In the past ten months, Dr. David Edelberg says, "I've written more prescriptions for people to read the Tibetan Book of Living and Dying than I have for antibiotics." He adds, "Usually when you clear up the mind problems, the body problem becomes more controllable." After 25 years as an MD, Edelberg established the Chicago Holistic Center as a place for Western medicine to work cooperatively with Eastern, eclectic, and bodywork therapies already widely available elsewhere.
The center--which opened last January at Fullerton and Ashland but is already hunting for more space--looks like a conventional multispecialty clinic: alternative healing in a conventional container. Most of its specialists are trained in acupuncture, Ayurvedic healing, the Feldenkrais Method, or one or more of 33 other therapies largely foreign to the standard medical-school curricula. As far as center administrator and acupuncture student Kirk Moulton knows, it's unique in Chicago and it offers medically supervised access to more different alternative practitioners than any other such center in the U.S. Its business has tripled since January and now averages 30 to 40 patients a day. "It's doing fine," says Moulton.
Still, the notion of such a place is hardly new. Americans already visit unconventional practitioners more often than primary-care physicians, according to a survey in the January 28 New England Journal of Medicine (425 million visits to 388 million in 1990). Most people go to these unconventional practitioners seeking a massage, relaxation techniques, or chiropractic treatment. And many of these patients, fearing disapproval, aren't telling their physicians about it.
The Holistic Center offers something to everyone. Under its umbrella Western-trained MDs can recover market share. Nontraditional practitioners, because they're supervised by MDs, can reach more cautious clients and no longer have to fear being prosecuted for unlicensed practice of medicine. And patients can find some mix of conventional and nonconventional therapies that works for them.
But gathering all these radically different healing traditions under one roof raises basic questions about our understanding of health. Who's in charge when East meets West? Can the largely materialistic Western view of the body coexist with the more spiritual views of other traditions? Does market-driven medicine make scientific sense? The answers are fragmentary and day-to-day.
Unlike most medical students of the 1960s, David Edelberg learned a little about chiropractic and naprapathy, which emphasizes the manipulation of connective tissue rather than bones. "I knew what they were," he says, and he was sympathetic enough that as a premed student he once gave a talk on how to get into the "healing game" if you weren't admitted to medical school.
His willingness to be skeptical of conventional medicine--at a time when it was more powerful and even less willing to share power than today--didn't keep him from practicing it. He was board certified in two specialties, internal medicine in 1974 and geriatrics in 1988. He maintains a practice in the Loop, is a clinical instructor at Northwestern University College of Medicine, and serves as section chief of geriatrics at Columbus Hospital. (He works four days a week at the center, but will go full time in January.)
Unlike many doctors, though, he has kept an open mind and an open ear. "During the past five to eight years patients have been telling me how well they've been doing with alternative forms of treatment. These are people with long-standing, chronic problems that neither I nor [conventional] specialists were helping--rheumatoid arthritis, osteoarthritis, irritable colon, chronic fatigue, chronic pain. I said, 'I've got to be impressed with this.'" He began looking into alternative therapies on his own and, as he writes in a letter encouraging fellow MDs to send patients to the center, "A rule-of-thumb emerged: absence of a particular healing art on a medical school curriculum need not deny its efficacy. And a corollary: if my patient's needs were met, so much the better."
A 1991 article in Time proclaiming the marriage of conventional and alternative treatments "inevitable" provided the catalyst for action. In the spring of 1992 Edelberg placed ads in two local new-age publications, Conscious Choice and the Monthly Aspectarian, asking for people who wanted to help establish the center. Within five weeks he had 200 replies, all but a couple from alternative practitioners.
He didn't want to take all comers. "I took the Columbus Hospital medical-staff application and just whited out the hospital's name. They had to have experience, good references, malpractice insurance, professional training, and accreditation." These formalities cut the pool to 60, and Edelberg interviewed them until he had a core group: "one or two people in almost every field of alternative medicine," plus a couple of interested MDs. Then he asked them to briefly describe their fields and personal philosophies for a staff directory to be distributed to prospective clients.
Behind this conventional approach is a spiritual language few doctors would apply to their clients. "The important thing to me is that at a certain point the center took over and began creating itself," says Edelberg, who acknowledges he's been influenced by turn-of-the-century German scientist/mystic Rudolf Steiner. "I would have run out of energy. Kirk Moulton came on a 'sweat equity' basis," taking a 90 percent pay cut; he'd been working as a trader on the options exchange. "Frank Yurasek [an acupuncturist with a 25-year background in advertising and marketing] brought in new people I didn't know. The wife of the printer who did our brochure became one of our massage therapists. I began to seriously believe that a higher power was involved. Clearly this was meant to be.
New patients at the center usually see an MD first, then other specialists by agreement. A chiropractor, a massage therapist, and an acupuncturist are immediately available; other practitioners come in by appointment. (They aren't employed by the center, and there wouldn't be room for them all at once anyway.) "The patients are in charge, and they like that," says Edelberg. "We get a different type of patient here--the type who would wear a T-shirt saying 'Question authority.'"
