A dramatic shift is happening in the American medical community - one which some might say is long overdue. Perhaps it is a result of patients demanding more options for care, perhaps it has to do with the acupuncture community's emphasis on outcomes studies and establishing their practice as a true medical profession, or maybe it just boils down to the simple economics of managed care. But complementary medicine is joining forces with Western medicine in clinics and hospitals all over the country, giving birth to a new field called Integrative Medicine.

Integrative Medicine calls a truce to the cold war between complementary modalities, such as acupuncture and herbology, and traditional western medicine. It is based on the understanding and acceptance that neither are complete medical solutions that address the entire human condition, and that by working together maybe, just maybe, patients will benefit from the expanded set of diagnostic and treatment tools.

Kovida Fisher, M.D., a licensed acupuncturist and instructor at Pacific College of Oriental Medicine explains it like this: "Western medicine and Chinese medicine offer two distinct attempts at describing the human condition. Both have strengths, and both have their limitations. The first step in joining the two is not to try to understand one another, but to admit the limitations of each so that the door will be opened to respect and trust the strengths of both."

Dr. Fisher practiced internal medicine in her native country of Germany for ten years before moving to the United States. In Germany, she explains, there is not the same division between Western medicine and alternative medicine as exists in this country. As a physician who incorporated a fair amount of mind-body and energetic techniques into her practice, she was reluctant to enter the strict science of medicine that is practiced in the U.S. So, after visiting several medical centers as well as Pacific College's clinic, she decided that she would transition her career to Oriental medicine.

"With Oriental medicine I found a new world view, not just a new way of looking at the body," Dr. Fisher recalls. "Chinese medicine offers a distinct concept - a new way of looking at life. I felt as though I was taking off one pair of glasses, my Western medicine glasses, and putting on a new pair of glasses, my Chinese medicine glasses, that brought entirely new ideas into focus."

So that explains Dr. Fisher's own personal evolution into integrative medicine. But why does she think the rest of the country is following?

"Many health problems today are the consequence of the modern lifestyle, and so a gap has developed between high-tech medicine and the state of disease that plagues many people today," she explains. "For many of these conditions, high-tech medicine is overkill. It is a strange irony, but modern-day health problems are actually bringing people to better understand the value of ancient medicine."

Perhaps this is why as many as one-third of all Americans are seeking alternative medicine treatments. Unfortunately, many are still doing so without the blessing of their physicians, but with integrative medicine that is gradually changing. As physicians learn to understand not necessarily the physiological effect of acupuncture and Chinese medicine, but more generally the idea that it does have proven applications for many health conditions, more and more doors are opening for acupuncturists to work side-by-side with Western medical professionals.

Hennepin County Medical Center

A common stereotype about this country is that the most progressive things first take hold on the two coasts and then move inward. Fashion, food and music are all often popularized first in either California or New York before moving on to the rest of the country. But Hennepin County Medical Center in Minneapolis has been quietly challenging that assumption - at least as far as health care goes - for over a decade.

In the early '80s, Hennepin Faculty Associates, a group of physicians affiliated with the Medical Center, started a research program for substance abuse that included acupuncture treatment. In 1987, Licensed Acupuncturist Patricia Culliton joined the group to help with the research program. In conjunction with Milton Bullock, M.D. and Robert Olander, Culliton published a study in 1989 which firmly established acupuncture's effectiveness in the treatment of substance abuse, and became the impetus for the establishment of acupuncture treatment clinics nationwide.

But the goal for Culliton was greater than that. Knowing acupuncture's applications in other areas of health and well-being, Culliton worked with the group to establish the Alternative Medicine Clinic of Hennepin Faculty Associates. The year was 1993, and the clinic was clearly among the first in the U.S. to be based within a health care organization. Through its post-doctoral fellowship program, it also became the first in the nation to train medical doctors in alternative therapies.

Then, just last year, Pacific College graduate Cynthia Miller moved to Minneapolis and sought an alliance with Hennepin County Medical Center. Miller, who has also been a registered nurse for 13 years, had focused much of her career on caring for people with cancer and AIDS. Through her work with life-threatening illnesses she grew frustrated with the limitations of Western medicine and began studying with Pacific. So, when she moved to the Twin Cities in 1997 she naturally sought a way to merge these two aspects of her career and, in the process, offer alternative medicine to all economic levels. This goal led her to the Alternative Medicine Clinic and Hennepin County Medical Center.

"Because of my experience as a nurse with cancer patients, I first went to visit the cancer center and meet with Becky Cordall, the program director of the cancer center who is also open to alternative medicine," recalls Miller. That initial meeting led to a job as an oncology nurse, with a plan to develop an alternative cancer program.

