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David Geffen School of Medicine

The Forest and the Trees

Dr. Mary Hardy (left) of the Simms/Mann-UCLA Center for Integrative Oncology has been instrumental in helping patient Jeannie Yee in her fight against cancer.LATE LAST YEAR, JEANNIE YEE came to the Peter Morton Medical Building at UCLA to endure another difficult appointment. The wife and mother was nearing the end of a grueling 10-week course of IV chemotherapy and high-dose radiation to combat inoperable stage-4 nasopharyngeal cancer, a diagnosis she received just months after giving birth to her second child. Strengthened by her Christian faith, yet physically and emotionally spent, Yee casually picked up a newsletter, published by the Simms/ Mann-UCLA Center for Integrative Oncology, in the waiting room and leafed through its contents.

“The radiation and chemo staff had mentioned the Simms/Mann Center during my treatments,” Yee recalls. “But I didn’t really get it until that day, when I read the center’s article about cancer and nutrition. I said, ‘Oh my goodness, this center is right upstairs. I had better see what this place is all about.’”

What Yee found, upon walking into the pastel-colored fifth-floor office, past a neatly trimmed row of sea grass and a calming infinity fountain, was a facility that addresses quality-oflife issues for patients and their families with a program of “integrative medicine” that combines the best of Eastern and Western approaches to include Chinese healing arts, imaging techniques and nutrition. There also is a retail shop on the ground floor, Reflections, that specializes in breast prostheses, wigs and herbal supplements.

Established 15 years ago, Simms/Mann is but one spoke in the dynamic wheel that is UCLA’s Collaborative Centers for Integrative Medicine (CCIM), conceived in 2000 as a means to marshal the diverse integrative-medicine facilities at UCLA. The CCIM was created not only to help feed research and evidence-based science into clinically directed entities like Simms/Mann, but also to demonstrate to the nation’s medical establishment UCLA’s leadership role in evidencebased complementary and alternative medicine.

In addition to Simms/Mann, CCIM includes the UCLA Center for East-West Medicine, the Center for the Neurobiology of Stress, the Pediatric Pain Program at Mattel Children’s Hospital UCLA, the Stiles Program for Integrative Oncology within the Jonsson Comprehensive Cancer Center, the Center for Human Nutrition, The Norman Cousins Center for Psychoneuroimmunology, the Mindful Awareness Research Center and UCLArts and Healing.

“UCLA has the most-extensive depth and breadth of integrative-medicine resources and clinical facilities in the country,” notes Emeran Mayer, M.D., Ph.D., founding chair of CCIM and a professor in the UCLA departments of medicine, physiology and psychiatry and biobehavioral sciences. CCIM is working hard to establish the university as the preeminent institution in the field, and the noted mind-body physician and researcher says the collaborative center has “taken off” under the leadership of its current chair, Ka-Kit Hui, M.D., the founder of the UCLA Center for East-West Medicine. Since its inception, CCIM has also focused on educating patients and doctors about the hard science that supports the concepts of integrative medicine. For example, Dr. Mayer points to a landmark infrastructure grant from the National Institutes of Health – the first ever for integrative-medicinerelated work at UCLA – that allowed the interdisciplinary research and clinical center he runs, the Center for the Neurobiology of Stress, to conduct a Pilot and Feasibility Program for integrativemedicine investigators at UCLA. That program in turn opened doors for other integrative-medicine investigators on campus to secure grants for such studies as the effectiveness of yoga treatments for pain management, the neurobiological underpinnings of traditional Chinese disease classifications and how the brain responds to meditation.

And federal support for the work being done at UCLA continues. Within the last two years, there have been nine integrative-medicinerelated studies and career-development projects conducted with funding from the NIH, through the National Center for Complementary and Alternative Medicine. The projects have addressed a wide range of issues, from the neurobiology of the placebo response to the effect of diaphragmatic breathing on the brain’s response to abdominal pain. In addition, UCLA integrativemedicine programs also have received substantial private support from the Gerald H. Oppenheimer Family Foundation, which has provided the longest on-going private funding for integrativemedicine studies on campus. These investigations have covered such topics as the beneficial effects of mindfulness meditation, Iyengar yoga, aromatherapy and green tea.

