On the ground floor of a hospital, 30 health-care professionals participate in a guided meditation. In a classroom, a fourth-year medical student presents a study on the use of Chinese medicine to relieve migraines. In a conference hall, 75 health-care practitioners are trained in tai chi, Reiki and essential oils therapy. In a lounge area, 30 students and faculty participate in a drop-in yoga class.
Does this sound like a typical day at UCLA? In 2012, it does.
A whole new age in medicine is blossoming across the UCLA Health System. By blending the best that Western and Eastern traditions have to offer, UCLA is leading the nation in integrative medicine practices.
“There’s no place else that offers as many opportunities to research, teach and practice integrative medicine than does UCLA,” says Woodson Merrill, executive director of the Continuum Center for Health and Healing, part of Beth Israel Medical Center and the Albert Einstein College of Medicine in New York City. “They’re the leader in the U.S. in that the medical center and the medical school are so in synch with each other.”
“Other programs around the country are strong in clinical, or in research, or in education, but UCLA is the leader in integrative medicine because we’re strong in all three,” adds Anne Coscarelli, director of the Simms/ Mann–UCLA Center for Integrative Oncology. What is emerging is a model of integration across the UCLA health-care system where Eastern traditions are used to maintain health, prevent disease and treat chronic conditions, and Western medicine is used when aggressive intervention is necessary for acute care. The trick is finding the right balance between the two.
When Worlds Connect
Eastern modalities first appeared in Westwood with the founding of such institutions as the Center for East-West Medicine in 1993 and the Simms/Mann center in 1994. Initial resistance from mainstream medicine practitioners began to ebb as Eastern modalities became more accepted by the general population, especially in West Los Angeles, where UCLA draws much of its patient base.
By 2004, so many such institutions had formed that the UCLA Collaborative Centers for Integrative Medicine (CCIM) was founded as an umbrella for 11 organizations and their subsidiaries. CCIM joined the national Consortium of Academic Health Centers for Integrative Medicine (CAHCIM). Last October, CCIM sponsored a national CAHCIM conference at UCLA attended by hundreds of medical professionals.
Now, with new research supporting the effectiveness of many alternative modalities, acceptance of integrative medicine is reflected in both outpatient and inpatient care in specialties ranging from family medicine, oncology, internal medicine and primary care to rheumatology, gastroenterology, head and neck surgery, and thoracic surgery.
“Certainly the fact that the administration is getting behind this makes a big difference,” says Diana Winston, director of mindfulness education at the UCLA Mindful Awareness Research Center, about the aggressive support given to integrative medicine. Such leaders include A. Eugene Washington, dean of the David Geffen School of Medicine and vice chancellor of health sciences, and David Feinberg, associate vice chancellor of UCLA Health Sciences and CEO of the UCLA Hospital System.
Feinberg was recently responsible for bringing the Donna Karan Urban Zen Integrative Therapy program to the campus. Instructing nurses and other health-care practitioners in Eastern modalities, the present goal is to train a force of 300, enough manpower for at least one practitioner to be stationed on every floor of the Ronald Reagan UCLA Medical Center 24 hours a day.
Rodney Yee and Colleen Saidman Yee, the famed yoga masters who run Urban Zen at its headquarters in New York City, travel to Los Angeles to head up the training. “These health care practitioners are the champions who are constantly on the front line,” Rodney Yee says. “We teach them the tools to deal with the stress, so it doesn’t have to be lodged in their pelvis, in their shoulder, in their jaw. … So that every day they wake up and have the practices they need to restore themselves back to clarity.
“It’s the total hospital that matters; it’s not just the physician or the nurse,” he continues. “Yes, heal one person at a time, but from a holistic point of view, we all have to arrange ourselves in the right way so that the whole health-care paradigm rises up.”
Creating East-West Doctors
Winston, who spent a year as a Buddhist nun in Burma and has been teaching mindful awareness since 1993, holds a seminar at UCLA’s David Geffen School of Medicine to instruct third-year med students on the moment-by-moment process of observing one’s physical and emotional experience in order to bring down stress levels and boost the immune system.
“Med students are overwhelmed and, realistically, one two-hour class is probably not going to change their lives,” she says. “But they’re getting exposure to all of this as a self-care process, and it’s also expanding their horizons in terms of where they’ll refer patients in the future.”
Both second- and third-year students are exposed to seminars on tai chi, acupuncture and Reiki, an ancient Japanese healing art where practitioners move energy around the body through the light touch of the hands.
Recently, an online module was added to the mix. “It’s on headaches and includes a number of different treatment modalities,” explains Margaret Stuber, professor of psychiatry at the UCLA Semel Institute for Neuroscience and Human Behavior, who helps plan the medical school’s curriculum. “It contrasts the integrative medicine approach with the allopathic (Western) approach.”
Fourth-year medical students can opt for an intense, two-week elective in Integrative East-West Medicine at the Center for East-West Medicine.
“It’s a great elective to get a new knowledge base and a new approach to medicine,” fourth-year student Peter Berberian says of the course. “I’m going into primary care, where Western medicine understanding is lacking.”