"I moved to the area last summer and immediately began planning how the alternative cancer program might work," said Miller. "At this point, I'm providing acupuncture to patients at the outpatient treatment center to ease the nausea and vomiting related to chemotherapy. But the goal is to expand the program to include one day a week over at the Alternative Medicine Clinic. There, I will address the broader issues of treating the cancer, not just the symptoms of nausea associated with the chemo."

As part of the treatment team at the Alternative Medicine Clinic, Miller will be able to provide comprehensive treatment protocols for cancer patients, and will work side-by-side with doctors in diagnosing patients and discussing treatment options, patient reactions to treatments, etc. The Clinic also has a full herbal pharmacy, allowing Miller to take advantage of the full range of tools available through Chinese medicine.

"It is very exciting for me to be able to draw from my knowledge and experience in both Western and Eastern medicine," said Miller. "I'm not nearly as frustrated as I was during my nursing days, because I'm far less limited in what I'm able to offer my patients."

The Alternative Medicine Clinic of Hennepin Faculty Associates collects data on all patients, and it is not unreasonable to expect that the results of Miller's work may someday become part of a greater national understanding among the medical community of acupuncture's applications in the area of oncology treatment.

Elmhurst Hospital

Pacific Institute of Oriental Medicine and New York-based Elmhurst Hospital have successfully launched a medical internship program allowing acupuncture students to treat the hospital's rehabilitation patients under the supervision of a licensed acupuncturist from the school. The joint effort gives rehabilitation patients the opportunity to benefit from both traditional physical rehabilitation and acupuncture treatment, all under the direction of their physician.

The program, which began in December 1996 under the guidance of licensed acupuncturist Magnolia Goh and Jerry Weissman, M.D., the director of the rehabilitation department at Elmhurst Hospital, is designed for rehabilitation patients who are recovering from an injury or illness such as stroke, back injury or other musculo-skeletal conditions. Since its inception, the program has grown from one clinic session a week to three, with each treating an average of 25 patients and, according to program administrator James Salmon, the demand for these services has been overwhelming.

"Elmhurst is the only western hospital in the New York region offering acupuncture for rehabilitation," said Salmon. "The hospital has recognized that acupuncture has fewer side effects and is less invasive than many conventional Western medicine procedures."

"So far the program has proven to be a great success," said Kevin Ergil, dean of Pacific Institute of Oriental Medicine. "It is an attempt to push the frontiers of medicine forward and to forge a bond between Eastern and Western medicine."

According to Ergil, this alliance is not designed to replace the hospital's traditional rehabilitative treatments. "The internship program creates an environment in which acupuncture and traditional modalities can be used to complement one another by looking at a medical condition from the context of both Western and Eastern medicine," said Ergil.

San Diego Hospice

Pacific College of Oriental Medicine is about to embark on one of the most unique and sensitive internship programs to date: hospice care. Late last year Pacific's president Jack Miller called San Diego Hospice to inquire about a possible working relationship. What he didn't know at the time was that two former Pacific students, Sheila White and Cynthia Miller, had worked at San Diego Hospice and had been laying the groundwork for his phone call months prior. Through their work with San Diego Hospice, both White and Miller knew that Dr. Charles Lewis, Associate Medical Director at San Diego Hospice, had had a long time interest in complementary therapies and had been instrumental in incorporating energy therapies such as Reiki, Healing Touch, Therapeutic Touch and aromatherapy into the treatment programs offered to patients in the Inpatient Care Center. What was particularly impressive to Cynthia Miller, who worked as a per diem nurse in the center, was that these treatments, and the patients' reactions to them, were being documented in the patients' charts.

"In other environments, I have seen nurses do these types of treatments to help ease patients' pain, but I had never seen it charted before," said Miller. "To me, that meant San Diego Hospice was taking this seriously."

That initial impression proved to be true, as Jack Miller learned when he contacted Patty Mittendorff, Complementary Therapy Program Director of San Diego Hospice, to initiate discussions on how Pacific College and San Diego Hospice could work together. In late 1997, four members of Pacific's board Jack Miller, Ana de Vedia, Rick Gold and Joe Lazarro made a proposal to Dr. Lewis, Mittendorff, and others from San Diego Hospice. And, while the program is still in the preliminary planning stages, "there is clearly an interest in getting something started," said Mittendorff.

According to Ana de Vedia, the Hospice program will be unlike any other internship experience currently available to acupuncture students. "We're treading unknown water here because not much literature is available on a Chinese medical approach to working with the dying," de Vedia said. "But we know that we can help to alleviate pain without a loss of consciousness, alleviate nausea, and calm the emotional mind, so these will be our three goals of treatment."

