But Kaiser is hardly alone in forging ahead with alternative care. OHSU now offers alternative therapies in several clinics, including the Center for Women’s Health, where Nedrow works; the Center for Health and Healing, a towering new clinic in the South Waterfront district that offers a range of services from ambulatory surgery to ophthalmology; and a newly opened Neurology Wellness Clinic that will treat patients suffering from conditions such as Parkinson’s disease, balance disorders and chronic pain. Students at the university can also receive training in integrative medicine—specifically, in how to incorporate acupuncture, meditation, diet plans and stress management directly into their treatment. The Providence Health & Services system opened an integrative clinic in 2005, offering therapies for cancer patients (such as acupuncture, massage and dietary changes) as well as for patients with heart trouble, fertility problems and chronic pain. Today the clinic sees more than 3,000 patients a year. Finally, OHSU and the three alternative medical schools jointly hold an integrative health “grand rounds” every month in which specialists from each tradition—allopathic, acupuncture, chiropractic and naturopathic—discuss a particular case, outline how they would treat it and try to reach consensus on the best course of action.
72 million adults, or one out of every three Americans, made use of some form of alternative care in 2002.
“When you look around the country at who is pushing the field forward, you have to say that Portland is in the forefront,” says Aviad Haramati, a professor in the Departments of Physiology and Biophysics and Medicine at Washington, D.C.’s Georgetown University School of Medicine, and a national leader in the integration of conventional and alternative medicine. “It’s a model for other places.”
To skeptics, the popularity of alternative therapies, and their creeping infiltration into conventional medicine, is proof of the enormous power of wishful thinking. “By definition, ‘alternative’ means not supported by acceptable scientific evidence,” says Dr. Harriet Hall, a retired flight surgeon who lives in Puyallup, Wash., and has become something of a professional disbeliever, penning articles on alternative medicine for magazines such as the Skeptical Inquirer.
Though Hall and other doubters believe that the scientific evidence for the effectivness of alternative care is scant, they don’t dispute that alternative therapies often produce results—but they insist that such improvements in health are actually due to other causes. People are fallible, says Hall. “They value hope and belief over scientific rigor and critical thinking. People make decisions based on personal experience, anecdotal experiences of their friends and family, personal feelings and prejudices, and other irrational reasons. People respond to placebos. People fall for the post hoc ergo propter hoc fallacy—symptoms tend to resolve sooner or later with no treatment, and whatever they were doing when the symptoms subsided gets the credit.”
Hall points out that proponents and skeptics often cite the same study to provide support for their position, because the studies on alternative care often yield ambiguous or contradictory findings. Last year, for example, Kaiser’s Elder published results of an experiment designed to discover whether ayurvedic medicine could help Type II diabetes patients control their symptoms. Sixty Portland patients who were being treated for diabetes were divided into two groups. The first received instructions on how to follow an ayurvedic regimen of herbs, diet, meditation and exercise; the second received standard diabetes education classes and follow-up with a medical doctor. After six months, the ayurvedic patients did only marginally better, statistically speaking, than the conventional patients in the study. On the other hand, they reported more subjective improvement in their overall well-being. Skeptics like Hall say this is simply an example of the placebo effect. Advocates say it shows how alternative medicine can improve what is, or should be, the ultimate bottom line of any therapy: to make people feel better.