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Integrative medicine expanding choices in care by Cindy Abole Public Relations In the search to improve health and wellness, Americans are spending more and more money on complementary and alternative medical therapies today. In 1998, about 42 percent of the U.S. population used some form of complementary and alternative medicine (CAM), spending about $27 billion, according to the NIH's National Center for Complementary and Alternative Medicine (NCCAM). About $12 billion was from out-of-pocket. Today, many consumers are benefitting from these healing therapies, under the care and guidance of a certified licensed practitioner and backed by a medical teaching institution. This level of expertise can be found through MUSC's Complementary and Alternative Medicine program.  The program is headed by Gary Nestler, DA, DOM, assistant professor, Department of Anesthesia and Perioperative Medicine. He is joined by acupuncturist Michael Dovey, DOM, and a staff of five other CAM practitioners. Both Nestler and Dovey are board certified in the areas of herbal medicine and acupuncture and accredited by the National Certification Commission for Acupuncture and Oriental Medicine. “This brand of medicine has been around for a long time,” Nestler said. “Patients are getting more involved in their health care and hold physicians accountable for every bit of  information they provide. The problem is they expect physicians to be fully knowledgeable about all of the effects of herbal medicines and pharmaceuticals. And that’s not realistic in today’s healthcare world.” Resources like the Internet and other materials keep patients more informed, especially when it comes to their own health. But studies indicate that less than 40 percent of patients have disclosed their Complementary and Alternative Medicine therapies to their own physicians, which has compromised its effectiveness as a helpful remedy. It could also be dangerous. CAM as an option It's hard not to pick up a magazine, journal or newspaper today without seeing a story that refers to some form of complementary and alternative medicine. Acupuncture, herbal medicine, vitamins, massage benefit stories are appearing everywhere—evidence of the public's interest and yearning for more information.  In 1999, more than 11 percent of America's community hospitals were able to offer some form of complementary and alternative medicine services, according to the American Hospital Association. That’s an increase of one third from the previous year. “What's challenging about this is that it's creating a whole new level of dialogue between the patient and doctor,” Dovey said. “I think physicians are becoming more open to our therapies and sometimes more accepting of its practices. Just about every age, ethnic or demographic group suffers from various ailments such as depression, stomach problems, pain that ran the course of allopathic treatments. As a result, physicians have become more accepting to these modalities.” In reality, physicians are just opening up to the practice of Eastern medicine. A recent local survey reported that complementary and integrative medicine have made some significant progress for acceptance among MUSC physicians and staff. “I think we're at the early part of a learning curve,” said Joanne M. Conroy, M.D., professor and chairman of anesthesia and perioperative medicine and associate vice president for medical affairs. “This is a tremendous opportunity for us to help determine the efficacy of treatment using alternative therapies and tradional medicine.” This pairing of Eastern and Western medical practice is the first of its kind within South Carolina. It allows patients to use multi-disciplinary complementary and integrative medicine through clinics at Hollings Cancer Center, their MUSC clinic on 30 Bee Street and the new Bone and Joint Center in West Ashley. South Carolina's largest health care provider, Blue Cross Blue Shield (BCBS), has stepped ahead of the insurance industry pack by becoming the first provider in the state to offer reduced fees for complementary and alternative medicines. The plan offers a 25 percent reduction in fees for approved chiropractic services, acupuncturists, massage therapists and fitness centers. Blue Cross' Natural Blue program was created in 1999 in response to the growing demand for integrative care and follows the trend in Florida and North Carolina.  “Natural Blue is both progressive and practical for consumers,” said Rick Gallion, director of BCBS’ Natural Blue program. “Our focus like most insurance providers is to maintain health and prevention. It saves money for everyone in the long-run.” Nestler sees alternative medicine as a therapy that can help fill the void when conventional medicine is ineffective. “CAM is not a replacement to mainstream, allopathic medicine. It doesn't promise to cure a specific disease, but it can help relieve symptoms and offer patients a better quality of life,” he said. Model efforts in three clinics On weekdays, Nestler and his staff make the eight-mile journey northwest over the Ashley River Bridge and past I-526 to MUSC's new Bone and Joint Center in West Ashley. For Nestler, the medical setting represents an ideal, integrative working environment found under one roof.  