Barbara Wick always had a gut feeling she’d get cancer – and when her younger sister died of breast cancer in 1996, Wick’s concerns became even more concrete. So when she began feeling bloated and experiencing abdominal discomfort a couple of summers ago, she felt certain she knew the diagnosis. When she went to the doctor, her internist told her the symptoms were probably nothing. Wick, 63, insisted on more testing.
Her gynecologist found ovarian cancer. “He told me it didn’t look very good,” says the Chicago-area resident. “I underwent a full hysterectomy and debulking (the removal of as much cancerous tissue as possible), and they removed cancer cells from my abdomen, too.”
After the surgery, Wick’s oncologist started her on the typical routine of chemotherapy. And then he did something that is a relatively new development in conventional medicine: He referred her to an integrative medicine (IM) program. Under the care of Karen Koffler, MD, director of the IM program at Evanston Northwestern Healthcare (ENH) in Glenview, Ill., Wick began to meditate and practice yoga. On Koffler’s advice she made major changes to her diet, cutting sugar because it exacerbates inflammation, and increasing cruciferous vegetables known to help fight cancer. She also sought massage therapy, which decreases stress and eases pain.
Nearly three years later, and 10 months after chemotherapy, Wick believes this integrative approach – blending conventional medical treatments with unconventional therapies – has been essential to her healing.
Wick isn’t alone: Thirty-six percent of Americans used some form of complementary and alternative therapies in 2002, according to a nationwide government survey. Rising healthcare costs – combined with frustration and disappointment about the limitations of conventional medicine – are driving many to explore complementary, alternative and integrative solutions they might have previously overlooked.
What Is Integrative Medicine?
Complementary? Alternative? It’s tempting to lump everything outside of mainstream medical care into one big heap, but the terms describing these new options for healthcare aren’t interchangeable. The National Center for Complementary and Alternative Medicine (NCCAM), a division of the National Institutes of Health, provides these definitions:
Complementary and Alternative Medicine (CAM) is a group of diverse medical and healthcare systems, practices, and products that are not presently considered to be part of conventional medicine. Therapies encompassed by CAM include things like acupuncture, nutrition, chiropractic, herbs, bodywork, yoga, qigong and aromatherapy.
Complementary Medicine is used together with conventional medicine. An example of a complementary therapy is using aromatherapy to help lessen a patient’s discomfort following surgery.
Alternative Medicine is used in place of conventional medicine. An example of an alternative therapy is using a special diet to treat cancer instead of undergoing surgery, radiation or chemotherapy that has been recommended by a conventional doctor.
Integrative Medicine may incorporate any of these therapies, which are finding their way into the conventional medical world. NCCAM defines integrative medicine as the combination of “mainstream medical therapies and CAM therapies for which there is some high-quality scientific evidence of safety and effectiveness.” The U.S. government estimates that CAM is currently a $27 billion industry, according to The New York Times.
The Benefits of Integration
Integrative approaches offer broad appeal in part because they address patient concerns at so many levels. “Some patients seek integrative medicine therapies because their symptoms are not responding to conventional treatment,” explains Gary Deng, MD, a senior physician with Memorial Sloan-Kettering’s Bendheim Integrative Medicine Center in New York City. Other patients, he notes, simply “want to take a holistic approach to their body, mind and spirit to improve health and wellness.”
Complementary and alternative therapies are rooted in this comprehensive approach to wellness, aiming to help the body recover from illness, but also to prevent disease and imbalance from occurring in the first place.
Wick, who still practices the healthy eating habits she learned at the ENH Integrative Medicine Clinic and continues to see Koffler several times a year, believes part of the power of her treatment plan was the time doctors took to get to know her as a whole person. “They looked at every part of my life: health, exercise, cholesterol, family history, and my emotional and psychological needs and concerns – and they listened to what I thought I should do,” she says. “Only then did they give me their advice. I really felt comfortable and cared for.”
She also appreciated that the IM practitioners let her chart her own course for healing. “I revised my whole diet, but I didn’t go whole hog for the macrobiotic diet they suggested. I practiced yoga, but I chose not to do acupuncture or Chinese medicine.” Since beginning the therapies in response to her cancer diagnosis, she’s felt a significant increase in her energy. She credits the IM therapies she practiced for giving her a greater overall sense of health and well-being.
Andrew Weil, MD, widely considered to be the founding father of integrative medicine in the United States, describes this combined approach as an effort to restore “the focus of medicine on health and healing.”
“In addition to providing the best conventional care,” he notes, “integrative medicine focuses on preventive maintenance of health by paying attention to all relative components of lifestyle, including diet, exercise, stress management and emotional well-being. It insists on patients being active participants in their healthcare as well as on physicians viewing patients as whole persons – minds, community members and spiritual beings, as well as physical bodies.”
