Can west meet east?
With two centers for integrative medicine in town, Greenwich is tapping into what may become the future of medical practice. But is it for everyone?
Greenwich Hospital’s Center for Integrative Medicine literally rests on the shores of the Mianus River in Cos Cob. Flanked by a boatyard where masts crowd the sky and a street where cyclists cruise by on the sleekest of bikes, the Center couldn’t look more serene. Certainly, its exterior of gray siding and white shutters says nothing of anything medical — that all too often frightening sobriquet that reeks of needles, blood tests, diagnoses. That’s because the adjective integrative somehow magically softens any anxieties about health matters.
Inside, the Center hums in Zen harmony due to feng shui’s signature “square within the circle” design of unbending strength, enforced by a wall of rippling water at the entrance. The visitor is beckoned into a healing place where exam rooms are painted in subtle jade and have names, if not visions, like Rain Forest, Indigo and Polaris. Exam tables are generous and cushioned, with privacy curtains etched in silkscreen drawings. The circular waiting room is called the “gathering room.” There is a library of books for sale or browsing, a small glass-enclosed boutique with such items as meditation tapes and lavender-filled eye pillows, and even a shower room for those who feel the need to cleanse after a massage, acupuncture, healing touch, physical exam or a yoga class.
If you are ill, the Center promises to offer comfort and hope. If you are well, it is a place to learn how to stay healthy. It is, at its very essence, a place in which to heal. Even Dr. Henri Roca, medical director of the Center, concedes that the environment has the feel of a spa, complete with an air of indulgence. It is a palpable place of balance where symptoms are not treated as isolated but holistically — a place where the patient is viewed and vetted from childhood to the present with questions concerning diet, lifestyle and hot spots for stress levels.
Integrative: a new term surfacing more and more in the layperson’s lexicon meaning medicine that combines both conventional and alternative approaches to address the biological, psychological, physiological, social and spiritual aspects of illness — and perhaps more positively and importantly — wellness. Emphasis is on the respect for the human being’s capacity and potential to heal. Even the National Institutes of Health recognizes integrative medicine or CAM (complementary and alternative medicine) as a viable entity.
Dr. Roca was holistic long before the term came into vogue as the last hope of the stressed-out Wall Streeter or something that is often touted all too frivolously as yet another trend in pop culture. For Roca, holism is a philosophy. The skeptics, of course, remain, those who feel this is just another gimmick, who give little credibility to anything other than such things as pills that promise to lower cholesterol, cure depression, slow the heart rate and lower blood pressure.
Roca was a geologist and paleontologist before entering the LSU School of Medicine at the age of thirty-three. A robust man, he wore the protective hazmat suit, identifying toxins in soil and water, until one day he realized he needed to translate his devotion to good health directly to people. It’s not difficult to understand why, after a national search, Greenwich Hospital chose Roca as their medical director of the Center.
Roca (if the truth be told, he likes to be called Henri and prefers hugs to handshakes once he’s made your acquaintance) lives and breathes holistic medicine, extolling its tenets with passion — and courage — to nonbelievers. The impasse, according to insurance companies and many allopathic (conventional) doctors, is that alternative and holistic techniques have not had their efficacy or safety evaluated by Western standards, be it on data-based evidence studies or through endorsement by the FDA. Roca, however, has a simple axiom when it comes to integrative medicine: “Our population-based studies do not honor the individual,” he says. “And now we’re recognizing that every style of medicine except for ours [Western] has recognized the individual — body, mind and spirit. We don’t do that in conventional medicine and we end up with side effects — and people often dying from side effects.”
With a focus on family, women’s and pediatric health, the Center does not eschew conventional medicine. “Conventional medicine has done wonderful things,” says Roca. “The biggest interventions have been public health interventions. They extend life, and that being the model, all of our studies have taken on a public health kind of model. What can we do that generalizes to everyone? Well, there’s a limit, and I think we’re approaching or have passed our limit. Complementary medicine is not based on data, and conventional medicine is. I look at this as a belief issue. I can present data and people can choose to believe it or not. Medicine is indeed also an art. Therein lies the nature of medicine.”
