Vol. 10 Issue 9
PAs Help to Make CAM a Viable Alternative
Not long ago, complementary and alternative medicine (CAM) was considered a field for witch doctors, burned-out hippies and outright quacks. Only the uninformed or the desperate ventured outside the world of conventional medicine. Herbs were for savages in the forest, acupuncture was an ancient, exotic mystery from the East and meditation was for Buddhist monks and New Age weirdos.
Times have changeda lot.
Research suggests that:
• Nearly 70% of Americans use unconventional medical therapies.
• More than half of Americans think their health plans should cover alternative therapies.
• Almost two-thirds of American medical schools offer courses in alternative medicine.
• The National Institutes of Health includes the National Center for Complementary and Alternative Medicine (NCCAM).
• Chiropractors are licensed in 50 states, acupuncturists are licensed in 34 states and naturopaths are licensed in 11 states.
• Complementary and alternative medicine (CAM) is a $20 billion industry.
Increasingly, CAM is mainstream medicine. And PAs are helping patients integrate CAM into their lives. ADVANCE spoke with four PAs who are contributing to the CAM revolution.
Robert Jarski, PhD, PA-C, Director, Complementary Medicine and Wellness Certificate Program, Oakland University Rochester, Mich.
About nine years ago, Robert Jarski, PhD, PA-C, received a $25,000 research grant from the Department of Public Health in Michigan to offer a seminar in CAM at Oakland University in Rochester, Mich.
"It was supposed to be small and a one-time thing," Jarski says. "As it turned out, 31 students signed up. Word got out. We got special permission to offer it a second time and it became standard curriculum."
Interest continued to grow. Two years ago, Jarski helped create Oakland University's certificate program for professionals in CAM and wellness, which emphasizes patient-client counseling and education about mind-body approaches, complementary therapies, health promotion, disease prevention and wellness.
"I knew there was more to patients' illnesses than physiology," says Jarski, who began his career as a surgical PA after graduating from the Alderson-Broaddus PA program in the mid-1970s. "Even in PA school I was fascinated that there was often very little correlation between lab reports, X-rays and how patients were doing."
Beliefs and attitudes were often important to recovery, Jarski says. Conventional medicine could not heal, cure or even explain everything.
"What we were doing was very good, but it was only half the story," he says.
Jarski began educating himself in CAM–not an easy task in the 1970s and 1980s. He had to seek out opportunities to learn about alternatives to mainstream medicine.
Jarski eventually trained in guided imagery in California and at the Mind-Body Institute of the Harvard Medical School in Chestnut Hill, Mass. He's worked with Dean Ornish, MD, at the Preventive Medicine Research Institute in Sausalito, Calif., and with Dr. Ornish's Heart Disease Reversal Program, as well as with noted mind-body medicine researcher and author John Kabat-Zinn at the University of Massachusetts. Jarski has lectured to PA students and contributed a chapter on mind-body medicine to a textbook for primary care PAs.
He doesn't eschew conventional medicine, but encourages people to combine conventional and unconventional approaches to wellness.
"My philosophy is to use the best of both worlds," he says. "If a modality does no harm and is part of the patient's belief system and has the potential to help, why not use it?"
Jarski encourages skepticism–about CAM and conventional medicine alike. He's been pleasantly surprised to encounter little opposition to his ideas. In the beginning, he'd worried that he'd lose support on campus.
"Ten years ago, this was considered crazy stuff," Jarski says. "Some people thought I'd come in to class with white flowing robes. We needed the support of the basic sciences. We kept it very evidence-based."
One time a member of the basic sciences faculty approached him the cafeteria. "He looked left and right and whispered to me, 'I always thought there was something to this.' It's been more rewarding that I'd anticipated," he says.
Nancy Benzel, PA-C, The Hills Medical Group, Austin, Texas
Nancy Benzel always had an interest in holistic health, but didn't receive a whole lot of instruction on the subject in PA school at Hahnemann University in Philadelphia. She worked for a time in geriatrics and for a year in occupational medicine before moving to Austin, Texas, in 1999 in search of opportunities to learn about CAM.
"Austin is sort of a holistic medicine Mecca," says Benzel, whose interest in alternative therapies grew from neurologic problems that she developed while training as a triathlete and that didn't respond to conventional treatments.
