Doctors Who Care: Does Alternative Medicine Work?
I met Brian Berman, A physician of gentle and upbeat demeanor, outside the stately Greek columns that form the facade of one of the nation’s oldest medical-lecture halls, at the edge of the University of Maryland Medical Center in downtown Baltimore.
The research center that Berman directs sits next door, in a much smaller, plainer, but still venerable-looking two-story brick building. A staff of 33 works there, including several physician-researchers and practitioner-researchers, funded in part by $35 million in grants over the past 14 years from the National Institutes of Health, which has named the clinic a Research Center of Excellence. In addition to conducting research, the center provides medical care. Indeed, some patients wait as long as two months to begin treatment there–referrals from physicians all across the medical center have grown beyond the staff’s capacity.
“That’s a big change,” said Berman, laughing. “We used to have trouble getting any physicians here to take us seriously.”
The Center for Integrative Medicine, Berman’s clinic, is focused on alternative medicine, sometimes known as “complementary” or “holistic” medicine. There’s no official list of what alternative medicine actually comprises, but treatments falling under the umbrella typically include acupuncture, homeopathy, chiropractic, herbal medicine, Reiki, meditation, massage, aromatherapy, hypnosis, Ayurveda, and several other treatments not normally prescribed by mainstream doctors. The term integrative medicine refers to the conjunction of these practices with mainstream medical care.
Berman’s clinic is hardly unique. In recent years, integrative medical-research clinics have been springing up all around the country, 42 of them at major academic medical institutions including Harvard, Yale, Duke, the University of California at San Francisco, and the Mayo Clinic.
At one of the University of Maryland Medical Center’s hospitals, I introduced myself to Frank Corasaniti, a 60-year-old retired firefighter who had come in for an acupuncture treatment from Lixing Lao, a PhD physiologist with Berman’s center. Corasaniti had injured his back falling down a steel staircase at a firehouse some 20 years earlier, and had subsequently injured both shoulders and his neck in the line of duty. Four surgeries, including one that fused the vertebrae in his neck, followed by regimens of steroid injections and painkillers, had only left him in increasing pain. He retired from the fire department in 2002 and took a less physically demanding job with Home Depot, but by last year his sharpening pain made even that work too difficult. “I was starting to think I’d have to stop doing everything,” he told me. He was particularly worried that he’d be unable to continue helping out his mother, who had been battling cancer for two years.
His wife, a nurse, urged him to try acupuncture and, with the blessing of his doctor, he finally met with Lao, who had trained in his native China as an acupuncturist. Their first visit lasted well over an hour, covering every aspect of his injuries and other health concerns–weight gain, constipation, urinary problems. They talked about his diet, his physical activity, his responsibilities and how they weighed on him. Lao focused in on stress–what was causing it in Corasaniti’s life, and how did it aggravate the pain?–and they discussed the importance of finding ways to relax in everyday life.
Then Lao had explained how acupuncture would open blocked “energy pathways” in his body, allowing a more normal flow of energy that would lessen his pain and help restore general health. While soothing music played, Lao placed needles in and around the areas where Corasaniti felt pain, and also in his hands and legs, explaining that the energy pathways affecting him ran throughout his body. The needle placement itself took only about three minutes. Lao then asked Corasaniti to lie quietly for a while, and Corasaniti promptly fell asleep, awakening about 20 minutes later when Lao gently roused him. Corasaniti continued to come in for 40-minute sessions twice a week for six weeks, and since then had been coming in once a week.
Though of course alternative-medicine experiences can vary widely, certain aspects of Corasaniti’s visit are typical. These include a long initial meeting covering many details of the patient’s history; a calming atmosphere; an extensive discussion of how to improve diet and exercise; a strong focus on reducing everyday stress; an explanation of how the treatment will unleash the body’s ability to heal itself; assurance that over time the treatment will help both the problem that prompted the visit and also general health; gentle physical contact; and the establishment of frequent follow-up visits.