While working the night shift as an intensive-care-unit physician in 1996, Koffler recognized a patient who had been admitted several times before. Looking around the intensive-care unit at 2 a.m., she realized that her department had become a revolving door. “We patched people up, sent them home, and they often came back again with the same problem,” Koffler recalls. Her epiphany? Physicians are trained to deal with sick people – not to keep people healthy or to prevent them from getting sick in the first place.
Not long after this “aha” moment, Koffler attended a conference where she heard Weil talk about the shortfalls of the conventional medical system – and she promptly enrolled in his IM fellowship program at the University of Arizona, the first of its kind in the United States. That was in 1996.
Around that same time, administrators at ENH in Illinois recognized the growing demand for alternative medicine, and they began to incorporate Weil’s teachings at its clinic. In 1998, the same year that NCCAM was established, just 6 percent of hospitals indicated that CAM services were available to patients, according to the American Hospital Association (AHA). But CAM was catching on, and from 2000 to 2001, the AHA found that 23 percent of the hospitals that responded to the survey offered CAM services.
In the midst of that growth, ENH hired Koffler to lead its IM program in 2001. Meanwhile, numerous healthcare institutions – including Memorial Sloan-Kettering and Duke University – were busily expanding their own IM offerings (see “Profiles in Integration“).
Despite the significant number of Americans who are embracing (or at least dabbling in) integrative medicine – and the dollars being dedicated to such programs by leading health institutions – some questions about complementary medicine remain unanswered. Critics of IM argue that alternative therapies haven’t been adequately studied.
“Integrative medicine lacks scientific basis,” says Jerome Kassirer, MD, former editor of the New England Journal of Medicine and author of On the Take: How Medicine’s Complicity with Big Business Can Endanger Your Health (Oxford University Press, 2005). He asserts that very few studies on alternative medicine test for effectiveness or toxicity. And Congress has never mandated testing of herbal medicines, which the U.S. Food and Drug Administration requires of other drugs.
Advocates of CAM therapies respond that many of these treatments have stood the test of time and have been demonstrated to present far fewer risks and side effects than many conventional treatments and prescription drugs currently approved by the FDA.
Chinese medicine, for example, has been around for 4,000 years. The largely noninvasive system promotes healing by balancing the body’s energy, called Qi (pronounced chee), with acupuncture, herbs, nutrition therapy, bodywork and qigong. It is the third-most sought-after medical treatment in the world.
Advocates also point to research that shows that bodywork, such as massage, can enhance circulation and combat stress, and that psychotherapy can help address emotional issues that underlie physical pain.
Critics like Kassirer remain unimpressed. “In the past three to four years there’s been an attempt to establish such a scientific basis,” he acknowledges, “but often, remedies that are recommended are found to be minimally effective.”
Still, both consumer and scientific interest in IM is growing. And there’s an increasing willingness in both the private and public health sectors to fund more research. NCCAM, for example, designated $123.1 million to fund research in 2005, an increase of $5.4 million from 2004. Doctors such as Memorial Sloan-Kettering’s Deng – an internal medicine physician by training, with a PhD in microbiology and immunology – know that such research is crucial for the advancement of integrative medicine.
The Memorial Sloan-Kettering Bendheim Integrative Medicine Center has 10 ongoing research projects to study the effects of CAM therapies. Their cancer research focuses on controlling symptoms with complementary therapies and using botanical agents (natural remedies) for prevention and treatment. “We are using herbal extracts to target cancer cells directly and looking at the effect on the immune system,” explains Deng. His group is also evaluating whether the use of acupuncture reduces hot flashes, dry mouth, pain and fatigue. “Sometimes we see dramatic results when we use complementary therapies with our patients,” he says.
At the Duke Center for Integrative Medicine at Duke University, director Tracy Gaudet and her team are working with obstetric patients to evaluate how mind-body techniques affect stress and its impact on the onset of labor. They are also studying how mindfulness and meditation help individuals with binge eating disorders regulate their eating patterns and improve their glucose metabolism. Koffler’s team has a grant, in conjunction with the University of Maryland, that’s designed to evaluate the clinical outcomes experienced by patients using an integrative approach.
Studies like these will help determine which CAM therapies are effective treatments for health problems such as cancer, asthma, cardiovascular disease, headaches and hormonal issues. And the IM physicians leading these studies hope that as more sound research is completed, integrative medicine will get more of the respect it has long deserved.
As patients begin demanding integrative care, and as doctors take note of successful patient outcomes, it’s likely that training in (or at least awareness of) integrative methods will find a place in standard medical schooling. Accordingly, the lines between conventional and alternative methods will continue to converge – and perhaps, eventually, to blur.
“Our vision and hope is that the term ‘integrative medicine’ will fall away,” Gaudet explains, “and therapies now considered complementary or alternative will be fully integrated into the standard of care.”