These centers are billing themselves as those that practice "integrative medicine," a term coined by Dr. Andrew Weil, which is geared toward putting the medical doctor in the integrating position: The idea is to bring alternative therapies within the fold, or the established medical center.
My most recent interview was with Drs. Steven and Sandi Amoils, directors of the Alliance Institute for Integrative Medicine, where construction is expected to be complete in June.
As the Amiolses explain it, the center is truly integrative.
First, patients are referred by their physician to the center. This implies that single conventional solutions might have failed and that the patient and physician seek an integrative approach. Or, the patient might be seeking a wellness/optimal health program that includes alternatives.
Although individual treatments will be offered, the institute "prides itself on programs in which alternative therapies are combined for a synergistic effect," Steven Amoils says. These programs range from wellness to more comprehensive interventions. In the comprehensive program, when "everything is falling apart," the patient sees a physician who will review the medical history and therapies to date, including which alternatives, if any, have been tried. Lifestyle, stress management, nutrient and biostructural issues might be recommended at this point. The patient then moves to other areas in the center depending on the personalized program set up.
A prominent treatment area will be rooms in which, in one hour, the patient gets chiropractic treatment, acupuncture, then an energetic technique or massage.
"I initially pushed for four hours of treatment, but this turned out not to be feasible," Amoils says. "However, as it turns out, the most pronounced effects of these therapies occur within the first 15 minutes of therapist/patient interaction."
A large part of integrating health, however, is knowledge and practice by the patient, and the center also is geared to teaching.
Two large areas have been set aside, one for instruction in movement therapies, and another for lectures.
The lecture hall also will serve visiting experts and consultants, those who are the national or international leading experts in any given therapy.
"Part of our goal is to have the best of the best available." In addition, Amoils points out that the various programs and overall center are designed to be continuously open to growth and change. What directs this growth and what will keep the center progressive, will be what is learned and discovered as much as how many are treated and helped.
Key, then, to the future of the center is the research and development aspect.
"We have already started doing this," Sandi Amoils says, "in a pilot project comparing detection of spinal cord disc herniation by energetic medicine as compared to MRI (magnetic resonance imaging)."
A key factor in running the center then will be to coordinate research into the efficacy of alternative treatments with the care of patients. Enhancing this will be an ongoing relationship with the experts mentioned and other institutions, such as the National Institutes of Health, looking into alternative treatments.
Correctly performed research is not only for scientific credibility, it also will help integrate workable therapies into center practices. In fact, the term integrative, truly describes the approach at the center. My personal concern upon my visit was a child with hyperactive airway disease after a viral bronchitis. The standard of care currently is the use of inhaled steroids which are anti-inflammatory, relieving the inflammation in the bronchi -- the larger breathing tubes in the lungs. When asked about other modalities, Steven Amoils stated that acupuncture also might be helpful, but difficult to perform in children. In such a way, the conventional therapy becomes first line.
Many medical problems might seem even more tied to conventional approaches, such as the famous "slipped disc" in the spine that sometimes requires immediate intervention. But most back pain, in reality, is helped with integrated approaches. This might involve chiropractic, acupuncture, massage, physical therapy, movement therapies such as the Alexander Technique and further patient education.
"This year," Steven Amoils says, "we will be doing a summer series of seminars describing integrative approaches to various problems. In one, we will address an integrative approach to back and neck pain, from massage to surgery."
I eventually got around to asking about cost, for the patients that is. "We had to go to a cash pay system, which I resisted for a long time," Amoils says.
Unfortunately, approaches to managed care organizations yielded little interest in covering patients for integrative health.
"Hopefully," Amoils says, "in the future, we can show this approach as not only effective, but as reducing overall medical cost and improving quality of life. Until then, we can only hope that some insurance plans will partially cover costs."
As I have written in the past, we often fool ourselves by thinking of alternatives as new. The Hippocratic oath, for example, may well have been written by priests who were the spiritual healers of the time. Ancient notions of healing among doctors often involved ideas of changing the patient's constitution or influencing the patient's energy field. In discussing the child with asthma, Steve Amoils says, "after the initial intervention, the next thing would be to try and affect the child's overall health."
Acupuncture itself, as well as physical integration techniques for human structure, are ancient endeavors. Notions of prevention and what constitutes health promoting behavior have never really left the mainstream. What is really new to us is the overwhelming public demand for alternatives, especially non-pharmaceutical therapies, and at least a more noticeable acceptance of "alternatives" by members of the medical field.
What has occurred, I believe, is an emerging awareness that we in medicine do not have absolute cures for many illnesses or ailments, and that something more is needed. Medicine itself has always addressed this need in the areas of research, quality-of-life issues, nursing care, social services and the specialties. Integrative medicine attempts to help complete the picture.
Most often, the alternative movements in this country, for the past four or five decades especially, have created attitudes of self-reliance and empowerment on the part of patients. Not to mention the daily practice of healthy lifestyles. All of this will enhance the healing effects of any therapy.
Finally, no one who thinks about it can just reflexively discount alternatives, since there are ultimately, once substantiated techniques are integrated into the mainstream, simply more options.
The Alliance Institute for Integrative Medicine can be contacted at 585-CARE