The integrative medicine program at Children's Memorial got off the ground in 2003 with $1.7 million in foundation seed money and is now chasing NIH grants. David Steinhorn, a pediatric intensivist and medical director of the hospital's CAM program, says several privately funded trials, including Mikey's, are underway or in the works. Steinhorn is a passionate champion of investigating CAM therapies, no matter how unlikely, if he believes they may help patients and are safe. "I'm a very serious, hard-core ICU doctor, but I have seen these therapies benefit my patients, even if I don't know how," he says.
Patient access. CAM's ascendance isn't entirely driven by money—researchers make frequent references to obligation. "We want patients to have access to these therapies in a responsible fashion," says Lisa Corbin, medical director of the Center for Integrative Medicine at the University of Colorado Hospital. That implies a public clamor for such services, and patients may indeed talk about and ask for CAM more than they used to (although that isn't clear). But surveys showing widespread use—like one issued by the Centers for Disease Control and Prevention in 2004 reporting that 62 percent of adult Americans had used some form of CAM in the previous year—are highly misleading. The big numbers reflect activities such as prayer, which few would consider CAM, and meditation, now routinely prescribed to help lower high blood pressure. The Atkins and Zone diets ("diet-based therapies") were counted in the CDC survey, too. A more selective reading indicates that about 5 percent used yoga, 1.1 percent acupuncture, and 0.5 percent energy therapy, to pick three more-representative offerings.
The purpose of Mikey's trial is to put his touch therapy to the kind of test demanded by CAM critics: Prove that it can produce medical results beyond simply reducing stress or anxiety. Children having a bone marrow transplant are being divided into two groups. One will receive the therapy before and in the weeks after the marrow transplant. The other group will be visited on the same schedule by staff or volunteers who talk, read, or color with them. (The investigators won't know which children are in which group.) The working presumption, says Steinhorn, is that the energy-therapy group will take up the transplanted bone marrow stem cells more readily and with fewer complications, allowing those children to leave the hospital sooner. Early findings should be available by the end of this year.
Most academic hospitals are fairly conservative when it comes to CAM; the usual menu offers acupuncture, yoga, meditation, and variations on massage such as reiki. This tracks the philosophy of Andrew Weil, founder of the University of Arizona Program in Integrative Medicine and CAM's public face, if there is one. "I teach and urge people to use a sliding scale of evidence," says Weil. "The greater the potential to cause harm, the greater the standard of evidence should be."
A few CAM treatments have demonstrated at least modest results. Massage shows promise for relieving postoperative pain. It was once part of routine postsurgical care, in fact, but was gradually shelved as other demands on nurses' time took priority. And studies demonstrate that acupuncture is somewhat effective at relieving nausea from chemotherapy or surgery and discomfort from dental procedures. It is used at Memorial Sloan-Kettering Cancer Center in New York, among others, for relief of chemotherapy-related nausea, and at many centers for chronic pain—from arthritis, for example.
Damaged and arthritic knees drove Joan Pettit in 2006 to see an acupuncturist at the University of Maryland School of Medicine Center for Integrative Medicine. The 51-year-old suburban Baltimore resident had been a competitive athlete from her high school days and played tennis until about eight years ago, when both knees would swell and throb painfully. "I'm always looking for something that doesn't have serious side effects," says Pettit, "so the idea of trying acupuncture was very appealing."