Shortly after moving to Austin, she went to work for Ted L. Edwards Jr., MD, a well-known physician who has been practicing holistic medicine for more than 15 years. Most of the practice's patients are athletic and have high-stress jobs. They've looking to maintain their vitality, Benzel says.
"Dr. Edwards considers himself an 'anti-aging' physician. He wants to age gracefully and help other people do the same," Benzel says. Benzel's practice focuses on integrating conventional medicine and alternative therapies.
"Some patients want conventional care. Others won't take medications and never have, and they want alternatives," she says. "We want to give people options. If you have a foot in both doors, you have a lot larger armamentarium. (But) you have to study both sides. There is a lot of hokey stuff, just like in conventional medicine. After a while you start to learn what's reputable."
Benzel attends conferences on CAM and mainstream PA educational dinners. Possibly the best learning device is her patients. Some will go on the Internet for hours and bring stacks of information to her office, she says.
Natural hormone replacement is a commonly used CAM therapy in her practice. She also uses chelation therapy, a series of IV infusions of EDTA, a synthetic amino acid that Benzel says helps the body filter out harmful molecules. Chelation therapy gradually dissolves and removes atherosclerotic plaques and fights heart disease.
"I was skeptical, but I have been amazed," she says. "It's unreal some of the things we've seen with chelation."
Tom Stewart, PA-C, JD, Rocky Mountain Multiple Sclerosis Center, Englewood, Colo.
At the Rocky Mountain MS Center in Englewood, Colo., Tom Stewart isn't applying a lot of complementary medicine. But Stewart spends a lot of time on research that he hopes will make a difference in the near future.
Stewart works part-time on a Web-based method for conducting and publishing survey-based research. At the Rocky Mountain MS Center (www.ms-cam.org), they've created a large disease registry to figure out which CAM therapies can make a difference for MS patients.
More than 9,600 patients have registered so far. The Web site is designed for patients to self-report the effectiveness of various therapies.
"Alternative medicine is probably alternative because it's not well researched," Stewart says. "This type of research is a stepping stone toward the acceptance of the good stuff and the rejection of the bad stuff."
The site's acupuncture survey, for instance, has gathered more than 1,200 responses. Patients and professionals can log on to the Web site and see what patients have said about their experiences with acupuncture. The site contains reviews for dozens of treatments.
"A lot of research is conducted by professionals, analyzed and published to professionals who give feedback to patients," Stewart says. "What I'm trying to do is give people the information directly and allow people with MS to talk directly to each other."
Linda Smith, PA-C, Director of Programs, Duke University Center for Integrative Medicine, Durham, N.C.
Linda Smith has been involved in the field of wellness almost as long as there has been a field of wellness in the United States. Before becoming a PA, Smith worked for 18 years at the Kripalu Center for Yoga and Health in the Berkshire Mountains of Massachusetts, which hosts about 170 programs a year in human development and wellness and draws more than 10,000 guests each year.
Smith, who has a strong background in yoga, meditation and stress management, also worked as a volunteer emergency medical technician before attending the Philadelphia University PA program from which she graduated in 1998.
She worked in family practice before joining the Duke University Center for Integrative Medicine (DCIM), which opened in December 2000. She now works with patients in clinical practice, helps design retreats and helps with marketing and public relations.
Duke established DCIM to promote the integration of conventional medicine, preventive medicine and CAM. It is also dedicated to including the patient in health care decision-making.
"We believe in partnerships. There is no absolute decision that can be handed down from on high," Smith says.
Clinicians at DCIM don't provide primary care. They act as consultants for people who are already receiving primary care services but are looking for more information.
"No one in medicine can know all fields," Smith says. "(Primary care clinicians) are happy to have us as a resource."
Smith has observed tremendous growth in the area of wellness, preventive medicine and CAM over the last two decades. She doesn't expect it to slow down.
"I think the people have spoken with the number of people (using alternative therapies)," she says. "They are looking for balance in their lives. We're all incredibly grateful for the gifts of conventional medicine, but (medicine) doesn't have all the answers. They're looking for more options."
Stephen Cornell is on staff at ADVANCE. Contact him at firstname.lastname@example.org.