the offices of alternative doctors who perform acupuncture, chelation therapy, offered herbal medicines, nutritional supplements, and an assortment of other remedies.
Ideally, patients would probably embrace the best of alternative and conventional therapies — what has come to be called integrative medicine — if they could find one practitioner who provided both. That’s where integrative medicine comes in, says Martha Howard, M.D., a Loyola University-trained physician who practices integrative medicine at Wellness Associates in Chicago.
Howard says alternative medicine can be as confining and limited as the conventional practice of medicine (termed allopathy). Howard, who is also an acupuncturist, maintains that true integrative medicine suggests equally blended disciplines of conventional and alternative medicine. The term, integrative medicine, is widely accepted as applying the least invasive procedures first, and then if they don’t work moving on to the heavy artillery of conventional medicine, namely prescription drugs and surgery.
Stuck in the System
Today, more than a decade after the alternative medicine revolution came to the fore via that New England Journal of Medicine paper, alternative doctors are lecturing at medical schools and young doctors are learning more about alternative therapies. But for the most part, patients are still having difficulty finding a well-recommended physician who offers effective alternative therapies.
There are about 700,000 medical doctors practicing medicine in the U.S. However, the number who are practicing integratively still remains small, says Erik Goldman, editor-in-chief of Holistic Primary Care Magazine. According to Goldman, economic and cultural barriers prevent many physicians from making the jump from conventional to alternative care.
Keith Berndtson, a Chicago M.D. who practices at Integrative Care Centers of Illinois, agrees. He says despite public demand for alternative health care services, medical doctors haven’t moved en masse to offering alternative therapies because of cultural biases within medicine, pharmaceutical companies’ tight control over medical school curriculums, and the simple fact doctors don’t feel comfortable applying alternative therapies for clinical problem-solving.
Berndtson, who offers such alternatives as chelation therapy, trigger point injections, and extensive allergy testing, says in talking to his colleagues he stresses the valid knowledge base that supports alternative therapies. He believes his colleagues need to move beyond medicine’s status quo, "Many physicians feel trapped. A doctor who’s stuck in a system where [he] must see six patients an hour won’t treat chronic fatigue [for example] very well."
Berndtson, who attended medical school at Chicago’s Rush Medical College and interned at Lutheran General Hospital in Park Ridge, says he crossed over to integrative medicine in 1996. At that time, a patient — a high-ranking executive of a large company — inquired about appropriate treatment for his young niece who had a chronic middle ear infection. When Berndtson saw the man at a later office visit and asked about the niece, he said she had gone to an alternative practitioner who had taken the child off certain foods and prescribed herbal therapies that remedied the condition.
The executive, in an obvious position to direct where company funds would be spent on healthcare — and also in a position to control referrals to the physician’s office — pressed the point. According to Berndtson, "He said that his company was paying an arm and a leg for health care services and he wanted to know why his niece had to go outside the conventional healthcare system for these services."
From that point on Berndtson says he rethought his skepticism of alternative therapies and began closing a knowledge gap that medical school had not addressed. It took Berndtson two years to get a handle on treating conditions that perplex conventional medicine such as menopausal symptoms, anxiety, depression, and chronic fatigue.
Mega-Vitamin Therapies, Chelation...Hardly
By and large, doctors are still practicing the way they were trained. While some might encourage massage therapy, yoga, or other meditative approaches, few have actually embraced the more "edgy" modalities such as mega-vitamin therapies or chelation therapy (which is promoted for treating angina and blocked blood vessels). Some 30 years after chelation’s inception, the American College for Advancement in Medicine, the major organization that trains physicians on how to perform chelation, still counts only a little more than 1,000 physician members.
Holistic Primary Care Magazine’s Goldman uses the American Board of Holistic Medicine as another barometer. The organization certifies some 300 to 400 doctors annually, illustrating the slow growth in the number of doctors who are becoming qualified to provide a wider range of services than the traditional allopathic offerings that mostly encompass drug therapy or surgery.
A widely known weakness in conventional physician education is the lack of training in diet, nutrition, and food. Yet many integrative medicine authorities believe the most effective service that conventional physicians can offer to their patients is nutritional therapy.
