Brigham and Women's magazine

Healing Redefined

The Osher Clinical Center’s integrative approach challenges medical boundaries

Maher discusses her progress with her chiropractor, Megan Tabor, DC After a motorcycle accident in 1992, Christina Maher, 41, suffered chronic pain and nerve damage in her neck. To make matters worse, her car was rear-ended last year. At the same time, her job as a caregiver for two seniors with dementia became more stressful. Christina ended up with debilitating neck, back, and hip pain. She grew increasingly depressed and anxious. She stopped doing activities she loved, like swimming, because her hands grew numb. Even driving became excruciating. Much of her day was spent just trying to minimize her pain. And the message from her doctors was less than comforting: she was told that only time would heal her.

Christina, who lives in Haverhill, Mass., didn’t want to wait and see if time would make her feel better. She noted that the 80-year-old woman she cared for moved with more ease than she did. She decided to explore other medical options. Then she read a story in The Boston Globe Magazine about a new center at Brigham and Women’s Hospital. The center focused on providing therapies to enhance the body’s natural ability to heal. Christina had discovered the Osher Clinical Center for Complementary and Integrative Medical Therapies.

After reading the article, Christine thought the center could help her, even though it meant driving over an hour to get there. She was right. She started by seeing chiropractor Megan Tabor and acupuncturist Xiaoming Cheng. She later signed up for a stress reduction class. Soon, Christina improved her range of motion enough that she can drive and look behind her without pain. She’s back in the pool without numb hands. And thanks to Cheng’s suggestion to use a thinner pillow, she no longer wakes up with a stiff neck. “It’s one-stop shopping for health,” Christina says. “I love the whole team approach. It’s preventive—what they can do to help you maximize health—instead of much of our current system, which is oriented toward disease care. At Osher they don’t just look at you, they show you what you can do to feel better.”

So much of Christina’s experience at the Center is about learning how to be healthier. In the mindbody stress reduction class taught by psychiatrist Randall Paulsen, MD, she learned meditation and breathing exercises. Instead of taking pills to help her sleep, she now meditates and doesn’t feel groggy in the morning. She is more aware of how she feels, how she eats, and how she experiences her day. Instead of picking up fast food, she plans ahead and buys healthy snacks. Says Christina, “I’m now able to participate in life to the full extent of my ability, and I know what I can do to maintain health.”

Integrating complementary and conventional medicine
Up until a few years ago, “alternative,” or more commonly named “complementary” therapies, were not provided at top academic medical centers such as BWH. But scientific research and clinical experience indicates that these treatments, some of which have their roots in Eastern medicine, do indeed offer viable and measurable medical benefits. With the opening of the Osher Clinical Center, therapies such as acupuncture and chiropractic treatment are not only available to BWH patients—they are integrated into their medical care. Osher clinicians are credentialed BWH healthcare professionals who use the same electronic patient record system shared by all BWH and Partners HealthCare System providers, which means patient treatments can be coordinated across the Partners HealthCare network.

“To be a leader in this field, we had to create a safe and effective service while embracing and translating findings from research. That will allow our program to serve as a model for other institutions to follow,” says Gary Gottlieb, MD, MBA, president of Brigham and Women's Hospital. “With its focus on prevention, education, and treatment, the Osher Clinical Center is truly revolutionary in its approach to comprehensive complementary care.”

Integrating complementary and conventional therapies may be a new idea for some. But not for David Eisenberg, MD, who is the director of the Osher Research Center at Harvard Medical School, and who also sees patients at the Osher Clinical Center. In 1978, as a second-year medical student, Eisenberg was part of the first Harvard Medical School delegation to the People’s Republic of China. A year later, he returned as the first U.S. medical exchange student to China since 1949.

Eisenberg has dedicated his career to bringing Eastern and Western medicine together—and asking what we can teach and learn from each other. At the same time, he applies rigorous research and scientific evidence to evaluate complementary treatments. Eisenberg recognizes the importance of using data not only to document what is safe and effective (and what is not), but also to support the larger medical community in advising patients about using these increasingly popular therapies.

Donald Levy, MD, medical director of the Osher Clinical Center, says that most BWH physicians are glad to have a place they trust to send their patients who are interested in complementary therapies. “We can develop a safe treatment plan that we can monitor,” he says. “For instance, a man taking two blood pressure pills may be appropriately advised by his doctor to take a third to get his pressure down 10 more points. However, the patient may not want a third pill because of potential side effects. His doctor can refer him to the Osher Clinical Center, where based on sound scientific literature and clinical experience, we can often find other ways—herbal supplements, tai chi, acupuncture, and additional therapeutic lifestyle changes—that may do the job without the unwanted side effects.”

Originally a primary care physician for 25 years, Levy says it was his former patients who sparked his interest in complementary medicine. The more he learned, the more it made sense. “When you have a heart attack, accident, or an emergency, a hospital is where you want to be,” says Levy. “Things like migraines, irritable bowel syndrome, and back pain are chronic problems where conventional medicine doesn’t work as well.”

It’s clear that complementary therapies are here to stay. Today, about one-third of adults in the United States regularly use some form of complementary therapy and spend more than $34 billion annually on treatment. Says Eisenberg, “Someday we won’t have to distinguish between the different kinds of treatments, but instead simply offer the best medicine, based on the best available information.”

