This article appeared in the March 1997 edition of San Francisco Focus.

Alternative Medicine
Goes Mainstream

Alan Brauer never set out to be a pioneer. But in 1968, during a class at the University of Michigan medical school, Brauer - then a fourth-year student - suddenly realized he could not see out of his right eye. In disbelief, Brauer closed the other eye and saw only a fraction of what he was accustomed to seeing. The rest was a big black spot. "I panicked," the soft-spoken psychiatrist recalls. "I felt that my entire career was in jeopardy."

At the time, Brauer had no way of knowing that his blind spot would eventually lead him to an entirely new vision of medicine, one that blends the best of mainstream Western health care with a variety of alternative therapies: acupuncture, biofeedback, chiropractic, hypnotherapy, nutritional therapy, and herbal medicine. He was simply worried that he was losing his sight.

Brauer immediately rushed to an ophthalmologist, who diagnosed a rare retina problem. He was told that laser surgery was a possibility. Then that option was ruled out. When Brauer pressed his physician for more answers, the only response he received was that he should "go relax."

Brauer's blind spot cleared up on its own after a few days. But for years afterward his semiblindness recurred. Brauer kept pursuing medical solutions.

In 1972, while a psychiatric resident at Stanford, Brauer was introduced to Transcendental Meditation, the discipline promoted by Maharishi Mehesh Yogi, one-time guru to the Beatles. "I didn't know much about it," Brauer recalls, "but my eye problem was getting worse. I figured if TM could help me relax, maybe that would help my eye." To his amazement, once he started meditating twice a day, Brauer says he "almost immediately felt calmer. Other people said I seemed happier and more relaxed. Best of all, I never had another blind-spot episode. TM was literally an eye-opener."

Brauer began nosing around the medical literature concerning TM. He soon discovered studies by a Harvard researcher, Herbert Benson, MD, who had wired up TM meditators and found that they could slow their heart rates and lower their blood pressure on cue, abilities then considered impossible by mainstream medicine.

Brauer also stumbled upon early studies of biofeedback, a Western scientific off-shoot of meditation, which gives immediate biological feedback on the degree of tension or relaxation a subject is experiencing. Brauer visited the pioneering Biofeedback Institute of San Francisco and came away convinced that TM and biofeedback were different paths to the same destination-deep, healing relaxation-as well as a potential boon to his psychiatric patients. Brauer knew that TM would never go over at Stanford; it was too "religious" and too foreign. "But biofeedback was Western. It had wires and machinery. It seemed perfect for the psychiatry department." Brauer's instincts were right; despite some early anxiety on the part of his department chairman, "the Stanford Biofeedback Clinic was an immediate success."

But with success came attention from colleagues concerned that Brauer, a psychiatrist, was wandering beyond his area of expertise into the realm of physical medicine-treating headaches, gastrointestinal problems, and asthma. Called on the carpet, Brauer defended his practice by citing the growing body of research showing that biofeedback did indeed help manage a host of nonpsychiatric medical problems. But the Lords of Stanford were unimpressed, electing to limit his practice and forcing him to junk his original clinic brochure for one with more muted claims. Brauer was deeply frustrated.

But frustration has an oddly energizing quality. By the time Brauer had completed his residency, he was ready to open his own practice, TotalCare Medical Center, introducing a new vision of medicine that combined mainstream psychiatry with biofeedback, meditation, hypnosis, and visualization therapy. To Brauer's surprise, some Peninsula MDs shunned him-they refused to refer patients to him. "I guess I had more of a reputation as a wild-eyed radical than I thought," Brauer recalls.

Fast-forward twenty years. Brauer's thriving practice includes not only biofeedback, but also acupuncture, herbal medicine, and additional alternative therapies. And he hardly seems like an edge dweller. These days, Brauer's in good company locally with other respected mainstream physicians who embrace alternative therapies, such as Dean Ornish, MD, founder of the Preventive Medicine research Institute in Sausalito. Ornish attracted international attention with his revolutionary approach to reversing heart disease through meditation, yoga, diet, and exercise. Only a decade ago, the idea that bypass surgery could be avoided through alternative therapy was sacrilege. Today, Ornish's less invasive, and less expensive, approach is widely accepted in the medical community.

Indeed, the trend toward integrated, or "complementary," medicine has spread nationwide. The shift hasn't been easy: many physicians still consider homeopathy and acupuncture worthless, and would never refer anyone to an alternative practitioner or prescribe an alternative treatment. But with increasing numbers of health car providers, insurance companies, and patients looking for low-cost, efficient medical care, the formerly outre practice of blending technological and alternative therapies has become a more conventional choice.

