Finding the Evidence
The search for solid evidence is key: Which therapies help and which don't? "There's a clamoring for understanding the biology of this," Sternberg says. Many proponents of integrative care say that it's crucial to hold alternative therapies up to scientific scrutiny, rather than dismissing them outright, because doctors and patients alike need answers. For example, a patient may be taking an herb that is harmful or may interfere with prescription drugs.

As a result, researchers across the country are studying complementary and alternative therapies for safety and effectiveness. Duke is studying whether stress-reduction techniques, such as meditation and writing in a journal, can help prevent preterm labor, which can be precipitated by stress-related hormones. In other clinical trials, researchers are trying to determine, among other things, how acupuncture affects brain activity, how biofeedback can better treat incontinence, and whether the medicinal herb valerian improves sleep in patients with Parkinson's disease.

With the large numbers of people using nontraditional therapies, even finding out what doesn't work can be valuable. For example, researchers affiliated with the Osher Center at the University of California, San Francisco, recently completed a study that showed that saw palmetto did not improve benign prostate hyperplasia, a noncancerous enlargement of the prostate gland. More than 2 million men in the United States take saw palmetto as an alternative to drugs. The results were published in The New England Journal of Medicine.

Tracy Gaudet, MD, director of the Duke Center for Integrative Medicine, says she encounters little resistance once fellow doctors understand that integrative medicine doesn't entail "blindly advocating for alternative approaches and rejecting conventional ones."

"That's not what we're about," she says. "There's a lot of quackery out there and a lot of dangerous therapies. Our first priority is to guide people away from them."

"We all want the same thing: the best care for patients," Gaudet says.

SOURCES: Esther Sternberg, MD, director, Integrative Neural Immune Program; chief of section on neuroendocrine immunology and behavior, National Institute of Mental Health and National Institutes of Health. Tracy Gaudet, MD, director, Duke Center for Integrative Medicine, Duke University. Susan Folkman, PhD, director, Osher Center for Integrative Medicine, University of California, San Francisco; chairwoman, Consortium of Academic Health Centers for Integrative Medicine. Tom Delbanco, MD, professor of general medicine and primary care, Harvard Medical School. Eisenberg, D.M. The New England Journal of Medicine, Jan. 28, 1993; vol 328: pp 246-252. Bent, S. The New England Journal of Medicine, Feb. 9, 2006; vol 354: pp 557-566. American Hospital Association statistics book, 2004. Oscher Center for Integrative Medicine web site. ClinicalTrials.gov web site: "Effect of Acupuncture on Human Brain Activity;" "Enhancing Non-Pharmacologic Therapy for Incontinence;" Valerian to Improve Sleep in Patients With Parkinson's Disease.