Inside, specialists in orthopaedics, rheumatology, pain management, radiology, physical therapy, occupational therapy, lab services and complementary and alternative medicine work together to provide patients with the best multi disciplinary care. Beyond a diagnosis, a specialist can recommend a variety of treatment options that may include acupuncture, prescribed drugs or other therapies to address a patient’s pain or path to recovery.  “Here, there's no competition for patients,” Nestler said. “This type of clinical setting allows practitioners to lay down their armor and work together to treat the whole patient. What’s great is that patients know they’re getting good care and are far more comfortable communicating with their health care team. Everyone's part of one team.”  They also maintain a full-time clinic working along with internists and other practitioners at their permanent office at 30 Bee Street. Their presence makes it convenient for other physicians who may need to seek their expertise or recommendations concerning some patients. “Doctors are thrilled, especially because they know we can help their long-term, chronically-ill patients. They now have a place to go,” Nestler said. In a key move last fall, Hollings Cancer Center (HCC) opened the Multi-disciplinary Complementary and Alternative Medicine Clinic. The move, with the strong support of HCC director Carolyn Reed, M.D., helped to establish the division’s foothold by offering cancer patients with a holistic approach to medical treatment especially its affects with their health and overall  recovery. The team provides a front-line approach in treating nausea, hot flashes and other side effects of patients undergoing chemotherapy and  radiation. “Many patients already use complementary or alternative medicine,” Reed said. “We wanted to give the option of learning about CAM to all cancer patients through an integrated approach. The availability of our CAM therapy program has added a new dimension to cancer symptom management at HCC.” In addition, Nestler's involvement extends to his services with the medical center's newly-formed Palliative Care Team. He is also in the process of meeting with the clinical coordinators of MUSC’s Pain Clinic. “At this point, staff and physicians are being educated regarding services available by Gary Nestler and his team,” Reed said. “Advice on herbal therapy, use of acupuncture to decrease side-effects of chemotherapy and radiation and use of massage therapy to reduce discomfort are all available to our patients.” “Our staff is just beginning to realize the benefits of the program, confirming the positive responses from our patients,” Reed said. “Because we at MUSC are lucky enough to have a leader in CAM (Nestler), we have the opportunity to study the value of CAM as it affects quality of life and specific cancer and treatment-related symptoms.” No barriers in education, learning Nestler is involved on the educational front to help train future MUSC physicians and other practitioners regarding complementary and integrative medicine. He already teaches CAM courses locally and statewide. For the past two years, he has hosted a CAM elective course for fourth-year medical students and regularly participates with continuing medical education classes for residents also approved by the National Center for Continuing Higher Education.  Nestler is a member of MUSC's Ethics Committee and is a contributing NIH Grant Reviewer. “I'm a firm believer in looking at all aspects of alternative and complementary medicine and applying it to the same tenants as how we study and understand Western medicine,” Nestler said. “Just because it's natural doesn't mean it's safe,” said Nestler, who is concerned about the negative stigma commonly associated with fraudulent therapies . To combat this, Nestler and his team are proactive in helping to educate patients in becoming informed health care consumers. His greatest concern is people seeking advice from  non-qualified individuals and establishments that supply herbal products, vitamins and other CAM services.  “We feel we add great value and credibility throughout our outreach and education to the community,” Nestler said. “Patients can walk into MUSC clinics and know that everyone involved in their care is not only dedicated to their patients medically, but also in the backgrounds of research and education.”  He and Dovey have logged dozens of hours traveling throughout the state and teaching groups about the benefits of Eastern practices like acupuncture, herbal medicine and touch therapy. The pair have presented at local and regional gatherings of the American Bar, Arthritis Foundation and other groups using themselves as key resources in outreach efforts.  “There should be no barrier to care other than good education, knowledge and a supportive network,” Nestler said. “Outreach can be a clinical advantage because MUSC is known as the state’s leader for healthcare in South Carolina.” “With cultural diversity, you have cultural medicine,” Nestler said, recognizing South Carolina’s changing patient population. “With transient groups come differences in people and different cultures. These groups will be specific in their expectations from their healthcare provider. ” Outlook for integrative medicine Because many complementary and alternative medicine therapies are not completely standardized or regulated, as of yet, by Western medical guidelines, its appropriate that consumers apply the Latin phrase, Caveat Emptor; “let the buyer beware” in seeking only qualified practitioners. Today, more studies and research are being focused on complementary and alternative medicine. In 1999, the NIH established the Alternative Medicine Initiative, which investigates and evaluates CAM interventions. Last July, the Department of Health and Human Services announced the White House Commission on Complementary and Alternative Medicine Policy to explore the need for administrative policies and legislation concerning CAM, confirm licensing and training of practitioners and recommend methods for consumer education.  Following leading research institutions like Harvard, Stanford, Yale and the University of Arizona, Nestler continues to broaden support and expansion of research methodologies, education initiatives and clinical interventions in the field of complementary and alternative medicine at MUSC. As consumers continue to integrate CAM techniques in their healthcare, Nestler foresees use of  a front-line approach for CAM in clinics. He can also envision CAM woven into the fabric of the medical mainstream. “We’re seeing medicine at its evolutionary time,” said Nestler, regarding the government and public’s focus on a patient’s bill of rights, health insurance reform and Medicare. Most importantly, he sees a shift in policy that will ultimately empower patients. “In the places where CAM is located, we still see a lot of opportunity for growth,” Dovey said. “What we’ve done so far for our patients is good, but we know that CAM’s inclusion is just scratching the surface of integration in healthcare.”  In the area of medical education, Nestler predicts the inclusion of fully-mandated classes on CAM and integrative medicine. He projects physicians will choose to specialize in CAM and that medical students will have the ability by example to learn more about therapies like acupuncture and its application for pain relief. “As MUSC continues its positive impact on our surrounding communities in CAM, we whole-heartedly commit ourselves and our resources to providing safe and effective healthcare choices for all of our patients,” Nestler said. “Therefore, we look forward to the day where we can provide an integrative center for health and healing that is consistent with the mission of excellence at MUSC.” For information about complementary and alternative medicine at MUSC, call 792-1270 or e-mail Nestler at nestlerg@musc.edu.   Artist conquers pain with acupuncture When 45-year-old Karen Stevens sketches out a painting using a pencil or brush, she’s grateful she can move without pain. Stevens, a former ceramic artist in residence for South Carolina, now spends her time painting and sketching murals in many South Carolina schools.  She is the epitome of a survivor. In 1996, she survived a deadly automobile accident which left her with a cervical fusion and incredible pain. It was then that she first turned to the ancient treatment of acupuncture to help her handle her pain, especially while sleeping or lying down. Later, she was reintroduced to the Oriental technique through MUSC’s Complementary and Alternative Medicine and its director, Gary Nestler. Shortly after receiving treatment, she received devastating news confirming her diagnosis of Multiple Sclerosis. She immediately sought care with MUSC specialists, Edward Hogan, M.D., Department of Neurology and Storm Eye Institute’s Charles Beischel, Department of Ophthalmology. Recently,  she was diagnosed with optic neuritis, an inflammation of the optic nerve and symptom with the disease. Its result caused her some vision loss. Meanwhile, she continued to see Nestler for acupuncture treatments for pain relief, numbness and general weakness.  “Gary has helped me in every way, locally, more than anyone else,” Stevens said. “He offers something for people who've never considered complementary medicine.” The practice of acupuncture is a natural and effective treatment that has been used by practitioners for  more than 5,000 years. Acupuncture uses a series of fine hair-thin needles placed at specific body points called acupoints, that can be stimulated to correct and rebalance the body's system to restore health and achieve pain relief. Stevens learned to deal with the disease and her own human reaction to learning such news. “I held onto a lot of anger,” Stevens said. “Bottling it all up is the conventional Western way of handling it. Gary helped me to realize that it was okay to release my anger and pain to help understand my emotions and its overall affect on my health.”  Today, she's content on seeing her medical specialists about once a year to monitor her MS, but she continues to see Nestler and the Complementary Medicine team weekly for treatments. Although Stevens' health insurance does not cover acupuncture at this time, she continues to use it as an out-of-pocket expense.