Corasaniti’s description of the results is fairly typical too. After two months of treatment, the worst area of pain, near his neck, had shrunk from a circle six inches across to the size of quarter, he said. He’d lost 10 pounds, and his constipation and urinary difficulties had cleared up. And because of his progress, he’d been cleared by his doctor to start a vigorous monitored-exercise program aimed at strengthening muscles in a way that should reduce the chances of reinjury, in addition to improving his general fitness.
“I just feel so much better,” he said.
“Dangerous Quackery”: The Alternative Medicine Controversy
“It’s cleverly marketed, dangerous quackery,” says Steven Salzberg, professor of medicine and biostatistics at the Institute of Genetic Medicine at Johns Hopkins University School of Medicine. “These clinics throw together a little homeopathy, a little meditation, a little voodoo, and then they add in a little accepted medicine and call it integrative medicine, so there’s less criticism. There’s only one type of medicine, and that’s medicine whose treatments have been proven to work. These people have been trying to prove their alternative treatments work for years, and they can’t do it. But they won’t admit it and move on. Of course they won’t. They’re making too much money on it.”
On his well-read blog and elsewhere, Salzberg has established himself as an expert on research studies related to alternative medicine–and as one of the angriest voices attacking the field. In particular, he calls for an end to government funding of clinics like Berman’s. He says the funding is in no way based on any genuine belief among scientists that alternative medicine merits further study. Rather, it is propelled by a handful of members of Congress–most notably Tom Harkin of Iowa, chair of the Senate subcommittee that oversees National Institutes of Health funding–who are determined to see their own misplaced faith in alternative medicine validated.
Medical centers are lining up to establish research clinics so that they can take NIH funding for alternative-medicine studies, Salzberg adds. Aggressive marketing of these clinics can also generate substantial patient demand (even a small integrative clinic can take in several million dollars a year). The anecdotal testimony these patients offer merely reflects their gullibility and self-selection into alternative care; subjective symptoms like pain and discomfort, he notes, are susceptible to the power of suggestion. These same symptoms also tend to be cyclical, meaning that people who see a practitioner when their symptoms flare up are likely to see the symptoms moderate, no matter what the practitioner does or doesn’t do. Patients simply misattribute the improvement to the treatment.
The biggest danger of all, Salzberg says, is that patients who see alternative practitioners will stop getting mainstream care altogether: “The more time they spend getting fraudulent treatments, the less time they’ll spend getting treatments that work and that could save their lives.”
It’s not hard to see alternative medicine as a dubious business, or even, in some part, a scam, if one includes all the supplements, devices, and patently absurd therapies that are hawked in magazines and infomercials. Anyone can make vague health claims for almost any reasonably safe product with the appropriate fine print–“The U.S. Food and Drug Administration has neither evaluated nor approved the claims for this product,” for instance. And so the public snatches up millions of hologrammed silicone bracelets that promise to revitalize the fatigued.
Most homeopaths, acupuncturists, and herbalists don’t have an MD and don’t work under the supervision of a physician, so they are free to make exaggerated claims or offer ungrounded advice. It’s difficult to get too worked up about teenagers dropping 20 bucks on a hip but medically useless bracelet, but we should all feel uncomfortable hearing about children with autism being pulled out of behavioral therapy and placed into herbal or spinal-manipulation treatment. About 40 percent of Americans have tried some form of complementary or alternative medicine, and some $35 billion a year is spent on it. A certain amount of abuse seems like a given.
Concerns of outright malpractice or naked hucksterism appear grossly misplaced when they are applied to a clinic like Berman’s. Nonetheless, says Salzberg, the bottom line is that studies clearly show that alternative medicine simply doesn’t work. The scientific literature is replete with careful studies that show, again and again, that virtually all of the core treatments plied by alternative practitioners help patients no more than do “sham” treatments designed to fool patients into thinking they’re getting the treatment when they’re really not. (Even acupuncture can be faked, by tapping the skin in random places with a metal tube; reliably, these taps produce treatment results identical to those of the needles themselves.) “Acupuncture is just a 3,000-year-old relative of bloodletting,” Salzberg told me.
