The hard line that many practitioners have held between alternative and conventional medicine is breaking down slowly as researchers determine which holistic practices might promote health and which ones hold the potential for harm.

The line that divides alternative medicine from conventional medicine is longitudinal: It separates East from West.

It divides practitioners who trust only what can be understood and scientifically validated from those who are open to practices that may improve a patient's quality of life in ways yet to be measured.

On one side of the divide, medical doctors perform heart transplants and other astounding technical feats. On the other, practitioners use acupuncture needles, herbs, laying on of hands, manipulation, meditation or rhythmic breathing in approaches to healing that purport to treat patients as whole beings -- body, mind and spirit.

Americans pick what they like from each tradition, according to research by Dr. David M. Eisenberg. They spent $27 billion in 1997 on alternative therapies, including massage, acupuncture, herbs, food supplements, megavitamins, energy healing and homeopathy. The amount was more than the out-of-pocket spending for all U.S. hospital stays that year.

In a survey almost a decade ago, Eisenberg found that 96 percent of respondents who used alternative medicine also sought conventional care from a medical doctor when they had a serious condition.

Promoting healing, avoiding harm

Locally, the hard line that most practitioners have maintained between alternative and conventional medicine is breaking down somewhat, as researchers determine which alternative practices might ease suffering or promote health and which ones hold the potential for harm.

That slight opening means heart-transplant patients at Barnes- Jewish Hospital are taking music therapy, while some stroke patients and new mothers at St. Joseph's Hospital in Kirkwood are getting massage therapy. Low-income women receiving prenatal care at the Women's Health Center, staffed by Washington University physicians, can get soft-tissue manipulation from a chiropractic physician, who is researching ways to reduce low-back pain in pregnancy.

Dr. Randy Tobler, a gynecologist and obstetrician employed by SSM Health Care St. Louis, said some clouds may be parting, but, generally speaking, the local climate is inhospitable to those who venture beyond standard medical practice. He treats patients with fibromyalgia, multiple sclerosis, depression and diabetes in addition to his regular practice, and he is an outspoken advocate of holistic healing.

Tobler said mainstream doctors criticize him for "practicing fringe medicine" because he sometimes recommends herbal remedies and dietary supplements. But patients who have been frustrated by standard medicine seek him out. "My practice is busier than ever," he said. His wife, Heliene M. Tobler, has an online business selling herbal remedies, vitamins and natural beauty products.

Osteopathic physicians at Des Peres Hospital regularly mix less conventional practices, including osteopathic manipulation of the spine, limbs and joints, with standard medical therapies and prescription medications. When a patient cannot tolerate the side effects of a prescription drug, Dr. Andrew Chao might recommend using the herb from which the drug is derived.

Chao, an osteopathic doctor with a private practice in Ballwin, has had patients complain that while a medical doctor relieved their pain, the treatment left them feeling out of whack.

If that happens, the body may heal in a way that is not conducive to long-term health, Chao said. "It's like having an undetected cavity in a tooth," he said.

Osteopathic manipulation conveys compassion through touch, he said.

"I have patients say: 'I went to see a doctor, and he did not touch me. How can he diagnose me?' In laying on hands, people realize we care," said Chao, who directs medical education at Des Peres Hospital.

Joanne Guerrerio, a registered nurse at Barnes-Jewish Hospital, uses healing touch to relax and comfort the gynecological and oncology patients she treats. In a session, she runs her hands a few inches above a patient in the type of fluid motion one uses to smooth a rumpled tablecloth.

"We are starting to explore the mind-body-spirit connection," Guerrerio said. "Who we are is not just enclosed in a physical shell."

Studying results

Dr. David Mutch, a gynecological oncologist and professor of medicine at Washington University, said a large percentage of patients undergoing treatment for cancer choose to add acupuncture, vitamins, herbs or some other form of complementary medicine to their chemotherapy regimens.

Some alternative therapies are harmless; some give comfort. But some interfere with cancer treatments or can increase the bleeding risk during surgery. Later this year, Mutch and his colleagues at the Siteman Cancer Center at Barnes-Jewish Hospital will post a primer on Siteman's Web site and publish a pamphlet for doctors and patients who want to assess or access complementary care.

