Steve Schulz describes himself as an outgoing, no-holds-barred kind of guy. But 10 years ago, while ice climbing in New Hampshire, he wasn’t sure he’d ever push the envelope again. He slipped off an ice wall, sustaining a serious head injury when his mouth met up with the head of his ice hammer. For the next three years, his health was in the crosshairs. Rebuilding his upper jaw with dental implants did wonders to help Schulz get his life back together—on the outside. But he still suffered from excruciating headaches. He finally scheduled neurosurgery to sever cranial-nerve endings and, he hoped, relieve his pain.
But first he decided to give chiropractic a try.
Schulz consulted Dr. Joe Unger, a chiropractor specializing in craniopathy. Uncovering a misalignment of the frontal bone of the cranium, Unger provided Schulz with a treatment regimen that within weeks had him feeling well enough to cancel surgery.
Some would call Schulz’s healing process pure sophistry—or, at best, a mystery. But more and more Americans—including physicians—are blending traditional Western-style medicine with an amazing array of what are variously called “alternative,” “complementary,” “nontraditional” and “integrative” therapies. These therapies broaden the definition of health and wellness, not only by combining methods of newer Western medicine with more ancient forms of health care but also by emphasizing personal responsibility and prevention. For example, the Integrative Medicine Alliance predicts that by 2020, brain surgery may be preceded by massage and prayer and followed by homeopathy and music therapy. Family members will be part of the healing process, and everyone will collaborate as a healing team.
Dr. Ralph Barrale, dean of postdoctoral education at Logan College of Chiropractic, says the future of medicine in this country depends on this kind of integrative medicine, which may have the added advantage of lowering healthcare costs.
Dr. Daniel Scodary, a neurosurgeon, knows firsthand the need for collaboration:
His godfather, a chiropractor, distrusted physicians so intensely that he wouldn’t let them treat him for prostate cancer, which eventually took his life. The moral of the story is that patients, physicians and other providers need to open up the lines of communication. “Chiropractors often find conditions like herniated discs or kidney tumors that pop up on the MRI scans they order for patients,” he notes. “It’s important for chiropractors to have a medical referral base so these patients won’t get lost in the system.”
Ten years ago, the federal government gave alternative medicine $2 million in seed money. Since then the field has exploded. It now incorporates treatments used in Eastern cultures for about 5,000 years—acupuncture, meditation, chiropractic, diets, biofeedback, reiki, tai chi, massage, Indian ayurvedic medicine and herbal supplements, to name just a few. According to a 2004 National Institutes of Medicine survey, more than a third of American adults are using nontraditional remedies. Add prayer and megavitamin therapy, and the proportion increases to 62 percent.
As far back as 1997, government surveys have shown that American health consumers spent between $36 billion and $47 billion on such therapies, of which at least $12 billion was out-of-pocket. Total visits for such treatments now exceed the number of annual visits to primary-care physicians.
The bottom line: Nontraditional therapies are a magnet for U.S. healthcare dollars. And to make the point, Congress has appropriated more than $123 billion in 2005 for the National Center for Complementary and Alternative Medicine to hand out as grants to study the success or failure of these treatments in promoting good health.
By studying and using medical traditions from other cultures, as well as incorporating the latest research on the effects of stress and nutrition or exercise on disease, doctors hope to move beyond a reliance on drugs and invasive therapies. According to Dr. Valerie Yancey, a professor at Barnes-Jewish College of Nursing and Allied Health, technical and rational methods don’t satisfy the needs of all patients. “As wonderful as Western medicine is and as much as it cures what is curable, much of illness is lifestyle-related or chronic in nature,” she says. “These problems don’t yield to curative strategies.”
As a teacher of holistic nursing, Yancey’s goal is to reorient nurses to the concept that they are in healing partnerships with patients. Her point: “People are more complex than their biology.”
Dr. Pat Penkoske, who recently completed a fellowship in critical care at Washington University School of Medicine and will be joining the faculty, says that medical students readily buy into the concept of integrative health care: “Not only do they express a personal interest in these therapies, but they realize that this is part of 21st century practice.”
Yancey sees “pockets of interest in complementary and alternative modalities all over the country, but, mostly, big strides in under-standing are happening on the coasts.” Medical schools, including those at Stanford, Harvard, Columbia and the University of California–Davis are the key players, answering important questions about integrative medicine’s safety, effectiveness and cost-efficiency in such areas as aging, chronic disease, women’s health and asthma.
