Holistic Enters the Mainstream

ST. LOUIS - Darcy Wolf's struggle with arthritis left her dissatisfied with the treatment she got from traditional doctors. The St. Albans, Mo., woman found the drugs given to her didn't help. And in one case, they made matters worse.

"One drug raised my blood pressure," said Wolf, 56. "So the doctor put me on blood pressure medicine.

"They throw chemical after chemical at you with all the horrible side effects and they don't listen when you suggest a different diet might work."

Of course, not all doctors are like that, but it was enough for Wolf to decide to take matters into her own hands, reading books and articles seeking holistic remedies. Using the therapies, she learned a few things, including that some foods caused her pain. For example, "When I ate citrus, my knees would flare," she said.

She said that she eventually discontinued her medications, "all except Vioxx (a painkiller)."

Wolf said she feels better, but not as well as she'd like. She hasn't lost her faith in physicians, she said, only in those who fail to respect her values.

Seeking answers that she wasn't getting elsewhere, Wolf recently attended a gathering of people interested in holistic practices.

In the audience, a woman told of visiting a holistic physician who discovered that the woman's arthritis was caused by a sensitivity to Aspartame, an artificial sweetener. A man, small and bent and slow-moving, had a cancerous tumor and said his doctors had told him they had nothing else to offer; he hoped he might hear something that could help. Many had pains that continued regardless of what the doctor did.

At the session, Wolf looked for someone who could "recommend a doctor who would listen." She is one of millions of people who have sought holistic practitioners who offer alternatives to traditional medical care.

The numbers and demands by patients have caught the attention of the medical establishment. The big guns of medicine and many physicians are taking a closer look at what once was dismissed as superstition and quackery.

The National Institutes of Health is leading the examination, and it trickles down to individual practitioners taking hard looks at holistic medicine, ranging from "folk" (ethnic-based) remedies to naturopathic and herbal approaches, yoga, diet and much more.

For example, there's Dr. Mark Mengel, a professor of community and family medicine at St. Louis University School of Medicine, who has integrated holistic practices into his conventional private practice.

"Some of these practices are being embraced because they work," Mengel said.

What is holistic medicine?

Explaining holistic medicine is like explaining what is medicine, Mengel says.

In short, holistic-a name boiled down from whole-istic-looks at the person as a whole entity: mind, body, emotions and spirit.

"It's a view that illness and disease are not just caused by organ dysfunction," Mengel said. "There are multiple causes of disease not addressed by traditional medicine, and therapies are needed to address those causes."

In addition, "It's a philosophy that the mind affects the body. The mind and body are connected so we need to take into account mind issues, like emotions, spirituality and culture, when you're taking care of a patient."

Some things take simple observation and prove that emotions and spirit are part of the medical process. "It's been established medically that upbeat people have fewer and less serious illnesses," Mengel said.

As a discipline, he said, "It's a group of nontraditional therapies that have been lumped into the term, `holistic medicine,' from herbal therapies to acupuncture, to homeopathy, cognitive behavioral therapies ..."

The American Medical Association says holistic treatments, including "folk" (ethnic-based) medical practices, can range from herbal medicine to prayer, Ayurveda and yoga, massage therapy, aromatherapy and diet therapy, among others.

The new attention to holistic practices is not a slam on traditional doctors. Frankly, all of the physicians interviewed described themselves as conservative when it came to diagnoses of illnesses and prescriptions of medications, supplements and lifestyle changes.

Also, those doctors reminded us that physicians are accountable for whatever they do to or for someone-unlike holistic health providers that aren't physicians.

"I'm a pretty conservative practitioner," Mengel said. "What I try to do is integrate the therapies that work into my practice and use them. I wouldn't call myself a holistic practitioner. But I do believe the mind affects the body."

The new interest in holistic medicine seems to have grown with the new epidemic of lifestyle illnesses-obesity, hypertension, stress-related maladies, even arthritis and diabetes-that may be caused by lifetimes of poor health habits and can be cured or at least relieved by better habits.

An example: Patients complain that a doctor will prescribe hypertension medicine, but won't take an active role in helping the patient lose weight and eat better.

Patients increasingly grow dissatisfied with pills that mask a symptom temporarily and with physicians who recommend willpower as their sole nonpharmaceutical remedy.

The response by patients has been to take matters into their own hands and seek other avenues-often self-treatment and diagnosis gleaned from the plethora of books, or help from nutrition counselors, appetite-suppressing herbs, stress-relieving forms of lifestyle changes, yoga, spiritual counseling, acupuncture, personal trainers for physical and dietary goals, even exotic rituals of prayer and meditation-to get at the root of problems.

Still, acceptance of holistic practices traditionally has been slow among physicians and medical schools. However, that's changing.

In 1996, the National Institutes for Health opened the National Center for Complementary and Alternative Medicine (nccam.nih.gov). It examines holistic medical approaches by testing them until they prove worthwhile or worthless.

The American Medical Association also is paying more attention to the trends and has published several articles in its Journal of the American Medical Association magazine.

The reasons why people turn to holistic practitioners tend to be consistent, CAM center documents say, including:

Traditional treatments have failed to cure them, or caused side effects that seemed worse than the illness.

Their physician doesn't have time to talk to them.

Dissatisfaction with a "technical approach."

A feeling that they're being passed around among specialists.

People say holistic practices are attractive because of:

-Media reports of dramatic results.

-A belief that holistic medicine is natural.

-A feeling of empowerment and that patients take their destinies into their own hands.

