🔒As alternative medicine treatment options grow, skeptics remain

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Earlier this year, the American College of Physicians, which provides medical treatment advice to its 148,000 member doctors and subspecialists around the world, updated its decade-old guidelines for lower-back pain, adding acupuncture to its list of recommended therapies to be tried before prescribing any drugs.

What might sound like a bit of routine industry news quickly became controversial.

At St. Francis Hospital and Medical Center, Dr. Kathleen Mueller said she felt vindicated.

“This is a long time coming,” said Mueller, medical director of the St. Francis Center for Integrative Medicine, a family physician and practitioner of acupuncture and medical hypnosis. “Guidelines are a very big deal. Their recommendations are what insurers base what they pay on.”

Some 42 miles to the south, the reaction from Dr. Steven Novella, assistant professor of neurology at the Yale School of Medicine, was the polar opposite.

“It was a big PR victory [for acupuncture],” said Novella, a longtime critic of “alternative” and “complementary” medicine. “But it was a scientific catastrophe.”

The dual reactions illustrate some of the friction that has developed as alternative treatments like acupuncture, reiki and homeopathy have become more commonplace in hospitals.

Novella, executive editor of the website Science-Based Medicine and a founder of the New England Skeptical Society, has written about alternative therapies for years, analyzing and picking apart medical studies, often criticizing their designs as less than rigorous. He has concluded that acupuncture amounts to “theatrical placebo” and should not be offered in hospitals.

His fight, however, appears to be an uphill battle as many community hospitals and large academic medical centers in Connecticut and beyond — including his own employer, Yale New Haven Health — have launched integrative departments that offer alternative health treatments.

Integrative medicine is a term used to describe a combination of conventional western medicine with non-standard treatments.

Hospitals push back against the notion that integrative medicine is ineffective. They say the treatments help patients every day, mainly with pain and stress.

“I feel really comfortable that not only what we offer in our center has great science behind it, but it also has a substantially lower risk than the majority of what is offered in western medicine,” said Mueller when asked about Novella's criticisms.

Safety is also top of mind, she added.

Her center would never, for example, do something like recommend acupuncture or reiki to a cancer patient instead of chemotherapy.

“First, do no harm. That's my job,” Mueller said.

As integrative treatments become accepted into medical guidelines and offered in hospitals, they're clearly becoming more mainstream.

The federal government stepped into the fray 26 years ago when it established the National Center for Complementary and Integrative Health Research. NCCIH funds research and educates consumers about how to read scientific studies.

NCCIH says “research suggests that acupuncture can help manage certain pain conditions, but evidence about its value for other health issues is uncertain.”

In updating its back-pain guidelines, the American College of Physicians (ACP) reviewed 14 acupuncture studies and dozens of others related to the condition.

Lower-back pain typically improves over time regardless, ACP said, so non-drug treatments are the best first-line approach. The guidelines say to mix superficial heat — a recommendation with “moderate-quality evidence” — with acupuncture, massage or spinal manipulation, which ACP says have “low-quality evidence.”

Connecticut growth

According to the most recent survey data available from the Centers for Disease Control and Prevention (CDC), Americans spent more than $30 billion out of pocket in 2012 on complementary health practitioners, natural product supplements, homeopathic medicine and related educational materials.

While the CDC doesn't break out complementary health data by state, there is evidence that such treatments are growing in Connecticut.

For example, there are now 385 acupuncturists in the state, up from 318 a decade ago and 107 in 1998.

Both St. Francis and Hartford HealthCare built their integrative departments on free inpatient acupuncture and massage — mainly to reduce pain and stress, often in cancer and surgery patients.

Each has since expanded to offer outpatient integrative services. In the past few years, Hartford HealthCare has opened dedicated space for its integrative department in Avon, with another suite in the health system's new Bone & Joint Institute.

Hartford HealthCare's integrative department, part of its cancer institute, is now billing insurance companies for roughly 60 percent of its services, said Eric Secor, associate medical director of integrative medicine.

That's a dramatic change from just several years ago, when most services were either billed out of pocket or provided free.

Secor, a naturopathic doctor who has a master's degree in public health, joined Hartford HealthCare nearly three years ago, after a decade at UConn. He's played a key role in building up Hartford HealthCare's integrative department, which he estimates will be 80 percent insurer pay within the next year or two.

“That's the trajectory we're working in and towards,” he said.

Meanwhile, over the past eight years, St. Francis has grown the number of outpatient acupuncture treatments it provides from virtually zero to upwards of 100 a week, according to Mueller. An additional 250-plus inpatients (mainly in oncology, surgery and maternity) receive 15-to-20-minute integrative treatments at no charge, she said.

“Integrative medicine has been a part of St. Francis for over a decade at least,” she said. ”It began because patients asked for it.”

“We go with what people are looking for,” she said. “People wanted acupuncture, so we gave them acupuncture. That's how this place has grown.”

The center has also started receiving more referrals from St. Francis physicians in recent years, Mueller said.

Building referrals

Among Mueller's key supporters at St. Francis is the Connecticut Joint Replacement Institute, which recommends patients try to reduce their stress levels before surgery through the integrative center's offerings.

Dr. Steven Schutzer, the Institute's director, calls himself an “active referrer” to Mueller's department. He said he's well aware of holistic treatment critics, but sometimes the medical evidence bar is too high.

Surgery patients are often terrified of going under the knife. Some even beg him to make the decision for them whether or not they should get surgery — something he said he can't do. If a patient is comforted by a massage before surgery, that's enough for him to support it, he said.

“Some patients who are high on the anxiety list, if you don't deal with it, it becomes free-floating or uncontrolled and there is no question it can have a major impact on outcomes,” Schutzer said. “A little pain to the anxious can get out of control.”