The Drawbacks of Modern Medicine
You might think the weight of the clinical evidence would close the case on alternative medicine, at least in the eyes of mainstream practitioners who aren’t in a position to make a buck on it. Yet many extremely well credentialed scientists and physicians with no skin in the game take issue with the black-and-white view espoused by Salzberg and other critics. And on balance, the medical community seems to be growing more open to alternative medicine’s possibilities, not less. That’s in large part because mainstream medicine itself is failing.
“Modern medicine was formed around successes in fighting infectious disease,” says Elizabeth Blackburn, a biologist at the University of California at San Francisco and a Nobel laureate. “Infectious agents were the big sources of disease and mortality, up until the last century. We could find out what the agent was in a sick patient and attack the agent medically.”
To a large degree, the medical infrastructure we have today was designed with infectious agents in mind. Physician training and practices, hospitals, the pharmaceutical industry, and health insurance all were built around the model of running tests on sick patients to determine which drug or surgical procedure would best deal with some discrete offending agent. The system works very well for that original purpose, against even the most challenging of these agents–as the taming of the AIDS virus attests.
But medicine’s triumph over infectious disease brought to the fore the so-called chronic, complex diseases–heart disease, cancer, diabetes, Alzheimer’s, and other illnesses without a clear causal agent. Now that we live longer, these typically late-developing diseases have become by far our biggest killers and account for three-quarters of our health care spending.
“We face an entirely different set of big medical challenges today,” says Blackburn. “But we haven’t rethought the way we fight illness.”
That is, the medical establishment still waits for us to develop some sign of one of these illnesses, then seeks to treat us with drugs and surgery. Unfortunately, the drugs we’ve thrown at these complex illnesses are by and large inadequate or worse. The list of much-hyped and often heavily prescribed drugs that have failed to combat complex diseases, while presenting a real risk of horrific side effects, is a long one, including Avastin for cancer (blood clots, heart failure, and bowel perforation), Avandia for diabetes (heart attacks), and torcetrapib for heart disease (death).
In many cases, the drugs used to treat the most-serious cancers add mere months to patients’ lives, often at significant cost to quality of life. No drug has proved safe and effective against Alzheimer’s, nor in combating obesity, which significantly raises the risk of all complex diseases.
It doesn’t help that some treatments are foisted on people who don’t need them. According to one study, a person who shows up at an emergency room complaining of chest pain has about an 80 percent chance of being admitted and subjected to a series of sophisticated tests, even when the patient is not at high risk for heart disease. These tests carry a significant chance of falsely indicating that a key artery is clogged, and sometimes lead to the utterly unnecessary surgical insertion of a stent, accompanied by a long-term drug regimen to fight off the real risk of clotting in that stent. In this way, many healthy people each year are converted into long-term patients.
All of these shortcomings add up to a grim reality: As a prominent 2000 study showed, America spends vastly more on health as a percentage of gross domestic product than any other country–40 percent more than France, the fourth-biggest payer. Yet while France was ranked number one in health care effectiveness and other major measures, the United States ranked 37th, near the bottom of all industrialized countries.
Treating the Cause: The Need for Preventative Medicine
The medical community knows perfectly well what sort of patient-care model would work better against complex diseases than the infectious-disease-inspired approach we’ve inherited. That would be one that doesn’t wait for diseases to take firm hold and then vainly try to manage them with drugs, but rather focuses on lowering the risk that these diseases will take hold in the first place. Aside from getting people to stop smoking, the three most effective ways, according to almost any doctor you’d care to speak with, are the promotion of a healthy diet, more exercise, and measures to reduce stress.
The evidence that these lifestyle and attitude changes have enormous impact on health is now overwhelming. Dean Ornish, a physician-researcher at the University of California at San Francisco and the founder of the independent Preventive Medicine Research Institute, has been a believer for more than three decades. “They used to say I was crazy,” he told me. “Now studies have shown that angioplasty and stents don’t prolong life in patients with heart disease. And studies have shown that lifestyle changes work better than drugs in preventing the complications of diabetes.” A major 2004 study that followed 30,000 people concluded that lifestyle change could prevent 90 percent or more of all cases of heart disease.
