- The Washington Times - Monday, September 17, 2001

The American Medical Association in 1998 defined alternative medicine, in part, as practices not widely taught in medical schools nationwide. The educational landscape has changed considerably in the few short years since that report.
Today, many of the nation's 125 accredited schools of medicine offer courses or electives in alternate medicine.
An announcement earlier this month by Georgetown University Medical School underscores that shift in educational ideology. On Sept. 5, Georgetown University received a five-year, $1.7 million National Institutes of Health grant to incorporate complementary and alternative medicine, also known as CAM, into its medical instruction in the next five years.
Georgetown professor Aviad Haramati, the lead researcher for the program, says his school's implementation plan differs in its intensity and breadth from other medical schools.
"Our approach is that every student will have a modicum amount of knowledge in the field. Period," Mr. Haramati says. "We start [teaching alternative medicine] on the first day of school. It's a whole different paradigm."
Alternative medicine covers a gamut of unconventional medical practices, including dietary supplements, acupuncture, herbs, homeopathy, therapeutic massage and traditional Oriental medicine to promote or restore good health.
The Georgetown grant goes a ways toward making such instruction an integral part of a doctor's training.
Such teaching isn't meant to transform aspiring doctors into acupuncturists or chiropractors. Simply, it gives neophyte physicians an understanding of alternative medicine, its strengths, weakness and applications.
Dr. Deborah Danoff, associate vice president of the Association of American Medical Colleges' division of medical education, says the majority of medical schools already have developed alternative medicine components in the past five years.
"Medical education is constantly evolving," she says.
But Dr. Danoff, whose nonprofit association works for reform in medical education, says Georgetown's new initiative puts it on the "leading edge" of the movement because it is so interwoven with the standard curriculum.
Mr. Haramati says the new program aims to quell a simple problem.
Without addressing alternative medicine education, "we're not meeting the mission of educating physicians responsibly," he says.
Mr. Haramati laments what he says is a "huge disconnect" between a public that regularly relies upon various alternative programs and a medical community often unenlightened about the topic.
Some aspects of the new training takes on a pragmatic tone.
"A student needs to know the interactions between [herbal] supplements and drugs," Mr. Haramati says. St. John's wort, an herbal supplement commonly taken to treat mild depression, can react with medication taken by transplant recipients and cause potentially life-threatening results.
The revamped instruction also will "teach students how to communicate with the patient," he says. "You need to ask [patients] what supplements they're taking."
A stigma remains in some quarters, though, that such techniques aren't deserving of significant attention in medical schools.
"It's a big concern," Mr. Haramati says, and a key reason the information is being gradually installed into the university's curriculum. "It's why it's evolving and not just being dumped on the school overnight."
Some of Georgetown's work already has begun. Michael Lumpkin, chairman and professor of physiology and biophysics, is currently teaching relaxation techniques, biofeedback and stress-management information to his physiology and endocrinology students.
The program's final phase will include the creation of a master's degree program in alternative medicine work.
Other local and national colleges align with Georgetown's stand on alternative medicine.
The American Association of Medical Colleges says 76 of the country's 125 medical schools offer courses in complementary and alternative medicine as part of required curriculum, up from 46 schools just five years ago.
Dr. John C. Pan, director of the Center for Integrative Medicine at the George Washington University Medical Center, says the Foggy Bottom university has been teaching alternative medicine practices for the past year, thanks in part to a $300,000 grant from the Fund for the Improvement of Postsecondary Education. The FIPSE is a government program that provides help for innovative programs that improve postsecondary education.
The university recruited students for a voluntary program this past year to measure the results of such instruction. It sought a group of 80 students — half of whom would be instructed in and would receive alternative medicine techniques, and the other half would serve as a control group and study only traditional medicines.
"Most have no idea how acupuncture treatments feel," Dr. Pan says. The students were able to experience what the needles felt like and what other techniques were like.
The program represents a different way of teaching medicine.
Role playing is nothing new for medical students, but because many techniques are invasive, submitting to them isn't an option.
The students underwent several procedures, from Reiki massage to acupuncture.
Just 40 students total, however, stepped forward to participate in the first round of this education method.
The response to the volunteer request "was more disappointing than I anticipated," he says.
Students were concerned the volunteer work would take time away from their traditional studies. Dr. Pan says such work would have the opposite effect.
"I think it will help them in their studies," he says.
Chiropractic work is the most common alternative medicine method used by the public, Dr. Pan says.
"Around here, acupuncture is a significant second, but nationally it's [use is] small," he says.
Mr. Haramati says observers shouldn't view the evolving lessons as an educational stamp of approval for acupuncture and many other alternative methods for healing.
"We're doing this in a nonadvocacy way," he says.
Dr. Maggie Covington, director of education for Complementary Education at the University of Maryland's School of Medicine in Baltimore, says demand is fueling the changes.
"It's not that the mainstream medical community believes it's more effective, but patients are using it in large numbers," Dr. Covington says. "We're forced to pay attention and learn about it."
The public's growing acceptance of such medicinal practices is not a matter for debate. According to a 1998 study published in the Journal of the American Medical Association, more than 42 percent of Americans used an alternative therapy in 1997.
Right now, medical students and physicians aren't always prepared to answer the patients' questions about various alternative practices.
Dr. Covington says mind-body medicinal work, like massage therapy in particular, is drawing heavy interest. Such practices a "physicians could very easily recommend" with little fear of negative consequence.
She adds that many alternative medicine techniques involve spending more time with patients to explore, a healthy trend in an age when doctor-patient contact appears to be waning.
News of Georgetown's grant, and the work of other universities, will also go a way toward addressing one of alternative medicine's main areas of concern, the lack of established research proving the practices' efficacy.
Even that isn't as true as it once was, she says.
"If you look at it, there's more research than most of us are aware of," she says.
Dr. Pan says in medical circles it has become "trendy" to get involved in alternative medicine.
"But it's not going to be mainstreamed any time soon," he says.
"My goal is at some point it won't be separated out as alternative medicine but be incorporated into medicine," he says.

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