From airy-fairy to the real deal: CAM gains credibility in the mainstream
From airy-fairy to the real deal: CAM gains credibility in the mainstream
Prestigious medical centers embrace complementary medicine
Just 10 years ago or so, complementary and alternative medicine (CAM) generally was considered the bailiwick of the fringe — it had no scientific backing and no credibility in the medical community. Gradually, research began to support some CAM practices and slowly but surely acupuncture, chiropractic, massage, meditation, and herbal therapies began finding their way into, and even acceptance by, mainstream medicine.
Now numerous forms of CAM are not only accepted but enthusiastically embraced by some of the most prestigious medical centers in the United States.
A growing number of medical centers have their own CAM centers, a present-day reality that was unthinkable a decade ago. Georgetown, Duke, Beth Israel, Columbia, the University of Pittsburgh, Cedars-Sinai, and many other highly respected and influential medical centers now embrace CAM therapies, and that simple fact has placed the stamp of approval on CAM and broadened its credibility. Those already operating CAM centers say the leadership of prestigious centers is giving smaller and lesser-known institutions the confidence to consider similar programs.
Recent statistics show 83 million Americans spend $27 billion a year on alternative care, much of it out of their own pockets, since few insurance companies will cover complementary therapies, according to a study recently published in the Journal of the American Medical Association.1
Medical care, however, lags behind the demand: Only 13% of U.S. hospitals provide alternative therapies, according to a recent survey of about 1,000 hospitals, published by the Associated Press.
Complementary medicine isn’t an easy sell to the medical establishment, to insurance companies, and even to some physicians and other health care practitioners, says Mary Hardy, MD, medical director of the Cedars-Sinai Integrative Medicine Medical Group in Los Angeles.
Cedars-Sinai’s center, up and running in a building on the Cedars-Sinai main medical campus for more than 18 months, employs a varied staff:
• three physicians, including an osteopath and one trained in medical acupuncture;
• two traditional Chinese medicine practitioners who prescribe herbs and provide acupuncture;
• one massage therapist;
• one aromatherapist;
• an assortment of support staff trained in a variety of mind-body healing modalities.
But the process was more than two years in the making, says Gregory Fontana, MD, a cardiothoracic surgeon and acupuncturist in the Cedars-Sinai group. "There was a lot of enthusiasm and a great deal of internal criticism," he says. "I was called a heart surgeon playing with crystal balls."
There are, however, ways to avoid some of the bumps in the road to getting a CAM center up and running, Hardy points out.
The innovative medical group "has been fairly well and happily integrated into the medical center," says Hardy. "We’ve been accepted quite well because we have been able to demonstrate the benefits of integrative medicine."
She advises health care professionals who would like to see integrative medicine facilities added to their medical centers to ponder several issues in the beginning stages of the process. She recommends asking these questions:
Who are you planning to treat? Will you restrict the center’s scope to certain kinds of diseases? Will you work with chronic disease management only, or will you be open to treating all kinds of illnesses?
What kind of practitioners are you going to bring on board? Depending on what diseases your center will deal with, consider exactly what types of practitioners will fill those needs. How will you pay them?
What questions are your patients asking? "Meet the needs you are asked to meet by the people who count: your patients," says Hardy.
Do you have good administrative support? When you have all the pieces in place, you can execute your plan and present it to administration much more effectively, she says.
Have you secured your referral base? Contact conventional and alternative health care practitioners in your area, she says. "Make sure you’re good to them." Send patients back for return visits to their referring doctors. "Don’t take patients away from them. If it’s a win-win, everyone will succeed and you’ll become a fundamental part of the community."
Do you expect too much from insurance companies? Insurance companies are becoming more open to CAM therapies, but they still don’t pay for most therapies offered in a center like Hardy’s. "As time goes on, we are increasing our ability to show that things work, and sometimes [the techniques] actually save money," she explains.
Inevitably, there will be naysayers within the administrative hierarchy of the hospital and outside it, says Hardy. There are several ways to address their concerns without creating enemies for your plan. She recommends these methods:
Make assurances. "I assure them that we all have one thing in common; we are advocates for the good of our patients, so we have the same goal," Hardy says.
Don’t get defensive. Skeptics have legitimate questions, says Hardy, and they are entitled to data that back up the claims for CAM therapies. "I answer them calmly and carefully and tell them, Here’s what I know clinically and from the literature, and here’s what I know about the safety and efficacy of these therapies,’" she notes.
Cut your losses. For some people with completely closed minds, fighting is a waste of time, says Hardy. "I try to look at the places where we agree, and I point out that [the physician’s] patients are using alternative therapies, so they need to learn about them so they can engage their patients.
