By Jeffrey Barg

• React to this article in the Discussion Forum.

Published February 1998

• You can purchase Lewis Mehl-Madrona's book Coyote Medicine at Amazon.com by clicking on the image of the book below.

PND: Can you tell me what the genesis of the Center for Complementary Medicine was and how you got involved?

LM: The center really arose out of public clamor. People wanted complementary medicine from Shadyside Hospital and Bev Spiro, who is a nurse practitioner, and Fred Rubin, who’s the chief of medicine, responded to that need and began to create a center that could operate in conjunction with the other physicians at the hospital and programs at the hospital to provide complementary medicine. I was recruited after I did a workshop here in May as part of my book tour for my book, Coyote Medicine.

PND: What type of services are provided at the center?

LM: Primarily, we try to help people with chronic disease to feel better and function better and sometimes to get better. In the context of that we usually start with a new patient assessment to find what they’ve tried and how they’ve tried it and what conventional therapies they’ve used, assessments they’ve had. We have team meetings in which we think about the disease, the person, the family and how we may be able to add to their care which sometimes includes referral to the other physicians at Shadyside for specialty consultations. Some of the things we might use include acupuncture, acupressure, bio-feedback, reflexology, shiatsu, deep tissue therapy, manipulative therapy, sighted imagery/visualization, trigger point injection, hypnosis, vitamin rejuvenation, Feldenkrais movement therapy, Rosenfeld body awareness therapy, psychotherapy, eye movement desensitization and retraining, botanical medicine and nutritional medicine.

PND: Is there a single underlying philosophy that unifies all the approaches being used?

LM: The philosophy is that disease arises as a logical development out of every aspect of the person’s life and it arises as disharmony within the person’s life, as a manifestation of their suffering and it’s our job to treat the person as a whole person in the context of their family, community, workplace and to identify those places of disharmony and, I guess you could say to make peaceful, to help people suffer less and to integrate more harmoniously with their environment in the context of their bodies, their loved ones, things like that. What we’re doing lies solidly in the tradition of western medicine as begun by Hippocrates and championed by Sir William Osler. What we’re doing is listening to patients, letting patients guide us, trying things that patients think will help and other people have found helpful in other places. Medicine has unfortunately in this decade become too closely identified with pharmaceuticals and surgery and it’s my opinion that the art of doctoring includes all of the things that we do. The art of doctoring includes touching patients, talking with patients, praying with patients sometimes, if that’s appropriate, helping people with diets and their lifestyles. That’s what physicians have done for centuries and the popularity of complementary medicine has to do with the fact that reliance just on pharmaceuticals and surgery restricts medicine unduly from being as effective as it can possibly be. It’s my sense that in forty years you won’t see centers for complementary medicine because what we do will have become fully integrated into Internal Medicine, Family Practice, Ob-Gyn, the various disciplines that already exist.

PND: How you would characterize the reception that you’ve received from patients and from other health care practitioners?

LM: The reception from most patients is strongly enthusiastic and deeply appreciative of UPMC and Shadyside for making this possible. The reception from physicians ranges from enthusiastic support to grumbling about selling and peddling snake oil. But most of the physicians at Shadyside are pleased to have us. We’re a resource for them. At least half of their patients are already dabbling in the kind of stuff we do, so we bring a kind of academic rigor to helping them understanding what their patients are doing and to sometimes maximize effective treatments that they may not be familiar with.

PND: Could you elaborate a little more on exactly how you interact with physicians outside of the center?

LM: If they refer patients, I will send them a letter describing what we’ve found and we’ll keep them informed of the treatment as it progresses. Sometimes we’ll call them to communicate what we’re doing and what we think should be done. Sometimes they’ll call us to tell us they’re sending a patient, what they think should be done and what they would like. They don’t have to go through me. If they know a technique they want a patient to have, they could direct the referral to whomever on our staff does that without needing to go through me.