Similarly, Cristina Barolet-Garcia, a fourth-year student at Northwestern Feinberg School of Medicine in Illinois who took the elective as a visiting student, hopes to “integrate yoga, acupuncture, meditation, acupressure and trigger point injections into my practice of psychiatry,” she says. “I believe my future patients will benefit from the mind-body-spirit connection by learning tools to curb anxiety, depression, asthma and other conditions.”
“The East-West center class is also a great place to find mentors who will care for your development as a physician,” Berberian adds. There’s no doubt Ka-Kit Hui ’71, M.D.’75 — the founder of the Center for East-West Medicine as well as the chair of the CCIM — has done a whole lot of mentoring.
“I’ve spent the last 18 years training students who are now faculty members,” says Hui, who believes this is just one reason why his center now receives patient referrals from more than 500 physicians across the UCLA system.
Renate Winkler was desperate to find a cure for her postural hypotension, recurring abdominal pain and constipation due to intestinal obstructions. In addition to two unsuccessful intestinal surgeries between July 2008 and May 2011, she was hospitalized nine times — nearly once a month in late 2010 and early 2011 — and doctors were unable to correct the condition. Then a professor at the Geffen School of Medicine suggested that she try UCLA’s Center for East-West Medicine.
At the East-West center, Hui recommended possible ways to help Winkler cope with her issues, which he saw as a defect in her autonomic nervous system. Besides receiving acupuncture, massage and trigger point injections, “I was taught how to massage my abdomen, as well as to massage my back and neck with a tennis ball, and my legs and feet with a golf ball,” Winkler explains. “They also told me to keep warm at all times and to avoid chilled food and drink.”
Under Hui’s supervision, Winkler began a meditation practice and added tai chi to her exercise regimen of swimming and yoga. Now, her postural hypotension, constipation and abdominal pain have been alleviated, and she has avoided hospitalization for a year. Hui can point to many successes like Renate Winkler’s, but he laments the lack of sufficient funds to develop scientific evidence to validate those successes. “We have 10 years of data — from emergency room visits, readmissions and laboratory data — and we’re analyzing that now. But we need more financial support to effectively study all this,” he says.
“The problem with many of the integrative medicine modalities is that they do not lend themselves to study using randomized, placebo-controlled, double-blind clinical trials, which are our gold standard,” Stuber says.
“It’s hard to do a placebo control with something like acupuncture, for instance. It is difficult to be blinded to what kind of treatment you’re getting.”
In addition, “Most of the integrative medicine approaches are very individualized to the patient,” she continues. “And randomized controlled trials usually look at only one specific intervention with a large group of people with very little individualization. … On the other hand, many of the modalities of integrative medicine have been successfully used for thousands of years.”
Still, there is some research to back the case for Eastern medicine. Michael Irwin, director of the UCLA Cousins Center in Psychoneuroimmunology at the Semel Institute, is at the forefront nationally and internationally when it comes to looking at mind-body treatments for physical- and mental-health outcomes through tai chi, yoga and meditation.
“We have used a variety of techniques to prove that these procedures are efficacious, some of the studies using randomized treatments with over 150 people,” he contends. “We’ve published extensively on it.”
This nationally recognized work is what prompted Irwin to be asked to chair a Blue Ribbon Intramural Research Strategic Planning panel for the U.S. government’s National Center for Complementary and Alternative Medicine (NCCAM), that will help to provide a blueprint on how to conduct mind-body research on a national level.
Cover More Lives
“We actually have two papers now that show that meditation alters the expression of genes that are involved in inflammation,” Irwin says. “And then a third paper showing that tai chi and a mindfulness approach can reduce inflammation.”
The Center for East-West Medicine, like many of the integrative medicine centers at UCLA, is so highly regarded that it receives frequent visits by physicians and administrators from all over the world, including one recent visit by the Chinese vice minister of health. Nevertheless, there’s a way to go.
“We’re still very much seen as a place of last resort,” Hui says. “And this needs to change.
“It’s very gratifying that there’s been so much acceptance of safer and cheaper integrative alternatives, but I’m very impatient,” he admits. “We need to scale this up to cover more lives. People shouldn’t be suffering as much as they do. … We need more supporters like the Oppenheimer family [who donated $9.6 million in 2002 to help underwrite the Center for East-West Medicine as well as the Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress].”
While the East-West center charges for patient visits, others do not. The Simms/Mann center, for instance, not only provides free services, it is not supported by university funds.
“We have to rely on the support of friends and former patients,” Coscarelli says of Simms/Mann. “We have many individual patients who’ve made contributions back to us after they’ve been helped here. That’s an important concept. You get what you need, and then hopefully you’ll give back so the services can grow and be there for the next group.”
“I think UCLA will continue to be the leader into the future,” Hui concludes. “By synthesizing the best ideas, wisdom and scientific evidence from different traditions, we can actually help people get back to health. And that’s why we’re in health care, after all.”