U. Health System ponders use of alternative medicine

Some departments within Penn's Health System already use non-traditional forms of treatment. Once derided by mainstream physicians -- and still not fully accepted in the medical community -- alternative therapies such as acupuncture, herbal remedies, massage therapy and spiritual healing have become more and more popular in the United States in recent years. As a result, hospitals and medical schools around the country, including the University's, are analyzing how alternative medicine could best fit into a traditional medical practice. At Penn, the role of alternative -- or complementary, as proponents prefer to call it -- medicine is unclear, though the University's Cancer Center, women's health center and other departments currently use it. A task force established this summer by Medical School Dean and Health System Chief Executive Officer William Kelley is charged with precisely defining that role. "Suddenly everyone is clamoring for alternative medicine," said Alfred Fishman, the Medical School associate dean chairing the task force. "Patients are sneaking out to get it after talking to their regular physicians." Until the group reaches a decision, which will not be until at least next May, an existing Program for Integrated Medicine -- established by the Department of Psychiatry and headed by Psychiatry Professor Richard Petty -- combines alternative with traditional medicine in research and clinical settings. The program -- which is run out of the Health System's satellite center in Radnor, Pa., and works like other medical-referral services -- is set up primarily for research. As part of the facility's work, physicians use a combination of approaches to treat patients with ailments like chronic fatigue, anxiety, stress and depression. Fishman, who was the chairperson of the Rehabilitation Medicine Department until July 1, described the task force as a "consumer-driven kind of an undertaking." Petty, who is also on the task force, said Americans spend about $15 billion a year on alternative medicine. Most of this expenditure comes from patients' pockets, although some insurance companies have begun covering therapies like acupuncture if a licensed physician performs them. Forty-two percent of U.S. adults have used some type of alternative medicine in the past year, according to a study by Landmark Healthcare Inc., a Sacramento, Calif.-based managed care company. Of these people, 74 percent used it in addition to conventional care, while 61 percent said their traditional medical doctor knows about their use of alternative care. The University task force, called the Working Group on Alternative Medicine, is made up of about 12 people. Half of them, like Petty, are staunch advocates of alternative medicine, while the rest practice only traditional Western medicine. Members hope to identify the "useful prospects" in alternative medicine in three areas: treatment, research and education. The dean will reach a final decision based on the group's recommendations at a May retreat. In the meantime, the British-born Petty practices therapies including acupuncture, acupressure and Qu Gong -- a type of massage used to treat phobias, for example -- on University Health System patients. When he came to the United States in 1994, his original plans were to research schizophrenia, his main area of interest, for three years at the University and then return. But he decided to stay because he "loved it here," and he started working on integrated medicine at Penn. Petty said that while there is widespread integration of alternative with conventional medicine in Britain, the practice of alternative medicine in the United States concerns him because many of the practitioners are "just out to rip people off." Also, some patients use alternative methods in place of proper treatments, leading to adverse results. Petty attributed some of the current interest in alternative medicine to its trendiness, but he added that many people "are very disillusioned with conventional medicine." "Also, there are many illnesses which [conventional] medicine is very bad at treating," he said, citing chronic illnesses, which complementary therapy seems to help. Petty emphasized that more research needs to be done to establish if this is really so. "These things don't work every time, but when they do, it's just great," Petty said. Research, the main project of the Program for Integrated Medicine, will explore if alternative treatments really do "work," and if so, by what mechanism. Petty said this research is necessary because of the possibility of the placebo effect, in which subjects who take a fake treatment -- but don't know it's fake -- get better because they think they should get better. Petty described a study in England that used Indian massage to treat patients bedridden for years because of paralysis from stroke. Conventional medicine treats this with physical therapy for six months, and then, he said, "they're stuck." "In the first uncontrolled segment of the study, we got four people [out of 12] walking in 16 weeks," he said. Petty stressed the need to integrate alternative medicine with traditional medicine, rather than solely relying on one. And Fishman and the rest of the task force are looking into all the options. "There are areas where Western medicine can only go so far in satisfying needs of patients," Fishman said. "I won't close the door to anything that would make my patients feel better."