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Alternative medicine in the mainstream


02/18/04

ANDY DWORKIN

For 25 years, Maria Fotis has faced down breast cancer as a nurse and, starting two years ago, as a patient herself.


But on a recent Friday, the Providence Portland nurse found herself in a health care position she had never encountered -- stretched out on a massage table.

Fotis got a long, relaxing massage courtesy of Rebecca Harrison, a Portland massage therapist who specializes in working with cancer patients. Starting this month, Harrison is working alongside an acupuncturist, a naturopathic doctor and an internal medicine doctor in Providence's new Integrative Medicine Clinics, which let cancer patients blend such alternative therapies with more traditional drug-based, or allopathic, care.

Alternative treatments are nothing new -- in fact, many stem from traditions centuries old. And some patients and medics have long been interested in mixing modern and ancient therapies, especially in Portland, home to major colleges for traditional Asian, naturopathic and chiropractic healing.

But most big, traditional health systems and medical insurers have ignored alternative therapies, saying they are not scientifically proven to work. That is changing, with hospital systems increasingly embracing them. A survey by the American Association of Hospitals found that 16.6 percent of U.S. hospitals offered such services in 2002, up from 7.9 percent in 1998.

Several health systems in the Portland area started such programs in recent years, responding largely to patient demand as well as to some doctors' interests. They generally treat three broad categories of illness: chronic pain, side effects caused by traditional treatments and chronic diseases that have poor records of treatment with standard medicine.

The programs aim to address the biggest criticism of alternative medicine -- poor scientific grounding -- by researching treatments carefully and offering only those supported by evidence.

"We're trying to be very cautious and very careful, and have a high degree of reason," said Ken Weizer, the naturopathic doctor involved in Providence's effort.

The Providence program focuses on cancer patients because surveys show that more than half of them pursue some form of alternative treatment, from herbal pills to acupuncture. The reason could be that "conventional therapy leaves something to be desired," with sometimes low cure rates and serious side effects, said Dr. Miles Hassell, medical director of Providence Cancer Center's new Integrative Medicine Program.

Hassell said the program will focus not on curing cancer but rather on relieving pain, exhaustion, nausea and other cancer symptoms or drug side effects. His interest lies in studying diet and exercise, such as whether flax seed can slow the growth of breast cancer. Acupuncture and massage aim to ease side effects such as nausea and pain.

The alternative therapies also aim to boost physical and mental health by easing stress -- the benefit Fotis saw after her massage.

"The physical effects of the massage lasted about a day and one-half. The feeling of well-being lasted all weekend," she said. "I made an appointment for another massage before I left."

Harrison, the Providence clinic's massage therapist, said conventional medicine sometimes ignores the emotional and psychological aspects of cancer that alternative therapies address.

"When (patients) are in crisis, in the hospital, it's almost a spiritual thing for some people" to get a massage, Harrison said. "They say it's the first chance for their body to feel good."

Kaiser Permanente programs

Other big Portland-area health systems have alternative medicine programs, including research projects paid for by the National Institutes of Health. The agency increased its alternative medicine budget from $50 million in 1999 to $117 million in fiscal 2004.

Kaiser Permanente's Portland-based Center for Health Research won one of the first grants. Kaiser researchers are studying several alternative treatments for facial and dental problems with colleagues from Oregon Health & Science University and the major alternative-medicine colleges in Portland, said Nancy Vuckovic, one of the Kaiser researchers.

The center is working to finish two trials involving problems with the temporomandibular joint, which can cause extreme jaw pain. The trials compare standard medical treatment with acupuncture, chiropractic care, massage, naturopathic remedies and traditional Chinese medicine. Another study looks at an herbal remedy for adult gum disease.

"We had really good response from people that we recruited for the studies," Vuckovic said. "People seem quite interested" in taking part in such research.

Kaiser has launched other studies on alternative treatments ranging from the Atkins diet to treating temporomandibular pain with "shamanistic healing," which Vuckovic described as "a form of spiritual healing, where the practitioner works with the client to try to resolve old issues."

Kaiser also runs a weekly natural medicine clinic for patients, group sessions that can lead to later one-on-one care, said Dr. Charles Elder, who runs the clinic. Elder is an internal medicine specialist who also has studied Ayurvedic medicine, an ancient Indian health system.

The weekly clinics focus on "diet, meditation, exercise, daily routine (changes) and herbs," Elder said. Patients seek help for varied complaints, including digestive problems, allergies, depression, cancer and menopausal problems.

OHSU gets grants

Federal grants also help pay for OHSU's alternative medicine work, which includes a program focused on neurologic disorders and an Integrative Medicine Clinic in OHSU's Center for Women's Health.

Dr. Wendy Kohatsu, an assistant professor of family medicine who helps run the Women's Center clinic, said its patients include men and women, ranging in age from their 20s to their 80s. Patients seek treatment for "a lot of conditions that allopathic medicine doesn't have answers for," she said, such as obesity and autoimmune diseases, as well as for food allergies and heart disease.

The OHSU and Kaiser programs include opportunities to teach doctors and medical students more about alternative medicine.

Skepticism remains

Doctors involved with the alternative medicine programs at leading Portland-area health systems said other doctors generally seem to accept the programs, though "there will always be some people who have skepticism," Kohatsu said. "And I think some skepticism is good."

Insurance companies are most skeptical. Kaiser's health plan covers some alternative care, Elder said, and the OHSU clinic can bill initial visits, at least. But many insurance plans cover few or no alternative therapies. Because of that, the new Providence clinics are not offering insurance billing services and are running on patient fees, Hassell said.

That could change, he added, if scientific research studies help prove that alternative therapies do ease patients' pain.

"I think we're all trying to find the best answers," Hassell said. "In reality, we should only have two types of medicine: good and bad. We shouldn't have integrative medicine and conventional."

Andy Dworkin: 503-221-8239; andydworkin@news.oregonian.com

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Moderator - State Licensing Forum

Still skeptical after all these years.
This is it. There are no hidden meanings.WYSIWYG

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There is a study stating that Omega3's can be used as a treatment for chronic back pain or arthritis, rather than NSAIDs. So now food is becoming more a therapy. like i was saying before.