The Free Clinic Project of San Diego

In January of 1997, students of UC San Diego School of Medicine opened their first clinic as part of the Free Clinic Project of San Diego. As a primary health care and educational outreach program for the homeless and indigent of San Diego, the project is staffed by students and community physicians, and currently operates at two locations twice a week. Now, it looks like they may add acupuncturists to that list of volunteer professionals.

Pacific College of Oriental Medicine has long enjoyed a relationship with UCSD's Division of Family Medicine, whose students include observation at Pacific Center of Health and the Pacific College Clinic as part of their fourth year rotation in family medicine. Dr. Ellen Beck, who was instrumental in establishing that relationship, is now the primary advisor to the Free Clinic Project, and so it was a natural evolution to include Pacific students in the project.

"I was delighted when Dr. de Vedia proposed the collaboration," said Dr, Beck. "I believe it will benefit both groups of students and patients."

The first clinic was established at the Pacific Beach Methodist Church where, every Wednesday night in conjunction with a meal program provided by Harvest for the Hungry, medical students attend to patients. Last summer the program expanded to a new site on Monday nights, at the First Lutheran Church at 3rd and Ash Streets in downtown San Diego. Each night, between ten and 20 people come for medical care, but, as Dr. Beck emphasizes, "the goal of the program is empowerment. We are not providing medicine in a narrow sense, we are providing healing in a broader sense." In addition to a meal and medical attention, the program also includes a legal clinic and assistance in connecting people with social resources.

Dr. Beck is currently working with Pacific board member Ana de Vedia to establish an internship program for acupuncture students to work at the clinic sites. Types of conditions commonly seen in this patient population include pain, colds/flu, pulmonary conditions and detox - all areas where acupuncture is proven to be useful. The program will start in May.

Dr. Beck, who has always been open to a mind-body approach, said that the program's success may help to open new doors for complementary medicine within the UCSD system. "Ironically, breaking ground with an underserved population of patients may help some physicians see first-hand the value of complementary medicine," she said. "My hope is that UCSD can look at this model of care and use it as an example of how complementary therapies can work with Western medicine for the good of the patient."

Operation Samahan

Operation Samahan is a non-profit community clinic providing care to Filipino-Americans from two clinic sites in San Diego. Eight-five percent of its patients are low-income, receiving care through Medi-Cal, Medicare or on a sliding scale. In response to the need to cut costs, its executive director, Joel San Juan, began looking at different ways of delivering care that could help them manage their patients' health more efficiently. This search brought him to Oriental medicine.

In Fall 1996, San Juan began taking classes as Pacific College of Oriental Medicine, with the thought that he himself could get licensed and do some small-scale outcomes studies on his own. But it wasn't a year later that he started getting anxious to bring Oriental medicine to the patients his clinics serve. He met with Jack Miller, Pacific's president and dean, to start structuring a program that would allow student interns to see patients at the Operation Samahan clinics. The program started in January 1998.

Now, every Friday morning a team of five students and one supervisor meet at Operation Samahan to provide acupuncture treatments to the clinic's patients. Doctors refer patients to the interns for such conditions as hypertension, circulatory and metabolic diseases, pain, diabetes, tuberculosis and gout. In the few short months since the program started, San Juan has seen such interest in the acupuncture that he is already planning to hire an on-staff acupuncturist. "We want to shift our focus to prevention, rather than reactive treatment," said San Juan. "All of our patients are entirely new to the idea of complementary medicine, which up to this point has only been available to people with the means to pay cash for their treatments or who have insurance that cover it. We're bringing Oriental medicine to the grassroots."

Ana de Vedia, the clinical supervisor for the program, agrees. "Through programs like this, we are not only serving a critical population in our community, we are creating future jobs for our professionals."

San Juan hopes that soon he will be able to expand Operation Samahan's programs to include massage therapy, herbology and exercise programs such as qi gong and tai ji.

Little Company of Mary

Pacific College graduate Cynthia Birkhimer is breaking new ground in the Los Angeles area with the Little Company of Mary Hospital in Torrance. A year ago, Birkhimer started working with a family practice physician, Jamie Lewis, M.D., who owned a primary care/workers' comp clinic called Memorial Prompt Care, affiliated with Little Company of Mary. At Memorial Prompt Care there are seven physicians and a physical therapy staff who refer patients to Birkhimer for such conditions as pain, migraines, PMS and various occupational health injuries.

The response had been so positive at Memorial Prompt Care that the administrator of Little Company of Mary recently contacted Birkhimer to work in another hospital-run center, Care Station Manhattan Beach, where she will receive referrals from as many as 50 physicians.

"The doctors consult with me on patient cases and check back with me to find out how treatment is going," reports Birkhimer. "They treat me like the professional that I am."