"(CAM) isn’t going to go away. The cat’s out of the bag, and it’s too late for that," says Hardy.
Most of the opposition comes from fear, says Hardy. "The strongest challenges will come from those for whom this is a real paradigm challenge." Some physicians are trapped between paradoxical fears — the fear alternative practitioners and alternative therapies may take patients from them and the fear they will lose their patients if they don’t learn more about alternative therapies, says Hardy.
The Cedars-Sinai experience has been very positive, says Fontana. "We are getting more and more calls from other hospitals asking how we set up this program," he says.
Now the hospital’s administrators are pressing for the center to do more, Fontana says. "That’s a nice change. They have become very supportive, and I’d like to think that it’s more than just the fiscal benefits we are providing."
The program is so successful, in fact, that the administration is considering a hospitalwide department of integrative medicine that would include inpatient as well as outpatient care, pain management, and management of chronic diseases.
Center grows from philosophy
For more than a decade, New York’s Beth Israel Medical Center has incorporated complementary healing into patient care by using reiki, biofeedback, yoga, massage, and therapeutic touch in many of the hospital’s departments. Those departments offering alternative treatment include the Cancer Center, the Center for Cardiac and Pulmonary Health, the Department of Pain Medicine and Palliative Care, and the Hyman-Newman Institute for Neurology and Neurosurgery.
Beth Israel’s five-month-old Center for Health and Healing housed in a freestanding facility at Fifth Avenue and 28th Street in Manhattan is a natural result of what had been growing inside the hospital during those years, say hospital officials. The center’s development is the result of about 18 months of planning.
Center executive director Woodson Merrell, MD, a physician and an acupuncturist, says, "We are giving the patients what they want. Integrative medicine is the medicine of the future because it provides more options for everyone. Its focus shifts from disease management to finding the safest and most effective tools for healing the whole patient in partnership with the health care provider. It’s all about patient empowerment."
The interdisciplinary team at Beth Israel has approximately 20 full-time physicians, nurses, nurse practitioners, psychotherapists, and complementary care practitioners. The center features a design based on Feng-shui, the Chinese belief of placement of objects to enhance positive energy flow, and furnishings made from natural and recycled materials. Patients also can use exercise and meditation rooms and a resource library.
"The center feels like a sanctuary, a calm, unhurried oasis where people are soothed and comforted when they walk in the door," he says.
Merrell, developer of one of the nation’s first medical school courses on complementary medicine at Columbia University in New York City, dismisses critics who say complementary therapies are a flash in the pan. "Five to 10 years from now, [holistic approaches to medical care] will be the standard not just for preventive medicine, but for all medical care."
The long road to acceptance has even extended to America’s conservative heartland. Iowa is conservative, not just in political terms, but in medical terms as well, says Sheila Gregan, MSN, MA, administrative director of the 15-month-old Central Iowa Health Systems’ Center for Health and Well-Being in Des Moines. "I guess because of our conservative reputation, people are just amazed we are doing this," she says.
Gregan, a firm believer in laying a strong foundation for a new program like hers, was involved in the last six months of the 2½-year process that brought the fully hospital-funded Center for Health and Well-Being into existence.
The movers and shakers on the ground floor at the Central Iowa Health System started with a multidisciplinary committee to put forth the idea.
Keeping physicians apprised of what is afoot throughout the process is essential to the success of a CAM Center, says Gregan. "It is not necessary to ask their permission but to let them know what you are planning and what you are not planning," she says.
It’s particularly important to put forward the concept of integrative medicine, she says. "We need to let them know we are not going to recommend meditation instead of chemotherapy for cancer, but we may recommend it in addition to more conventional treatments," she says.
She also recommends letting the medical community know about the research base for the modalities that will be offered, "so they know what this is and what it isn’t. There are a lot of misconceptions out there."
Planners of the Iowa CAM center also made a point of attending all section meetings and medical and administrative meetings so that when the topic of the proposed center came up, someone with the facts at hand was available to provide real information. "[We wanted to ensure] there were no surprises for them or for us," Gregan says.
"The community has welcomed us and more and more doctors are becoming open to it," says Gregan of her center, which offers services ranging from acupuncture to natural hormone replacement therapy to yoga and meditation at a freestanding center about six miles from the hospital’s main campus.
"We give patients more of a comfort level because they know we’ve checked out these practitioners," Gregan says.
"People always marvel that we are able to do something like this in Iowa," laughs Gregan. "I tell them, If we can do it in Iowa, you can do it anywhere.’"
Reference
1. Eisenberg D, Davis R, Ettner S, et al. Trends in alternative medicine use in the United States, 1990-1997. Results of a follow-up national survey. JAMA 1998; 280:1,569-1,575.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.