Monday, December 18, 2006
Center's opening signals growth of integrative approach
By JOY BUCHANAN
Glowing candlelight softly illuminates the doctor's exam room, where the only sound is the muted tick of a small clock.
Andrea Wheeler lies on a padded table with her eyes closed.
Dr. Dainia Baugh circles her hand over Wheeler's head without touching her. Then she forms circles over her chest and stomach before sweeping a hand from the top of Wheeler's head to her feet and flicking her fingers as if she's shaking off crumbs.
Baugh completes the Reiki treatment, used to move energy through the body.
Not a typical medical setting, not a typical visit to the doctor. Baugh, owner of Nima Holistic Wellness in Nashville, is one of a handful of local doctors who combine unconventional therapies with Western medicine, such as drugs and surgery, in an approach called integrative medicine.
The recent opening of the Center for Integrative Health at Vanderbilt University Medical Center may signal growing acceptance of the approach.
Internet-savvy patients and people desperate for relief that Western medicine hasn't provided are asking for different therapies than doctors typically offer — but they still want the expertise and credibility of an M.D.
Wheeler came to Baugh because she was dissatisfied with the typical doctor visit.
"It felt all physical. They never really asked how I was doing," she said. "They're going to give you a medicine and tell you what to do. I was looking for more."
Wheeler wasn't sick when she came to Baugh, but she said the Reiki treatment helps her feel more alert and energized. She's also lost 20 pounds.
While a traditional doctor may prescribe medication for high blood pressure, an integrative physician probably will ask about diet, exercise, stress and family life. Such doctors often perform lab tests and take a complete medical history to develop a medical plan.
For advocates of integrative medicine, neither conventional medicine nor complementary therapies are enough on their own.
"I think our approach to alternative medicine is a little different because it's more scientific," Baugh said.
Studied therapies used
Complementary and alternative medicine, also known as CAM, includes diverse medical practices and products not part of conventional medicine. Therapies used alone are often referred to as alternative. When used in tandem with conventional medicine, they're considered complementary.
But integrative medicine is different from complementary because a team of practitioners works with a patient and, typically, a doctor monitors the patient's progress. The other critical factor is evidence.
Advocates of integrative medicine mostly use therapies proved to be safe and effective by scientifically valid studies, though they also may use treatments that are being studied if the methods show benefits for patients.
Integrated medicine is the focus of the new Vanderbilt center, which employs an acupuncturist, two yoga instructors and four massage therapists, among others.
Dr. Roy Elam is the center's medical director and lone doctor, and he believes the integrated approach fills a gap in medicine when people are not helped by conventional means.
"The system works great if you sail through it and everything works and you feel great," he said.
"But if you're one of those patients who are struggling and the procedures and the medications are not helping, you get lost. There's no place for you to go."
More adopt approach
The approach is catching on nationally. The American Hospital Association reported that the number of hospitals offering these therapies has risen from 7.7 percent in 1998 to 18.3 percent in 2005.
The most popular therapies offered on an outpatient basis are massage, tai chi, qigong, relaxation training and yoga.
According to the Association of American Medical Colleges, 78 percent of schools require students to take a complementary medicine course compared with 21 percent in 2001. Vanderbilt offers such classes, but Meharry Medical College does not.
Yang Guo is a third-year med ical student at Meharry interested in integrative medicine. "I like the whole philosophy to be able to heal people with as many options as possible," she said.
She acknowledges that someone who's been in a car wreck or is having a heart attack needs surgery and drugs, not herbs, but integrative medicine is about prevention and maintenance, not life-and-death intervention.
"If we want people to accept this, we have to go out and make them see that this is not just some other type of medicine," Guo said. "It's a way of life."
Patients drive trend
While some doctors gravitate toward integrative health care, the trend is largely driven by patient demand.
About 87 percent of the nation's hospitals that offer complementary therapy do it because patients ask for it, according to the American Hospital Association.
Dr. Stephen Reisman owns Mind-Body Medical Center in Nashville. Patients come to him because they want to take fewer prescriptions or because years of medicine, surgery and testing haven't cured their illness or made them feel better.
Tabb Loveless, 39, of Columbia was a skeptic.
"I would have told you, 'Don't go see some goon who's going to give you some herbal tea to drink and, voila, you're better.' "
He came to Reisman in desperation. Nearly two years ago, he was diagnosed with multiple sclerosis, a debilitating disease of the nervous system.
The diagnosis shocked Loveless. He immediately began steroid therapy and special injections he'd have to continue for life, but his symptoms didn't improve.
"It got to where I could hardly walk," he said. "The last straw came when I went to the mailbox but got so tired that I sat down on the lawn for 20 minutes. I couldn't go back to the house."
His own research pointed to Lyme disease, but his doctors dismissed it. Finally, Loveless took a friend's suggestion to see Reisman. The doctor also suspected Lyme, and a lab test confirmed it.
Reisman prescribed antibiotics, a five-day fast and detox on little more than juice and supplements to rid his body of the steroids and injections. Loveless has improved dramatically, with just occasional tingling in his legs. More recent medical tests have ruled out MS.
"I'm convinced now that the mind-body connection is strong," he said.
Despite growing interest in integrative therapies, skeptics abound.
"I think skepticism is good in medicine," said Dr. Donna Seger, medical director of the Tennessee Poison Control Center.
"You don't want to dismiss therapies that may prove beneficial to patients, but you want a physician to be skeptical, too, so they don't adopt therapies that are unproven and may not be safe."
Seger said people should always check with their primary care doctor before using any supplement, procedure or therapy.
"We don't have surgeons doing surgeries without the proper certifications or surgery that isn't up to the standard of care," she said. "We shouldn't have physicians doing therapies that aren't scientifically sound either."
Baugh doesn't disagree. She said people may feel better using a method that isn't proved to work, and that's fine, so long as they don't quit a proven therapy.
Integrative-medicine doctors who are trusted by patients are often trusted by doctors, too. Most of Baugh's patients initially came from recommendations and word of mouth. In the past year, many of her patients are coming from other, more traditional doctors whom she has sent patients to for acute or advanced care.
Elam said most of the integrated health center's patients come from other Vanderbilt doctors.
"We don't see ourselves as providing services as an alternative to traditional medicine," he said. "When research documents that this works and the outcomes are positive, then this is the way medicine will go."