HMS Takes Herbs Mainstream

BOSTON--Sitting at the back of a ballroom at the Copley Place Marriott on Sunday, Eugene F. Hummel talks about how he came to be a naturopathic medical doctor.

He was having trouble keeping food down and traditional doctors could not tell what was wrong. At the chiropractor's suggestion, he consulted a non-traditional practitioner who examined his eyes and made the correct diagnosis--a bone lodged in his digestive tract just above the stomach.

That experience played a part in making Hummel a believer that non-traditional practitioners often have the answers that Western biomedicine does not.

Participating in this week's Complementary & Integrative Medicine Conference sponsored by Harvard Medical School's (HMS) Department of Continuing Education, Hummel says he is looking to forge connections between traditional Western medicine and other approaches to health.

This conference is just one example of how HMS, considered a bastion of traditional Western biomedicine, has begun studying acupuncture, herb therapy, and other non-traditional therapies.

Through its six-month-old Division for Research and Education in Complementary and Integrative Medical Therapies, HMS has firmly inserted itself into the burgeoning sector studying treatments once considered quackery.

A Non-Traditional Conference

For the seventh year running, Associate Professor of Medicine David M. Eisenberg '76, who became interested in alternative medicine as a young doctor on a trip to China, has brought medical doctors and pharmacists together with massage therapists, acupuncturists and naturopaths like Hummel.

Eisenberg, who graduated from HMS, directs the school's newest division and is best known for his landmark surveys on the use of non-traditional therapies in the United States. His is also the director of this week's conference.

The conference, which ends today, has highlighted speakers who are leading the charge for the acceptance and use of non-traditional medicine by the medical establishment.

Besides prominent speakers, the conference included breakout sessions with demonstrations of non-traditional therapies.

Attracting over 500 participants, the four-day conference highlighted the growing acceptance of such therapies in the Western biomedical world.

The Dictates of the Dollar

The conference reveals a curious fusion between two seemingly exclusive worlds.

"Seven years ago, most clinicians in traditional care would have said complementary medicine is irrelevant," Eisenberg said in his opening remarks. But now, he said, physicians are bowing to market forces and the realization that some techniques that were considered useless may have real health benefits.

According to Dr. David S. Rosenthal '59, director of University Health Services and Medical Director of the Zakim Center for Integrative Medicine at the Dana-Farber/Harvard Cancer Center, the market is a potent force driving research into alternative medicine.

"A lot of it comes from patients themselves," Rosenthal says. "Over the past two decades, there has been an increase in people using these methods for their wellbeing. The current estimate is that this is a multibillion dollar industry."

Though the scientific basis for non-traditional therapies is unproven, consumers have found these alternatives to be increasingly attractive.

Eisenberg's studies revealed a marked increase in both dollars spent on and number of visits to non-traditional practitioners in the 1990s. The results, published in The Journal of the American Medical Association (JAMA) in 1998, showed that visits to non-traditional practitioners increased nearly 50% from 1990 to 1997. In both years, visits to non-traditional practitioners outnumbered visits to primary care medical doctors.

What MDs Need to Know

Even physicians who are skeptical of non-traditional therapies encounter patients who self-medicate with herbal treatments.

Eisenberg stressed the need for traditional medical doctors to be willing to talk with patients about the herbal or botanical substances they are taking. He cited, for example, evidence that the popular herbal supplement St. John's Wort seriously impaired the ability of Indinavir, an anti-viral drug used to treat AIDS, to function in the blood stream.

"One of the most important things about herbs is that they can interfere with medications people may be on," Rosenthal says.

Some physicians may refuse to treat patients if they discover the patient is using herbal medications in addition to traditional drugs. Patients may therefore hesitate to tell their doctors about such outside treatment.

" We need to make it easier and more comfortable for patients to talk to [physicians]," says Eisenberg. "The potential for drug-herb interaction is huge."

A New Medical Orthodoxy?