Bernadette Johnson, director of the Center, has been in nursing for more than twenty years. At a Catholic college in Manchester, New Hampshire, she was practicing holistic nursing long before she defined it as such. “It was clear to me early on that spirituality was part of our training at St. Anselm’s,” she says. “Sacred moments with our patients were emphasized, whether it was offering a bath or any sort of communication. Given that, I thought that’s how the world of nursing would be. You can imagine my shock when I graduated and landed on a busy surgical floor where I had eight patients who all needed medications, and I also had to get to my red- tape paperwork. There was little, if any, room for the sacred connection.
“I saw so many nurses who were in the room with the patient physically, but who really weren’t there, myself included. I’d walk into a room and say, ‘How’re you doing?’ and in my mind, I was in the next room, two doors down, already thinking about when I’d be able to get to the next patient.”
Given that disconnect, Johnson decided to get a master’s in physiology, and then, in 1988, was determined to work for the Olympic Committee in Colorado. A medical recruiter said jobs with the Olympic team were filled, but there was an opening at Greenwich Hospital to start the cardiac rehabilitation program that ultimately morphed into the Healthy Living Center. Five years ago, the HLC, where stress management was the running theme, compelled her to again start from scratch, this time into divining a center for integrative medicine within the confines of the hospital.
“I wasn’t interested in moving positions when the hospital set up the Center here in Cos Cob last June,” she says. “I wanted to keep my program as a separate entity within the hospital even though we were borrowing space and I was using my laptop in any space I could find to book appointments. Clearly, though, this was my path from the beginning.”
The path, according to those who practice integrative medicine, is one in which all aspects of a patient’s life are examined, not just symptoms, but also root causes of illness. Roca will spend at least an hour with each patient, taking a careful history that includes diet and lifestyle since childhood. He will examine levels of stress and where those levels can be reduced. Healing touch, yoga, acupuncture and cranosacral massage are a few of the therapies he might recommend. But there is one significant catch: HMOs and insurance won’t pay for this.
The fact of the matter is that neither physicians nor consumers are happy with healthcare these days. Doctors are fed up with the HMOs, and patients are becoming hard-pressed to find a doctor who will spend quality time with them. Some patients are having a hard time even finding one who will take their insurance.
“Healers are frustrated,” admits Johnson. “They don’t have time to think and deal with the root problems. They only have time to deal with the symptoms. It’s not that we won’t suggest medication, but we start with what’s causing the symptom, for example, why people aren’t sleeping at night and their lives are filled with stress. We try to make the connection with patients that what they’re thinking affects how they feel, so that the physiology behind their thoughts can start changing the thoughts, and they can begin de-stressing.”
Although many allopaths in Greenwich agree with this approach, they view the Center’s existence as an economically motivated endeavor, feng shui and holism aside. Frank Corvino, president and CEO of Greenwich Hospital, insists that the hospital’s strategic vision is to provide the best in Western medicine and apply principles of Eastern medicine that have been proven effective and are evidence-based. His goal is to make Greenwich Hospital the premier healthcare facility serving Fairfield and Westchester counties.
However, there are many traditional physicians at Greenwich Hospital, all of whom asked to remain anonymous, who question Corvino’s credibility. Says one, “The problem for those of us showing up every day to take care of people whether they have a cold or cancer is that this Center puts our hospital’s blessing and stamp of approval on a list of unproven therapies. Look, I believe that gargling with warm salt water makes a sore throat feel better, but that’s not medicine. So I feel that when our hospital says to the community, ‘Here’s an alternative to what all of our hard-working doctors do,’ it’s more than a little insulting.
“There’s no question that this was an economic move on behalf of the hospital. They had donations to promote this. You see the huge number of dollars that people spend on things other than conventional medicine, and you say, ‘Let’s get a piece of that.’ ”
Roca begs to differ. “The commitment we make here is that we honor the [scientific] data that exists, and now we deal with the individual. I have had people come in here with a bag of stuff.
They’re spending five hundred dollars a month on natural remedies and are unable to pay for their pharmaceutical medication because that’s how they’re managing their health choice. If I can limit what they’re also taking ‘natural,’ it gives them more freedom when it comes to what they are going to do with their healthcare dollars.”