Robert Crayhon, M.S., president of Designs for Health, Inc., and author of the book Nutrition Made Simple, conducts courses for physicians on how 50 common ailments can be remedied with food and nutrition supplementation. "You can’t say you know what healing is if you haven’t spent time learning nutrition. Not learning about nutrition is like ignoring one of the continents of the world and saying you know geography."
Since 1996, Crayhon, an accomplished and highly respected nutritionist based in Boulder, Colorado, has trained about 300 physicians, nurses and physician assistants to put into practice his mantra: "foods and nutrients heal the best." Crayhon says one physician came up to him angry after a course lecture and asked, "Why didn’t we learn this in medical school?" That doctor closed his practice, according to Crayhon, pursued a nutrition education and then re-entered medical practice.
What do doctors learn at Crayhon’s courses? Stuff like throwing away waffles and pancakes for breakfast and eating protein that does wonders for, among other ailments, mental depression. Course attendees are versed in nutritional supplements, like coenzyme Q10, essential omega oils, acetyl L carnitine and mega-doses of the B-vitamin, folic acid. One of Crayhon’s favorite therapies in his course curriculum is for normalizing irregular cervical pap smears; he suggests high oral doses of folic acid along with applying liquid folic acid vaginally via a tampon.
Other groups are reorienting doctors as well. The Institute for Functional Medicine, based in Washington state, also trains physicians in nutritional therapies. It completed its 10th annual meeting in Tucson, Arizona, last May with some five Chicago-area physicians among the 500 in attendance.
Doctors Can Change...and Do
Most physicians who have adopted alternative therapies didn’t embrace them initially but rather, arrived at them through either one defining experience or a series of them. Such is the case with various Chicago physicians who are actively practicing integrative approaches.
Treats More Than Symptoms
John Hicks, M.D., a conventionally trained pediatrician, who practices at Pathways Medical Advocates, Inc. in Grayslake, Illinois, says about 10 years ago he realized conventional medicine didn’t have all the answers and often found himself simply treating symptoms.
Today patients seek out Hicks for his track record in using alternative approaches. "I love medicine now. I was bored for a time. I am thinking again! I get to be a detective and look for the underlying roots of these [tough health] problems."
He contends that since many alternative therapies emphasize sophisticated analyses at the cellular level, the biochemistry he studied in medical school — that he says often goes unused by conventional doctors — is now serving him well. "The difficult and sometimes puzzling conditions, like chronic fatigue, celiac and fibromyalgia, respond to alternative therapies. The biggest thing I am working with now is the epidemic of autism. A lot of this has to do with the vaccines."
Hicks agrees that the resistance to alternative therapies is rooted in insurance companies and health plans which dominate the practice of medicine today. He says these health plans want doctors to follow protocols that dispense with the patient in the most expedient manner rather than looking for the root cause of disease.
Acupuncture in Family Medicine
When the doctor becomes the patient, attitudes change. A personal health challenge shocked Dr. Martha Howard into thinking about alternative therapies, which eventually led her to practicing integrative medicine. Howard’s first notion that alternative therapies work was the result of a nagging neck injury she suffered which was eventually successfully treated with acupuncture. She later came to teach acupuncture and Chinese medicine at DePaul University before entering medical school at Loyola to specialize in family medicine.
Howard’s motivation for learning conventional medicine is an elegant example of the foundation that conventional medicine offers. Howard earned a medical degree because, as she says, she was concerned about treating a sore shoulder with acupuncture while not recognizing that the pain might be caused by an underlying tumor.
Beyond the Medical Specialty
As medical director of the outpatient heart center at the University of Illinois, Dr. Stephen Devries is a rare cardiologist who embraces alternative therapies. Devries describes himself as a preventive cardiologist practicing integrative medicine. Yet it’s obvious that he has one foot firmly planted in the conventional approaches that his medical specialty endorses. Nonetheless, just giving the nod to the fact that medicinal herbs and nutritional supplements can be of benefit puts Devries far ahead of his cardiologist colleagues in acceptance of alternative therapies.