Creating the clinical model
The Osher Clinical Center is the result of an experiment that began more than four years ago. Could a team of physicians and complementary and alternative medicine (CAM) providers be trained to deliver coordinated care? Funded by a National Institutes of Health (NIH) grant, team training mirrored the philosophy of the future Osher Clinical Center—to work cohesively in the best interest of the patient.

The project enlisted Bonnie O’Connor, PhD, a medical anthropologist, to help create an atmosphere of mutual respect, a common vocabulary, and an understanding of all the disciplines. The group first tested its approach on volunteer patients with chronic back pain who were considered hard to treat. After two CAM treatments of each patient’s choice, every one of them improved. In a few cases, the results were dramatic—people who were previously unable to move without pain could now bend down and reach their ankles.

The team then moved on to a randomized clinical trial with patients who had chronic low back pain, often so severe they were unable to work. One group received the usual medical care. Patients in the other group saw both a physician and CAM providers. After 12 weeks, the patients treated by the integrative care team had less pain and a greater ability to function. These results provided credibility for BWH to move forward with the clinic and conduct more research on outcomes and cost effectiveness.

Thanks to the generous philanthropic support of Bernard and Barbro Osher, the Center did indeed move forward. In 2006, the Bernard Osher Foundation gave $5 million to establish the Osher Clinical Center and renovate the space at BWH’s Ambulatory Care Center.

The creation of the Osher Center was an important first step. However, little or no reimbursement for complementary therapies remains a constant operational challenge. One of Eisenberg’s goals is to conduct a national demonstration project for employees with low back pain or a similar condition. “If we can demonstrate the cost effectiveness of our BWH integrative care model, we expect that insurers will respond, and these therapies will be available to patients regardless of income,” says Eisenberg. “The potential for savings in diagnostic testing and medical, surgical, and prescription costs is enormous. Moreover, companies may benefit from higher productivity as a result of reduced employee replacement and disability costs.”

The Osher Clinical Center experience
Brigham and Women’s Hospital is not the first academic medical center to provide complementary and integrative care options. Nearly all the top U.S. and Canadian medical schools are members of the Consortium of Academic Health Centers of Integrative Medicine, and most have clinical programs. But the Osher Clinical Center is unique in several ways.

THE TEAM APPROACH.

The team of 16, which has trained together for five years, collaborates across disciplines. Every Thursday, the Osher Center shuts down for an hour so that the entire staff—administrative and clinical—can attend a team meeting to discuss cases, review a current topic of integrative medicine, and The camaraderie and respect that team members have for each other is readily apparent. When the hour is over, the team approach doesn’t end; it continues with informal consults and referrals when appropriate.

THE BRIGHAM AND WOMEN’S CONNECTION.

The Osher Center is part of BWH and its supporting infrastructure. This means a lot to patients and their doctors. It means that the Osher Center has unequivocal BWH support and is part of a system that monitors patient safety and quality and carefully screens practitioners. Patients are able to talk openly about the care they receive at the Osher Center with their doctors. Because Osher providers use the same electronic medical record, care is coordinated, and notes are available to all caregivers. And the location makes it easy to give and get referrals from other programs in the building, such as primary care, women’s health, rheumatology, sports medicine, pain management, rehabilitation, and the spine unit.

THE PHILOSOPHY.

One size does not fit all at the Osher Center. Providers talk with patients about particular aspects of their condition, as well as their individual risks and preferences. Prevention, wellness, and education are part of that process. Patients choose to participate in a range of therapies—from tai chi to yoga—and learn healthier ways to eat or exercise. “We want patients to have a superior experience,” says Mark Cunningham, Osher Clinical Center administrative manager. “We ask patients what brings them joy and try to get them back to doing that thing, whether it’s gardening or biking. At the same time, we try to manage expectations. If we’re not able to help you, we’ll let you know that too.”

THE RESEARCH ROOTS.

The Osher Clinical Center is one of the first integrative care centers in the country to spring from a scientific research program—the Harvard Medical School Osher Research Center, established in 2001 though a generous gift from the Osher Foundation. What’s learned from research projects translates directly into better care for patients. “The research and the clinical are inextricably linked,” says Eisenberg. “And one of the unique aspects of the clinical center is its ability to evaluate complementary therapies—individually or in combination, the way these therapies work, their application in a real-life setting, and their cost effectiveness.”

THE ROLE OF TRAINING AND EDUCATION.

As part of its investment in the next generation of healthcare leaders, the Osher Research Center offers a fellowship training program. The program is the largest and most robust in the country, with six fellows supported by the NIH. As of 2008, this research fellowship program includes a clinical component at the Osher Clinical Center. Education also extends to grand rounds and presentations to other physicians and providers who want to learn more about integrative medicine. In the future, the Osher Clinical Center hopes to expand training opportunities for physicians and CAM providers.

Like many of our patients, Christina wasn’t just looking for a single provider. She could have found an acupuncturist or a chiropractor closer to home. But at the Osher Clinical Center, the whole is much better than the sum of its thoughtfully put-together parts. So, does Christina feel all this is worth a trip from Haverhill? You bet!