Relieving patient stress, in particular, is looking more and more important, according to Blackburn. She earned her Nobel for her work on telomeres–the protective caps at the ends of chromosomes. Her studies and others have shown that stress is linked to the shortening of telomeres, which is linked to aging and cancer. “We tend to forget how powerful an organ the brain is in our biology,” Blackburn told me. “It’s not that you can wish these diseases away, but it seems we can prevent and slow their onset with stress management.” Numerous studies have found that stress impairs the immune system, and a recent study found that relieving stress even seems to be linked to slowing the progression of cancer in some patients.
Medicine has long known what gets patients to make the lifestyle changes that appear to be so crucial for lowering the risk of serious disease: lavishing attention on them. That means longer, more frequent visits; more focus on what’s going on in their lives; more effort spent easing anxieties, instilling healthy attitudes, and getting patients to take responsibility for their well-being; and concerted attempts to provide hope.
This “healing” approach to patient care clearly isn’t found in the typical visit to the doctor’s office. Studies show that visits average about 20 minutes, that doctors change the subject back to technical talk when patients mention their emotions, that they interrupt patients’ initial statements after 23 seconds on average, that they spend a single minute providing information, and that they bring up weight issues with fewer than half their overweight patients.
Many medical students start out with a healer mentality, but few retain it. “It gets beaten out of you by the system,” says Brian Berman, noting a study showing that medical students score progressively lower on empathy tests the further they get into their training. Berman himself was a conventional MD until, at age 33, he took up the study of traditional Chinese medicine–which, like many alternative approaches, is largely focused on patients’ lifestyles, feelings, and attitudes, and which emphasizes stress reduction, healthier eating, and regular exercise, as well as encouraging the patient to believe in self-healing. “I saw how much more I could do to help people,” he says. “For the first time since medical school, I felt like a healer again.”
The benefits of a healing approach extend beyond the prevention of major chronic diseases to the management of everyday maladies that plague millions of people. Amit Sood, a physician at the Mayo Clinic in Rochester, Minnesota, came to the United States from his native India to practice medicine in 1995 and was shocked at what he found. “I thought America would be a Disneyland of health,” he said. “And what I saw was patient after patient who seemed wealthy, who tested healthy, and who was completely miserable.” Aches and pains, fatigue, anxieties, lack of mobility, digestive ills–all of these problems are extremely common, and all can greatly diminish quality of life. Yet they are seldom easily diagnosable in the conventional sense, and drugs and surgery can be clumsy tools for dealing with them.
Typical of people who complain of hard-to-pin-down ailments is Mary Pinkard, another patient I met at the University of Maryland Medical Center. A petite, young-looking 54-year-old, Pinkard has a long history of extreme fatigue, sinus discomfort, and other symptoms, which under the care of conventional physicians had resulted in three operations on her sinuses and a hysterectomy, as well as intense courses of antibiotics–none of it very helpful. “In 30 years, I didn’t have three months in a row of good health,” she said. Since seeing Lauren Richter, an osteopath trained in acupuncture and other alternative approaches, however, Pinkard’s health improved dramatically. She hadn’t been sick in five months and hadn’t had to take any drugs. She declared well worth it the $2,500 she’d had to pay, out of pocket, for her treatment.
The Mayo Clinic’s Sood, after seeing how dissatisfied American patients were with their costly, state-of-the-art health care, reacquainted himself with the traditional medicine of his childhood and now runs a stress-reduction program loosely based on meditation techniques. “Awareness and stress management are key to resilience and the ability to self-regulate health,” he says. Many of the large companies that contract with the Mayo Clinic to provide executive-wellness programs have been so taken with Sood’s program that they’ve asked him–to no avail–to be accessible to them through the clinic full time.
