At age 68, Martha McInnis has had her share of health woes: breast cancer, high cholesterol, clogged arteries, osteoporosis, and scoliosis — curvature of the spine. Once a year she journeys from her home in Alabama to the Duke University Medical Center in North Carolina where an internist, endocrinologist, and other specialists monitor her with blood tests, X-rays, bone scans, and other tests.

But McInnis knows that she’s more than the sum of her illnesses. When her checkup ends, she heads for the Duke Center for Integrative Medicine, where she has learned about nutrition, fitness, yoga, tai chi, meditation, and other practices she says have helped her to live better. “I became an avid tai chi person,” she says. “I’m a type A personality. I knew I had to do something about my lifestyle. I had to bring myself down to a type B.”

Many Americans have never heard of integrative medicine, but this holistic movement has left its imprint on many of the nation’s hospitals, universities, and medical schools.
Treating the Whole Person

Both doctors and patients alike are bonding with the philosophy of integrative medicine and its whole-person approach — designed to treat the person, not just the disease.

IM, as it’s often called, depends on a partnership between the patient and the doctor, where the goal is to treat the mind, body, and spirit, all at the same time.

While some of the therapies used may be nonconventional, a guiding principle within integrative medicine is to use therapies that have some high-quality evidence to support them.

Conventional and Alternative Approaches

The Duke Center for Integrative Medicine is a classic model of integrative care. It combines conventional Western medicine with alternative or complementary treatments, such as herbal medicine, acupuncture, massage, biofeedback, yoga, and stress reduction techniques — all in the effort to treat the whole person. Proponents prefer the term “complementary” to emphasize that such treatments are used with mainstream medicine, not as replacements or alternatives.

Integrative medicine got a boost of greater public awareness — and funding — after a landmark 1993 study. That study showed that one in three Americans had used an alternative therapy, often under the medical radar.

In the past decade, integrative medicine centers have opened across the country. According to the American Hospital Association, the percentage of U.S. hospitals that offer complementary therapies has more than doubled in less than a decade, from 8.6% in 1998 to almost 20% in 2004. Another 24% of hospitals said they planned to add complementary therapies in the future. Patients usually pay out of pocket, although some services — such as nutritional counseling, chiropractic treatments, and biofeedback — are more likely to be reimbursed by insurance.

The Appeal of Integrative Medicine

What makes integrative medicine appealing? Advocates point to deep dissatisfaction with a health care system that often leaves doctors feeling rushed and overwhelmed and patients feeling as if they’re nothing more than diseased livers or damaged joints. Integrative medicine seems to promise more time, more attention, and a broader approach to healing — one that is not based solely on the Western biomedical model, but also draws from other cultures.

“Patients want to be considered whole human beings in the context of their world,” says Esther Sternberg, MD, a National Institutes of Health senior scientist and author of The Balance Within: The Science Connecting Health and Emotions.

The Mind-Body Connection

Sternberg, a researcher who has done groundbreaking work on interactions between the brain and the immune system, says technological breakthroughs in science during the past decade have convinced even skeptics that the mind-body connection is real.

“Physicians and academic researchers finally have the science to understand the connection between the brain and the immune system, emotions and disease,” she says. “All of that we can now finally understand in terms of sophisticated biology.”

That newfound knowledge may help doctors to see why an integrative approach is important, she says.

“It’s no longer considered fringe,” Sternberg says. “Medical students are being taught to think in an integrated way about the patient, and ultimately, that will improve the management of illness at all levels.”

The Osher Center for Integrative Medicine at the University of California, San Francisco, takes a similarly broad view of health and disease. The center, which includes a patient clinic, says on its web site: “Integrative medicine seeks to incorporate treatment options from conventional and alternative approaches, taking into account not only physical symptoms, but also psychological, social and spiritual aspects of health and illness.”

To promote integrative medicine at the national level, the Osher Center and Duke have joined with 42 other academic medical centers — including those at Harvard, Columbia, Georgetown, and the University of Pennsylvania — to form the Consortium of Academic Health Centers for Integrative Medicine.

Medical Schools and Integrative Medicine

Even medical schools have added courses on nontraditional therapies, although doing so can sometimes be a point of contention among faculty.

At the University of California, San Francisco, medical students can augment their coursework in infectious disease and immunology with electives, such as “Herbs and Dietary Supplements” or “Massage and Meditation.” They can even opt to study as exchange students at the American College of Traditional Chinese Medicine. In the world of integrative medicine, it’s not unusual to see a Western-trained MD who also has credentials in acupuncture or hypnosis, or a registered nurse who is also a yoga teacher and massage therapist.

Opposing Views

Not all doctors are jumping onboard, though. Some critics have charged that integrative medicine is driven largely by market forces, as well as public fascination and demand for alternative treatments.

“This is a very faddish country,” says Tom Delbanco, MD, a Harvard Medical School professor and doctor at Beth Israel Deaconess Medical Center in Boston. In one national survey of hospitals that offer complementary therapies, 44% listed “physician resistance” as one of the top three hurdles in implementing programs, along with “budgetary constraints” (65%) and “lack of evidence-based research” (39%).