Missouri does seem to have its own alternative-energy vortex, though, and even if the St. Louis area isn’t exactly a hotbed of holistic methods for keeping the brain, body and spirit going stronger and longer, a steady drumbeat of movement is sounding here. For example, the integrative-medicine market is getting a boost from the University of Missouri–Kansas City School of Medicine, which is looking to establish a center for complementary and alternative medicine and to make integrative medicine a part of the core curriculum. Promising clinical research includes the use of prayer in cardiovascular outcomes.
“Medical institutions get into this field because of the demand from patients,” says Dr. Richard Derman, an associate dean and Schutte Chair in Women’s Health at the UMKC School of Medicine. “Let’s face it: Western medicine is very good at treating acute illness but isn’t so good at treating chronic or life-threatening diseases where outcomes are poor—like fibromyalgia or severe forms of malignancy. Nontraditional therapies improve the quality of life for those patients.”
Clearly some of this newfound interest springs from the fact that these therapies are moneymakers. The St. Louis Business Journal highlights Massage Envy, a membership-based massage-franchise operation in St. Louis. Structured to offer prices lower than those at many spas, the business’ services appeal to a broad audience. St. Louis entrepreneur Dan Lowery is hoping his operation’s first-year revenue reaches $750,000. He’s sold four more franchises all over St. Louis County and wants to sell a total of 25 this year.
The Center for New Health Options is the first holistic health facility in the St. Louis area to be offered by a major medical system—in this case, St. John’s Mercy Medical Center. Cancer pain, back and neck pain and diabetic neuropathy are some of the more common reasons for referral.
A healthcare-consulting firm based in Philadelphia, Health Strategies & Solutions Inc., found that although most integrative health care is still paid for out of pocket, managed-care groups are getting in on the action, especially to cover massage therapy, chiropractic and acupuncture.
And self-contained clinics offering an array of nontraditional services have been sprouting up in St. Louis for some time now. Dr. Sharon Fitelson, a chiropractor and acupuncturist, says the clinic she directs, InMotion Health Center in Richmond Heights, is one of the oldest in the area and offers chiropractic, acupuncture, physical therapy, massage therapy, athletic training, martial arts and a medical doctor, all under one roof.
“When I was in private practice, my patients trusted me to make referrals to them for services like massage therapy or acupuncture,” Fitelson says. “The issue of trust is paramount. That’s why the idea of different kinds of holistic care under one roof seemed like a natural evolution when we started the center.”
A caring attitude and an approach that considers the mind, body and spirit must be part of integrative practice, or a clinic or center will usually fade out of the picture. Yancey stresses that what people value most about their healthcare provider is the relationship. “Studies of patients show that they like people who will listen to them, sit with them and explore with them what their own health goals might be. They want people who won’t tell them what to do and who understand healing instead of curing.”
Fitelson says younger doctors fresh out of medical school are open to nontraditional therapies—“and older doctors, who have been around long enough to see when their medicine isn’t working anymore, are thrilled to be able to give patients the name of someone trustworthy who has something new to try. Every physician wants to give patients hope.”
When conventional options run out for conditions as diverse as Bell’s palsy, lower-back pain in pregnancy and nicotine withdrawal, acupuncture is often suggested. Acupuncture is a form of Chinese healing used for at least 2,000 years. According to Chinese medicine, the body relies on the vital life force (chi) to control how the organs and systems work. Chi circulates among organs and along 12 channels, or meridians. When an imbalance of positive and negative energy occurs, the chi becomes blocked and disease results. When the chi is rebalanced through the insertion of needles at certain points on the meridians, the body may be returned to a state of health. Acupuncture may also involve the burning of a special herb on the acupuncture points, a procedure called moxibustion.
Nobody likes needles, but because acupuncture needles are so fine (the thickness of about four human hairs), patients actually experience little or no sensation when they’re inserted.
Jane Smith (not her real name) wasn’t crazy about the idea at first, but she was desperate for relief from her pain.
Smith was suffering from residual problems after a recent double mastectomy. “I hurt everywhere. The fatigue was overwhelming,” she says. Anxiety and upper gastrointestinal problems plagued her, but once her chemotherapy was over, doctors told her there was nothing else they could do for her. “They told me to take tamoxifen and to come back in a year,” says Smith. “There was a feeling like ‘Oh my God, I’m on my own. Now what do I do?’”