Examining the Patient-Practitioner Relationship and Placebo Effect
Steven Novella calls the notion that alternative care’s benefits are rooted in closer practitioner-patient interactions the “touchy-feely defense.” Novella is a highly respected Yale neurologist and the editor of Science-Based Medicine, an influential blog that has tirelessly gone after alternative medicine. He argues that claims about the practitioner-patient relationship are only intended to draw attention away from the fact that trials have failed to show that alternative treatments work better than placebos. And while he concedes that sham treatments can give patients a more positive attitude, he is adamant that providing sham treatments at all–essentially fooling patients into believing they’re being helped–is highly unethical. “Alternative practitioners have a big advantage,” says Novella. “They can lie to patients. I can’t.”
Yet on its own terms, this argument is not as cut-and-dried as it first appears. “Mainstream medicine uses the placebo effect all the time,” says Ted Kaptchuk, a Harvard researcher who studies the impact of placebos. “Doctors don’t tell you the drug they’re giving you is barely better than a placebo. They all spin.” To be approved by the FDA, a drug has to do better than a placebo in studies–but most approved drugs do only a little better. A number of studies have indicated, for example, that most antidepressants don’t do better than placebos, but patients filled more than 250 million prescriptions for them in 2010.
Of course, whether doctors or alternative practitioners are really “lying” when they ply patients with drugs or homeopathic remedies is a matter of judgment–we can’t know how much any individual caregiver believes in these treatments, although a noteworthy 2008 survey found that about half of U.S. physicians admit they routinely prescribe treatments they don’t think are likely to be of direct physical benefit. Regardless, notes Kaptchuk, patients absolutely end up feeling better, and often testing healthier, when they get these noneffective treatments, thanks to the placebo effect. “Knowing that you’re getting a treatment,” he says, “is a critical part of the ritual of seeing any kind of practitioner.”
Many studies have proved that sham-treatment rituals can do as well as drugs and surgery in relieving symptoms of many common and debilitating ailments. A 2002 study found that sham knee surgery involving an incision but nothing else did as much to relieve arthritis as the standard real procedure, and a 2009 study found that the same was true of a common back operation for osteoporosis. A 2001 study showed that in patients suffering from Parkinson’s disease, a condition marked by the brain’s diminished ability to produce dopamine, a placebo treatment caused dopamine production to surge. A German Medical Association study in 2010 found that 59 percent of patients with stomach discomfort were helped by sham treatments.
Studies have also shown that alternative treatments such as acupuncture tend to produce a larger placebo effect than merely handing out sugar pills, presumably because alternative treatments involve more ritual, and thus further raise patients’ expectations. In other words, alternative practitioners tend to do a better job at “selling” the placebo effect.
One might argue that a system of care that merely delivers a powerful, relatively safe placebo for many conditions–without side effects–has at least something to commend it, compared with the system of care we actually have today. Yet to focus on alternative medicine’s placebo effect ignores what may be its largest benefit–its adherence to a “healing” model of patient care.
Randomized controlled trials, the medical world’s gold standard for assessing the efficacy of treatments, cannot really test for this effect. Such studies are perfect for testing pills and other physically administered treatments that either have a direct physical benefit or don’t. But what is it that ought to be tested in a study of alternative medicine? To date, the focus has mostly been on testing the physical remedies by themselves–divorced from any other portion of a typical alternative-care visit–with studies clearly showing that the exact placement of acupuncture needles, for example, doesn’t really have any significant physical effect on the patient.
But what’s the sham treatment for being a caring practitioner, focused on getting a patient to adopt healthier attitudes and behaviors? You can get every practitioner in each of the study groups to try to interact in exactly the same way with every patient and to say the exact same things–but that wouldn’t come close to replicating what actually goes on in alternative medicine, where one of the main points is to customize the experience to each patient and create unique bonds.
The University of Maryland’s Berman wants to demonstrate what alternative approaches can or can’t accomplish. He’s undertaking “cluster care” studies, for example, which attempt to carefully compare how patients fare at different care facilities, and he thinks these studies might offer convincing proof that with certain types of patients, integrative clinics can get better outcomes than their mainstream counterparts. Steven Novella decries such suggestions. “The randomized controlled trial has been the standard of evidence in medicine for a long time,” he told me, “and it’s nonsense to claim that we have to lower our standards just to find some way to justify alternative medicine.”
