Working together

Angu Sawni-Sikand grew up in a home where traditional Indian folk medicine – "grandma remedies," as she calls it – was always around. Her brother and mother used herbal remedies for arthritis; her brother saw a chiropractor for back pain. As an adult Sawni-Sikand added meditation and yoga to the therapies she learned at home.

In itself, Sawni-Sikand’s story is not especially unusual. From traditional Chinese healing to aromatherapy, hundreds of cultures have developed just as many remedies over thousands of years for an untold number of ailments.

But Sawni-Sikand is a medical doctor. For the past few years she has championed an approach to medicine that integrates Western medicine with the vast patchwork of therapies collectively called alternative medicine.

"I began reading and doing research into the medical benefits of alternative therapies for my patients," says Sawni-Sikand.

"I also began working with colleagues – faculty and students – to look at evidence-based treatments, treatments that are proven to work."

Sawni-Sikand is on staff at Children’s Hospital of Michigan in Detroit and an assistant professor of pediatrics at Wayne State School of Medicine. Since 1994, WSU’s medical school has offered an elective in alternative health care, covering therapies ranging from acupuncture to herbal medicine to prayer healing. Sawni-Sikand helps administer the popular program.

She is also one of five staff physicians at the Center for Holistic Medicine, a Detroit Medical Center clinic in West Bloomfield, and is working on a National Institutes of Health (NIH) grant proposal to expand all of these programs.

"I think it behooves (doctors) to employ scientific research and programs that recognize the benefit of the Eastern models," she says. "I believe in an approach that is very much complementary and integrative. It’s not all or nothing."

Only a few years ago, many medical doctors would have avoided alternative programs for fear of being seen as quacks by their peers or as witch doctors by their patients. But now, while alternative treatments remain controversial, many doctors are scrambling to educate themselves.

Patients interested in an alternative treatment should first consult their primary care physician, says Sawni-Sikand. In turn, physicians should be informed about alternative therapies and be prepared to make referrals, as they might for medical specialists. If the physician is dismissive of alternative treatments altogether, perhaps it’s time to find a another doctor, she says.

"These treatments give doctors more tools," says Sawni-Sikand. "Patients really want to know what works and what’s available."

In ever-growing numbers American do want to know more. Upward of 120 million Americans sought some form of alternative therapy in 1997, according to the Journal of American Medicine, a figure up from 80 million in 1990. Many of those went to a practitioner of alternative medicine before they saw a physician.

The race to "mainstream" alternative medicine is definitely on, says Dr. Jay Sandweiss, an Ann Arbor-based osteopathic physician and long a supporter of alternative therapies, which he says can be hugely effective for a variety of chronic conditions, including back pain, diabetes and arthritis.

"If you’ve got an acute, life-or-death illness – a heart attack – (Western) medicine is best and you want to be at one of the region’s top-notch hospitals," he says. But when a problem isn’t life-threatening, "other systems of healing approach these kinds of complaints better and with better outcome."

But with so many alternative therapies out there – not to mention the number of illnesses they can treat – identifying those that work is difficult, says Sandweiss.

Alternative care by its very nature is an interwoven element in a person’s life. Patients must be responsible for learning about their own health.

"The healing process must involve education," Sandweiss says. "Read and get in touch with people who have solid backgrounds in the particular area of care that interests you."

As with medical doctors, most people choose an alternative practitioner by word of mouth or by referral from another doctor, said Sandweiss. But many practitioners belong to professional organizations, such as the American Academy of Acupuncture, that seek to ensure high professional standards and maintain regional lists of practitioners. There is also an ever-growing number of consumer resource guides (see book review).

The government, too, is working to inform and safeguard the public about alternative care. NIH maintains a comprehensive Web site that lists resources and answers frequently asked questions about alternative medicine.

NIH also pays for medical research at hundreds of hospital and research centers around the country and is spending billions of dollars to test alternative therapies. When the NIH Office of Alternative Medicine was opened several years ago it had a budget of a paltry $2 million. Today, the office sports an upgraded status – The Centers for Complementary and Alternative Medicine – and a $15 billion budget for research.

At Duke University, 330 patients have been enrolled in an NIH study of St. John’s wort, an herb thought to relieve mild depression. At the M.D. Anderson Cancer Center in Houston, Texas, shark cartilage is being tested as a treatment for lung cancer. At the University of Michigan Medical Center, 180 people have been enrolled in $6 million study of hawthorn, an herb that has been used successfully in Europe to treat heart failure.

Despite the boom in consumer interest, NIH research, and growing acceptance among doctors, effectively testing and using alternative medicines in a Western medical setting is easier said than done. Many medical concepts and methods do not easily translate between alternative and Western medicine and ideas may get lost.

A diagnosis of "osteoarthritis of the knee," for example, does not exist in traditional Chinese medicine. The closest translation may be to say "the knee area is energy blocked."

"I think it’s a huge problem," says Dr. Sara Warber, co-director of the Complementary Care and Research Center at the University of Michigan. "We tend to practice conveyor belt medicine. We tend to be very specialized and fragmented in the way we administer care."

The gold standard for medical testing is the randomized, double-blind study, which uses control groups, placebos and total anonymity to guarantee the accuracy of results. But how do you apply a placebo for acupuncture?

Most alternative medicines are individualized and depend on integration with every aspect of the patient’s life, a conflict that Warber acknowledges even as she administers testing.

To bridge this gap the scientific community must begin to rethink some aspects of its approach to health, she says. Patients, too, need to re-examine how they interact with health care practitioners of all stripes.

"These treatments are about a kind of ongoing, working, approach to health," she says. "They really call for doctors and patients to do more than the therapies themselves. We need to re-examine the entire therapeutic relationship."