PND: What would you say to the skeptical physician who might consider a lot of what’s being done at the center as selling snake oil?

LM: They haven’t read the research, they’re not keeping up on the theory of this rapidly developing area of medicine.

PND: Could you talk a little about what sort of research has been done?

LM: There are thousands of studies in complementary medicine. I recently found out that there are 30,000 studies on homeopathy and someone just gave me a thick file on therapeutic touch. I find pretty much that, for any modality that I would want to know about, I can get on the Internet a pile of studies about that modality, some better than others, but the studies are being done and for the most part are showing effectiveness of the treatments that we use. What I do is bookmark a number of Web sites that allow me to get into what’s been published each week and try to keep up with it. It’s very difficult to keep up with.

PND: How do you go about trying to evaluate the efficacy and safety of complementary treatments?

LM: We keep extensive data on all of our patients to make sure that they are getting better and we give them a very thick questionnaire at the beginning of treatment and follow-up questionnaire pertinent to their disease periodically during treatment. Luckily, our therapies either help or they don’t help. It’s very rare that they make anyone worse. So we’re lucky in that regard that we’re not in the same boat as say the oncologist who might be trying a new protocol that hasn’t been published yet, and they don’t know for sure if it will work or not, but it’s harder for them because their protocols might hurt people. Ours for the most part are either ineffective or are helpful.

PND: Are you doing any clinical research at the center?

LM: We are. We have a study under way on complementary medicine treatment of uterine fibroids, which has three components. Guided imagery or visualization is one; Chinese medicine with acupuncture and nutritional modification and herbs is the second treatment; and the third treatment is a kind of deep tissue body therapy primarily related to the pelvis and abdomen. We’re randomly enrolling patients who have medium growing fibroids, are symptomatic and are not at the point where they need immediate surgery. We also have a study we’re developing with cardio-pulmonary rehab on what happens when you add yoga and guided imagery to patients with congestive heart failure and COPD. We have a study we’re developing with the Family Practice Department on the use of complementary medicine with the somatization disorder patients. For that study we’ll be randomly assigning patients to either (1) conventional cognitive behavioral therapy; (2) twelve sessions of complementary medicine to be chosen in a manner that appeals to the patient; (3) a group that provides guided imagery, relaxation training, information on nutrition and supplements. We’ll be testing the efficacy of these three treatments for somatization disorder.

PND: What led you to explore complementary techniques and how did you train in them?

LM: I’m Native American and where I grew up we really didn’t have doctors. We had medicine people and none of us could afford doctors even if we had them. When I got to medical school I discovered that there were a whole group of patients that back home the medicine man would treat and would help that we weren’t helping and I resolved to undertake a study of the medicine of my culture and to incorporate it into my conventional doctoring to the extent that I could and to the extent that it would help my patients. So I’ve studied with various medicine men and women for the last 25 years learning more and more about a tradition that’s been alive and well for thousand of years on the North American continent.

PND: How do you apply that with your patients?

LM: I use botanical medicine, which I derived from my study of native North American shaman, nutritional therapy derived from that study, sometimes ceremonial treatments, psychotherapy that’s been influenced by my work with medicine people, touch therapy that I’ve learned from Native American healers. I also learned acupuncture in medical school, so I do that.

PND: Are most of these approaches covered by health insurance?

LM: There isn’t a lot of what we do that is covered by insurance. We’re primarily treating the middle and upper class patients and I would very happily treat the people who were similar to those I grew up with, the patients on Medicaid, Gateway and things like that. Those plans don’t pay for what we do. We can treat those patients as part of a research study and I hope to have a way to treat patients with students and residents for no charge at some point so that we can serve the poor.

PND: How can other physicians in western Pennsylvania learn more about these complementary techniques and receive training in them?

LM: We’re in the process of setting up mini-internships where people can come to work with us and learn from us. In terms of observation, we’re very pleased to have physicians coming and sitting with us and watching what we do.