Mainstreaming Alternative Medicine

People are incorporating naturopathy to acupunture into traditional medical treatment
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!--paging_filter--p class="TEXT"spanWhen one of Dr. Andrew Simon’s patients came in to his office complaining of flu symptoms, discussing whether medication was needed to mitigate the symptoms was just the beginning. “[He] complained about some upper back pain, so I did a back adjustment for [him]; and then we discussed stress, so I also helped with some stress management exercises.” ¶ That kind of all-encompassing care is all in a day’s work for Simon, a naturopath in his first year of clinical residency at the Bastyr Center for Natural Health in Wallingford, where he supervises student physicians and sees patients./span/p
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p class="TEXT"spanOne of the reasons he trained as a naturopath, as opposed to a traditional medical doctor, is that he can offer his patients more time to discuss their ailments and treat many of them with both homeopathic and mainstream (or allopathic) remedies. It’s the best of a few worlds. “I didn’t have to refer them out to a chiropractor, I’m trained to do those kinds of adjustments, and when I was evaluating him, I could have ordered a chest X-ray,” he says. “I think from a patient point of view, [going to a naturopath] gives someone a lot more ability to not be shuttled around in the health care system.”/span/p
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p class="TEXT"spanSimon, who has a special interest in sports and physical medicine, represents the changing face of complementary and alternative medicine, a far cry from the “granola” stereotype that sometimes persists even as increasing numbers of people—nearly 40 percent of Americans, according to the National Center for Complementary and Alternative Medicine (NCCAM)—incorporate some form of alternative medicine treatment, whether it’s acupuncture, chiropractic, naturopathy, massage, or simply taking vitamin supplements. Medical centers are listening and making natural alternatives a part of their offerings. According to the American Hospital Association, more than 42 percent of hospitals in 2011 indicated that they offer one or more types of complementary (which encompasses both Western and alternative medicine) and alternative medicine therapy, up from 37 percent in 2007; before that, between 1998 and 2004, the number had doubled./span/p
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p class="TEXT"spanFor people interested in exploring alternative medicine, the Pacific Northwest is the place to be. Bastyr University in Kenmore, and its Wallingford teaching clinic, is one of the leading training grounds for alternative medicine practitioners. The Seattle area is a hotbed of alternative treatments, from acupuncture to massage to naturopathy. In fact, in the 1990s Washington was a pioneer in requiring insurance companies to cover various forms of licensed natural health care./span/p
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p class="TEXT"spanIn Washington state (as in 16 others), naturopaths have strict licensing requirements: They are required to graduate from a four-year, residential naturopathic medical school and pass a board exam to become licensed. They’re able to prescribe most conventional medicines, barring opiates, such as oxycontin and vicodin, and barbituates, and are considered primary care doctors, opening the doors for insurance companies to include them in their coverage systems. This year, one of the provisions of the Affordable Care Act allows naturopathic physicians to participate in Apple Health, Washington’s Medicaid program./span/p
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p class="TEXT"spanMost people who use alternative medicine use it in tandem with conventional medicine, a practice sometimes referred to as complementary medicine. The practice has made the specialty of integrative medicine, in which medical doctors get training in alternative medicine practices, gain popularity (see sidebar, page 39). “We don’t get patients in and immediately go, ‘We’re gonna treat you with nettles and chamomile,’ says naturopath and medical doctor Marina Abrams, laughing. Abrams is trained and licensed as an anesthesiologist and practiced in emergency rooms in her native Russia, and later earned her naturopathy degree at Bastyr.nbsp; She is the medical director of Water’s Edge Natural Medicine on north Queen Anne./span/p
p class="TEXT"spanAbrams says that many of the clients who come to her clinic have already been to traditional medical centers without finding a completely satisfactory treatment. “Most of our patients come in on 10 different prescription drugs, with a chronic issue; they’ve been going doctor to doctor. We try to be very careful—we would never say, ‘Go ahead and stop taking drugs’—but you can treat most conditions and improve the situation just by changing their diet, lifestyle, and encouraging weight loss.”/span/p
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p class="TEXT"spanSimon says that one of the benefits of being a holistic provider is the luxury of more time with patients to cover a wider range of issues, because such providers are not under the same constraints that doctors can be—so a conversation about treating back pain can incorporate advice about diet, if the patient is looking for that. Naturopaths like Simon are trained to create treatment plans that work toward more natural options./span/p
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p class="TEXT"spanAstrid Pujari, M.D., is an integrative medicine practitioner with a medical degree and training in natural medicine practices, who heads her own practice, the Pujari Center in Fremont. She considers her position to be one that’s a bridge between natural medicine and conventional medicine providers. That’s much easier than it used to be, as medical providers learn more about natural medicine and encounter patients who ask about it./span/p
