Small Doses Of Acceptance

Alternative medicine is slowly gaining ground in the Western medical world


Suffering from multiple sclerosis, Cynthia Crowner sees her neurologist and physiatrist regularly. But the 57-year-old Annapolis resident also pays regular visits to a spacious examining room on the wooded campus of the University of Maryland's Kernan Hospital near Dickeyville.

There she discusses her degenerative nerve disease with Dr. Brian Berman, a family medicine professor who runs the university's Center for Integrative Medicine.

Satisfied that Berman has heard her out, Crowner leaves with a bottle of homeopathic pills and advice to add seaweed to her diet. "They don't treat you like an idiot," she says of her health care team.

After 15 years at the center he founded, Berman believes health care increasingly will look like Crowner's regimen -- integrating Western practices with those from other traditions, such as yoga, meditation, acupuncture and Chinese herbal treatments.

The center is one of a few in the nation that does all of those things and more, operating a clinic, conducting research into the effectiveness of alternative medicine and spreading word of its findings to the public and the medical profession.

So far, however, Berman and other advocates have had more success with patients than with medical peers. Their work also illustrates the fine ethical line that some practitioners of "integrative" medicine must walk -- dispensing treatments proven in clinical trials along with therapies that they and their patients believe in but which haven't been subjected to rigorous scientific testing.

Robert Stover, for example, is among the millions of Americans who, according to the U.S. Centers for Disease Control and Prevention, use some form of alternative medicine every day.

At the UM clinic, the 53-year-old Rockdale resident receives acupuncture, along with a form of Chinese massage known as Tui Na and a variety of traditional and homeopathic drugs, some designed to stimulate his immune system to ward off allergies.

His visits were among 3,100 the center recorded in fiscal 2005, and it projects 3,600 visits this fiscal year

Stover hasn't found a cure for his migraines, but he has found satisfaction at the center, which emphasizes identifying and avoiding the factors that trigger his problems, as well as treating them.

"I pretty much zeroed in on it after I came here," Stover says of learning which environmental factors to avoid -- a list that included the kind of paper found in catalogs, phone books and computer printouts.

Despite their popularity with patients, Berman and his colleagues have persuaded few University of Maryland doctors outside the center to integrate alternative medicine into their practices.

This reluctance appears to mirror national trends, even as studies show increasing numbers of Americans are using alternative medicine on their own. An Institute of Medicine report shows that 62 percent of adults used some sort of complementary medicine in 2002, up from 29 percent three years earlier.

Proponents say physicians will be more likely to adopt alternative medicine as rigorous studies show which treatments are effective.

Connections made

There have been some apparent successes. For example, University of Maryland researchers told colleagues at a scientific meeting late last year that a small study has linked meditation and yoga with alleviation of some rheumatoid arthritis symptoms -- including inflammation and psychological distress.

Other studies have shown what doesn't work, as well as integrative combinations that might be dangerous.

HIV patients on the protease inhibitor indinavir, for example, saw the level of the drug in their systems suppressed when they took the mild depression treatment Saint-John's-wort at the same time, National Institutes of Health researchers reported in 2000.

Still, Dr. Stephen E. Straus, director of the NIH's National Center for Complementary and Alternative Medicine, says integrative medicine is a long-term trend.

"Medicine is not only changing because of the evolution of new technologies: It has been integrating all along," Straus says, noting that the increasing acceptance of acupuncture and chiropractic is evidence of that. "Whether organized medicine has fully accepted chiropractors or not is not quite the same as whether the public has accepted it and whether insurers have accepted it, and they have."

As the research continues, Berman cares for Stover and other patients in a beautifully appointed clinic that features free tea, a tiny waiting room waterfall and halls lined with Eastern art.

In deciding how to treat his patients, Berman says he relies on a relatively small number of existing studies and his own experience.

"You are doing the best you can at this stage with the evidence that's available," he says, adding that the same can be said for Western medicine.

Still, the study of alternative medicine faces unique challenges and barriers, according to a strategic plan developed for the NIH.

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