ALL OF THIS IS LIGHT YEARS from when psychologist Anne Coscarelli, Ph.D., established the Simms/ Mann Center. “The term integrative medicine did not even exist,” she says. Clinical activities like mindfulness meditation, yoga and placebo response that are now commonplace were barely recognized. “We started with a focus on psychological and mind-body approaches, and we’ve been able to expand to include therapies like the ancient Chinese healing art of Qigong, art therapy, mind/body-imaging techniques and herbal nutrition,” Dr. Coscarelli says.

For Jeannie Yee, discovering Simms/Mann has been like acquiring a new suit of armor in her battle with cancer, which involved 39 sessions of 7,000-centigray radiation that caused severe tissue inflammation. “This has not been just a little postscript,” Yee insists. “I had a tumor the size of a small lemon in my brain that was feeding off the nutrients in my bloodstream. And the critical questions were: ‘What kind of anti-cancer foods can help stop it? What kinds of supplements can I take that will boost my immunity to fight this brutal disease?’”

The center’s medical director, Mary Hardy, M.D., guided her toward supplements to help minimize the inflammation and the fibroid scarring that followed, as well as problems that the tumor, which pressed against her optic nerve, caused her eyes.

“I needed information about the big picture that was more hard-core than just eat healthy foods and get your rest,” Yee says. “And I found that. Each time I visit the center, I feel that I come away with a new lease on life.”

A new way to practice medicine is what Dr. Hardy discovered decades ago, while a Tuft’s University resident working on the edge of Boston’s Chinatown. Dispensing primary care to an unassimilated Chinese population upended Dr. Hardy’s views and training. “I had these 3-by-5 cards that said in Chinese, ‘May I examine you?’” Dr. Hardy recalls, “and as I was taking out my stethoscope, these little old Chinese ladies were undoing two buttons to reveal their navels!”

Not long out of medical school, Dr. Hardy traveled to China to observe cranial-tumorresection surgeries during which the patient was alert and talking. “Seeing this 20 years ago was shocking,” she continues, “and I came home vowing to gain more training in Eastern and herbal medicine.” She started the integrativemedicine program at Cedars-Sinai Medical Center and was helping to run the herbal-medicine center at UCLA when Simms/Mann offered her the chance to work directly with patients. Since then, Dr. Hardy has carefully stocked the Reflections boutique with herbal supplements that have been proven safe and efficacious through clinical research studies and trials published in Western medical journals. She works with patients at various points in the cancer chain, for example, at the outset of treatment to minimize chemotherapy’s toxic side effects like mouth sores, vomiting and neuropathy.

“Patients with cancer have a real need to get accurate information about using dietary supplements and other complementary therapies,” Dr. Hardy says. “Our goal is to help patients make good choices that will not interfere with conventional treatments but do enhance their well-being.”

Some physicians may resist this hybrid approach, but “there really is no conflict between conventional Western treatment and integrative medicine,” asserts oncologist John Glaspy, M.D., director of the Women’s Cancers Program at the UCLA Jonsson Comprehensive Cancer Center. “Combining conventional and alternative healing techniques is not a lion and a lamb relationship. It is two lions working in cooperation with each other for the benefit of the patient. If taking supplements makes the patient’s life richer, helps them to tolerate conventional treatment better, lowers their anxiety and makes them feel more in control, then the benefits are very positive.”

THE MERGING OF TWO LIONS has defined Dr. Hui, who grew up in British-controlled Hong Kong and can recall his parents taking him to a Western doctor for burns or infections and to a Chinese physician for chronic problems like skin or dietary issues. “Blending East and West is who I am,” he says. Dr. Hui founded UCLA’s Center for East-West Medicine in 1993, amid mainstream perceptions that integrative medicine was “quackery,” and he began integrating its clinical programs into UCLA’s medical school just two years later.

“The key to acceptance in the medical community of this model of medicine is education early in the physician’s career,” Dr. Hui insists. Last year, 18 UCLA residents rotated through the East-West center’s clinic. Along with the eight medical students who took the center’s advanced clinical clerkship for fourth-year students, there was a practicing UCLA rheumatologist, a UCLA rheumatology fellow, a dental anesthesiologist in private practice and a resident in physical medicine and rehabilitation. The center also has launched a primary-care fellowship program, and Dr. Hui harbors the broader hope that the work of CCIM and its constituent centers may influence the curriculum of the new medical school that is being built at UC Riverside.

