When patients in the University of Maryland Medical System are referred to a treatment center near Dickeyville, they are just as likely to receive acupuncture, Chinese herbs or a homeopathic remedy as they are a prescription drug.
Murry Nichelson, a 36-year-old man wracked with muscle spasms in his shoulder, went there after deciding surgery was too risky and anti-inflammatory drugs might irritate his stomach. Desperate for help, he said he felt as if a knitting needle were piercing his shoulder.
He saw Dr. Lixing Lao, a native of China who led him to a table and delicately inserted an array of acupuncture needles into his skin. The effect was immediate.
"For 20 years, if I exercised I'd get a pain radiating out from my shoulder to the point where I'd throw up," said Mr. Nichelson, whose problems began when a hit-and-run driver knocked him off his motorcycle on a road in Mount Washington.
"Three months ago, Dr. Lao did one treatment and the pain is gone."
Acupuncture centers and alternative drug stores have become commonplace, but what's unusual about this program is that it is part of an academic medical center. In the same institution where doctors rely on prescription drugs, vaccines and surgery to help patients fight illnesses, researchers are using acupuncture, herbs, homeopathy and even Chinese martial arts and are examining their effectiveness.
At the Project for the Integration of Orthodox and Complementary Medicine, researchers hope to bring these treatments from the exotic periphery into the center of American medicine by testing them in clinical trials.
The philosophy: If the treatments work, they ought to hold up under scrutiny.
The program, directed by Dr. Brian Berman, has been established at a time when the public is increasingly skeptical about orthodox medicine and hungry for alternatives. In 1990, the most recent year for which figures are available, 34 percent of Americans used at least one unconventional therapy. A study by researchers at Harvard University found those patients spent $13.7 billion on treatments such as acupuncture, chiropractic medicine and biofeedback.
UM scientists are in the midst of two studies evaluating acupuncture as a treatment for arthritis and postoperative dental pain.
They expect to broaden their inquiry to encompass treatments such as homeopathy, a 200-year-old system founded in Germany. Homeopathy employs an arsenal of 2,600 plant, animal and mineral substances, and Chinese herbal medicine, an ancient system that uses more than 6,000 substances to combat disease.
Now in its fourth year, the project is perhaps the most extensive at a mainstream medical center. Others have been established at Harvard, Columbia, Georgetown and the University of Virginia.
In 1992, the National Institutes of Health established its own Office of Alternative Medicine, which provides grants to institutions wishing to study unorthodox treatments. Although its million budget represents a sliver of the total NIH budget of $10.9 billion, its very existence amounts to official recognition that alternative regimens are being taken seriously.
Dr. Berman prefers "complementary" to "alternative" because it conveys the idea of different treatments working together. Similarly, he doesn't see the issue as a clash of East and West, but a blending of traditions for a common purpose.
"One is not right, and one is not wrong," said Dr. Berman, 43. "You can't be fixed on 'I only use acupuncture' or 'I only use homeopathy.' We need to look for what's best for our patients, whether it's conventional medicine or not."
Dr. Berman's medical career began conventionally enough. Trained at the University of Maryland, he went to work in the emergency room at Kent and Queen Anne's Hospital in Chestertown. Later he opened a family practice nearby.
"When I went into practice, I found that my training was excellent for acute diseases and trauma but when it came to some of the chronic diseases, I didn't have all the answers," he said.
He said he felt, for instance, that he could do little for the persistent pain of arthritis, back injuries and some neurological conditions.
In search of answers, he went to Los Angeles to study acupuncture, a 3,000-year-old branch of Chinese medicine that employs long slender needles to alleviate suffering. Later, he studied at the Royal London Homeopathic Hospital in England, where homeopathy enjoys a large following.
Founded in the 1790s, homeopathy is based on the principle of "like cures like." The premise is that illnesses can be relieved with extremely small doses of substances that, in larger concentrations, would produce similar symptoms in a healthy person.
He was skeptical at first.
"People were coming in with problems like asthma and arthritis, and after a while they seemed to be getting a lot better," he said. "It wasn't really what I was used to seeing. When I started to look into it, it was difficult to get my mind around to accept it."
He saw children with recurrent bronchitis and ear infections who had been making regular trips to their physicians but didn't really get better until they received a homeopathic remedy.
