The Evolution of
Integrative Medicine

Traditional healing systems that help provide a complete approach
to health long advocated by Energy Times are moving toward
acceptance in mainstream medicine.


September 2011

By Linda Melone

In its 20 years, Energy Times has sought to educate its readers about healing traditions designed to
preserve health by treating the root causes of disease instead of reducing symptoms through
prescription medication. From our earliest issues, we have presented stories on Chinese medicine, Ayurveda and other prevention-based systems—practices that are considered “alternative” in a
society in which healthcare costs of $2.5 trillion (as of 2009) are “normal.” To celebrate our 20th anniversary, we thought we’d look at how alternative medicine is being integrated into standard medical practice.“Teach children to read labels when shopping and to choose vegetables and fruits just as you teach them to brush their teeth,” Johnson says. “Social and cultural influences may increase the challenge, but parents still teach best by example.”

The time is in the not-too-distant future and the setting is the office of a standard MD: After complaining of migraines and other ailments, a woman walks out with a script for prescription medication. But she also receives a sheet of suggested yoga poses along with a recommendation that she keep a food diary to help pinpoint the cause of her pain.

Considered “alternative” medicine when Energy Times began publishing in 1991, practices such as yoga, acupuncture, music therapy and deep-tissue massage are increasingly being incorporated into treatment plans by conventional doctors and major hospitals on a regular basis.

“We use the term ‘integrative’ rather than ‘alternative’ medicine, because it’s not really an alternative but a complementary approach,” says Stefan Friedrichsdorf, MD, medical director of the Pain and Palliative Care Program at the Children’s Hospitals and Clinics of Minnesota, the largest integrative program for children in the US.

Friedrichsdorf often uses a combination of pain medicine along with self-hypnosis techniques to treat his young patients. Five massage therapists on staff help patients with pain management. “We combine western medicine with integrative, non-pharmacological modalities. It’s very well liked and there’s good data to support its effectiveness,” says Friedsrichdorf.

Greater Acceptance

The treatments employed at Children’s Hospitals are part of a rapidly growing trend. A recent Consumer Reports survey found that roughly 75% of all Americans have turned to therapies such as yoga and acupuncture for relief of what ails them. According to the report, more than 38 million adults make more than 300 million visits per year to chiropractors, massage therapists, acupuncturists and other practitioners of what used to be considered “alternative” techniques.

Survey respondents have found many of these therapies helpful. Of those who use meditation, 42% say it helps anxiety. Deep-tissue massage, Pilates, yoga and chiropractic treatment rated the same as prescription medication for back pain.

The way these treatments work isn’t always clear and don’t always have the science to back them, which makes some standard physicians hesitant to recommend them. Those practices supported by standard research studies, such as acupuncture, find the greatest acceptance among health care professionals and institutions.

David K. Walmar, MD, PhD, division chief of endocrinology and fertility at Duke Fertility Center in Durham, North Carolina, recommends acupuncture for patients who are trying to conceive, even though he believes the jury is still out regarding acupuncture’s effectiveness in promoting fertility.

“However, we know that acupuncture helps in relaxation, so we’ve built acupuncture into a
de-stressing program to help couples deal with a stressful process,” says Walmar.

Another part of Duke Health, Duke Integrative Medicine, focuses exclusively on integrative and proven complementary approaches to health care. Programs include yoga and numerous mind-body approaches including nutrition and fitness programs.
Institutional Choices

Supporting Supplement Availability

One popular way to help maintain health and well-being is through the use of nutritional supplements, often on the recommendation of a naturopathic doctor or other complementary medicine professional. Energy Times has covered supplement regulation from early in its history, starting with the push to pass the Dietary Supplement Health and Education Act (DSHEA), which classified supplements as foods instead of drugs, in 1994. As he signed the bill, President Bill Clinton said the passage of DSHEA “speaks to the diligence with which an unofficial army of nutritionally
conscious people worked democratically to change the laws in an area deeply important to them.” Today, Energy Times continues to monitor regulatory and other issues involving the public’s access to supplements
via its Washington Update page through its partnership with the Nutritional Health Alliance (NHA).

In addition, Energy Times has covered other supplement-related topics. A 1992 story took manufacturers who used inferior ingredients to task. In 2008, ET ran articles in April and June on raw ingredient price hikes. And January 2011’s “Healthful Synergy” focused on the health benefits of supplements based on whole foods.

Hospitals that employ integrative medicine often present their patients with a wide range of options. “Patients are amazed that a hospital offers these services,” says Michelle L. Smith, DC, head of Integrative Medicine and Therapy Services at St. John’s Mercy Medical Center in St. Louis.

St. John’s provides traditional Chinese medicine, including acupuncture, as well as meditation, guided imagery and other therapies, including healing harp music, healing touch and massage.

Auriculotherapy, which uses electricity to stimulate an acupuncture point in the ear, is used to treat low back pain, carpal tunnel syndrome, nausea and even substance addiction. “Patients enjoy receiving these therapies in a safe and comprehensive approach to care,” says Smith. The favorite integrative treatment among patients: massage. “It’s the most requested treatment.”

Standard medical practitioners in various fields and forms are starting to embrace integrative medicine, as Energy Times reported in an April 2010 story on holistic nursing and a September 2005 story on holistic pediatrics. Hilary Garivaltis, president of the National Ayurvedic Medical Association (www.ayurveda-nama.org), agrees. NAMA promotes Ayurveda, India’s traditional healing system in which yoga plays an important role. “Yoga has made headway and Reiki [a form of energy healing] shows up quite a bit in hospitals as well,” notes Garivaltis.

