A Tough Pill to Swallow2 Comments
Lina Pradeep is always on the move — she shovels the driveway and bustles around the house. She even plays with her toddler. However, less than a year ago, Pradeep was diagnosed with symptoms of multiple sclerosis, an immune disease that severely affects a person’s nervous system and impairs mobility.
Pradeep had constant pain in her legs and was unable to walk for more than 10 minutes when her doctor first identified the symptoms in June. Rather than follow through with additional testing, though, Pradeep decided to come to the Amadeus Center for Health & Healing in New Haven for acupuncture treatments. The biweekly visits are a family affair — her husband and son accompany her for the two hour round trip from her home in Woodbury, Conn..
Now, eight months into her treatment, the pain is nearly gone.
While the walls of herbal supplements inside the Amadeus Center hint at its healing philosophy, similar treatments are also in progress in the Yale Stress Center, about a mile away. In the past year, the Stress Center has started offering acupuncture to many conditions ranging from chronic pain to mood disorders.
For Eunjie Klegar, clinician in psychiatry at the Yale School of Medicine, “It’s a way of being able to treat the whole person.”
This field of medicine has many names: alternative, integrative, complementary, naturopathic, oriental. They all refer to the wide range of non-conventional treatments that includes homeopathy, naturopathy, acupuncture and even lifestyle management.
However, despite common tendency to use these names interchangeably, Marcia Prenguber, dean of the University of Bridgeport College of Naturopathic Medicine, does not think that all are equally appropriate.
“Calling it ‘alternative’ can put up a barrier,” Prenguber said. “‘Complementary’ is better, but can still sound insignificant.”
Though “alternative” may indeed sound alienating, it appeals to some patients who are frustrated with conventional medicine. In Pradeep’s case, for instance, distrust of American doctors drove her to see a naturopathic practitioner. In her native Russia, eastern medicine plays a more prominent role than it does in the United States.
“The effectiveness of acupuncture is a fact there,” Pradeep said. “I want to be cured, not diagnosed. And I don’t see that happening with [conventional] medications.”
Pradeep’s journey is a familiar one to David Katz SPH ’93, director of the Yale-Griffin Prevention Treatment Center. Formerly involved in the Integrative Medicine Center at Griffin Hospital, Katz often saw patients who had tried all other mainstream options available to them. Integrative medicine provided him with the creativity he needed to effectively treat those who had exhausted conventional treatments.
Integrative medicine can also afford patients a sense of control. Robert Krause YSN ’98, a lecturer at the Yale School of Nursing, incorporates alternative medicine into his psychiatry practice, using yoga and meditation in conjunction with psychopharmacology to treat patients. He said his patients who pick non-conventional treatments often report feeling in command of their daily lives.
Erin Hofstatter, professor of medicine, noticed similar results when her patients began requesting herbal supplements. At the Yale Cancer Center, Hofstatter tries to accommodate her patients’ desires — she typically allows the use of herbal supplements as long as they don’t interfere with the patient’s other medications.
“The patients want to feel in control,” Hofstatter said. “There’s nothing like a cancer diagnosis to make you feel out of control.”
Hofstatter began her research into plant-based therapies in response to her patients’ demand for treatments with fewer side-effects. She is currently working on a clinical study of black cohosh, a compound with cancer-preventative properties — she hopes that this study will fit into a larger trend of non-conventional clinical trials.
But elsewhere in the Yale School of Medicine, some clinicians see alternative medicine in a less favorable light. Steven Novella is a professor of neurology and a prominent member of the opposition, termed the “scientific skepticism movement.” Novella is the founder and executive editor of Science-Based Medicine, a blog that evaluates alternative medical treatments from a scientific perspective.
“Alternative medicine is a term that’s used a lot,” said Jann Bellamy, a contributor to the blog. “But there should just be medicine.”
Medicine is rooted in safety and effectiveness, and according to Bellamy, if a treatment can’t ensure both, then it cannot be classified as medicine. This critique — that non-conventional treatments do not have a scientific basis — is a popular critique among skeptics.
However, many practitioners of alternative medicine maintain that science provides a firm grounding for their work. Michelle Hessberger is a naturopathic physician who practices at Revive Wellness Center in New Haven. In addition to her doctoral degree in naturopathy, she also has a master’s degree in cellular and molecular biology, a qualification that surprises many people.
