Bridging the Gap. James Eugene Munson
in the interview asserts that acupuncturists must consider their role in integrative hospitals as providers responsible for acclimating to the Western medical environment. It is upon us to bridge the gap, communicate on their terms and weave into conventional standards. As an example, he suggests, “…instead of discussing Qi with a medical team, we should speak more of how acupuncture can affect the production of endogenous opioids or reduce inflammation. Instead of relying solely on pulse and tongue, looking through MRI/CT or PET scan to gain intimate knowledge of tumor location or surgical changes is essential.”19
Chinese medicine doctors should be familiar with Western biomedicine, cancer diagnosis, tumor pathology and treatments. The ability to dialogue with an oncologist is necessary, and providers must become well-versed in the medical vocabulary associated with neoplastic disease. In modern medicine, there is always an opportunity to translate our terminology in order to clarify its purpose. We argue, however, that if the ideology of integrative oncology relies upon collaboration and equal regard for other disciplines, then Western physicians must also learn our language as well. This goes beyond palliative care referrals. We are inviting our colleagues into the medical acumen of Chinese medicine.
The program at MD Anderson Cancer Center is one example of an integrative oncology model. From this established perspective, we present a brief comparative analysis of an equally renowned cancer hospital, Memorial Sloan Kettering Cancer Center (MSKCC). Between the two reputable facilities, there are obvious overlaps and similar philosophy toward integrative practices. MSKCC has designed a broad integrative department that promotes multidisciplinary avenues in cancer management. In addition to program offerings, it is a leading research institution. As such, it has carved a pathway enabling greater access to complementary therapies alongside conventional treatments. Cancer patients consult with a physician or nurse specialist to coordinate an “integrative care plan,”20 and patient records are shared among disciplines. The IM model is well-designed with a multitude of classes, workshops and services available to cancer patients. Individual therapies include acupuncture, both private and community style, as well as Swedish, deep tissue, or lymphedema massage. Mind-body therapies, medical Qigong, Reiki and Shiatsu are also available. All of these are fee-for-service, on-site at the IM facility.
The indications promoting the use of acupuncture for cancer and its related symptoms align with those previously noted at MD Anderson. They emphasize palliative care protocols to reduce side-effects that correlate to the disease or conventional treatment. An equally short description of acupuncture, MSKCC notes it is a form of traditional Chinese medicine validated by science through its ability to “…stimulate the nervous system to release certain chemicals in the brain.”21 This highlights a challenge Chinese medicine contends with in modern medicine. It gains relevance when validated by scientific methods, ushered into programs only after having determined its efficacy as safe and nonthreatening. However, this message does not encompass an integrated viewpoint. It leans West and into scientific interpretations. This discounts thousands of years of empirical research and methodology engraved in TCM. So, the Chinese medicine profession is caught between both paradigms, science and art. While this may appear to be self-limiting and an undesirable position for the profession, it actually illustrates the flexible nature of Eastern medicine to evolve alongside our conventional colleagues, as well as the disease itself.
How does this flexibility occur? Quite simply, the field of TCM has the benefit of an extremely well-rounded education. Practitioners adhere to classical texts, relying upon empirical research of physicians more than three-thousand years ago to detect and prevent disease. But this philosophy and method is not accepted in modern medicine paradigms. We cannot casually reference the classical interpretation of tumors from the Nei Jing when discussing a case with an oncologist. Fortunately, at least half the didactic coursework for licensed acupuncturists is biomedicine. Medical terminology, anatomy, physiology, physical exam, lab analysis, red flag/emergency cases are all included in the curriculum to an almost equal measure. This means, we have an unseen advantage because of this comprehensive training. TCM doctors review and interpret pathology, physiology, and allopathic treatments and then (sometimes immediately) shift these findings into Chinese medicine concepts to create an individual treatment plan. Essentially, simultaneously translating from one medical language to another.
While this process can be straightforward for the common cold, when it comes to cancer, nothing is easy. Communication is imperative among providers of different training with equal regard for education, skill and expertise despite these known differences. Perhaps the acupuncturist at MD Anderson is accurate, and this duality assumes that the TCM profession is responsible for dialoguing with collaborative medical partners because we speak both languages. If that is what it takes, then ultimately the onus is on Chinese medicine doctors to introduce our medical vernacular as a valuable construct into the conversation with our IO colleagues. This is certainly the end goal. Until that time, however, the significant obstacles that create barriers to integration must be recognized and averted.
Dr. Di Giulio had the unique privilege to intern at a prominent IO facility during her doctoral program. It provided an opportunity to observe IO model of care and the promise of a collaborative healthcare network. What became most evident was the routine logistical barriers imposed on the Chinese medicine practitioners that overshadowed the healthcare team’s potential for collaboration. The Cancer Treatment Centers of America (CTCA) in Tulsa, Oklahoma is a well-established cancer hospital. This is a reputable facility, which was founded in the late 1980s by Richard J. Stephenson who envisioned a cancer center with comprehensive medical oncology. Disillusioned by the treatment his mother received during her cancer diagnosis, he developed a multidisciplinary facility with all services under one roof. The philosophy of patient-empowerment and patient-centered care is embedded in the CTCA mission. It is appropriately referred to as the “Mother Standard” of care.
CTCA is considered a destination hospital. Every step of treatment from initial consultation to imaging, labs, chemotherapy, radiation, surgery and extended stays occurs onsite. This is appealing for patients and caregivers who can rely on complete supervision and quick access to medical care. Conventional medicine is the cornerstone of treatment at CTCA, but complementary therapies are numerous and extensively available. Physical therapy, cold-laser therapy, nutritional counseling, mind-body services, pastoral care, naturopathy, and acupuncture are on the menu of services. There is also entertainment and activities, such as bingo, movie nights, daily exercise groups and transportation to events in the community. This exemplifies an approach that considers psychosocial wellness, quality of life, and acknowledges the needs of the patients beyond biomedical parameters of care.
At CTCA, acupuncturists fall under the umbrella of “Naturopathic Therapies.” This department is led by a naturopathic physician and is comprised of licensed acupuncturists, naturopathic residents and doctors, most of whom are dual-trained in acupuncture therapy as well. This influences the structure of the department accordingly. In the hierarchy of this particular component of complementary medicine, naturopathy comes first and then Chinese. As such, the disconnect among the disciplines is apparent. Furthering this divisiveness was the fact that naturopaths shared offices in one area of the hospital while Chinese medicine was in another. Paths only crossed in corridors and hallways unless there were meetings. Communication about shared patients occurred by way of electronic charts. Thus, there were clear indications that the separate scopes of practice remained precisely that, separate.
A more integrative collaboration appeared in a process called grand rounds. Oncologists, nurses, social workers, therapists, pastors and naturopathic doctors (ND) are invited to attend and check-in with their shared patients. At the time of this internship, the licensed acupuncturists were not included in these collaborative rounds. The understanding was that the naturopaths represented the department. This process illustrated a significant discrepancy in the ideology of IO. In this example, there are two distinct features. Firstly, naturopathic medicine is an entirely different discipline, compared to TCM, not better or worse. It is likely more respected because of its scientific methodology as an evidence-based medicine, which better aligns with the West. Secondly, this particular environment results in minimal regard for TCM, which inherently implies that acupuncture is simply a technical modality. The clinical observations showed just that: short intakes, needles in, needles out, and repeat. The practitioners were