A core of Greenwich residents supported the establishment of the Center with hefty donations to make the dream come true. One person steeped heavily in the fundraising aspect is Christine Gordon, an interior designer, wife and mother. Although she was reticent to make calls asking for dollars, she graciously hosted several gatherings at her home where cocktail receptions led to checkwriting from many affluent members of the community. A believer, Gordon touts the virtues of healing touch and acupuncture, both of which she has used. “It’s amazing how it works and how much better you feel afterwards. Ideally, in ten years, insurance companies will recognize integrative medicine and alternative therapies and cover them. Statistically, they’ll reap the benefits. Right now, I think it’s morally and politically wrong, let alone absurd, that they don’t.”
The rumbling rift between some allopaths and integrative physicians is further exacerbated, says one physician, by the huge disparity in income. “You see,” an allopath says, “we get the same co-pay whether we spend fifteen minutes or two hours. We’re not getting any $300 per hour the way they are at the Center for a consultation and doing it with the blessing and financial support of the hospital when that money could be allocated to floor staffing. Nothing draws in good nurses and technicians than being the highest paid in the area. I think that would be a good and better way to spend our hospital’s money.”
The truth is that competent, dedicated physicians maintain that their practices are integrated, jargon aside. “As far as I’m concerned, I’m also an integrative physician,” says another internist. “It’s important when you’re a general doctor to talk to people — from what they do for transportation, to what help they have at home, family support systems, about their diet, caffeine and alcohol intake, exercise and fitness routines. I think we are quite holistic.
“Of course, when it comes to naturopathy, no. As I see it, Mother Nature didn’t do a very good job for humans. We were all dead by the time we were thirty-five when she was in charge. I ask you, what is the meaning of natural? Natural had women dying in childbirth. Our medicine is good stuff. I don’t know the side effects of bayberry and milk thistle. No one does.”
There is no question that hospitals need to generate revenue to survive, but is an integrative center an answer? One such integrative medical center at New York– Columbia Presbyterian died a few years ago, and then revived to serve only its own patients, not the general public. That would be unacceptable to a Greenwich physician who has long been an advocate of integrative medicine, “We need to be connected to the community and to the medical community,” he says. “The Center is not going to take away patients from good doctors and conventional diagnoses. Time will tell, I suppose. The Center can’t work if it operates outside the realm of the medical community. And I think the Center will be in big trouble if it starts treating patients who are terminally or acutely ill.”
While integrative centers are catching the first wave of what the future of medicine hopes to be, there’s no question that those able to afford the treatments and consultations at the Center do not worry about whether or not their HMO will cover doctor/patient visits and alternate therapies. A conventional doctor, in giving Roca and his associates his blessing, offers another perspective.
“I see far too many people,” says the physician, “who are paying $30,000 out of pocket for an elective cosmetic procedure. And there are all the doctors who make sure the patient has no complications and clear her for a plastic surgeon, who, unlike the doctors who do the pre-op clearance, do not have to function within the confines of reimbursements. That disparity causes a lot of resentment among conventional doctors. The insurance situation has become so abysmal that doctors are looking to find ways outside the purview of insurance to generate revenue, and if it can be done in a way that makes people better — and feel better about themselves and is not hurtful in any way — then I think you’re going to see more and more integrative centers like the one in Greenwich. And I don’t think that’s a bad thing.”
A physician familiar with all the pros and cons of integrative practice says, “One of the problems in medicine in general nowadays is that in conventional medical school, our students are poorly educated and poorly informed about alternative or integrative medicine. The teaching of traditional medicine is the use of drugs and surgery as the two ways to approach illness. This is a fundamental flaw in the way today’s doctors are trained. More of us need to be open to the notion that there certainly is a connection between the mind and senses and the emotions in terms of how people respond to illness and healing. There’s well-documented evidence that stress, grieving and emotional trauma have a negative effect on the body’s immune system. Some doctors treat patients in an arrogant and limited fashion and discount a holistic approach. I think there’s some substance to holistic medicine.”