And while it is educating new generations of physicians who are interested in integrative medicine, Dr. Hui says the East-West center also maintains strong ties to its Chinese-medicine heritage. Last year, it hosted Professor Han Jisheng, the director of Peking University’s Institute of Neuroscience Research and the scientist former-Premier Zhou Enlai handpicked, in 1965, to elucidate the neurochemical basis for acupuncture as a pain reliever. Dr. Jisheng’s work led the Ministry of Health to establish departments of pain medicine in all of China’s major hospitals. There also have been legacy projects – a visual-history project that includes a Web portal, documentary film and video archive – with other Chinese-medicine pioneers. These include Professor Chen Keji, the president of the China Association of Integrative Medicine, who utilized scientific techniques to study the 1,000-year-old Chinese-medicine concept of blood stasis, and Professor Tu Youyou, chief research fellow of the Institute of Chinese Traditional Medicines, whose work led to the development of a first-line anti-malarial drug, artemisinin, derived from the Chinese herb qinghao.

“Western medicine looks at the trees, branches and roots – the micro,” Dr. Hui explains. “Eastern medicine looks at the forest – the macro. Oftentimes in Western medicine, we are successful only if we can zero in on the certain things that we can actually do. But sometimes we don’t know why a patient is not well, and Eastern medicine works without necessarily knowing all the details by rebalancing the system and reestablishing the flow by using the body’s own mechanisms.”

Helena Chang, M.D., director of the Revlon/ UCLA Breast Center, is a thoroughly Westernstyle physician who is completely comfortable with integrative medicine. “It defines the new model of care, from a disease-oriented treatment model to a patient-centered wellness model … an improved model for patients and doctors to embrace,” Dr. Chang says.

Treatment for conditions like chronic pain, asthma, allergies and gastrointestinal problems at the Center for East-West Medicine begins by taking into account the whole pattern of medical issues described by the patient. Therapeutic modalities used by the center’s doctors – all of whom are board-certified in such specialties as internal medicine, clinical pharmacology and geriatrics – include acupuncture, trigger-point injections, acupressure massage and Chinese nutrition. Apparently, consumer demand is high. With more than 14,000 patient visits a year, the East-West center (an insurance-based clinic whose treatments are recognized by mainstream medical payers) is the CCIM’s most-direct link to UCLA’s vast patient community. And according to a recent nationwide survey by the National Center for Complementary and Alternative Medicine, approximately 38 percent of adults and 12 percent of children are seeking out and using some form of complementary or alternative medicine.

FOR THE PAST 30 YEARS, Lonnie Zeltzer, M.D., has devoted her career to helping children in pain, and the Pediatric Pain Program she developed at UCLA soon after arriving here in 1988 has become the nation’s leading-edge integrative-medicine center for adolescents and children. Dr. Zeltzer’s book, Conquering Your Child’s Chronic Pain: A Pediatrician’s Guide for Reclaiming a Normal Childhood (HarperCollins, 2005), along with appearances on shows like Good Morning America and Bill Moyers’ mind-body-medicine series, Good Medicine, has helped nervous parents to embrace the many different methods utilized in Dr. Zeltzer’s pain-treatment program – acupuncture, hypnotherapy, Iyengar yoga, craniosacral therapy, biofeedback therapy, art therapy, music therapy, psychotherapy, family therapy, physical therapy and meditation/ mindfulness-based stress reduction among them.

 Acupuncturist Michael Waterhouse has been a part of Dr. Zeltzer’s team for 13 years, and he says that Dr. Zeltzer’s unified approach to treatment addresses the biological, psychological and social aspects of chronic pain. He describes two recent patients who highlight Dr. Zeltzer’s multi-pronged approach.

“Patient A and B are both high-achieving 17-year-old girls,” Waterhouse begins. “From the age of 15, they start to develop chronic headaches that become so severe they’re missing weeks of school. Patient A’s family had been pressuring her to attend a top college but eased off during her therapy. After eight acupuncture treatments, in conjunction with a small amount of biofeedback, her pain is completely resolved. Patient B was much-less verbal, but she was high-achieving in mathematics. Her family was dysfunctional, and even after 10 or 12 treatments, acupuncture alone was inadequate without the intervention of a family therapist, which the girl’s parents never embraced.”

