[Congressional Record Volume 140, Number 73 (Monday, June 13, 1994)]
[Extensions of Remarks]
[Page E]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]
[Congressional Record: June 13, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]
ALTERNATIVE MEDICINE
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HON. GEORGE W. GEKAS
of pennsylvania
in the house of representatives
Monday, June 13, 1994
Mr. GEKAS. Mr. Speaker, the Congressional Biomedical Research Caucus
held its 27th briefing recently on an important aspect of the practice
of medicine, namely, bringing science to alternative medicine.
Dr. Joseph Jacobs, of the NIH office of Alternative Medicine, Dr.
Richard Friedman of SUNY at Stony Brook, and Dr. Herbert Benson of
Harvard discussed how mind/body interventions have been scientifically
proven to be therapeutically effective to offer prevention and cost
effectiveness. Because of the scientific studies documenting efficacy,
many alternative therapies have already become part of routine,
mainstream medical care and they serve as a model for how alternative
approaches can be incorporated into the practice of medicine.
I would like to share with my colleagues the enlightening remarks of
Dr. Benson and Dr. Friedman.
Alternative to Mainstream Medicine: Science as the Arbiter
herbert benson, m.d.
Throughout history medicine and healing has relied heavily
on non-specific factors such as the placebo effect. In other
words, what patients believe, think and feel has profound
effects on the body. Thus, physicians and other healers have
historically appreciated the injurious effect of negative
thoughts and emotions and have also recognized the healthful
effects of positive thoughts and emotions.
Modern medicine has largely disregarded the importance of
mind/body interactions. Starting with the work Dr. Louis
Pasteur about 150 years ago, the Western tradition of
incorporating these non-specific factors in treatments was
progressively replaced with an almost total reliance on
specific remedies for specific illnesses. Insulin and
antibiotics took the place of the power of the mind to heal.
The specific therapies were so dramatically effective that
they became the sole treatments utilized. They also changed
our attitudes toward the nature of healing. Rather than using
a combination of specific and non-specific therapies to
promote healing, medicine began to value and rely exclusively
on the specific effects of pharmacological and surgical
interventions. The non-specific effects of beliefs, thoughts
and emotions were devalued.
For many of the medical problems facing our society today,
specific drug and surgical interventions alone are not
effective. For example, between 60 to 90% of visits to
physicians are prompted by conditions related to stress which
are poorly treated by drugs and surgery. To better treat this
vast number of conditions, there is an understandable
movement to utilize alternative treatments. Unfortunately,
many alternative treatments are without scientific foundation
and we could fall prey to the influence of charlatans and
quacks. It is thus very important to distinguish between the
alternative therapies that have been scientifically tested
from those that have not.
Some so-called alternative treatments, have however been
scientifically examined with similar standards used to test
accepted drug and surgical interventions. Our work related to
the relaxation response is a prime example of how a treatment
previously considered to be nonspecific and alternative has
evolved into an acceptable therapy for these extremely
prevalent stress-related disorders as a result of scientific
research.
To best understand the relaxation response, let me first
describe the physiology of its counterpart, the stress
response. Stress has been defined as the perception of threat
or danger that requires behavioral change. It results in
increased heart rate, increased blood pressure, increased
metabolism, increased rate of breathing and increased blood
flow to the muscles. These internal physiologic changes
prepare us to fight or run away and this stress reaction has
been named the ``fight or flight'' response. The ``fight or
flight'' response was first described by the Harvard
physiologist, Dr. Walter B. Cannon earlier in this
century. It is mediated by an increase in the activity of
the sympathetic branch of the autonomic nervous system
which releases adrenalin and noradrenalin.
Building on the work of Swiss Nobel laureate Dr. Walter R.
Hess, my colleagues and I over 20 years ago described a
physiological response which is the opposite of Cannon's
fight or flight response. It results in decreased heart rate,
blood pressure, rate of breathing, and metabolism. We
labelled this opposite reaction the ``relaxation response.''
The relaxation response differs from the fight or flight
response in another way. The fight or flight response occurs
without requiring the use of a technique. Two steps are
usually required to elicit the relaxation response. The are:
(1) the repetition of a word, a sound, a prayer, a phrase or
a muscular activity and (2) when other, everyday thoughts
occur, there is a passive return to the repetition.
As scientific evidence has established that many medical
diseases result from repeated exposure to stress, scientific
evidence has established that regular elicitation of the
relaxation response results in alleviation of these stress-
related medical disorders. Specifically, the relaxation
response has been demonstrated to be effective in the
treatment of hypertension, cardiac arrhythmias, chronic pain,
insomnia, anxiety, hostility, depression, premenstrual
syndrome, infertility, and the symptoms of both cancer and
AIDS. In fact, to the extent that stress causes or
exacerbates any condition, the relaxation response is
effective. Because of the scientifically documented efficacy,
a physiological basis for millennia-old techniques has been
established and the relaxation response has become a part of
mainstream medicine.
