By Meredith Goad, Blethen Maine Newspapers Inc.
Dr. Howard Margolskee of Pittsfield is a traditionally trained internist. But when a patient asks to try acupuncture for an ailment, he's prepared for that, too.
He simply sets up an appointment with the acupuncturist who comes to his office on Tuesdays to see some of his patients and consult with him on their problems.
"She's been trained in traditional Chinese medicine as well," he said, "so she has the ability to give herbs to go along with it. We've developed a very good camaraderie."
Now Margolskee and his business partner, Janet Thorp, want to help other physicians trained in traditional Western medicine feel just as comfortable prescribing acupuncture or massage or herbal remedies for their patients. So they've just formed a New England chapter of the nonprofit Association for Integrative Medicine, a national organization dedicated to integrating alternative therapies into the health care system. It will be AIM's first regional chapter in the country.
AIM-New England will act as an information resource for Maine physicians who would like to try alternative therapies but are still a little wary of them because of the lack of professional and regulatory support.
Doctors in Maine generally are open to the idea of integrative medicine, Thorp said, but they worry about referring a patient to a practitioner or product that may or may not be reputable. How can they be sure, for example, that the biofeedback specialists or hypnotherapists they send patients to really know what they're doing?
Similarly, if insurance companies decide they want to pay for an alternative therapy, there are few places for them to go to get advice on how such a system should be structured, or information on how alternative health care professionals get their credentials.
"We don't feel a lot of resistance (from doctors) to concepts, especially with the more well-established alternative therapies," Thorp said, "but the issue becomes how do I know that this product or this provider is qualified to do what this person wants them to do? If they want a chiropractor, they can at least call the state of Maine and find out if this person is indeed a qualified and licensed chiropractor in Maine. You can do that for some complementary medicines, but not many."
Doctors, she said, also want to know that they'll get feedback about their patients from alternative practitioners and that they'll be kept informed about what's being done to those patients.
"They don't want patients to disappear into a black hole," she said.
Thorp, a nurse, is on the advisory board of the national AIM organization and chairs its insurance committee. She will be executive director of AIM-New England. Thorp and Margolskee also run a consulting business called Alternative Healthcare Systems of Maine that has worked with several New England hospitals addressing some of the same issues, especially around setting up insurance payments.
Asked if a resource like the nonprofit AIM-New England would be valuable to the average physician, Dr. Paul Balzer Jr., a family practice doctor from Cumberland, answered with "an enthusiastic yes."
Doctors in Maine don't mind trying alternative therapies, he said, but they need solid evidence that a treatment works for a particular condition before they'll recommend it to their patients.
With herbal remedies, for example, doctors want to be sure that the supplements contain what their manufacturers claim they contain.
"I, like many doctors, have a pretty strong feeling that many of these supplements have strong active ingredients in them and therefore could be quite valuable," he said. "But if the supplements aren't standardized, then it's pretty hard to recommend them to your patients, unless you know which brand has the right amount of stuff in it. So I think a clearinghouse like that is quite valuable."
Balzer says more of his patients have been asking him about alternative therapies in recent years, and he knows there are others who go ahead and use them anyway without telling him.
"If I don't ask them about it, many of them won't tell me the truth," he said. "Sometimes I ask them and the floodgates open that they're on 10 or 15 things, and my jaw drops a little bit."
Of all the nontraditional therapies, Maine physicians probably use chiropractic more than any other, Thorp said, followed by acupuncture, massage and other bodywork therapies, biofeedback and hypnotherapy.
In his own practice, Margolskee has tried to integrate the use of what he calls "some of the more common sense or commonplace" remedies.
"I've used a lot of vitamin therapy," he said. "I've used a lot of herbal therapy where I just advise people, 'Use this type of product at this dose. Make sure it's standardized, and you can use it with this medicine and don't use it with that medicine.' "
At various times he has invited a chiropractor, a massage therapist and the acupuncturist who also does traditional Chinese medicine into his office to treat patients after hours. In that way, he's able to communicate with the practitioner about his patients' care.
"I've had several patients who have had low back pain who have been on a lot of therapies, a lot of medications, or who have not been feeling good on medications with side effects," he said. "And through the acupuncturist, several of the patients are totally off of medication."
Margolskee understands how the wide variety and lack of regulation of alternative health care practitioners can make traditionally trained doctors uneasy.
"The rigorousness of some of (the training) is quite varied," he said. "For some of them, you pay your $25 fee and you're certified. I think that's what we want to try to avoid because that's what's been giving alternative therapies a bad name."
Margolskee says that being open to integrative therapies has improved his relationship with his patients. For one thing, they are now more honest with him about the treatments they try outside of his office.
That kind of honesty "makes it a lot better from my perspective because I can treat them better when I know what they're taking," he said. "And I think it engenders a better sense of trust."
Both Thorp and Margolskee say they think the field of integrative medicine is going to grow even more in the future because of the huge consumer interest.
"Patients demand it," Margolskee said. "Patients want it. We can put our heads in the sand up to a point, but patients are going to use it."
