[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

                                 ______


                          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.

                          ____________________