Approximately 60% of US medical schools now teach the
therapeutic use of relaxation-response techniques and it is
frequently recommended therapy in standard medical textbooks.
Therapies such as the relaxation response are now not
alternative or unconventional, but are accepted within the
academic medical establishment. Their widespread clinical use
is a direct result of scientific studies that document the
physiologic basis and therapeutic utility. Age-old, self-
care, mind/body techniques became validated.
In summary, as we broaden our concept of medical care to
embrace non-drug and non-surgical self-care interventions, we
need not and should not compromise scientific standards.
Rather, science can be utilized to separate the wheat from
the chaff.
richard friedman, ph.d.
Dr. Benson has indicated that scientific evidence supports
the efficacy of the relaxation response, a non-drug, non-
surgical self-care intervention. It is an example of what was
previously considered to be an alternative medical
intervention becoming a part of mainstream medicine. There
are other practical issues which should be addressed
regarding the integration of the relaxation response and
other proven mind/body, self-care interventions into medical
care.
Consider for a moment that I were here today discussing a
new drug and that scientific evidence indicated that this new
drug could treat a very wide variety of prevalent medical
conditions--conditions that lead to 60 to 90% of visits to
physicians. Furthermore, this new drug could also prevent
these conditions from occurring and recurring. And, the new
drug was demonstrated to reduce the total costs of health
care by as much as 30%. The discovery of such a new drug
would be front page news and immediately embraced.
Scientifically-validated mind/body therapies have resulted in
such clinical and economic benefits, but as yet have not been
so enthusiastically embraced. I'll discuss the reasons for
this later.
First, I'll provide examples of how mind/body interventions
such as the relaxation response can be successfully
integrated with mainstream medicine. I'll start with one
particularly common and expensive medical complaint, chronic
pain. When integrated with routine biomedical care, mind/body
approaches can result in the better treatment of chronic pain
and in significant economic benefits. Millions of Americans
are in chronic pain, which by definition, is pain that cannot
be eliminated, but must be managed. Chronic pain sufferers,
motivated both by medical and emotional factors, often become
frequent users of the medical system. The treatment of
chronic pain becomes extremely costly and frustrating for
patients and health care providers. In one study, we
assessed clinic usage among chronic pain patients at an
HMO who participated in our outpatient behavioral medicine
program, of which the relaxation response was an integral
part. There was a 36 percent reduction in clinic visits
for over two years in the patients who participated in the
behavioral medicine program as compared to their clinic
usage prior to the intervention. In 109 patients, the
decreased visits projected to an estimated net savings of
$12,000 for the first year following treatment and $23,000
for the second year. These savings did not include those
realized by the decreased use of medications.
Next, I'll focus on another extremely common disorder,
insomnia. I'll present how these very same mind/body
interventions can result in better medical care and also
effect cost savings. Approximately 35 percent of the adult
population experiences insomnia. Half of these insomniacs
consider it a serious problem. Billions of dollars are spent
each year on sleeping medications, making insomnia an
extremely expensive condition. In fact, the direct costs to
the nation are approximately $15.4 billion yearly and actual
costs are astronomical in terms of reduced quality of life,
lowered productivity and increased morbidity. Although
frequently employed, the chronic use of sleeping pills is
ill-advised. The shortcomings of such drug therapy, along
with recognition of the role of behavioral factors in
insomnia, have prompted our development of mind/body
behavioral interventions for this condition. We studied the
efficacy of a multifactor behavioral intervention for
insomnia that included relaxation-response training. Compared
to controls, those subjects who received behavioral and
relaxation response treatment showed significantly more
improvement in sleep patterns. On the average, before
treatment it took patients 78 minutes to fall asleep. After
treatment, it took 19 minutes. Patients who received
behavioral and relaxation response treatment became
indistinguishable from normal sleepers. In fact, the 75%
reduction in sleep-onset latency observed in the treated
group is the highest ever reported in the literature.
To return to the issue I raised earlier--Why, given results
such as these, have mind/body therapies such as the
relaxation response not been more effectively integrated?
Barriers to integration include bias against the shift to
self-care approaches; the lack of knowledge of the existing
scientific data among health care providers, patients and
policy makers in government and private industry; a bias
against mind/body interventions in medical care as being too
``soft''; and inadequate insurance payments for these
treatments.
Overcoming the barriers to integration requires a continued
commitment to scientific rigor and a willingness to adopt and
advocate what is scientifically proven to be therapetucially
effective and to offer cost savings. The full integration of
mind/body, self-care medicine is thus completely compatible
with the health care reform agenda we are currently
confronting. This is a prime example of science being the
arbiter of bring so-called alternative medicine into
mainstream medicine.
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