Integrative Medicine

At the Mayo Clinic in Rochester, Minnesota, they’ve an active research program in the field, including treatments like massage. Brent Bauer is director of Complementary and Integrative Medicine at Mayo.

Brent Bauer said that: We’ve done two studies now, in patients who’ve had cardiovascular surgery. So big a incision down the front of the chest, rib cage spread open, and what we’ve done is taken a group of patients, given them massage on Day 2 and Day 4 after their surgery, and mostly worked in the upper back, because that’s where a lot of the pain and discomfort resides after having your chest opened. And what we found is comparing that group to a group who did not receive massage, we were able to show a statistically significant improvement in pain, anxiety and tension.

This was a certified massage therapist who was fairly free to use the different types of massage that she wanted. She could use light massage, deep massage, Swedish massage and so forth. We didn’t try and restrict her to a certain number of strokes, or certain patterns, we wanted to allow a massage therapist to do the best job she could.

And it’s important to do that though, you have to have some kind of control, because otherwise we can’t be sure if it’s the massage or just the simple fact that somebody’s spending time with you. So we did as we actually had our massage therapist go in the control group, the patients that did not receive massage, and she actually spent about the same amount of time, about 20 minutes, speaking to them, talking to them, and just mostly trying to be a caring presence. So we were matching the amount of time spent in both groups.

The first one was a small study, about 60 patients that did show statistical significance, but the second study which we’re just looking at now, is about 220 patients, and that’s where we’re trying to tease out some of the questions Can we reduce the use of narcotics? Can we reduce the length of stay?

We’ve done a number of studies on herbal products, because that’s very popular with our patients, and we really want to be able to say what’s good, what’s not, and make sure our patients have a an ability to make an informed decision. So this was a study in cancer patients, a wide variety of cancer patients, by and large the number one concern they complain about is fatigue. Ginseng has some old studies that suggest it might be helpful for fatigue. We gave one group a placebo, we gave the other group ginseng, and we found the group that received ginseng less fatigued, better quality of life, overall greater satisfaction.

It was kind of ‘Gemisch’ of different patients. We had different cancer types, different stages and so forth, and that actually probably is a weakness of the study, so we’re actually replicating that study with a much more focused group of cancer patients to see if we can get stronger data.

The problem with previous studies in ginseng in other areas has been which ginseng, there’s different varieties, and what concentration, because you never quite know what you’re buying off the shelf.

It’s a critical component for any herbal medicine, but especially ginseng. We actually are lucky; right across the border here in Wisconsin, we have a group of ginseng growers, and so we’re able to work with them to harvest the single batch in a uniform fashion, all of the same age, processed the same way, we analysed the ginsenoside content, which is the active ingredient, before and also after the study, so we were sure that we didn’t lose potency over time. So doing all those precautions, you then have a much more replicable result. But it also means you can’t just go to the shelf and pick a ginseng and think you’re going to get the same results. You really have to follow the same type of product.

Which is the point. So you’re sitting, listening to this in Perth, Australia, or Adelaide, Australia, and you think ‘Well that sounds good, I’ll just pop down to the local chemist and buy some’. What are you buying, what do you look for?

With any study, you have to go back to the study and the study should identify the product. In this case we used the ginsenoside concentration of 5% and actually the Ginseng Growers Association of Wisconsin actually has a link on their site to a product that is similar to what we used in the study.

And you’ve done a fascinating study, coming more into Australia’s region, a herb from Ambon, just in Indonesia.

Brent Bauer: So there’s a beautiful old text about 350 years old, called the Ambonese Herbal, written by Rumphius who was a Dutch East Indies soldier and ended up on Ambon. Spent his entire life talking to the natives and really recording in a very detailed fashion how they used the herbs and what they used them for. Now we flash forward 350 years later, we now have a translation of the first book of seven. We looked at that first chapter, we found all the references to herbs and how they were used, and then we looked at all the databases subsequent to that time, to see if any of those uses had been validated. And we were able to show that about 80% of the herbal uses in that first book have subsequently been validated. In other words, indigenous knowledge appears to have been correct. So that was pretty cool, and I think that gives a lot of cache to our historical knowledge and historical use. What was really cool though, there were about eight herbs that had not been subsequently studied. So the Ambonese Herbal said, ‘Here are some things that we think work, but nobody’s ever studied them.’ So we actually went to Samoa where one of our PhD students had a connection, it wasn’t the island of Ambon, but harvested some Atun racemosa, which is a kernel, or a little nut-like plant, that’s actually used after their tattooing ceremonies. And if you’ve ever seen the tattoo ceremonies, lots of punctures to the skin, not much infection. So they use it as kind of an antibacterial. Well it turns out in Rumphius’ book that was one of the indications, Atun racemosa was used for infections.

