2005-11-11 / Columnists

Health & Harmony

Pediatricians Embrace Integrative Medicine
By Dr. Nancy Gahles


DR. nancy gahlesDR. nancy gahles It has long been a dream of mine to see the day when we can all work together for the good of the patient. Integration means addressing the needs of the whole person by utilizing all the professional therapies that might best suit the individual case. Traditional medicine is familiar with the concept of referring to a practitioner of a different specialty than their own when the case warrants it. Indeed, medicine has fast become a profession of specialists where each of the body parts are represented, i.e., the heart man, the lung man, the GI man. While it is certainly important to have a person with a specific understanding of the organ that is malfunctioning to consult with, healthcare in general is moving beyond the mechanistic view of people into the mind/body realm. Mind/body implies that we, as humans, have a greater dimension that transcends our physical body. We are recognizing that our emotions and other functions of our mind play an integral role in maintaining our state of health or the deterioration of it.

The concept of whole person-whole system seems to have taken root. In the vanguard were people like Jon Kabat-Zinn, a Ph.D. in Molecular Biology who, in the 1980’s, used mindfulness meditation to reduce stress and inaugurated a hospital based program at the University of Massachusetts Medical Center which exploded in popularity and became known as MBSR-mindfulness-based stress reduction. This bold movement helped change the consciousness of conventionally trained physicians to support integrative medicine. In 1995, Dr. Andrew Weil, now a household name, began a residency program in Integrative Medicine at the University of Arizona. His model was wildly successful and its graduates now direct programs in Integrative Medicine across the country.

According to the American Academy of Pediatrics, a well trained physician should be able to advise patients on the indications and benefits of complementary and alternative therapies (CAM) that most Americans utilize such as chiropractic, nutrition and vitamin therapy, massage, homeopathy, acupuncture and stress reduction techniques.

On October 21-23, the Pediatric Integrative Medical Conference was held at The New York Academy of Medicine in New York City. I had the pleasure of interviewing the conference coordinator, visionary and all around nice guy, Dr. Lawrence Rosen. I resonated strongly with Dr. Rosen’s vision of forming “borderless connections,” connections to the community of health care providers that can unite us and enable us to work together for the collective relief of some of our society’s most challenging conditions such as autism and the chronic diseases like Crone’s and the ever increasing asthma epidemic.

Dr. Rosen was taught about the Native American culture by his grandfather and came to understand our connection to the earth, as they understood it and incorporated the concept into their medicine. He realized that it was not just about cure and disease but about healing. Prevention and wellness were not taught in medical school and so Dr. Rosen sought out mentors along the way in the fields of herbs, homeopathy, acupuncture and biofeedback. He utilizes diet, nutrition and biofeedback in his practice and refers to cranial sacral therapies. Dr. Rosen practices at Westchester Medical Center, Valhalla, New Years and in Old Tappan, New Jersey.

The conference itself was a success in that it brought pediatricians together from all over the world to share the common interest in advancing the understanding and utilization of CAM therapies and in forming a community of like minded individuals. In speaking with many of the attendees, I asked the question, “What is it that your patients ask for in CAM?” Overwhelmingly the response was “What can I give my child instead of medicine?” They were there to find out how to respond to their patients.

Dr. Sunita Vohra from Canada gave a thorough, knowledgeable and precise protocol for building a Pediatric Integrative Medicine program in your community. The downside to this was that these programs are hospital based and there was no mention of how to build connections with the CAM practitioners outside of the hospital. The “borderless connections” that Dr. Rosen alluded to may be a bit too futuristic. Integrative- minded though they may be, M.D.’s still tend to shun the idea of referrals outside of their own. The controversy of fee for service for these CAM therapies is another matter as most of the alternative treatment modalities are not covered by insurance.

Doctors love data and so there was a workshop on conducting Pediatric CAM research. This was a well thought out and smoothly presented workshop. Well-designed studies preserve and enhance the integrity of practice and are crucial to the safety and efficacy of both conventional and non-conventional disciplines.

Dr. Ben Kligler, a pediatrician at the Beth Israel Continuum Center, teaches at the Albert Einstein Medical School. His passion is to influence people while they are forming their habits in medical school and so presented a wonderfully enthusiastic workshop on the educational and training initiatives in Integrative Medicine. In Dr. Kligler’s practice, he uses integrative medicine principles in a longitudinal fashion, that is, as a primary care physician, he follows a family over time and implements the appropriate therapy as it comes up. In his experience, he says that the patients want the doctor not to be so quick to prescribe. More and more, they want natural alternatives. He helps them coordinate these with his medical back up. Here comes the “borderless connections” into play but, hey, it’s New York, folks.

Near and dear to my heart was a workshop on Spirituality, Movement and Healing Energy. Yep, right there in the midst of all those evidenced-based lovin’ M.D.’s, Reverend Melanie Gambino, deftly demonstrated the power of energy medicine. Prayer, which is one of the most utilized CAM therapies, has begun to receive recognition as a healing modality but it carries the same stigma as other energy medicines. That is, there is no plausible method of action. As far as mind/ body therapies go, this is usually the case. When the human mind is at a stage where it can accept and understand it creates the technology to measure such things. Remember the x-ray and the MRI and the electron microscope? All in good time, my dears.

All that heals is not medicine and all that heals may not be measurable now or in the way we are accustomed to doing so. The best we can do is to be in the moment. Proceed with right intent and let it all unfold. As we are charged in taking the Hippocratic oath, “At least do no harm.” When we all work together for the good of the whole, there can be no failure. Only learning experiences. And a sense of community.

Thanks to this group of caring, dedicated and forward thinking pediatricians, Integrative Medicine was brought to the consciousness awareness of many seekers. “When the student is ready, the teacher appears,” is an adage I am fond of. In this case, we are all more than ready so, in the words of Max, in one of my favorite children’s books, WHERE THE WILD THINGS ARE….Let the wild rumpus begin!

You can begin by empowering yourself to engage in discussions with your pediatrician about your child and other avenues of access to wellness care, prevention as well as treatment of illnesses. Most are not life threatening and, if caught early, you can discuss choices without fear or time pressures. It is always best to act out of knowledge and strength. Inform yourself about the complementary and alternative therapies that are represented in your community. Inquire within. Ask yourself which of these are most suited to you and your family’s needs, temperament and budget. Call on these practitioners and ask them about their education and credentials in their field. Google the professional associations for more information. Ask about their fee schedule. Discuss your child’s health situation and ask what type of treatment plan they would suggest in conjunction with your pediatrician’s protocol. What are the short and long term costs involved. Give feedback on your inquiries to your pediatrician. Suggest that they call each other to discuss your child’s case. Building bridges may have to start with you. You create your own scenario and bring in the professionals that best fit you and your child’s needs. Use your intuition and the information at hand. Remember, the President of the United States assembles a team of cabinet members who are the smartest in their fields and he consults them before making any decision. Considered, informed decision making is the domain of the responsible parent. And that goes for health care decisions as well. No one knows our child better than you do. Create choice. Cultivate empowerment.

Nourish your child with the rich soil of freedom.

May The Blessings Be!

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