Even in England, he was subtly ostracized by some friends and (( colleagues. They seemed to be saying: " 'What are you doing with your life? Come back into the fold, my boy.' " Nonetheless, he found enough support to establish an eclectic practice there with a psychologist, a psychiatrist and an osteopath.
The patient care was rewarding but whetted his curiosity.
"I really wanted to rigorously, scientifically evaluate these therapies," he said. "We didn't know what worked, what didn't work. We needed a multidisciplinary research program to look at these therapies and see what might actually benefit our patients."
Armed with a $1 million grant from two British foundations, he persuaded the University of Maryland School of Medicine to let him set up a pain clinic within the anesthesiology department. Founded in 1991, it began to receive a steady flow of patients suffering from chronic neck and back pain, migraine headaches, trauma, symptoms of neurological illnesses and phantom limb pain -- a common fallout from amputation.
Increasingly, doctors began referring patients with a broader array of medical problems, including chronic ear infections, asthma, allergies and skin rashes. Many of his patients had already tried mainstream treatments to no avail.
Recently, he shifted his project to the Department of Family Medicine -- an opportunity to branch further into various illnesses -- and moved from the university hospital to the James Lawrence Kernan Hospital, part of the UM system. His staff includes Dr. Lao and Jodine Cognato, a registered nurse who practices a method of stress management known as therapeutic touch. Doctors with other departments consult with him on a regular basis.
Dr. Herbert L. Muncie, chairman of family medicine, said he realizes that Western medicine doesn't hold all the answers, and he hopes the venture will provide useful strategies against arthritis, digestive diseases and other illnesses that defy solution.
Dr. Lao, 40, graduated from the Shanghai College of Traditional Chinese Medicine, where he learned acupuncture and herbal medicine. In 1986, he came to the University of Maryland to study physiology. After obtaining his doctorate, he joined Dr. Berman.
"Ask a Chinese person doing acupuncture whether it works and they'll say, 'Of course.' You don't even think about it. But the West is skeptical. There is a lack of scientific support." He adds: "Theoretically we can treat all diseases: stomachaches, ulcers, nausea, vomiting, diarrhea, Bell's palsy. But we have to scientifically convince society that it works. Here, people need studies to be convinced."
Twice a week for eight weeks, Dr. Lao administered acupuncture to 12 patients with arthritic knees who had been taking medication but still reported moderate to severe pain. All remained on their pills.
When it was over, most said they felt less pain and could walk more freely. The improvement was notable for four additional weeks.
"But 16 weeks after the acupuncture treatments, the benefits seemed to wane, although patients were not necessarily back to where they were," said Dr. Marc Hochberg, a rheumatologist involved in the study.
The results suggest that acupuncture brought relief to patients who didn't benefit much from medication alone. But Dr. Berman says it's possible that the improvement was due to a "placebo effect." Perhaps patients felt better because they expected the treatments to work.
Now, the department is enrolling 80 patients for a follow-up study that should determine whether the benefits are psychological or rooted in physiology. In this trial, half of the patients will be given acupuncture while the other half will continue on medication alone.
In designing the study, researchers realized they had to trick the untreated patients into believing that they, too, were receiving acupuncture. With everyone thinking they are being treated, acupuncture will prove itself an effective pain remedy if those getting the real thing feel better than their counterparts.
The challenge was a dicey one, given the fact that acupuncture is administered by sticking patients with fine needles. Traditionally, acupuncturists insert needles along the body's "meridians," lines described as conduits for life-sustaining energy. One strategy, it would seem, is to stick half the patients ++ in the wrong places.
But acupuncturists have discovered that the needles deliver an effect even when they are off the mark. What this means remains open to question, but the researchers had to find another method.
Dr. Lao decided to tap the patients with empty plastic sheaths, the same ones that normally envelop acupuncture needles to keep them sterile. Then, he will tape them to the patients' skin, giving them the illusion of treatment.
In preliminary tests, untreated volunteers spoke as if they had received acupuncture, perhaps because they were novices.
When Chinese herbs and homeopathic treatments are put to the test, they should be easier to disguise as conventional drugs. Patients who take the pills won't know which are the placebos.
Jack Daniel, dean of the Center for Traditional Acupuncture in Columbia, said such research should go a long way toward convincing Americans that the technique is effective.
"Whether it's necessary to show that it works is another thing," said Mr. Daniel, who also has a private practice in acupuncture.