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p class="TEXT"spanPujari was a primary care doctor at Virginia Mason Medical Center for four years. When she struck out on her own as an integrative medicine specialist, she stayed on with Virginia Mason, to work at the facility’s cancer institute. She has been educating doctors about natural medicine for years./span/p
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p class="TEXT"span“When I started, I remember doing a lecture in 2002 or 2001 about fish oil, and the doctors were looking at me like—‘What?’” she says. “Now there’s a lot more information. The Internet has helped that; it has allowed patients to be better informed. I think patients being better informed drives doctors to have to know more.”/span/p
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p class="TEXT"spanThere is an increasing amount of research that backs up natural medicine to treat a variety of ailments. “There’s data that started in the ’70s,” says Pujari, “but now there’s getting to be such a great amount. I don’t have to do as much explaining as I used to.” Group Health Center for Health Studies’ Daniel Cherkin, M.D., led the largest randomized trial on acupuncture, published in the emArchives of Internal Medicine/em (now titled emJAMA Internal Medicine/em) in 2009, that showed that treatment effectively reduced lower back pain in study participants, which included patients from Group Health and California-based Kaiser Permanente. According to Fred Hutchinson Cancer Research Center, there are a few pieces of research indicating that massage can help with the scarring process for cancer, as well as to stimulate lymph node flow. Other studies back up probiotics for lowering high cholesterol. Evolving studies also mean that sometimes, treatments long assumed to be healthy are debunked, as in a recent Fred Hutch study disproving the effectiveness of vitamin D and selenium for preventing prostate cancer./span/p
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p class="TEXT"spanThere are particular health issues for which holistic medicine is a very natural fit, says Pujari. “I have the capacity to see a wide range of different problems. Where it is really good is for autoimmune disorders and colitis, allergies and skin conditions (where often allopathic options are very limited), menopause, hormonal issues, cancer, high cholesterol, anxiety and depression.” She requires her patients to have a primary care doctor if they come to see her, and she keeps that physician in the loop regarding the patient’s treatment when necessary; it’s a way for her to ensure that patients are getting the fullest health care picture./span/p
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p class="TEXT"spanSimon says that anxiety and stress management have been big themes for his patients lately. “I think the recession hit people quite a bit, and it led to a lot of people working two jobs, not getting enough sleep, that kind of thing. I do a lot of work with stress management for people, anxiety, chronic pain, muscle tension, irritable bowel syndrome. One of the things I ask them, in addition to what are they eating, is how are they eating,” he says. “I found, when I was a student at the [Bastyr] teaching center, we saw a lot of people who’ve been everywhere else—for chronic fatigue, fibromyalgia, acid reflux.”/span/p
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p class="TEXT"spanPatients who go to a naturopath or integrative medicine specialist for the first time can expect a similar experience to going to any primary care provider—they will complete a medical history, detail what medications they are taking, and explain why they decided to see the provider. Simon tries to make sure he gets all of the patients’ old records and find out when they last talked to their other health providers./span/p
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p class="TEXT"spanFinding a naturopath, acupuncturist, chiropractor or other holistic medicine provider isn’t difficult in Seattle, where there are many options, but finding the right one, as with conventional medicine, requires a little trial and error./span/p
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p class="TEXT"spanAlthough there is no one-size-fits-all guideline, Pujari says that choosing an alternative medicine provider is much like choosing any primary care doctor; it’s subjective, and quality can be hard to assess. “One way to tell is if you’re getting better; another way is to look at how other providers see them,” she says./span/p
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p class="TEXT"span“For myself, when I evaluate a provider, I look at how well they listen, how confident I feel about the treatment, and that they’re explaining why that treatment is going to help that complaint.” She adds that it’s important to her that the doctor has a clear objective for an end to treatment as well as “Is [treatment] practical?”/span/p
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p class="TEXT"spanThe NCCAM also publishes tips on its website for talking with your complementary or alternative medicine provider, which include making sure that your provider knows about everything you already use, prescriptions to vitamins, and asking lots of questions./span/p
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pspanWith more people turning to alternative medicine to supplement the care they already receive, holistic treatments have lost many of the old stereotypes associated with them, particularly in Seattle./span/p
pspan“My patients, they work for Microsoft, Boeing, Amazon and Google,” says Abrams. “They’re very driven, very athletic, very ambitious.”strong+/strong/span/p