Medical students and researchers consider alternatives

Alternative medicine is big business in America. A national survey conducted in 1997 estimated that Americans spent $21.2 billion on alternative medical services that year, and 42 percent of the survey’s respondents had used one or more of 16 alternative therapies. Many Americans are particularly likely to turn to alternative treatments for chronic conditions such as back pain, depression, anxiety, and headaches.

Many traditional doctors and medical researchers have responded to this fact by learning as much as they can about these treatments, whether and how well they work, and how to incorporate them into standard medical practice.

Penn’s School of Medicine has made complementary and alternative medicine an integral part of both its research and its teaching. “We undertook this not so much to teach the individual therapies as to show students what was going on in the outside world,” said Alfred P. Fishman, senior associate dean for program development at the Medical School.

Educating physicians about alternative therapies is important, he said, because otherwise, they might never find out what their patients are using. “Unless they ask about it, the patients won’t tell them anything about it.”

Fishman attributes this reluctance to talk to several factors, not least among them patient uncertainty about how their doctor would respond to the news. But as some recent events demonstrated, lack of information can be deadly.

“Alternative treatments were supposed to be safe,” Fishman said. “People took them feeling comfortable about their safety.” The ephedra experience, in which several people died from using the weight-loss supplement, illustrates how that sense of security may be false.

Research into the safety and efficacy of herbal and other alternative medicines is being conducted by several Penn faculty members. Assistant Professor of General Internal Medicine Phillippe Szapary, for example, is currently engaged in several studies assessing the safety and effectiveness of such substances as flaxseed, turmeric extract and gugulipid, an extract of myrrh that has shown some promise as a cholestrol reducer (“Research,” Current, Nov. 30, 2000).

The fruits of this and other research are also incorporated into the educational program. Gail Morrison, vice dean for education, explained, “In biochemistry, for example, you learn about all the different kinds of vitamins, some of which are considered nutripharmaceuticals”—foods that have medicinal properties. “In first- and second-year pharmacology, they learn about herbs. In neuroscience, they learn about acupuncture for pain control. In psychology, they learn about the mind-body connection and stress reduction.

“Students have wanted this in the curriculum, and they’re right to want it, given the amount of money the public spends on these treatments.”

Interest in teaching and research on alternative medicine has existed at Penn for several decades—Fishman recalls that several veteran acupuncturists were already on Penn’s rehabilitation medicine faculty when he became department chair in 1989—but serious efforts to integrate it into Medical School operations began in earnest in the late 1990s under then-Medical Dean William Kelley.

Fishman also notes that the public perception of doctors as indifferent or hostile to alternative treatments is unfounded. “If the people who were advocating alternative treatments 20 years ago were willing to subject them to conventional evaluations, there would have been no problem. But early on, there was reluctance to have them tested. They argued that these worked by different means from conventional drugs.”

However, even alternative treatments that fail the clinical effectiveness test can still have a place in medicine. “The placebo effect is not to be sneezed at,” Fishman said. “I’ve often thought that the biggest placebo we have is the physician in a white coat.”

Originally published on February 12, 2004