One of the featured speakers on the first morning of the conference was Ted J. Kaptchuk, an expert in traditional Chinese medicine. He sported a short salt-and-pepper beard, a black beret, and a short ponytail.

"In 1978, I was arrested for practicing medicine without a license," Kaptchuk says. "Now I'm an assistant professor at Harvard Medical School teaching the next generation of physicians."

Kaptchuk also studies the history of non-traditional medicine in the United States. There have always been conflicts between those who expose medical orthodoxy and proponents of other kinds of treatments. He spoke about the early 19th century when there was no medical licensing.

"The most important issue is power," he says. "The medical profession realizes that it is a cohabitant in the medical landscape."

According to David Reilly, a doctor at both the Glasgow Homeopathic Hospital and the Glasgow Royal Infirmary, the relationship of medical orthodoxy with non-traditional medicine typically goes through three stages.

First, there is hostility, then acceptance, and then "the third phase is to be crushed in a bear hug," Reilly says.

Some conference attendees expressed concern that association with traditional medicine would subsume, rather than integrate, non-traditional practices.

"The act of co-opting would alter the practice and individuality (of non-traditional medicine)," Eisenberg says. "That is part of our global health care challenge."

Hummel, for one, says he is not worried about engaging with the medical establishment.

He commended those physicians who investigate non-traditional medicine because they bring such therapies to the attention of the scientific community.

"Dr. Eisenberg made a good point," he says. "You need to know all about it. You can't disapprove of it if you don't like it."

From Alternative to Integrative

Much discussion at the conference centered on the proper way to describe the work that massage therapists, acupuncturists and herbalists do.

The government term for non-traditional therapies is "complementary and alternative medicine," or CAM.

The name comes from the National Center for Complementary and Alternative Medicine (NCCAM), an institute at the National Institutes of Health established by Congress in 1998.

But some practitioners of CAM find that label inaccurate, demeaning, or both.

"I find some of those terms very insulting," Kaptchuk says. "I'm not a doctor of complementary, or unconventional or alternative medicine."

One term acceptable to most parties is "integrative."

This label change reflects the increased acceptance of studying non-traditional practices.

For example, Rosenthal is involved in an integrative cancer treatment program at the Dana-Farber/Harvard Cancer Center. He stresses that integrative treatments are used in addition to traditional therapies, not instead of them.

"The success of the field will be when the labels disappear from the conversation and we just have good medicine," says Eisenberg.

Science and Not Science

Both physicians and non-traditional practitioners say the next step is to use science to investigate the effectiveness of unproven therapies.

One physician who has embraced non-traditional medicine is Dr. Felecia L. Dawson, an obstetrician/gynecologist from Atlanta. After going into private practice, Dawson says she realized that "what I had been taught in medical school was insufficient to help my patients heal."

She says that she does not hesitate to recommend herbs or massage therapy for her patients.

"I know that complementary medicine works," Dawson says. "The main reason I came to this conference is to gather scientific information to support what I believe."

The question remains, however, how scientifically unproven therapies should be tested.

"The reductionist model is not the best way," says Andrew Weil, a professor of medicine at University of Arizona and well-known author of books on nutrition and integrative medicine.

"The current model does not allow for non-physical causes for physical events," he says.

He criticizes scientific studies that attempt to isolate the single active component of herbal medicines. He says such studies do not appreciate the full effect that all the components the medicines have.

Hummel says he agrees, and says in many cases, technology to test non-traditional therapies is not yet available.

For example, the qi, or energy that is part of traditional Chinese medicine, has not been detected with traditional scientific methods.

"There will be a point in time when we can detect these things," he says.

Eisenberg echoes the idea that more research is needed, quoting Carl Sagan, a famous science philosopher that "exceptional claims require exceptional evidence."

"If we all commit ourselves to figure out what is useful, useless, safe, and unsafe, we will create a better model of health care for the next generation," Eisenberg says.