Med School adopts complementary care

Kelly Wittman

Students at the University’s Medical School will soon learn therapies dating back hundreds of years alongside the cutting edge of modern medicine.
A report issued by the Academic Health Center’s Complementary Care Task Force recommended that information about therapies, such as chiropractic, acupuncture and homeopathy, be integrated into the Medical School curricula. The report also suggests that interdisciplinary courses should be developed if a demand arises.
Recommendations suggest that the health center should become not only a center of excellence and a model for other programs in teaching and using complementary therapies, but also become a leader in researching the effectiveness of the therapies.
Even though full implementation of the committee’s recommendations will take years, Academic Health Center administrators hope to offer two courses as early as spring quarter that include instruction in “alternative” therapies, said Mary Jo Kreitzer, co-chairwoman of the AHC Complementary Care Task Force.
“There was a strong consensus in the end that this was an important direction for the AHC to move,” she said.
The center prefers to use the term complementary care instead of alternative therapy because the therapies the task force recommends will be combined with and used to augment conventional care, Kreitzer said.
“These therapies are not alternative to anything,” she said.
The task force findings point to a growing trend among health care consumers toward using such therapies. The recommendations also stress the need for research and reflect the growing controversy about the effectiveness of the therapies and the certification of providers.
The alternative health care industry has become a $13 billion business, with $10.5 billion of that money being spent out of patients’ own pockets because most insurance companies do not cover the therapies.
Medical School student Retu Saxena, co-chairwoman of the Students Committee on Holistic Health, said patients are using alternative therapies because they are less invasive than conventional therapies and because they have a past grounded in history and culture, she said. Thousands of Americans consider alternative medicine their traditional medicine, she said. “People are saying thousands of people every day use it, (and) why would they use it if it didn’t work?” Saxena said.
The insurance industry is having an effect on interest in alternative therapies, Saxena said. With the prominence of health maintenance organizations, insurance companies have been placing a bigger emphasis on keeping people healthy and preventing problems. That concept is also a focus of alternative therapies, she said.
People are using alternative therapies because they are effective, said Dr. Andrew J. Lucking of the Minnesota Naturopathic Medicine Clinic. People want to know why they’re ill and what caused the condition in the first place, he said.
“They don’t want some bozo who is going to write them a prescription for the latest pill he’s seen in a journal,” Lucking said. “People just aren’t that stupid anymore.”
Congress created the Office of Alternative Medicine within the National Institutes of Health in 1992, and the office continues to grow. AHC Provost Frank Cerra last August charged the task force with reviewing the emerging trend.
The impetus to look into complementary therapies came from many directions, Kreitzer said. “Basically, the question became ‘what leadership can the AHC provide in this huge, growing area?'” she said.
The implementation of complementary therapies into teaching at the hospital and in patient care works well with the University’s initiative on diversity, Kreitzer said. In the memo that empowered the task force, Cerra noted that the metro area has a strong immigrant community that has differing views on health care.
The complementary therapy course work will raise the level of awareness of future physicians and other health care providers of the existence of these therapies. It will also help health professional school students decide when to refer a patient to a complementary care provider, Kreitzer said.
Lucking said the findings of the task force are a step forward for alternative medicine, but is a step unfortunately driven only by money. Seattle’s King County Hospitals and the University of Oregon have already implemented complementary care programs successfully. The University is just following suit, he said.
Saxena said that it is important for future care providers to be exposed to alternative therapies because they might prescribe a drug in the future that will interact with an herbal remedy the patient is taking. The training will make them more sensitive to patients using alternative therapies and allow them to be open-minded when talking with patients about the therapies they’re using.
“Lots of patients want to talk to their doctor about alternative treatments, but are afraid their doctor will just shoot them down,” Saxena said.
A medical student who did not want his name used for fear of retaliation said there is a place for training in alternative therapies, but the Medical School is not it. He thinks the Medical School should concentrate on teaching students what they need for their medical board examinations.
A chiropractor is not a doctor, he said, and the term doctor should be reserved for those who pursue academic truth. “The so-called chiropractic doctors have not shown a shred of evidence that their therapies work,” he said.
Teaching alternative medicine in the Medical School lessens the significance of being called a doctor.
“In Canada, it is illegal for a chiropractor to call himself a doctor. Only an M.D. or a Ph.D. can call himself that,” he said.
Kreitzer stresses that the task force doesn’t recommend using and teaching complementary therapies indiscriminately. “The task force is clearly advocating a scientific approach,” she said. “Complementary therapy integration into patient care will take place only after careful consideration of what makes sense,” Kreitzer said.
In fact, research is a big part of the task force’s recommendations and a major sticking point for those who don’t think complementary therapies are effective.
Greg Bury, spokesman for Blue Cross Blue Shield, said that research on the proven efficacy of the therapies is holding the insurance company back from covering alternative therapies in the same manner as conventional therapies. “We’re waiting for hard evidence,” he said.
Blue Cross Blue Shield investigated covering several alternative therapies last summer and presented their findings to company executives. However, the committee has not received any word on its recommendations, Bury said.
Blue Cross Blue Shield currently covers chiropractic and acupuncture used for anesthesia, Bury said. Should the Fairview-University Medical Center start using other alternative therapies in addition to conventional care, patients would be responsible for covering those charges at this time, he said. Complementary therapies provide a wealth of research opportunities, Kreitzer said. “Some of the more popular approaches may prove to be ineffective,” she said.
Kreitzer said that although many people might think conventional therapies are more fully tested than the alternative therapies, in fact they are not. The government’s Office of Technology Assessment released a report in September 1978 stating that only 10 percent to 20 percent of procedures currently used in medical practice had been shown to be effective in controlled experiments.
“If you hold up complementary care to the traditional model, you’ll find research in both is not complete,” Kreitzer said. “Acupuncture has actually been tested more than other approaches.”