Integrative medicine balances conventional, alternative healing

Elton Brand's miraculous recovery was an interesting example of an integrative approach to healing. As noted by Dick Vitale during the Carolina game, Brand had appropriate surgery by a top orthopedic surgeon at one of the best medical centers in the country. In addition, he had ultrasonic treatments and electrical bone stimulation, a controversial method of enhancing bone healing. Would he have healed as quickly without it? Nobody knows for sure, but it does raise some provocative issues relevant to the evaluation of alternative therapies.

Electromagnetic bone healing was first conceived in the 1950s and after many years of clinical research, it has finally gained some acceptance as an alternative to surgery for ununited fractures that fail to heal in the expected period of time. A number of commercial companies make bone healing devices, but they are only allowed by the FDA to market them for the limited purpose just described. The mechanism by which they stimulate healing is not well understood, and there is no hard scientific evidence to support their use to enhance routine fracture healing, as in the case of the "Big E."

With the ACC and NCAA championships on the line, however, it was certainly worth a try and what could it hurt? This type of logic works well in big-time sports where cost is not a factor, but unfortunately the same cannot be said of managed care where patients with life threatening diseases are confronted by difficult choices regarding conventional and alternative therapies every day. Certainly their sense of urgency when facing their personal "final elimination tournament" is no less than that of Coach K in considering the Final Four. How then do we respond to their needs in a reasonable and ethical manner?

Perhaps first we should ask a few more questions about Brand's case and make sure we have considered all the possibilities. What if his powerful will to heal and play and win were equally as important as surgery and the other therapies? What would have happened if for some reason he had a great fear of surgery and wanted to use only the non-invasive therapies? What if due to cultural or religious beliefs he had wanted to enlist the aid of a spiritual healer who claimed to be able to accelerate bone healing through the laying on of hands or the use of herbal remedies?

Answers to these kinds of questions lie at the heart of the ongoing debate about integrating alternative and complementary therapies into medical practice. One place where these answers are being sought is the University of Arizona, where botanical medicine expert Andy Weil, best-selling author of "Spontaneous Healing," has established a Fellowship Program in Integrative Medicine to train primary care physicians to become leaders in this emerging field. A few weeks ago, a team from the Medical Center went on a fact-finding mission to Tucson, Ariz. to observe the program whose medical director, Tracy Gaudet, is a Medical School graduate.

In the clinic, the four integrative medicine fellows see new patients on Monday morning and present their cases in an afternoon conference to Weil, Gaudet, and an interdisciplinary team consisting of an acupuncturist, an osteopath, a homeopath and a mind-body therapist. Conventional medical treatments are discussed and then recommendations are made for any of the complementary therapies that are felt to be appropriate. The clinic has a 1,000 patient waiting list and is particularly popular with patients who have cancer and autoimmune diseases.

The program's strengths lie in its clinical and educational components, but some early research efforts are underway. There is considerable interest at Arizona in forming a consortium with other academic institutions such as Duke to establish additional fellowship programs and move the research agenda forward. In many ways, Duke is a perfect complement to Arizona with a strong research tradition supplemented by educational and clinical initiatives which are in an earlier stage of development.

Symbolic of this situation, our Department of Psychiatry recently added herbal medicine to its large research program with a $4.3 million grant to study St. John's wort. The Center for Aging also receives significant funding to study the effects of spirituality and religion on health. In related clinical research, the Durham VA Medical Center is sponsoring the MANTRA project, in which patients undergoing cardiac catheterization are randomized to a control group or one of four complementary therapies including meditation, imagery, healing touch or remote prayer by several off-site prayer groups from around the world.