Specialty yoga, such as yoga for cancer patients, has become more popular, too. “Yoga and Ayurveda can target specific things using techniques to balance a particular disorder or illness, using postures, pranayama [yogic breathing techniques] and so on,” says Garivaltis. As the dean of the Kripalu Center for Yoga and Health in Stockbridge, Massachusetts, Garivaltis sees many referrals from doctors who send patients to the center for stress reduction training.

Acupuncture is already widely accepted in helping to treat pain. “It’s much more of a science in pain
management with its own system analysis in balancing the whole body, opening the pranic flow or chi to allow the body to heal itself—as yoga does,” says Garivaltis. Such approaches to healing can embrace everything from symptom control to disorders such as heart disease, a topic Energy Times covered in the February 2004 story, “Centering Your Heart.”

One reason complementary medicine is gaining acceptance is the growing amount of research on various alternative therapies. According to the National Library of Medicine, the past year has seen nearly 1,200 studies published on acupuncture, more than 1,400 on herbal medicine and more than 400 on massage therapy. And while not all of these studies have had positive results, many have provided evidence of benefit. For example, a study in the Journal of Bodywork and Movement Therapies (1/11) supports the use of massage in reducing anxiety, depression and pain.

Recognition and Licensure

Naturopathy, which uses diet, supplements and herbs to help the body heal itself, has also seen an upswing in interest. “We get approximately 38,000 unique visitors to our website each month,” says Karen E. Howard, executive director of the American Association of Naturopathic Physicians (www.naturopathic.org), who adds that many of these visitors are searching for naturopathic doctors.

Naturopathic medicine, based on regional press coverage, was previously concentrated on the West Coast and in New England. “Now interest has spread greatly across
the entire country,” says Howard. Energy Times first reported on naturopathy in mid-1996 in the
article “Naturopathic Healing.”

Naturopathy provides an example of how complementary medicine is integrating itself into the medical mainstream. Practicing as a naturopathic doctor requires an ND license, which requires graduating from a four-year, residential naturopathic medical school and passing an extensive postdoctoral board examination. Currently 16 states plus Puerto Rico, the Virgin Islands and the District of Columbia have ND licensing laws. “We continue to expand the scope of practice in states where we’re already licensed and we’re working to increase the number of states that are licensed,” Howard says.

Other therapies have also found more formal recognition. Some 38 states and the District of Columbia regulate massage therapy, according to National Certification Board for Therapeutic Massage and Bodywork (www.ncbtmb.org). In addition, 43 states and the District of Columbia require acupuncture practitioners to be licensed through the National Certification Commission for Acupuncture and Oriental Medicine (www.nccaom.org), which also certifies practitioners in Chinese herb­ology, Oriental medicine and Asian bodywork therapy. (You can find practitioners through either NCCAOM or the American Association of Acupuncture and Oriental Medicine, www.aaaomonline.org.)

All 50 states require chiropractors to practice with a license, although specific education requirements vary from state-to-state, according to the Federation of Chiropractic Licensing Boards (www.fclb.org). Licensure as a homeopathic physician is available only to medical and osteopathic doctors in Arizona, Connecticut and Nevada, according to the National Center for Complementary and Alternative Medicine (www.nccam.nih.gov).

 

Looking to the Future

Howard believes consumers are driving the trend towards integrative medicine. “It’s what they want and they’re largely paying for it out of pocket. What will constitute primary care is a mystery right now,” she says.

Howard says she and many people in her office take advantage of health savings accounts (HSAs) to defray the costs of alternative care. An HSA allows you to pay for current health expenses and save for future costs on a tax-free basis. “It’s one way people have been able to utilize services without having to incur tremendous expense,” says Howard.

Insurance coverage for integrative treatments vary. “In good times, insurance companies may add on ‘bells and whistles’ such as chiropractic and massage, but they’re often the first things to drop off when profit margins are not what they normally are in the insurance world,” says Howard. Or a treatment such as acupuncture may be covered only if it’s performed by a physician. Alternative medicine’s focus on prevention, which tends to be less expensive than treatment, may eventually make it more appealing to both the government and private insurance companies—a topic Energy Times covered in the January 2010 story, “An Ounce of Prevention.”

“There’s still a bias to adopting anything outside of mainstream medicine, yet, the number of doctors involved in issues such as environmental medicine is growing,” says Howard. “In addition, doctors
who are not trained in integrative medicine are also adopting some of the practices on their own,” such as recommending supplements like fish oils to patients.

There is still work to do; Garivaltis believes that merging integrative medicine with traditional medicine is in its beginning stages. “It’s a slow process. Acupuncture has been in this country for 30 years and was not immediately embraced. Now traditional Chinese medicine has developed themselves into full medical schools. But it’s been only in the last five to 10 years that
they’re entered into the mainstream a little bit more,” she says.

Ayurveda, Garivaltis’ specialty, is about “teaching people how to stay in balance and prevent disease. People are looking for that and may not be getting it from traditional, allopathic medicine as a way to take control of their health.”

What’s true for Ayurveda is true for the other alternative healing paths that a growing number of Americans are taking in search of greater well-being.

 

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