East Meets West in UCLA Medicine
By Scott Fields
Published Jul 1, 2012 8:00 PM
Creating East-West Doctors
Winston , who spent a year as a Buddhist nun in Burma and has been teaching mindful awareness since 1993, holds a seminar at UCLA's David Geffen School of Medicine to instruct third-year med students on the moment-by-moment process of observing one's physical and emotional experience in order to bring down stress levels and boost the immune system.
"Med students are overwhelmed and, realistically, one two-hour class is probably not going to change their lives," she says. "But they're getting exposure to all of this as a self-care process, and it's also expanding their horizons in terms of where they'll refer patients in the future."
Both second- and third-year students are exposed to seminars on tai chi, acupuncture and Reiki, an ancient Japanese healing art where practitioners move energy around the body through the light touch of the hands.
Recently, an online module was added to the mix. "It's on headaches and includes a number of different treatment modalities," explains Margaret Stuber, professor of psychiatry at the UCLA Semel Institute for Neuroscience and Human Behavior, who helps plan the medical school's curriculum. "It contrasts the integrative medicine approach with the allopathic (Western) approach."
Fourth-year medical students can opt for an intense, two-week elective in Integrative East-West Medicine at the Center for East-West Medicine.
"It's a great elective to get a new knowledge base and a new approach to medicine," says fourth-year student Peter Berberian of the course. "I'm going into primary care, where Western medicine understanding is lacking."
Similarly, Cristina Barolet-Garcia, a fourth-year student at Northwestern Feinberg School of Medicine in Illinois who took the elective as a visiting student, hopes to "integrate yoga, acupuncture, meditation, acupressure and trigger point injections into my practice of psychiatry," she says. "I believe my future patients will benefit from the mind-body-spirit connection by learning tools to curb anxiety, depression, asthma and other conditions."
Urban Zen Comes to UCLA
Experts train health practitioners in Eastern medicine modalities.
Video by UCLA Health Systems
"The East-West center class is also a great place to find mentors who will care for your development as a physician," Berberian adds. There's no doubt Ka-Kit Hui '71, M.D. '75—the founder of the Center for East-West Medicine as well as the chair of the CCIM—has done a whole lot of mentoring.
"I've spent the last 18 years training students who are now faculty members," says Hui, who believes this is just one reason why his center now receives patient referrals from more than 500 physicians across the UCLA system.
Renate Winkler was desperate to find a cure for her postural hypotension, recurring abdominal pain and constipation due to intestinal obstructions. In addition to two unsuccessful intestinal surgeries between July 2008 and May 2011, she was hospitalized nine times—nearly once a month in late 2010 and early 2011—and doctors were unable to correct the condition. Then a professor at the Geffen School of Medicine suggested that she try UCLA's Center for East-West Medicine.
At the East-West center, Hui recommended possible ways to help Winkler cope with her issues, which he saw as a defect in her autonomic nervous system. Besides receiving acupuncture, massage and trigger point injections, "I was taught how to massage my abdomen, as well as to massage my back and neck with a tennis ball, and my legs and feet with a golf ball," Winkler explains. "They also told me to keep warm at all times and to avoid chilled food and drink."
Under Hui's supervision, Winkler began a meditation practice and added tai chi to her exercise regimen of swimming and yoga. Now, her postural hypotension, constipation and abdominal pain have been alleviated, and she has avoided hospitalization for a year. Hui can point to many successes like Renate Winkler's, but he laments the lack of sufficient funds to develop scientific evidence to validate those successes. "We have 10 years of data—from emergency room visits, readmissions and laboratory data—and we're analyzing that now. But we need more financial support to effectively study all this," he says.
"The problem with many of the integrative medicine modalities is that they do not lend themselves to study using randomized, placebo-controlled, double-blind clinical trials, which are our gold standard," says Stuber.
"It's hard to do a placebo control with something like acupuncture, for instance. It is difficult to be blinded to what kind of treatment you're getting."
In addition, "Most of the integrative medicine approaches are very individualized to the patient," she continues. "And randomized controlled trials usually look at only one specific intervention with a large group of people with very little individualization. … On the other hand, many of the modalities of integrative medicine have been successfully used for thousands of years."
Still, there is some research to back the case for Eastern medicine. Michael Irwin, director of the UCLA Cousins Center in Psychoneuroimmunology at the Semel Institute, is at the forefront nationally and internationally when it comes to looking at mind-body treatments for physical- and mental-health outcomes through tai chi, yoga and meditation.
"We have used a variety of techniques to prove that these procedures are efficacious, some of the studies using randomized treatments with over 150 people," he contends. "We've published extensively on it."
This nationally recognized work is what prompted Irwin to be asked to chair a Blue Ribbon Intramural Research Strategic Planning panel for the U.S. government's National Center for Complementary and Alternative Medicine (NCCAM), that will help to provide a blueprint on how to conduct mind-body research on a national level.
Cover More Lives
"We actually have two papers now that show that meditation alters the expression of genes that are involved in inflammation," Irwin says. "And then a third paper showing that tai chi and a mindfulness approach can reduce inflammation."
The Center for East-West Medicine, like many of the integrative medicine centers at UCLA, is so highly regarded that it receives frequent visits by physicians and administrators from all over the world, including one recent visit by the Chinese vice minister of health. Nevertheless, there's a way to go.
"We're still very much seen as a place of last resort," Hui says. "And this needs to change.
"It's very gratifying that there's been so much acceptance of safer and cheaper integrative alternatives, but I'm very impatient," he admits. "We need to scale this up to cover more lives. People shouldn't be suffering as much as they do. … We need more supporters like the Oppenheimer family (which donated $9.6 million in 2002 to help underwrite the Center for East-West Medicine as well as the Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress)."
While the East-West center charges for patient visits, others do not. The Simms/Mann center, for instance, not only provides free services, it is not supported by university funds.
"We have to rely on the support of friends and former patients," Coscarelli says of Simms/Mann. "We have many individual patients who've made contributions back to us after they've been helped here. That's an important concept. You get what you need, and then hopefully you'll give back so the services can grow and be there for the next group."
"I think UCLA will continue to be the leader into the future," Hui concludes. "By synthesizing the best ideas, wisdom and scientific evidence from different traditions, we can actually help people get back to health. And that's why we're in health care, after all."
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