Both Roca and Johnson make it clear that they would refer patients to an allopath when necessary. For example, if a patient came to them with symptoms of GERD (gastro esophageal reflux disease, generically known as heartburn), that patient would be referred to a specialty physician for a diagnostic endoscopy, and they would ask the patient’s permission to consult with his conventional primary care physician. “We are truly integrative,” says Johnson. “We are not totally separating our patients from conventional medicine. This is important for conventional practitioners to hear. We’re not in the business of taking away their patients: We simply want to look at the patients holistically and give them options.”
Dr. Barry Boyd, a passionate man who carries an overflowing briefcase that is a veritable library of excerpts from medical journals, was well ahead of his time when he first integrated Western medicine with Eastern modalities. Boyd, whose original plan was to become a biologist, was inspired instead to attend nutrition school by his mother who worked at the Continental Baking Company. Cornell Medical School came later. With a specialty in oncology (he is founder of the Integrative Cancer Center at Greenwich Hospital and the Integrative Cancer Care Research Foundation, and is co-author of The Cancer Recovery Plan), he opened the Boyd Center for Integrative Health on the Post Road in Greenwich two years ago.
Heavily influenced by the ways in which nutrition affects incidence of disease, Boyd studied the intersection between cancer outcome, prevention and the effects of nutrition on human biology twenty years ago, long before a focus on nutrition was considered to be scientific. He was fascinated as he explored nutritionally based alternative treatments, the role of exercise and other non-conventional approaches that spoke volumes on the mind-body connection.
“Physicians are just beginning to think in terms of nutrition,” says Boyd. “There’s no doubt that drugs have been miraculous. Unfortunately, however, because of limited nutritional training, many physicians don’t emphasize nutrition. Hopefully, more will recognize the need for nutrition in healthcare. It is a discipline that has been largely overlooked in the clinical arena and only viewed in the public health arena.”
Although a devotee of sound nutrients, fitness and stress reduction, Boyd is not a homeopath; he concedes that he doesn’t have a comfort level with homeopathic remedies, although he doesn’t discount them. “I believe in integrating biologically based conventional nutrition and lifestyle. We now know that stress leads to weight gain whether you eat more or not. Stress leads to hormonal changes that make it hard to lose weight and actually triggers weight gain, which causes elevation in cortisol levels, and that leads to obesity.”
As for holistic medicine, Boyd likes the adjective. “It’s a nice term. I like to think of holistic medicine as a large and varied group of physicians who do all sorts of things. It’s lifestyle medicine. It’s what I practice.”
As it has been with every new horizon operating or attempting to operate within the parameters of brave new worlds, there has been dissension, skepticism and argument. In some cases, as with Darwin, people are still debating conclusions.
Of course, Darwin’s was a theory and, some still say, hardly evidence based. Louis Pasteur was probably one of the greatest contributors to modern biology and vaccination. He solved the mysteries of rabies, anthrax and chicken cholera, established the groundwork for the first vaccines, debunked the myth of spontaneous generation and set the stage for modern biology and biochemistry.
But even he had his opponents, as did Galileo, who is now embraced by Stephen Hawking, as he was by Einstein, as the father of modern science.
What is perceived as unorthodox, despite a history that dates back thousands of years as in the case of holistic healing, takes a long time to resonate within not only the general community but also the scientific. Even after Pasteur, Koch and others proved the germ theory of disease, many surgeons neglected to wash their hands before an operation. Doctors scoffed at the idea that there was a link between heart disease and elevated blood cholesterol. Even the association between smoking and illness was disputed for years as doctors lit up in the lounges of hospitals. Says one conventional physician, “There is no question that many controversial treatments of today will be accepted in the future. Of course, we don’t know which ones — not yet. However, stress reduction, good nutrition within a healthy diet, exercise, not smoking, maintaining a healthy weight, and moderation in alcohol and caffeine would go a long way in eliminating illnesses that plague modern society. Doctors, by nature and training, are very traditionalist and conservative in how they think.”
Perhaps Bernadette Johnson has the best story when it comes to resistance from traditional doctors and the skeptical public: “When I started the Healthy Living Center, one of the doctors said, ‘I give this two years, Bernie. You’re going to end up in the parking lot reading tarot cards. You’re now entering the dark side of medicine.’ Well, I’m still here almost five and a half years later. Now his opinion is one of ‘no comment,’ which is, I suppose, better than being totally against it.”