"We need to study if massage or meditation or healing touch work to improve treatment outcomes or a patient's quality of life," he said.

The National Institutes of Health primed the pump for this kind of research in 1998 when it established the National Center for Complementary and Alternative Medicine. The center is under congressional mandate to stimulate and support research on the effects of these unproven therapies. Once researchers identify safe and unsafe practices, the center will help to integrate the best practices into the American health-care system.

Addressing medical priorities

Until now, health systems and physicians in the St. Louis area have made limited and cautious concessions to alternative health care.

This summer, St. John's Mercy Medical Center became the first hospital here to open a stand-alone center for holistic medicine. Michelle Lavery directs the St. John's Mercy Center for New Health Options in Town and Country. She said the early, overall reaction has been good, but she admits that most physicians remain skeptical.

While some doctors support the concept of a holistic health center, others think it's "way too out there for the medical community to support," Lavery said. The center is holding open houses to introduce doctors to the services in hopes of winning more of them over.

St. John's opened the center in a section of west St. Louis County with a sizable population of Indians and other Asians nearby. Asians are culturally in tune with the use of herbs and natural healing methods.

David Seifert, president of St. Anthony's Medical Center, said consumer demand for holistic health services is less pronounced in the south St. Louis County area his hospital serves.

"I think there is a wide variety of things that benefit our health, but whether we can afford to provide those things is another issue," Seifert said. "Recently, the need to recruit and maintain staffing, particularly nurses, has drawn all our attention."

That's not to say those services are not of value, Seifert said. But some services, such as acupuncture, are readily available from chiropractors, "and for an institution to go out and develop an acupuncture program to compete, I personally don't think that is a good use of resources."

Dr. Donna Kalauokalani, an anesthesiologist and clinical researcher at Washington University, treats patients in the chronic pain clinic at Barnes-Jewish Hospital. Barnes-Jewish is the area's largest hospital, and Kalauokalani is the only medical doctor there to practice acupuncture for pain management. Next month, she will publish a study comparing the varieties of acupuncture used by physicians to treat low-back pain.

Kalauokalani learned acupuncture as a pain-management fellow at the University of Washington. She said alternative therapies have greater acceptance among patients and doctors in the Northwest than she has found since moving to the Midwest two years ago.

It got a big boost a few years ago when the state of Washington passed a law requiring insurers to pay for acupuncture and other alternative therapies.

In St. Louis, Kalauokalani said, insurers typically pay physicians who use trigger point therapy needle injections, but a physician using acu-puncture needles is usually denied insurance payment for the treatment.

But Kalauokalani said it is just a matter of time before acupuncture becomes more widely accepted for pain management here.

"I hope it is not going to be a long time coming," she said. "I think changing peoples' attitudes and beliefs is a lot more complicated than we like to imagine."

Meanwhile, Dean Weich, a Hazelwood chiropractor, is one of the trailblazers in multidisciplinary chiropractic practices. He reorganized his clinic in north St. Louis County once in 1998 to include a chiropractic school colleague and again in 1999 to add a medical doctor and two nurse practitioners.

Weich said his is one of about a dozen multidisciplinary practices in the Bi-State area. He thinks it is the only one to employ a family practitioner whose practice will reach beyond physical medicine to include all aspects of primary care. "Basically, we want to provide total health care," he said.

The first medical doctor Weich hired at the Primary Health Care Rehabilitation LLC. clinic was a psychiatrist, a specialist in rehabilitative medicine. That doctor left the practice last fall.

Weich then hired Dr. Lora M. Abell. A family practitioner in mid- career, Abell volunteered at free clinics after being laid off from a group practice owned by a hospital system. Abell plans to rebuild a general medical practice in addition to her physical medicine practice at the Primary Health clinic.

"A lot of people who go to a chiropractor don't have a physician, and they may find it convenient to have a doctor in the same center," Abell said. "One of the things I would like to have in the practice is the same thing chiropractic has always provided - same-day services. If you are sick, come in. If you are hurting, come in."

　　From Healthy.net