Delbanco says he’s concerned that there’s not enough scientific evidence to justify the amount of resources spent on integrative medicine and complementary therapies. “I worry that people are making claims in the context of scientific medicine that they cannot really justify. I think there have been few rigorously controlled, scientifically sound studies in the area, and when they have been done, the vast majority have shown these medicines to be no different from placebo.”

“I have no trouble with offering hope,” he adds. “I think people need hope and optimism. Where I have trouble is when we promise things to people that aren’t real.”

Finding the Evidence

The search for solid evidence is key: which therapies help and which don’t? “There’s a clamoring for understanding the biology of this,” Sternberg says. Many proponents of integrative care say that it’s crucial to hold alternative therapies up to scientific scrutiny, rather than dismissing them outright, because doctors and patients alike need answers. For example, a patient may be taking an herb that is harmful or may interfere with prescription drugs.

As a result, researchers across the country are studying complementary and alternative therapies for safety and effectiveness. Duke is studying whether stress-reduction techniques, such as meditation and writing in a journal, can help prevent preterm labor, which can be precipitated by stress-related hormones. In other clinical trials, researchers are trying to determine, among other things, how acupuncture affects brain activity, how biofeedback can better treat incontinence, and whether the medicinal herb valerian improves sleep in patients with Parkinson’s disease.

With the large numbers of people using nontraditional therapies, even finding out what doesn’t work can be valuable. For example, researchers affiliated with the Osher Center at the University of California, San Francisco, completed a study that showed that saw palmetto did not improve benign prostate hyperplasia, a noncancerous enlargement of the prostate gland. More than 2 million men in the U.S. take saw palmetto as an alternative to drugs. The results were published in The New England Journal of Medicine.

Tracy Gaudet, MD, director of the Duke Center for Integrative Medicine, says she encounters little resistance once fellow doctors understand that integrative medicine doesn’t entail “blindly advocating for alternative approaches and rejecting conventional ones.”

“That’s not what we’re about,” she says. “There’s a lot of quackery out there and a lot of dangerous therapies. Our first priority is to guide people away from them.”

“We all want the same thing: the best care for patients,” Gaudet says.

One Columbus, Ohio-based doctor and ovarian cancer survivor wants women (and men) to know that they don’t have to live with all the side effects from cancer treatment that affect their appearance. As a skin care professional, you might consider creating a menu designed specifically for cancer patients, whose regime changes dramatically during such a difficult time. Not only could such tips help prevent premature aging of the skin, but more importantly, it could help an underserved client realize that he or she deserves special care.

Dr. Carol Clinton, founder of Timeless Skin Solutions (www.timelessskinsolutions.com) was diagnosed with ovarian cancer at the same time she was opening her very own medical-based skin care practice. She was concerned about the reaction her patients might have to her ever-changing appearance—hair loss, scaly skin, etc.  But instead of hiding behind masks and wearing wigs, Dr. Clinton embraced the changes and took control.  She proudly showcased her cancer battle, and in return, she discovered things patients can do to feel beautiful. Now cancer-free, Clinton share tips on how to approach and care for skin care clients who are undergoing treatment for cancer:

*Recommend a cleanser that is gentle for the skin. Many treatments during illness can cause skin to become very sensitive, break out easily or develop rashes. Avoid performing harsher glycolic treatments on cancer patients. Also, strongly suggest that they wear a moisturizer with sunscreen.

*Encourage patients to schedule a facial every month. Perhaps you can partner with your local branch of the American Cancer Society to create a special monthly promotion designed to pamper those suffering from cancer. Explain to such patients that their skin will not turn over in its normal 28-day process, which will result in a sallow and tired look.

*Don’t neglect their scalp. When a cancer patient comes to you for a basic facial, suggest a scalp treatment, as well. This is especially important for men and women who have lost their hair in chemotherapy sessions and are covering their scalp with a wig most of the day. Microdermabrasion for the face and scalp would be an effective offering.

*Finally, if they wear makeup, be sure it’s mineral based. Invest in a good mineral-based cosmetic line. Zinc and copper are particularly soothing to the skin. Make the client feel beautiful and confident. Her skin tone has likely changed, so when she visits your spa, offer her a complimentary makeup application and lesson.

*Laser treatments, Botox and facial fillers are not out of the picture during treatment.Have clients first check with their physician to be sure that their particular medical state doesn’t prevent them from smoothing a few lines here and there. Giving them skin that looks healthy and vibrant will help them face some of the tougher days with a better outlook.

By Renew @ insidethespa.com

Presents
Shin Lin, PhD
Professor of Cell Biology, Neuroscience, & Biomedical Engineering
Dr. Lin is on the faculty of the Samueli Center and a long-time collaborator with researchers at the Shanghai University of Traditional Chinese Medicine. He is currently a member of the National Advisory Council on Complementary and Alternative Medicine at the National Institutes of Health and serves on the editorial boards of the Journal of Alternative & Complementary Medicine and the journal Chinese Medicine.

“Frontiers in the Integration of Eastern and Western Medicine”

After a brief introduction to the fundamental differences between Traditional Chinese Medicine and Western medicine, Dr. Lin will give an overview of how modern biomedical technologies are applied in the mechanistic research on herbal medicine and Eastern mind-body practices. This will be followed by examples of the integrative use of Eastern and Western therapies to treat complicated diseases such as diabetes and cancer, and an inside look into some of the largest and most advanced hospitals for integrative medicine in China.