Recently, many clinics that resemble Brauer's have opened around the country: among them, the American Holistic Centers in Chicago; the Arizona Center for Health and Medicine in Phoenix; Boston's Spence Center for Women's Health; and more locally, Kaiser Vallejo's Alternative Medicine Clinic.

Even cash-strapped public health departments are offering blended care. This past January, the King County Council, which governs Seattle, Washington, appropriated $750,000 to open the nation's first publicly funded natural-medicine clinic. Operated by Seattle-based Bastyr University, the nation's only accredited college that teaches naturopathy (an umbrella term for alternative therapies), the clinic supplements mainstream medicine with acupuncture, massage, chiropractic care, stress management, and nutrition therapy.

Much of this growth has occurred during the nineties. According to a widely noted Harvard survey released in 1993, one-third of Americans were spending close to $14 billion each year on alternative therapies, mostly without telling their MDs. And in 1995, Syracuse University psychiatrist Daniel Blumberg (who now works with Brauer) surveyed 572 family physicians and internists around the country and discovered that 94 percent were willing to refer patients to alternative practitioners. Relaxation therapies (meditation, biofeedback, hypnotherapy, massage, and visualization therapy) enjoyed the greatest support. A large proportion of the doctors also said they were comfortable with referring patients for acupuncture, chiropractic, nutrition counseling, and yoga classes.

Also in 1995, University of Maryland researches published a survey of 180 family physicians in Maryland, Virginia, and Washington, DC. More than half judged many alternative therapies "legitimate," and 70 percent expressed interest in being trained to practice them.

"Mainstream medicine doesn't have all the answers," says Jon Kaiser, MD, a San Francisco-based internist. "When I have a cold, I take a vitamin C and zinc because good studies show that they minimize symptoms and speed recovery. I also add some tincture [alcohol extract] of the medicinal herb echinacea to tea, because several studies show that it's an antiviral immune-system stimulant. When alternative therapies are safe and effective, I have no problem recommending them and using them myself."

What kind of MDs work in these integrated medical centers? Until recently, most have been people like Brauer-physicians who became interested in alternative therapies by accident, usually because they or a loved one developed an illness that mainstream medicine could not treat. But that's changing as the nation's medical schools, bastions of medical conservatism, have begun to offer courses on therapies outside the medical mainstream. Today, twenty-nine major medical schools - among them, Harvard, Yale, Johns Hopkins, and Stanford - offer instruction in alternative therapies. In December 1996, UCSF Medical School Dean Haile T. Debas, MD, announced plans to create an ambitious Program in Integrative Medicine (PIM) to coordinate rigorous scientific research of alternative therapies. Even former U.S. Surgeon General C. Everett Koop has embraced blended medicine. Now at Dartmouth Medical School, he is developing am medical center that will combine mainstream and alternative treatment.

Today, Brauer boasts thirteen professional colleagues: four MDs, three PhDs, a doctor of chiropractic, a certified hypnotherapist, a traditional Chinese physician, a body therapist, a pain therapist, and an MFCC (marriage, family, and child counselor). They all subscribe to the mission statement posted prominently on the waiting-room wall: "To integrate conventional medicine with scientifically validated alternative physiological, psychological, and natural therapies." Brauer hopes to add homeopathy "as soon as I can find a practitioner who fits in well with the rest of us."

At Brauer's center, patients get more than a combination of therapies. They also get something that is increasingly hard to find in mainstream medicine - time. When new patients call for appointments, a staff member interviews them for about twenty minutes to determine which clinician they should see first. "For medical or emotional complaints," Brauer explains, "people usually see an MD first; then that clinician refers them to the alternative practitioners in our clinic. But if a caller has already seen several other doctors without any relief, that person might start with one of our alternative practitioners."

Initial visits typically last fifty minutes, and subsequent consultations average about a half-hour - a far cry from the fifteen-minute appointments that have become standard at many mainstream medical facilities. "It takes time to practice good medicine," says Brauer. "With fifteen-minute appointments, people are out the door before they've relaxed enough to tell you what's really going on with them. We could make more money if we scheduled shorter appointments, but factory medicine doesn't work for me."

Despite its rapidly increasing popularity, integrated medicine remains an insurgent philosophy. But today, its opponents are under pressure from an unexpected corner - the health insurance industry. Until recently, insurers were contemptuous of unconventional therapies. But with the advent of managed care and its mania for cost control, insurers have embraced several alternative approaches because they work just as well as mainstream medicine but cost much less. "For years," Brauer explains, "we've been recommending garlic to diminish high cholesterol. It often works just as well as the cholesterol-lowering pharmaceuticals, but it's much cheaper and has fewer side effects. Then last September, one of the HMOs we belong to sent a memo to member doctors insisting that before prescribing cholesterol-lowering medication, we had to prescribe a course of garlic capsules. When I read that, I did an honest-to-God doubletake."