-Treatments focusing on spiritual and emotional well-being as well as physical cures.

-Holistic therapists that find time to "touch and talk."

The AMA adds another reason for the growth of holistic "folk" medicine in the United States: the influx of immigrants who bring their own medical values and practices, which haven't been as strictly regulated as in America.

As the big agencies examine holistic practices, some medical professionals have been using them all along.

Mengel says he's integrating holistic elements into his practice as they are cleared by the scientific process.

"After examining the patient, I prescribe what's needed, taking all things into account," Mengel said. Diagnosing an illness doesn't stop when he finds a remedy; he may need to look into the lifestyle causes and make recommendations on that, too, he says.

Dr. Lena R. Capapas runs Preventive & Healing Arts and Anti-Aging Medicine at 522 North New Ballas Road. Having started her practice in the mid-1960s, she's maintained the holistic element much of her career.

"What's being practiced now as mainstream should be complementary," she said. "Practicing holistically should be the mainstream. I prefer the term `integrative medicine.'"

Formerly a cardiologist, she is now a holistic practitioner who says she gets to the root of the problem, past the symptoms.

The root is what went wrong between the time a healthy child was born in perfect chemical balance and when the person became ill during adulthood.

Humans, she said, pollute their chemistry with questionable food and environment. The result: lifestyle-related illnesses.

As a physician, Capapas says she does a complete examination and tests on patients before reaching a diagnosis.

"Medicine is an art," she said. "When I look at a patient and the problem, I do a lot of investigative work. Then, when I find the root of the problem, we attack the root, in the meantime controlling the symptoms. The root is the place where we should be."

In the face of lifestyle illnesses, she said, she looks at diseases as results of deficiencies caused by poor habits or by simply not getting proper nutrition.

Her patients sit on leather recliner chairs. Then, after long conversations, the small woman with a soothing voice may prescribe a traditional medication, but she also may recommend a dietary supplement.

Dr. Richard Moore, a practitioner of internal medicine for years, embraced a holistic style but doesn't call it that. He recently opened a nontraditional practice called The Lifestyle Center in St. Louis, also addressing the trend of lifestyle health.

"I choose the term complementary and alternative," he said.

Moore said that when a patient comes in, he will spend up to an hour talking, checking, testing and coming up with a head-to-toe treatment plan.

Moore has taken holistic medicine to the high-tech level. His suite of offices includes rooms for massage and rock therapy (placing hot rocks on parts of the body through massage or other movement), rooms for aromatherapy, and a fitness center where personal trainers are actually physical therapists.

In another room is a laser-propelled machine that measures electrolytes and can tell if a person is deficient in elements, which can lead to disease.

The walls of the offices offer information on everything from remedies for skin ailments to vitamin supplements.

But Moore is still a doctor and considers himself a conservative practitioner. He just takes a lot longer with each patient to learn everything he can before rendering a diagnosis or recommendation.

One element that will slow the embrace of holistic practices by physicians is time. More time per patient adds up to less pay per hour from patients who are subsidized by insurers.

The nature of holistic medicine requires that practitioners spend a lot of time with patients. The time is spent in discussion and learning about a patient's personal history as well as his medical history.

For example, consider the first question Capapas asks a new patient: "I ask if he believes in God. And if he doesn't, I ask what does he believe in, and we work from there."

Mengel has patients fill out a questionnaire that includes unconventional questions. "It takes a little more time, but not much more," he said.

Moore spends an hour on the initial visit.

Capapas and Moore said that because of their methods, they don't accept insurance; what insurance would pay for a one-hour office visit is not worth the paperwork. So their patients pay out-of-pocket.

Mainstream practitioners who are adding holistic practices agree that it's a matter of time-albeit a long time-before the use of any remedy can become part and parcel of medicine. Some of it will find its way into the medical model within the normal process, and not be dismissed as mumbo jumbo.

Take, for instance, a study by Robert A. Nicholson, a psychologist with St. Louis University's Department of Community and Family Medicine.

Nicholson recently contributed to a study that linked the emotion of anger to the physical manifestation of headache. While the researchers didn't set out to enlarge the holistic arena, that's what happens.

In helping an individual, all of the elements of what makes a person a person must be considered in order to get good diagnosis, said Nicholson. "I don't look at this separately. Headache is a biological phenomena for which there are various factors that can influence it, one of them being an emotional component such as anger.

"Holding your anger in may trigger a headache. But you also may have a day when you don't eat breakfast or lunch and that may trigger a headache."

The principle of his paper, he said, is that while a painkiller may relieve the headache for that moment, "wouldn't it be better to get at the underlying cause? What triggers the headache may not be purely biological."

And that's what holistic medicine is, more preventive medicine-how to keep a problem from ever happening.

"To look at it together, that's the best way," Nicholson said. "It's not an either-or. It's an integration of effective, empirically validated interventions or preventions of the disease."

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FACTS ABOUT HOLISTIC MEDICINE

-40 percent of Americans, and 66 percent of people worldwide, had used some form of holistic medical approach as of 2001.

-People had paid $27 billion in out-of-pocket expenses for holistic practitioners and remedies as of 2001.

-There was a 30 percent increase in people visiting practitioners of alternative medicine between 1990 and 2001.

-Most patients use holistic medical care as an adjunct to conventional care.

-A minority of patients use holistic care as an alternative to conventional care.

-60 percent of holistic practice is not reported by physicians.

Source: National Center for Complementary and Alternative Medicine

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(c) 2003, St. Louis Post-Dispatch. Distributed by Knight Ridder/Tribune News Service.