He still believes conventional heart medications usually offer the most valid treatments although he doesn’t stand in the way of patients who insist upon avoiding prescription drugs. "Good health can come from natural sources as well as from prescription medication and certainly many people feel less anxious and concerned about possible side effects from natural approaches."
Devries says a variety of metabolic factors underlie heart disease and his work focuses on identifying them. "The fascinating finding is that the blood tests required to identify these factors are incredibly high tech, but the best treatments for the problems identified are often from natural sources. Lifestyle changes and vitamins are the treatment of choice for many of the newly defined disorders."
Alternative from the Get Go
Some doctors who practice alternative therapies were inclined to do so before they entered medical school. Ross Hauser M.D., an Oak Park physician, says he never had to integrate alternative medicine into his practice since he married a nutritionist during medical school who introduced him to dietary measures for maintenance of his personal health. These personal habits were eventually incorporated into his medical practice, which is comprised largely of alternative therapies rather than any blend with conventional treatments.
Hauser says once physicians begin to learn what alternative medicine has to offer they will never turn back. He insists he is practicing science-based medicine and says he would stand by his treatments — such as prolotherapy for pain, ozone therapy for infection, and chelation therapy for angina — in a court of law.
He advises physicians who want to begin to practice alternative approaches to stick their toe in the water by taking simple dietary histories of their patients. While this is only a starting point, Dr. Hauser says its vital for physicians to recognize the nutritional needs of their patients and use it to begin practicing nutritional medicine — a mainstay of an integrative practice.
Any time an entrenched paradigm like conventional medicine is confronted by a popular challenger — in this case alternative medicine — it will incorporate and assimilate the competition’s best features rather than resist change altogether. It’s apparent this is exactly what is occurring in medicine today. Many physicians may tolerate alternative therapies more so than a decade ago and even prescribe vitamins and give the appearance they are not resisting what patients want, but they aren’t about to be re-trained.
Berndtson says more doctors now prescribe or even sell nutritional supplements, but they need to go beyond merely showcasing alternative therapies. To practice integrative medicine, says Berndtson, "they need to employ a new knowledge base in their everyday problem-solving for patients."
The spectrum of therapies outside of conventional medicine goes by many different names — alternative, complementary, holistic, and integrative. It may be difficult for health care consumers to determine the difference, or even if a particular brand of medicine is really what it says it is. For the moment, branding of medical practice styles is muddy. Patients will need to interview their doctors about the exact approach to their practice of medicine.
While physicians today may begin to dabble in alternative medicine by integrating massage or acupuncture into their services, Hauser says patients today are looking for a doctor with experience and a good reputation in alternative therapies because they are largely paying for these services out of their pocket rather than by insurance coverage.
Does practicing in an integrative fashion make financial sense for physicians? The doctors interviewed for this story say yes, but Berndtson advises doctors who are considering a transition to integrative medicine to add physical medicine (i.e. occupational and rehabilitative therapy), to their menu of services. Physical medicine, while a conventional medicine mainstay, is non-invasive, hands-on, and covered by most health insurance companies. He says these services will help keep medical practices financially viable as physicians move away from the drug and surgery financial juggernauts of conventional medicine.
In a truly market-based, free enterprise health care system, competition should have filled the demand for alternative modalities. In reality, that hasn’t happened. The biases in physician training and the handcuffing policies of insurance companies and health plans have thwarted all but the slowest evolution in American medicine.
Bill Sardi is a health journalist and consumer advocate for the Web site www.askbillsardi.com. His latest book is How To Live 100 Years Without Growing Old.
Doctors in This Story:
Keith Berndtson, M.D., Integrative Care Centers, Chicago; 773-472-2600;
Stephen Devries, M.D., University of Illinois Medical Center, Chicago; 800-842-1002
Ross Hauser, M.D., Caring Medical and Rehabilitation Services, Oak Park, IL; 708-848-7789
John Hicks, M.D., Pathways Medical Advocates, Grayslake, IL; 262-740-3000 (WI main office)
Martha Howard, M.D., Wellness Associates of Chicago; 773-935-6377