Patients' desire for alternative therapies is driving changes in medical education.
Now that nearly 40 percent of American adults swear by some form of complementary and alternative medicine, or CAM—from nutrition and mental relaxation to acupuncture, magnet therapy, and foreign healing systems like traditional Chinese medicine and Indian ayurveda—a growing number of medical schools, too, are supplementing medication with meditation.
Interest in teaching alternative approaches "has exploded, especially this last year," says Laurie Hofmann, executive director of the Institute for Functional Medicine, which is based in Gig Harbor, Wash. The nonprofit institute educates healthcare professionals to look for underlying systemic imbalances as a cause of illness rather than focus on treating symptoms and, when possible, to correct with lifestyle changes and mind-body techniques.
The Consortium of Academic Health Centers for Integrative Medicine, which encourages the spread of CAM education, was founded in 2000 after an initiative by eight academic medical centers; it now boasts 46 medical school members.
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Traditional study of drugs and surgery, of course, still dwarfs class discussion of alternative medicine. Still, students want to add complementary methods to their black bags because they "know their future patients are going to be using them," says Shelly Adler, director of integrative medicine education at the University of California–San Francisco School of Medicine, which has a long history of teaching the topic.
"I could already see the limitations of Western medicine, especially when treating recurrent pain or other chronic conditions. I thought other healing traditions could fill in some gaps," says Carson Brown, a first year resident at San Mateo Medical Center in California. Spurred in part by the relief that acupuncture had offered her for hip pain induced by a sports injury, she took a two-week elective offered to fourth-year UCSF students last year that covered topics from acupuncture to mind-body medicine to herbs.
A similar elective was launched last spring at the Loma Linda University School of Medicine in California; the school is planning a second, more in-depth elective on functional medicine for chronic conditions. Such an approach to managing—even reversing—diabetes, for example, emphasizes exercise and a plant-based diet rich in whole foods, with medication as a last resort.
The schools insist that they approach the subject with an eye toward the evidence, advocating only methods that have withstood scientific scrutiny even as they examine any methods patients frequently use. But critics charge that this is not always the case. A 2009 review in the journal Academic Medicine of a handful of course curricula found a bias "in favor of CAM," noting recommendations of acupuncture for conditions like asthma where there is "no credible evidence" and instances of ignoring research—for example, studies associating chiropractic neck manipulation with stroke.
At the University of Arizona, where bestselling CAM guru Andrew Weil is a member of the faculty, a curriculum overhaul five years ago expanded the discussion beyond the scope of an elective or two. Based on the growing body of research supporting some holistic remedies, especially nutrition, and of smaller-scale studies on other treatments with limited risks, such as journaling to help rheumatoid arthritis, "it made sense to integrate these ideas into a variety of courses," says Victoria Maizes, executive director of the Arizona Center for Integrative Medicine at the medical school.
As before, fourth-year students have the option of a four-week elective on the topic. All students, in classes across the curriculum, now gain an understanding of the role of nutrition and recognized alternative remedies in healing and prevention and of the body's innate ability to heal itself. Faculty members who have gone through the center's full-fledged, two-year fellowship in integrative medicine often give students a window on how they may eventually incorporate CAM.
One cardiovascular surgeon, for example, provides surgical patients with pre-operative guided imagery (shown in numerous studies to reduce stress and aid healing), offers detailed nutrition guidance for heart health, and is researching the effectiveness of Reiki, an energy healing method that relies on touch, on surgical recovery.
Educators at the University of Maryland School of Medicine in Baltimore are similarly inserting a discussion of integrative therapies wherever in the basic physiology and therapeutics curriculum "there is reasonably good evidence that CAM is helpful, or where there is widespread use by the public for those conditions," says Delia Chiaramonte, director of education for the school's Center for Integrative Medicine.
There's a fourth-year elective, too, that emphasizes the importance of caring for the mind, body, and spirit of the physician as well as the patients. Students not only learn about yoga and tai chi, for example, but also practice them to de-stress, Chiaramonte says. "Students recognize that, to be good healers, they need to facilitate their own wellness, that [it's] is a part of healing a patient," she says.
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Medical schools that can't find the resources or the space in their packed curricula to add CAM—a recent Institute for Functional Medicine (IFM) survey indicated that time, not lack of interest, is the prime impediment—may find that online education can fill the gap. Next year, the University of Arizona will launch a 16-hour Internet-based holistic course on prevention and wellness, open to medical students from other schools.
The IFM will debut Web-based modules later this year on gastrointestinal health, the principles of functional medicine, and nutrition. (Time constraints are no doubt the reason a recent study in Academic Medicine found that only 27 percent of medical schools currently meet the minimum target, set by the National Academy of Sciences, of 25 hours for class time about nutrition.)
Whether or not students who learn about alternative approaches ever incorporate herbs or acupuncture in their practices, believers say, they stand to gain from viewing medicine in a more holistic way. Maizes recalls one cancer doctor who some years ago took the University of Arizona elective. He later told Maizes that the main takeaway he incorporated in his practice was a determination to spend time getting to know his patients as people.