And yet the question of whether the benefits of the “touchy-feely” aspects of alternative medicine can be proved in randomized trials seems strangely beside the point. That’s because just about everyone in medicine, including hard-core critics like Novella and Steven Salzberg, already believes that a more caring practitioner is an enormous boon to health. “Of course it benefits patients to have a practitioner who spends more time with them, and listens more carefully to them,” says Novella. He agrees that a caring, bonding practitioner is more likely to get patients to adopt healthier lifestyles, and that these changes lead to better health.
But like most alternative-medicine critics, Novella claims that these aspects of a better patient-practitioner relationship should not be uniquely associated with alternative medicine. Instead, we should look to our doctors to be the nurturing caregivers who take the time to listen to us, bond with us, and guide us toward healthier lifestyles and lower levels of stress. “I try to do that with my patients,” Novella told me. Does he think most doctors do? “No,” he said, after a moment. “I have the luxury of taking time with my patients because I’m at an academic medical center. There are things in the system that have to be fixed before most doctors could do that too.”
Every single physician I spoke with agreed: The current system makes it nearly impossible for most doctors to have the sort of relationship with patients that would best promote health. The biggest culprit, they say, is the way doctors are reimbursed. “Doctors are paid for providing treatments, not for spending time talking to patients,” says Victor Montori, an endocrinologist at the Mayo Clinic. A medical system that successfully guided patients toward healthier lifestyles would almost certainly see its cash flow diminish dramatically. In 2010, “75 percent of the $2.6 trillion the United States spent on health care was for treating chronic diseases that, to a large degree, can be prevented or reversed through lifestyle change,” says Dean Ornish of UCSF. Who (besides patients) has an incentive to make changes that would remove that money from the system?
With systemic costs in mind, it doesn’t even really make sense to ask physicians–who, after all, spend hundreds of thousands of dollars and a decade of their lives becoming trained in anatomy, biochemistry, pharmacology, and more–to spend long blocks of time bonding with patients. Other sorts of professionals could be better at the healing, bonding, and placebo-selling part, and for less money. These might include behavioral-medicine therapists, social workers, nurse practitioners, or even some entirely new sort of practitioner specially trained for the task–working under the direction of a conventional physician, who could focus on quickly prescribing conventional tests, drugs, and surgeries when they were specifically called for.
Of course, the result wouldn’t be much different from what one already encounters in an integrative clinic like Berman’s. If an alternative practitioner is also an MD or works in conjunction with one, it’s hard to see what’s being risked. The biggest catch is likely to be that insurance won’t cover most visits, leaving many patients with the difficult choice of paying out of pocket or seeing a covered doctor who doesn’t have much time for them.
Rather than going ballistic when they hear that patients believe themselves to benefit under the care of alternative practitioners, argues the Mayo Clinic’s Victor Montori, doctors ought to be praising, or at the very least tolerating, alternative medicine for the way it plugs gaping holes in modern medicine. “Who cares what the mechanism is?” he says. “The patient will be healthier.”
The Future of Modern Medicine
Montori and Amit Sood are not the only voices of support for alternative approaches at the Mayo Clinic, a medical center renowned for the excellence of its medical care and for the relatively low cost of that care. I met with a range of prominent physicians there to discuss their views on the growing presence of integrative medicine in mainstream medical care, including at the Mayo Clinic itself, which houses a program it calls Complementary and Integrative Medicine.
One of them was Morie Gertz, a hematologist, who chairs the Mayo Clinic’s internal medicine department. “Most of the doctors here were top of their medical school class, top of their residency, blah, blah, blah,” he told me. “That’s technical mastery. That doesn’t make them effective healers. Over the past 30 years, I’ve seen hundreds of patients who clearly feel they’ve benefited from alternative therapies. It’s not my job to tell them they shouldn’t feel better. And I wouldn’t tell patients they shouldn’t try alternative medicine if they want to–we need to follow the clues patients give us about what might help them. If a patient chooses to walk away from the therapy I’ve prescribed and go to an alternative therapist instead, that’s not the fault of alternative medicine; it’s because I’ve failed as a doctor to do a good job of making my case in terms that are important to the patient.”
