Montori and Amit Sood are not the only voices of support for alternative approaches at the Mayo Clinic, a medical center renowned not only for the excellence of its medical care, and for the relatively low cost of that care, but also for a culture that is fanatical about doing whatever is best for each patient over all other considerations. With its soaring, graceful buildings and an almost pious, midwestern earnestness about patient care, the Mayo Clinic feels a bit like the mother church for modern medicine. I met with a range of prominent physicians there to discuss their views on the growing presence of integrative medicine in mainstream medical care, including at the Mayo Clinic itself, which houses what it calls the Complementary and Integrative Medicine program.
One of them was Morie Gertz, a hematologist, who chairs the Mayo Clinic’s internal-medicine department. “Most of the doctors here were top of their medical-school class, top of their residency, blah, blah, blah,” he told me. “That’s technical mastery. That doesn’t make them effective healers. Over the past 30 years, I’ve seen hundreds of patients who clearly feel they’ve benefited from alternative therapies. It’s not my job to tell them they shouldn’t feel better. And I wouldn’t tell patients they shouldn’t try alternative medicine if they want to—we need to follow the clues patients give us about what might help them. If a patient chooses to walk away from the therapy I’ve prescribed and go to an alternative therapist instead, that’s not the fault of alternative medicine; it’s because I’ve failed as a doctor to do a good job of making my case in terms that are important to the patient.”
Gertz is among the many physicians who dismiss the lack of supportive randomized-trial data as a reason to write off alternative medicine. “The randomized trial is a very high bar,” he says. “Eighty percent of what I do here isn’t based on randomized-trial data.” Physicians routinely write “off-label” prescriptions, Gertz says—that is, prescriptions that call for drugs to treat conditions for which those drugs have not been officially approved. It’s a perfectly legal and ethical practice, and even one that physicians consider essential, accounting for about a fifth of all U.S. prescriptions. “It’s off-label not because it doesn’t work, but because there’s no good randomized-trial data on it. In the same way, we may not have great evidence that alternative medicine works, but that’s very different from saying it doesn’t work.”
This notion that alternative medicine is a legitimate response to mainstream medicine’s real shortcomings is one I heard, in variations, from everyone I spoke with at the Mayo Clinic. Keith Lindor, a liver specialist, even went a bit further. “I see how often there’s little we can do with specific therapies to help patients,” he told me. “One of the most common complaints we see from patients is chronic abdominal pain, and we only figure out what’s wrong 10 percent of the time. These people deserve a chance to be helped by someone who takes a different approach.”
His own positive view of alternative practitioners was shaped early in his career, when he spent time working alongside a Native American medicine man at a reservation clinic. “I had been trained to aggressively treat patients with drugs that often only made them even more ill,” he says. “But he could often do much better with just a press of his hand.” When Lindor himself developed severe neck pain from long hours doing procedures, a doctor suggested drug injections into the base of his skull, but he ultimately found relief from several sessions of massage. The beneficial effects of alternative therapies on Mayo Clinic patients, he says, have been observable in shorter hospital stays, in lower levels of self-administered painkillers, and in reduced tissue inflammation, which is a general indicator that the immune system is better holding its own.
Lindor’s opinion is perhaps of special significance, because he is also the dean of the Mayo Clinic’s medical school. Ultimately, what today’s medical students think about alternative medicine will be more important to the future of medicine than what anyone else thinks of it. Mayo Medical School has woven alternative medicine into its curriculum. And its students seem eager to learn more. Among the dozen or so “interest groups” the student body has set up to arrange further discussion and education outside the normal curriculum is one focused on alternative medicine, attracting about a third of the students, on par with the other groups. “I’m probably not interested in being an alternative practitioner, but I want to learn more about it so I can have a better conversation with patients,” says Lauren Jansons, the ebullient second-year student who heads the group. “As physicians, we learn to identify disease and treat it. What we’re not always taught is to identify with patients, to understand what they’re thinking and feeling, even though that’s important to human nature. It’s an approach that motivates people to be more active in their treatment and healing, and we can channel that.”
In fact, a more open-minded consideration of alternative-medicine practices has become par for the course at medical schools. In recent years, the American Medical Student Association has co-sponsored an annual International Integrative Medicine Day, which, according to this year’s press release, “will increase awareness and availability of integrative medicine, promote inter-professional collaboration, encourage self-care, foster cultural awareness and enhance patient-physician communication” (an “infiltration of quackademic medicine,” blogged David Gorski, a surgical oncologist at Wayne State University and one of the more prickly anti-alternative-medicine warriors, in despair).
Before leaving the Mayo Clinic, I stopped in to watch a small mountain of muscle named Ryan Berry receive massage therapy, through the integrative-medicine program, to address the discomfort he was experiencing two days after extensive thoracic surgery. When I came in, Ryan, who is 34, was stiff with pain, and seemed sewn to the chair in which he had been propped up. He clutched the arms of the chair, grimacing with each shallow breath. Over soothing music, the therapist spent several minutes talking with Ryan, getting him to discuss, through clenched teeth, the details of his pain. When she finally started the treatment, she seemed to barely brush her hands against the top of his back. But within a minute, his hands started to release their death grip, his teeth unclenched, and he was slumping a bit. Within three minutes, he was breathing deeply and slowly, his hands were open and limp, he was sunk down in the chair, and his grimace had been replaced with a hint of a smile. Personally, I doubt it mattered much where exactly the therapist placed her hands and how she moved them, which means a randomized trial would have found the treatment to be no better than sham massage. But it was as compelling a picture of suffering relieved as I have ever seen.
Scenes like that one, witnessed by more and more doctors in clinical settings, make it obvious why the front lines of medicine are pushing toward a less rigid stance on alternative medicine, if slowly, and in pockets. Open-mindedness can strike in even the most unexpected of places. Steven Salzberg happened to mention to me in passing that he didn’t consider hypnosis to be an alternative practice. I asked him why he left it off his long list of shams and frauds, and he seemed surprised, as if he had never considered the possibility that it might not be a legitimate therapy. “I don’t know,” he said. “I guess it’s because my father was an academic clinical psychologist, and he used it in his work.” Had he looked at studies on the effectiveness of hypnosis? “Not very closely,” he said. “But I believe it works.”