All this therapeutic blending raises a curious question: if alternative therapies go mainstream, are they still "alternative"? "Increasingly," Brauer observes, "they are not-and I'm quite pleased about that. We shouldn't divide healing into 'mainstream' and 'alternative'. We should use anything and everything that's safe and effective." Apparently, Brauer's medical colleagues on the Peninsula agree. Many of the Palo Alto-area physicians who refused to have anything to do with him twenty years ago refer patients to him today.

"Complementary therapies don't replace mainstream medicine," Brauer explains. "Rather, they complete it, expanding it to include areas conventional medicine has undervalued or overlooked: diet, exercise, traditional healing arts, and mind-body therapies."

Two of the nation's most outspoken proponents of complementary therapies are Andrew Weil, MD, and Deepak Chopra, MD. Each has impeccable mainstream medical credentials. Weil trained at Harvard and today is a professor of medicine at the University of Arizona College of Medicine in Tucson. Chopra is a board-certified endocrinologist and former chief of staff at New England Memorial Hospital in Stoneham, Massachusetts.

Both Weil and Chopra draw large crowds at complementary-therapy conferences; both have been attacked by mainstream medical conservatives. But contrary to what their admirers and detractors may believe, neither Weil nor Chopra has abandoned mainstream medicine - both embrace integrated health care wholeheartedly.

"If I'm involved in a serious auto accident," Weil says, "I want the ambulance to rush me to the nearest high-tech trauma center. Mainstream medicine is definitely the way to go for serious injuries. But let's say I developed chronic pain as a result of the accident. Beyond narcotics, mainstream medicine doesn't have much to offer. But several complementary therapies can help. I might try chiropractic, acupuncture, yoga, or massage therapy."

"I'm not at all opposed to medical technology," Chopra insists, "But technological medicine undervalues the connection between the mind and body. That's where the alternative therapies excel."

Other leading practitioners of complementary therapies feel the same way, notably Joseph Pizzorno, ND (naturopathic doctor), president of Bastyr University: "Natural medicines may take a little longer to work, but they're less expensive, have fewer side effects, and don't contribute to the terrible problem we now have with antibiotic-resistant bacteria, a problem caused largely by overuse of pharmaceuticals."

After decades of rancor between defenders of mainstream medicine and those of the complementary therapies, the growing mood of mutual accommodation is a relief. But today's medical pluralism can also be confusing. Who should you see for what? How long should you stick with one practitioner before consulting another? These questions are moot if your health care provider is an integrated clinic (like Brauer's) with a multidisciplinary philosophy. But most people don't have easy access to such medical department stores. They must obtain care at various single-approach medical boutiques. Choosing among these can be difficult.

When you get sick enough to consult a physician, says Richard Jenkins, MD, a Berkeley physician and a homeopath, most Americans still feel comfortable starting with an MD. "Mainstream medicine is very good at diagnosing serious illness and treating life-threatening infections," he explains. Patients shouldn't be shy about asking their physicians for recommendations on both technological and alternative therapies, says Jenkins, although if the answer addresses only conventional treatment, you might want to consult a health care provider at a clinic with a blended approach.

But even if you have a condition that lends itself to conventional treatment, complementary relaxation therapies can help. "They minimize the anxiety and emotional suffering any illness causes." Brauer says. "Deep relaxation is more than just a therapy. It's a boon to wellbeing whether you're sick or well."

If mainstream medicine does not provide sufficient relief, or if the treatment a doctor suggests does not appeal to you, Jenkins advises trying one of the complementary therapies that emphasize diagnosis; homeopathy, Chinese medicine, or naturopathy. "You want a diagnosis," he says, "because that points the way to treatment."

As for which approach to choose, Jenkins says it's a matter of availability and personal preference. Of course, availability is not an issue in the Bay Area. "You can find every imaginable practitioner around here," Jenkins says, "so choosing among them usually comes down to personal preference or word-of-mouth referrals."

How much time should you give a therapy - either mainstream or complementary - before moving on to something else? Jenkins says it depends on the problem: "If you're in severe pain and mainstream medicine doesn't help within a day or two, it's reasonable to try something else. But if you've had a vague chronic condition for several years, I'd give a therapy a few months before moving on."

Brauer's Palo Alto clinic, the oldest and most comprehensive integrated medical practice in the Bay Area, has come a long way. Today, the debate focuses less on whether complementary care should be used with mainstream medicine than on how. It's hardly shocking any more when a doctor skips the aspirin and instead prescribes a homeopathic remedy, a yoga class, a trip to the chiropractor-all thoroughly "alternative" therapies.

Or are they? As complementary care joins the mainstream, it's increasingly hard to tell.