The notion that alternative medicine is a legitimate response to mainstream medicine’s real shortcomings is one I heard, in variations, from everyone I spoke with at the Mayo Clinic. Liver specialist Keith Lindor’s positive view of alternative practitioners was shaped early in his career, when he spent time working alongside a Native American medicine man at a reservation clinic. “I had been trained to aggressively treat patients with drugs that often only made them even more ill,” he says. “But he could often do much better with just a press of his hand.” The beneficial effects of alternative therapies on Mayo Clinic patients, he says, have been observable in shorter hospital stays, lower levels of self-administered painkillers, and reduced tissue inflammation, which is a general indicator that the immune system is better holding its own.
Lindor’s opinion is perhaps of special significance, because he is also the dean of the Mayo Clinic’s medical school. Ultimately, what today’s medical students think about alternative medicine will be more important to the future of medicine than what anyone else thinks of it. Mayo Medical School has woven alternative medicine into its curriculum. And its students seem eager to learn more. Among the dozen or so “interest groups” the student body has set up to arrange further discussion and education outside the normal curriculum is one focused on alternative medicine, attracting about a third of the students, on par with the other groups. “I’m probably not interested in being an alternative practitioner, but I want to learn more about it so I can have a better conversation with patients,” says Lauren Jansons, the ebullient second-year student who heads the group.
In fact, a more open-minded consideration of alternative-medicine practices has become par for the course at medical schools. In recent years, the American Medical Student Association has cosponsored an annual International Integrative Medicine Day, which, according to a press release, “will increase awareness and availability of integrative medicine, promote inter-professional collaboration, encourage self-care, foster cultural awareness, and enhance patient-physician communication” (an “infiltration of quackademic medicine,” blogged David Gorski, a surgical oncologist at Wayne State University and one of the more prickly anti-alternative-medicine warriors, in despair).
Before leaving the Mayo Clinic, I stopped in to watch a small mountain of muscle named Ryan Berry receive massage therapy, through the integrative-medicine program, to address the discomfort he was experiencing two days after extensive thoracic surgery. When I came in, Ryan, who is 34, was stiff with pain and seemed sewn to the chair in which he had been propped up. He clutched the arms of the chair, grimacing with each shallow breath. Over soothing music, the therapist spent several minutes talking with Ryan, getting him to discuss, through clenched teeth, the details of his pain. When she finally started the treatment, she seemed to barely brush her hands against the top of his back. But within a minute, his hands started to release their death grip, his teeth unclenched, and he was slumping a bit. Within three minutes, he was breathing deeply and slowly, his hands were open and limp, he was sunk down in the chair, and his grimace had been replaced with a hint of a smile. Personally, I doubt that it mattered much where exactly the therapist placed her hands and how she moved them, which means a randomized trial would have found the treatment to be no better than sham massage. But it was as compelling a picture of suffering relieved as I have ever seen.
Scenes like that one, witnessed by more and more doctors in clinical settings, make it obvious why the front lines of medicine are pushing, if slowly, and in pockets, toward a less rigid stance on alternative medicine. Open-mindedness can strike in even the most unexpected of places. Steven Salzberg happened to mention to me in passing that he didn’t consider hypnosis to be an alternative practice. I asked him why he left it off his long list of shams and frauds, and he seemed surprised, as if he had never considered the possibility that it might not be a legitimate therapy. “I don’t know,” he said. “I guess it’s because my father was an academic clinical psychologist, and he used it in his work.” Had he looked at studies on the effectiveness of hypnosis? “Not very closely,” he said. “But I believe it works.”
David H. Freedman is the author of Wrong: Why Experts Keep Failing Us–And How to Know When Not to Trust Them. Excerpted from The Atlantic (July/August 2011), Copyright 2011, The Atlantic Media Co. as published in The Atlantic Monthly. Distributed by Tribune Media Services.
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