A friend referred Smith to Dr. Marcy Goldstein, who, as director of the department of plastic surgery at what was then Jewish Hospital, began to study acupuncture because of his interest in acupuncture anesthesia. Later, after he was severely injured in an auto accident, he studied acupuncture in earnest—to heal himself. He now practices acupuncture in association with a West County surgical group.
When Goldstein placed a needle on one of the meridians in Smith’s hand, Smith felt immediate relief from anxiety and fear. She calls it “her happy spot” and says a feeling of self-acceptance may help acupuncture—or, indeed, any nontraditional treatment—work. “It’s a way of clearing your mind and accepting what’s happening to your body,” she says. “Let your body do the work.”
Acupuncture may still be on the fringes of the medical community, but chiropractic is considered pretty tame stuff by most standards and is widely used in St. Louis to promote and maintain a healthy lifestyle. More than 26 million Americans seek chiropractic treatment each year, most often for upper respiratory tract infections or lower-back pain. Medicare, the U.S. Department of Defense, the Department of Veterans Affairs and most private health-insurance plans now include some form of coverage for chiropractic care.
Dr. Nancy Wilkinson, who has practiced chiropractic for 23 years, says she’s seen it gain mainstream acceptance in the Midwest over the last decade. “There was a point in time when the American Medical Association had misconceptions about chiropractic medicine,” she recalls. “When doctors began to realize that their education and ours weren’t so different after all, that was the turning point in St. Louis.”
Chiropractic medicine is commonly used to treat neck and back pain through its focus on spinal biomechanics. Wilkinson, like most chiropractors, uses adjustments as a big part of her healing repertoire. “I find an area that is misaligned or imbalanced and will do an adjustment that will either put something that’s out of place back into place or free up an impingement to that area,” she says. “I may move bones, work muscles, rub reflex points, do muscle stimulation or ultrasound.”
Scodary believes so strongly in the idea of interdisciplinary cooperation that he developed an observation program at BJC’s Christian Hospital Northeast to give chiropractors the opportunity to observe surgeries performed on their patients. “All healthcare providers are in the same boat: We want to help the patient,” he says. “I won’t buy into something that sounds crazy, but if there’s some science behind it, I’m for anything noninvasive in a nonemergency situation.”
Massage therapy, or bodywork, is another nontraditional remedy that’s been recognized by Eastern cultures for thousands of years. The American Massage Therapy Association says consumers spend between $2 billion and $4 billion annually for these treatments, which works out to about 75 million visits a year. For some patients, it’s like a one-hour vacation. For others, it’s a therapy to treat medical conditions.
Research shows that massage helps relieve low-back pain, is effective in treating postmastectomy lymphedema, eases pain and muscle spasms after heart bypass surgery, reduces post-traumatic headaches better than cold packs, stimulates the brain to produce endorphins and boosts immune function.
The Healing Arts Center, which trains massage therapists, has been in business in St. Louis since 1987, when bodywork wasn’t even a blip on the radar screen in St. Louis. Owner and director Tom Tessereau has a son who, though healthy now, was born with a congenital heart defect. At 9 months, the boy, Adom, underwent open-heart surgery at St. Louis Children’s Hospital; myofascial release and craniosacral work kept his scar tissue from toughening. And Tessereau has been performing infant massage, which he claims helps babies acclimate to the world more gently, on his newborn.
The use of integrative therapies is widespread, and they’re here to stay. As health budgets are squeezed ever tighter, patients must be more responsible for their health, finding ways to prevent illness and promote healthy living. Safeguarding the public therefore has become increasingly important. Carrie Harrison, executive director of outpatient services at St. John’s Mercy Medical Center, believes that St. Louisans’ conservative nature isn’t such a bad thing when it comes to these treatments: “It forces due diligence on the providers to make sure what we offer to improve patient health is safe, efficient, credible and effective.”
However, randomized controlled trials don’t always lend themselves to nontraditional remedies, many of which have their roots in Eastern sensibilities. Scientists must develop new research methods. During her days as a cardiac surgeon, Penkoske first became a convert to nontraditional remedies when she saw what a difference they made for families whose loved ones were undergoing invasive procedures. The teaching hospital where she performed surgery had a healing garden and offered massage to the families of patients. “Usually after surgery the patient’s family is huddled together in the waiting room,” she says. “The minute you open the door to talk with them about the patient’s condition, everybody jumps. I was amazed at the difference massage made for these anxious people. I saw families who were so relaxed that they almost had to be shaken awake to hear the news about surgery. To me, that seems like a much healthier place to be.”