Raffi Tachdjian, M.D., is another member of the team. While doing his pediatric residency at Massachusetts General Hospital in Boston, he began to pair his interest in inflammation and immunology with a lifelong passion for music, asking music-therapy students at the nearby Berklee College of Music to assist him with patients. Years later, Dr. Tachdjian has brought his music-therapy techniques to Dr. Zeltzer’s pain clinic.

He described one patient, a non-communicative 14-year-old boy with cerebral palsy and developmental delay who suffered with pain from scoliosis. “He is very difficult to engage in any meaningful way, but he responds to music therapy,” Dr. Tachdjian says. “The boy’s mother is elated; he’s subdued and playful, and he no longer pulls out his mother’s hair the way he did when he’s in pain.”

(Because music therapy is not covered by insurance, Dr. Tachdjian has established a taxexempt non-profit organization, the Children’s Music Fund, to help pay for such interventions.)

Music therapy can also be effective during a highly invasive procedure, like a bone-marrow aspiration, Dr. Tachdjian says. “Rather than do a conscious sedation, which is risky and requires four hours of post-sedation care, with high-skilled nursing and cardiovascular monitoring, we can bring in a music therapist to achieve similar results. I see it as sort of the Aikido of pain management; because the human brain responds so quickly and efficiently to music, its therapeutic value runs the gamut from chronic to acute applications.”

These modalities are just two examples of how the various entities that make up the CCIM are well ahead of the curve. Dr. Zeltzer, for example, has used hypnotherapy techniques since the 1980s on complex patients with such conditions as sickle cell, diabetes and non-compliant cancer-associated pain. Her first NIH grant was to study hypnotherapy to control children’s pain in procedures like spinal taps and expanded later to include its use in quelling the aftermath of chemotherapy for children with cancer.

“There’s less research available with pediatric pain,” Dr. Zeltzer notes, “so my commitment has always been to do rigorous scientific studies to prove the safety and efficacy of these modalities for children. We have a psychophysiology pain laboratory set up just for that purpose; the key to mainstream acceptance of complementary and alternative modalities is good science and research.”

INTEGRATIVE RESEARCH HAS BEEN at the core of the Center for the Neurobiology of Stress (CNS), created by Dr. Mayer and Clinical Professor of Psychiatry and Biobehavioral Science Bruce Naliboff, Ph.D., and its NIH-funded subprogram, the Center for Neurovisceral Sciences and Women’s Health. Research efforts at CNS have included human-physiology studies on cerebral, autonomic, neuroendocrine and perceptual responses to visceral and somatic stimulation and health outcomes, quality-of-life and epidemiological studies in populations suffering from chronic functional-pain disorders. Another CNS program, the CNS Program for Mind-Body Research, targets therapies like yoga meditation and diaphragmatic breathing for common functional-pain disorders like irritable bowel syndrome, interstitial cystitis and fibromyalgia.

Dr. Mayer says he entered medical school specifically to pursue mind/brain/body interactions. His research has included work with the indigenous people living near the Orinoco River in Venezuela, the Irian Jaya of West Papua and with Native American healers. He has used the most-modern research tools, like functional brain imaging, to identify the neurological basis of ancient healing traditions.

“With the issue of healthcare reform front and center, now is the best time to have the medical establishment accept the many costeffective techniques integrative medicine offers for treating chronic illness,” Dr. Mayer says. And although he acknowledges CCIM struggled with its identity in its early years, Dr. Mayer says it is “now recognized around UCLA as an entity that is grounded in the same biomedical research and outcomes as the more-traditional facilities. Given the many diverse physicians and facilities connected by CCIM,” he adds, “the next logical step would be to position UCLA as the leading institution for integrative medicine within the University of California system.”

Patients like Jeannie Yee likely would embrace the long-term goals of CCIM’s leadership to extend its reach beyond UCLA, where she found a truly integrative approach in which all of those involved in her case – from her oncologist, ophthalmologist and radiologist to her nutritionist and Dr. Hardy at Simms/Mann – communicate with each other to coordinate her care.

“A stage-4 diagnosis of cancer, coming just months after giving birth to a vigorous and healthy baby boy, was beyond shocking,” she says. Yee falls quiet for a moment, then continues. “My coming to UCLA was just one of many miracles God has brought to me on this journey, and I am so thankful for that.”

To learn more about CCIM and integrative medicine at UCLA, and to find links to individual centers and programs, go to  www.ccim.med.ucla.edu.


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