Norman Swan: There’s been a fairly significant move in American hospitals towards having departments such as yours, Integrative Medicine, because of the enormous demand outside. But it’s a difficult area because if you take the cynics here who’ve looked at some of these alternative medicines, or complementary medicines, they say, ‘Look, the bigger the trial, the better the trial, the harder it is to find any effect’, and in the end what you’re doing is patronising patients, to make them feel a bit better, but not really finding real evidence that what they’re doing helps them, and sometimes if they’ve bought it say from India, Ayurvedic medicine, it could be doing them harm.

Brent Bauer: And I think there’s a good distinction here, certainly things with herbs and dietary supplements. Americans have a fascination and we tend to think that we can still smoke, drink too much, never exercise, and eat junk food, ‘But if I take the magic herb, I won’t have that many health problems’. So that is a real challenge, and that’s one of the reasons I think maybe herbal studies don’t come out very positive, because we’re looking for magical qualities instead of how they’re traditionally used. You know, green tea, you could drink five or six cups a day, as in many Asian cultures, you probably get a very different experience than if you pop two extracts of green tea. So there are a lot of challenges there.

Norman Swan: Now just on that, it’s the whole thing which we said often on the Health Report is the stuff in whole foods, which have got benefits working together, which when you extract what you think is the main game, it may not be.

Brent Bauer: We’ve often gotten burned with that type of philosophy, maybe Vitamin E is a good example. Vitamin E in the diet looks like it’s very healthy; Vitamin E as a concentrated alpha tocopherol doesn’t seem to work, and may actually have some negative effects. So I think if you put the broad category of dietary supplements on one side, I think there’s been a lot more hype than delivery.

Now on the other side though, I think the mind-body side, where we talk about meditation, imagery and things, if you look at how the typical American is right now, frazzled, running at full tilt, too many things going on, we know there’s a price to pay for that type of stress. So when you introduce things like meditation, acupuncture and massage, things that might be leading to a slow-down, things that might be leading to reduced response to stress, and that’s what many of these studies do confirm, then we start to get into an idea of maybe this is something important. There’s probably a dividing line between some of the magical thinking, which I think has been over-hyped and we should be very cautious. On the other hand, we shouldn’t throw out the baby with the bathwater. If we’re frazzled, we darn well had better start thinking about ways to take better care of ourselves in that regard.

Norman Swan: And indeed, particularly out of Britain, there’s been some very good randomised trials of mindfulness meditation, Buddhist-style meditation, which show significant benefits.

Brent Bauer: Absolutely. I think you know, what’s the harm from meditation? Very limited. Maybe you spend some money to go to a class, maybe you buy a DVD or a book. If you don’t like it, if it doesn’t fit for you, there’s no harm, you know, you try something else. But if you find it to be useful, if you find that it fits your lifestyle, and it starts to get you off that rapid train of non-stop the brain’s going, the brain’s going, the brain’s going, I think we’re actually starting to see a lot of studies suggesting that kind of stress kills neurones, affects our cognition. So not addressing anything I think would actually be a mistake.

Norman Swan: How do you get the balance in practitioners? Because one of the controversies in Australia is that you tend to get general practitioners who either do one or the other. They kind of say they do both, but some of them are so committed to complementary medicine, that’s kind of all they do. And getting the balance right is the critical issue. How do you deal with that issue?

Brent Bauer: The Mayo Clinic is a very conservative institution. I mean we have a deeply-held vision that the needs of the patient come first. So as long as we live under that, then I’m free to ask ‘What’s going to make my patient do better, feel better, get better’? And so I can pick from either side, and as long as I have evidence, then the colleagues who live over here maybe on the more cynical side, have actually been very accepting. And those who are very much more on the earlier doctor side, may be too quick to adopt. When we show them the evidence that things don’t work, they actually can be brought into kind of that middle ground as well. So I think by bringing science first, doing the research and doing it well, and applying those results locally, we actually can kind of keep to the middle ground where the best benefit for the patient’s going to occur.

Norman Swan: Dr Brent Bauer who’s director of Complementary and Integrative Medicine at the Mayo Clinic in Rochester, Minnesota.


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