“I’m looking at cells and molecules to see how I can make them function better,” she said. “For example, by looking at biochemical processes, you can help the mitochondria produce more energy.”
Although she carries out conventional lab testing for her patients, she does not take results at face value, the way a primary care physician would. Rather than check if a patient’s vitamin levels fall within the accepted range, she determines the patient’s optimal level, given their lifestyle and history; this approach has helped many patients who felt ill despite normal lab results.
For Prenguber, too, science is central to naturopathy. Modern science can explain the mechanisms of ancient treatments, she said.
“We’re blending centuries-old traditions with the backing of more advanced research,” she said.
The long-standing history of plant-based medicines — including everyday aspirin, which can be derived from willow tree bark — is a common argument for the scientific soundness of naturopathy. Skeptics do not dispute this; they just ask that alternative medicine and conventional treatments meet the same rigorous standards.
Hofstatter has encountered this very dilemma in carrying out her black cohosh study. While she acknowledged that alternative treatments should be as effective and safe as conventional therapies, she said that a lack of funding and grant money complicates the process. The large pharmaceutical companies that typically fund studies are less interested in integrative medicine, a less profitable endeavor.
Many School of Medicine researchers attempting to carry out studies on natural treatments echoed this concern. Ather Ali SPH ‘06, a director of the Integrative Medicine at Yale program, pointed out that many alternative treatments cannot be patented, making them less profitable.
Since there is little funding, researchers have less incentive to pursue studies that could otherwise prove the effectiveness of alternative treatments, Hofstatter said, generating a vicious cycle preventing progress in the field.
She posed a question to skeptics and fellow researchers alike: “Is it fair to hold [alternative medicine] to the same standards when there’s no feasible way to test the treatments in the same rigorous manner?”
Although most agree that a gap exists between practitioners and researchers of alternative medicine, successful research could ultimately unite the two groups.
“Theoretically everyone benefits,” Ali said. “If [a study] demonstrates promise, it becomes directly applicable to the small practice down the street.”
At the moment, though, the field is finding it difficult to gain traction in the academic community. In November 2014, the Integrative Medicine Center at Griffin Hospital, a Yale affiliate in Shelton, closed. According to a note on the website, this closure was due to “the changing landscape in healthcare.”
Katz, the founder and director of the Integrative Medicine Center, explained that the facility had difficulties maintaining a cost-effective model of integrative care. Each session with a patient required a team of clinicians and took as long as two hours. The center was losing money for the hospital, Katz said, resulting in its closing after fifteen years of operation.
At the Yale School of Medicine, integrative medicine does not have its own department — instead, the Integrative Medicine at Yale program provides a limited opportunity for students and faculty to collaborate and receive guidance. However, it is not a formal program.
Yung-Chi Cheng, professor of pharmacology at the Yale School of Medicine, thinks that Yale can do better when it comes to alternative medicine. There is a lack of research activity and faculty interest, Cheng said. He did note, though, that Yale is taking action — the School of Medicine has helped found the Consortium for Globalization of Chinese Medicine, of which Cheng is chairman.
“In spite of the limited activity at Yale, our work is being watched carefully around the world,” Cheng said. “If it works, it can be modeled for people to show how they should approach exploring the potential of Chinese medicine.”
The next generation of practitioners and researchers may have a chance to break the vicious cycle currently impeding the progress of alternative medicine.
There are currently five accredited programs in naturopathic medicine in the United States — one just down the road in Connecticut at the University of Bridgeport, under Prenguber’s leadership. Prenguber admits that her students have trouble getting hands-on experience in the field without the clinical access that medical students enjoy.
At Yale as well, resources are somewhat limited for students interested in alternative medicine. Vanessa Noelte ’16 has been excited about integrative medicine ever since high school. After hosting a screening of the film “Escape Fire” in order to spark discussion about the healthcare system, Noelte realized that a substantial group of undergraduates shared her interest.
In her sophomore year, she founded the Integrated Medicine at Yale Undergraduate group to invite speakers and host discussions, but she still feels a lack of mentorship for undergraduates interested in integrative medicine. As the only undergraduate director of the Integrative Medicine at Yale program, Noelte acts as a liaison, directing Yale College students to opportunities in non-conventional medicine.
“I think integrative medicine is the future,” Noelte said. “Hopefully the school and the students realize that soon.”
Correction: Feb. 28
A previous version of this article misstated the class year of Robert Krause YSN ’98.