U-M medical group hunts for evidence that alternative treatments might work

April 30, 2002

BY MARTY HAIR
FREE PRESS STAFF WRITER

Max Heirich lay in the hospital recovery room with a brand-new heart valve and a qigong master standing at his bedside.

"He simply looked at me and turned his hands toward me," recalls Heirich of qigong (chee-GONG) practioner Gabriel Chin, who was administering a Chinese therapy that advocates say promotes health and vitality through directing universal life energy or chi.

"Once I was conscious, I would feel it very strongly," says Heirich, 70, a University of Michigan sociology professor. The experience, he says, felt like "something coming into me, which was warm and pleasant, like it was humming."

The U-M Complementary and Alternative Medicine Research Center facilitated Chin's administrations to Heirich following his 1998 surgery. Heirich subsequently joined the advisory board of the center, which is measuring qigong's impact on cardiac patients.

The center created a randomized, controlled trial with more than 400 U-M Hospital heart surgery patients to see how quickly their wounds heal, how long they are hospitalized and how much pain they have when they receive treatment from Chin and other qigong practioners in addition to the standard cardiac care.

It is a flagship research project for the Complementary and Alternative Medicine Research Center, which draws knowledge both from university medical experts and from practitioners trained in acupuncture, massage, energy healing and herbal remedies.

Besides conducting randomized, controlled trials, the center works with other U-M departments to educate doctors and students in medicine and related fields about alternative therapies. It also plans to open a clinic in the Ann Arbor area this summer.
Searching for evidence

"We are very interested in the evidence. But we also recognize that practitioners' experiences are a kind of evidence, and patients' experiences are a kind of evidence. All of that is fair game for investigation," says Dr. Sara Warber, the center's codirector and a U-M lecturer in family medicine.

Initial results of the cardiac patients' study are expected to be published within a year in what will be the largest scientific trial of energy healing techniques conducted in the United States.

As many as half of all Americans have used some kind of alternative medical treatment, a broad umbrella that includes herbal remedies, massage, magnet therapy, acupuncture and energy therapies. People with chronic back pain, headaches and arthritis are among the most frequent users.

Total out-of-pocket spending on alternative medicine will top $30 billion this year -- more, for the first time, than will be spent on traditional "white coat" hospital treatments, according to Dr. Steven Bolling, a U-M cardiac surgeon who directs the university's Complementary and Alternative Medicine Research Center.

"It really is a huge industry in the United States," Bolling says.

Although alternative therapies are in wide use, little scientific evidence exists on how or whether they work.

So the National Institutes of Health established the National Center for Complementary and Alternative Medicine and funded a dozen research centers around the country, including the one at U-M, to gather data.

The Ann Arbor center received a five-year, $6.7-million grant to investigate complementary and alternative therapies relating to cardiovascular disease and related conditions.

"We owe it to our patients to investigate it. If it works, we owe it to our patients to incorporate it," Bolling says.

The NIH funding for the U-M center continues through next year, when Bolling and Warber say they hope the funding will be renewed.

The center also receives some smaller grants.
Work in progress

In two decades as a volunteer in China, Japan, India and Korea doing valve replacements with Project HOPE, Bolling has seen first-hand how medical treatment can incorporate many approaches that U.S. doctors may consider unorthodox.

"I can be in one room doing a highly technical heart surgery case and in the very next room they can be doing acupuncture. In their medical system, which is very different from Western medicine, it is not incongruous," Bolling says.

In the qigong study, one group receives standard care for cardiac surgery patients. A second group is, in addition, treated by a qigong master. The third group receives standard care plus therapy from a practitioner who is not a qigong master but is trained specifically for this trial.

The traditional Japanese energy therapy of reiki (RAY-key) and the pain of people with chronic diabetic neuropathy is the subject of a second major trial. Warber, who studied with a Native American healer for 14 years while completing her formal medical training, residency and fellowship, likens both reiki and qigong to "the laying on of hands," in which positive energy is said to be transferred from one person to another to promote healing.

Another trial in progress looks at hawthorn extract and treatment of congestive heart failure. Both the reiki and the hawthorn trials have about 120 patients. Center researchers also have a grant from the J.P. McCarthy Foundation to study how nutrition, yoga and mind-body therapy may improve the quality of life for people diagnosed with blood disorders.

Results are expected this fall of a pilot study comparing stress levels among students at two charter middle schools in southeast Michigan. At one school, the students meditate using Transcendental Meditation for 20 minutes twice a day with their teachers. The school initiated the program as a stress reduction technique and to prevent alienation and at-risk behaviors among adolescents.

The study will compare those students' social and emotional competence with students at another school with a similar student population that does not meditate, according to Dr. Rita Benn, director of the Integrative Medical Education program at the Complementary and Alternative Medicine Research Center. If there are differences between the two groups of middle school students, researchers will develop a larger study.

"There's been very little done on the impact of meditation and mind-body techniques on children and on adolescents in general," Benn says.

In the clinic expected to open this summer, physicians working with the Complementary and Alternative Medicine Research Center will evaluate each patient, talk with the other doctors treating the person and develop a plan of alternative treatments that might be helpful, such as massage, acupuncture and nutrition and herbal counseling. Money to establish the clinic came as a gift, matched by the university, from Marge and Bob Alpern of Bloomfield Hills.
Part of the training

Marge Alpern has been studying, teaching and practicing alternative treatments such as energy healing, massage and meditation since the late 1960s and currently gives classes on qigong self-massage to promote health and well-being for people with cancer at Gilda's Club in Royal Oak.

She says attitudes about alternative medicine are changing and "it's not some far-out, kooky, hippie thing anymore." More people are intrigued by the connections of mind, body and spirit. She and her husband practice meditation and yoga daily.

The Complementary and Alternative Medicine Research Center recently received a grant from the National Center for Complementary and Alternative Medicine to develop a curriculum for students in the health professions. Right now, first-year medical students hear an introductory lecture about alternative medicine, then divide into small groups to visit a provider's office, where they see and try a healing treatment themselves. Back in class, they talk about their experiences.

Students studying health care also learn about herbal remedies, their use and the research about them, as well as potential problems, such as interactions with other drugs. In this country, herbal remedies are classified as dietary supplements and the manufacturer is responsible for their safety and purity.

Many students arrive at medical school already aware of herbal remedies and other alternative approaches to healing.

"They're aware of what their family members do, what their friends might do, so they recognize that it's important to understand about these things," Warber says.

As a college freshman, Andrew Heyman began to study shiatsu, a Japanese acupressure and massage therapy.

He later pursued a master's degree in health services administration and worked as the Complementary and Alternative Medicine center's administrator before deciding to go to medical school.

"Alternative medicine challenges what's important, what's not important," says Heyman, 29, now a second-year medical student. "What do patients want? What are they getting from their alternative practitioner that they're not getting from regular physicians and why?"

Heirich has used a number of alternative treatments over the years. Following Heirich's heart surgery, Chin, who learned qigong in China and has been practicing it for more than 50 years, visited Heirich for 15 to 30 minutes a day in the hospital.

Heirich says he's pleasantly surprised at the reaction within the university to integrating alternative therapies into medical practice compared with the reaction 25 years ago, when he first taught a U-M course on the topic.

"At that time, there was such skepticism and expressions of hostility that anyone would consider anything except medical science," Heirich, who is on CAMRC's advisory board, says.

"There are still many people who are very, very skeptical, but they do not try to stop this kind of activity as they might have a number of years ago."