University Times

UPMC Health System is world famous for breakthroughs in cutting-edge specialties such as organ transplantation and bioengineering.

But the system also is moving ahead with its study and practice of complementary and alternative medicine (CAM), including some non-Western therapies that are centuries old.

Expect to see a major marketing campaign this fall, promoting UPMC programs in such areas as massage therapy, smoking cessation and exercise to help relieve depression.

The non-controversial nature of these programs reflects UPMC's cautious approach to alternative medicine, said Bruce Rabin, a Pitt professor of pathology and psychiatry who chairs the health system's CAM program.

"There are people out there who are just waiting to tear apart any type of program like this which is not on a scientifically sound basis," Rabin said in a May lecture at Mellon Institute.

CAM includes treatments and preventive approaches foreign to mainstream Western medicine, such as acupuncture and the medicinal use of herbs. Critics of alternative medicine say it's unjustified scientifically, and that hospitals are offering CAM in an attempt to cash in on patients' gullibility.

In 1999, an anti-quackery journal called the Scientific Review of Alternative Medicine denounced the former director of alternative medicine at UPMC Shadyside, questioning his credentials and the scientific soundness of his writings, which, among other things, claimed miraculous healing associated with Native American sweat lodge ceremonies.

UPMC Shadyside also came under fire for offering reflexology therapy, in which massaging different parts of the foot is believed to improve organ functions.

"I am embarrassed that the good name of my university is associated with quackery such as reflexology and therapeutic touch," Pitt psychology professor Donald H. McBurney wrote in a letter last December to the editor of the Pittsburgh Post-Gazette.

Arguing that UPMC officials know the difference between science and pseudoscience, McBurney wrote: "We are left with the conclusion that UPMC is either cynically or cravenly responding to market demands for unproven and dangerous treatments."

Stung by the bad publicity, UPMC convened a task force last fall to further investigate CAM. The group's final report recommended the continued practice and study of alternative medicine — but with an emphasis on research into its safety and effectiveness. UPMC's board of directors endorsed the report.

"We will use research protocols to determine whether complementary and alternative medicine procedures enhance the delivery and effectiveness of current medical practice," said Rabin, an internationally known investigator of how stress affects the brain and the body's immune system.

As an example of the type of alternative medicine research that UPMC wants to pursue, health system officials have cited a study here, funded by the National Institutes of Health (NIH), that is examining whether a ginkgo extract can prevent dementia.

Last year, the NIH distributed $70 million for research on CAM.

Even the name of UPMC's new program was chosen to soothe uneasiness about CAM: the UPMC Health Enhancement Program.

Originally, it was to have been called the UPMC Center of Excellence in Complementary and Alternative Medicine. But chief executive officers of the 19 UPMC Health System hospitals balked, according to Rabin.

"They told me: 'No way. We don't want to be associated with anything called complementary or alternative medicine. Doctors will not send patients to these programs. People will say it's quackery.'"

A survey of UPMC patients yielded the alternative name, Health Enhancement Program. "The CEOs loved it," Rabin said.

(McBurney, in an interview, chuckled when told of the program's name. "If they're doing health enhancement, then what is the rest of UPMC doing?" he asked.) The new program is affiliated with the Pitt medical school's Department of Family Medicine.

Rabin said: "We have an oversight committee, responsible for running the program, which reports to the chair of family medicine. We have a clinical research committee which will review and approve all clinical modalities and help to establish the research programs."

Rabin said the Health Enhancement Program will make available, throughout the UPMC system, existing programs that heretofore have been offered only at certain hospitals. These programs include, among others:

* Smoking cessation and prevention programs developed by Pitt researchers. "People ask, 'Why do you need to offer smoking cessation programs? There must be 50 [such] programs,'" said Rabin. "The fact is, there are no clinical programs for smoking cessation available to the public other than the American Cancer Society program."

* A stress management program incorporating education, meditation, Tai Chi movements and journal writing.

* Education programs to help patients and family members cope with chronic diseases and conditions such as arthritis, asthma, cancer, Crohn's disease, chronic fatigue syndrome, hypertension, incontinence and osteoporosis.

* Music therapy to promote relaxation and relief of anxiety. "Music programs are being developed that will be available over the TV systems throughout the 19-hospital health system," Rabin said. Upon request by patients, musicians will go with clergy on their rounds, playing soft music after clergy have counseled and prayed with patients.

* Various massage and exercise therapies, including exercise to help treat depression ("When done properly, it's as good as Prozac, with fewer side effects," Rabin said) and a program to improve balance in elderly people.

Rabin said: "During our fall marketing campaign, when these programs will be announced, there will be messages like: If you are older, if you're concerned about falling, if you experience weakness in your lower limbs, come to your local UPMC facility for help."

David Servan-Schreiber, medical director of UPMC Shadyside's Center for Complementary Medicine, sees no conflict between CAM and Western medicine. "We are meant to collaborate with traditional, Western medicine and Western-oriented physicians," he said. "I myself am a Western-trained and -oriented physician. We are working hand-in-hand with the other physicians in the system to provide individualized care, and I think that role is going to expand."

Rabin, testifying last spring before the White House Commission on Complementary and Alternative Medicine Policy in Washington, D.C., said standardization of alternative medicine is critical.

"I cannot emphasize strongly enough, due to the increasing numbers of patients seeking non-standard approaches to health, that it is essential to have proper medical evaluation before embarking on a procedure that superficially may appear to be safe but may do harm, or delay proper treatment," Rabin said.

He gave this example: A man suffering from fatigue and lower back pain goes to a massage therapist. The massage fractures the man's sacrum. It turns out that the man has an undiagnosed multiple myeloma (a malignant tumor of the bone marrow), the first symptoms of which are tiredness and lower back pain.

Many Americans are using alternative medicine to manage their own health, whether it's swallowing herbal supplements or placing crystals on their foreheads, Rabin pointed out.

"We need to determine the safety and efficacy of these therapies," he said.

— Bruce Steele