Integrative Medicine: It Takes a Village





If you do not respond to the ministrations of mainstream medicine, you’re not alone. For anyone interested in pursuing a different approach, we decided to reprint LittleBird Mary Carpenter’s story about integrative health centers published here last February. 

READING LOCAL HEALTH magazines, such as “Pathways” or “Natural Awakenings,” reaffirms what you may already know : the D.C. area offers a host of unconventional healthcare possibilities. While some people turn to these to improve their general health, many go because they’re suffering from severe, often chronic, symptoms that their MDs were unable to diagnose, treat or cure.

For them, a comprehensive approach is offered at centers of “integrative” medicine, where conventional MDs work together with specialists in acupuncture, nutrition, yoga, etc. – treatments that often work well for subtle or chronic conditions where conventional medicine has failed. (In contrast, “alternative” refers to a non-mainstream approach used in place of and “complementary” in addition to conventional medicine.)

At the George Washington Center for Integrative Medicine, now in its 16th year, evaluation begins with conventional blood and urine tests as well as a toxicity profile and/or a genetic profile, which is based on the commercial genetic test “23andMe.”  These profiles can be cornerstones for the detailed and individualized treatments which the center provides — especially for its “Detox Program,” prescribed for patients suffering from chronic immune or infectious conditions, including Lyme disease or from exposure to toxic substances such as mold.

The GW Center’s treatments include such far-out-sounding options as aromatherapy and infrared light therapy along with exercise and nutritional prescriptions. According to Medical Director Mikhail Kogan, the center’s list includes only those approaches that are evidence-based.  It does not include, for example, “ionic foot baths,” found at other health practices in the area as well as at health spas.

Kogan is frustrated by how often these treatments are provided without sufficient prior patient evaluation.  When asked about naturopathic advice offered by practitioners of individual treatments, like massage, as well as by purveyors of naturopathic supplements, he points out that the practice of naturopathy — based on the concept that removing internal obstacles to treatment will allow the body to heal itself — requires a four-year degree in Naturopathic Medicine, during which an important focus is detox programs.

One patient at the GW Center, a woman in her early 20s, dropped out of college because of Lyme- and mold toxicity-related “brain fog,” nausea, night sweats and hair loss – for which she had been in treatment with a Lyme disease specialist and had been taking three antibiotics and three anti-depressants.  After several months in the center’s Detox Program,” she was able to stop all medications except one anti-depressant, and is now planning a trip to Central America.

Anywhere from one-third to one-half of patients at the center are referred by MDs, and a large percentage come for weight loss or for symptoms related to chronic fatigue and fibromyalgia, as well as for cancer and neurological diseases, such as Parkinson’s and Alzheimer’s.

The center also has a program of “Healthy Aging.”  According to Kogan: “We can determine which parts of the system are the weak links and work to strengthen them.”  If there’s oxidative damage, for example, which is thought to contribute to Alzheimer’s disease, “treatment is usually simple,” he says. “Change the diet and teach about reducing stress, which can affect the entire body.”

A GW Center patient, a man now in his 80s, had used a wheelchair since his 60s because of difficulty walking, and he recently began losing speech and becoming confused.  After the center diagnosed late-onset Celiac disease, he was put on a gluten-free diet and within a few weeks began walking and talking with ease.

According to NCCAM (National Center for Complementary and Alternative Medicine) at NIH, about 38 percent of American adults use some form of CAM, the vast majority for back pain (17.1 percent), neck pain (5.9 percent) and joint pain (5.2 percent).  Comparing 2002 and 2007 (the most recent years for which statistics are available), CAM therapies with the largest growth included meditation (7.7 to 9 percent); and massage (5 to 8.3 percent); while the biggest decrease occurred in the use of CAM for head colds: 9.5  to 2 percent.

Self-described “quackbusters” David Gorski and Steven Novella in a recent “quackademia update” jumped on integrative health centers for the “continued infiltration of quackery into medical academia” – although in turn they have been accused of receiving support from the pharmaceutical industry.

But for people whose suffering has not been allayed by mainstream medicine, integrative centers can offer real hope by bringing together the brainpower of practitioners trained in many different disciplines.  Dr. Kogan makes the comparison to “palliative medicine,” hardly known 40 years ago and now an accredited specialty with several mainstream academic training programs.

What seemed clear during a weekly staff meeting at the center was how personalized each patient’s treatment is, and also how it can change over time depending on practical concerns, such as time and money; although some treatments are better covered by insurance than others, the bill can rise very quickly.  Also clear was the willingness of the center’s staff to bandy suggestions back and forth, with input from complementary practitioners, both respected and added to by MDs, to come up with the best treatment.

Dr. Kogan explained the difference in care at integrative centers like GW: “We don’t just prescribe treatments, we think about and look at the whole person, then we think some more.”  Because most doctors today, even primary care doctors, have specialized interests, Kogan believes: “It takes a village to care for a sick person today.”

— Mary Carpenter



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