Edelberg finds other contrasts between alternative and conventional medicine. At the institutional level, he says, "the staff here really wants to make the center go, with an intensity of dedication you rarely see. I've been medical director of Health First for 17 years, and it's been hard to get doctors motivated about spreading the word. In this group there is unmitigated enthusiasm to make it succeed."
At the treatment level, he's seen chronic conditions helped even as medical colleagues scoff. "One of my first patients was suffering from rheumatoid arthritis. Her rheumatologist had recommended cortisone and methotrexate--the Mount Saint Helens of the intestinal tract. Instead, we used a lot of alternative work: on food allergies, on the mind-body connection, some naprapathy. She was able to go back to her rheumatologist and show more movement and less pain.
"Unfortunately, he dismissed it as an insignificant placebo effect: 'You'll be back to see me when this wears off.' But she's still fine. She takes a couple of Tylenol a day when it hurts--that's all. The greatest thing we can tell patients is, 'You don't need us anymore.'"
"Conventional form, alternative content" also describes the center's "Staff Directory & Guide to Holistic Medicine." Superficially it looks like a mainstream clinic booklet, in which specialties are divided up and assigned according to some overall frame of knowledge. But it reads like a new-age grab bag.
The 60 listed practitioners (37 of them women) one by one describe a huge and seemingly mutually incompatible array of healing alternatives. Through the center you can get your three principles (movement, metabolism, structure) properly balanced. You can get your yin and yang balanced and your natural flow of chi improved. You can get your spinal column realigned. You can have a variety of massages. You can take herbal extracts or highly diluted homeopathic medicines. You can undergo humanistic, transpersonal, awareness, person-centered, or Gestalt psychotherapy.
If any of these makes you feel better, fine, I said to acupuncturist Yurasek. But for everyone to work together here, doesn't each tradition have to give up any claim to being the complete authority on healing? They can't all be right, can they?
The former advertising executive just grinned. "The market will out. I define leadership as not starting your own parade, but getting in front of the one that's going on. If 5,000 people show up for homeopathy and five for Ayurvedic medicine, we'll do more homeopathy." (And in the new edition of the center's directory some new practitioners have been added, while others who failed to draw clients were dropped.)
Moulton isn't all that interested in theory either. "Healing comes from within. All we do is facilitate it. How do we know [if a particular therapy works]? When the patient feels better. When they stop coming back."
If not restrained, this kind of rampant subjectivism could run right over science and common sense, so part of Edelberg's job as the center's "facilitator" is to put on the brakes. After all, some treatments make you feel better by curing the problem, while others make you feel better by temporarily covering it up. The consumer at the Chicago Holistic Center may be an authority questioner, but he or she is not always right.
"If a woman comes in with a breast mass and wants herbal therapy for it, we have to say, 'No, you need a biopsy. If you mess around with that for a couple of months, you could die,'" says Edelberg. But with a chronic condition like arthritis there's time to try alternative things. He acknowledges that those things don't always work. "Not all sciaticas will respond to acupuncture, etc. We've sent our share of people to neurosurgeons."
Nor does Edelberg welcome every kind of alternative healing practice. "Originally naprapathy claimed to be a panacea. It would cure anything. They gave that up years ago. Now they do musculoskeletal work. That's what they're good at. If I interviewed a naprapath and he said he was of the traditional school and would eliminate all antibiotics, I'd say, 'very interesting.' End of conversation."
Edelberg thus steers a middle course between an anything-goes position and the official AMA position. That may sound simple and obvious, but the location of this middle course has changed over time. For instance, in his letter to physicians encouraging them to refer patients to the center, Edelberg assures them that any "medical questions" their patients have will be referred back to them. But the definition of "medical question" has changed--under pressure--in the last 30 years. A persistent backache might be a "chiropractic question" today, but if Edelberg's medical-school professors had said so in the 1960s they would have risked professional ostracism.
Yurasek is right: in medicine the market--what patients want--is more important than it used to be. And the Chicago Holistic Center is an attempt to get in front of a big parade that's been going on for quite a while. Today patients have more power to choose, and the professionals have less power to limit that choice (through state licensing or insurance reimbursement policies). So the center's staff directory is not a grab bag but a map of the mall, a microcosm of what's happening throughout medicine.
In the constant tussle between free choice and professional authority, the pendulum is swinging back toward where it was 150 years ago. In the 1820s and 1830s states including Illinois repealed their medical licensing laws and allowed free enterprise in healing. Nineteenth-century courts treated conflicting schools of therapy like religious convictions, trying not to decide between them. (Sociologist Paul Starr tells this story in The Social Transformation of American Medicine.) Even after orthodox medicine learned about sanitation and anesthesia and dropped lethal practices such as bleeding and purging, the profession remained weak until the turn of the century. Then social factors--the disappearance of the self-reliant frontier and the growth of cities and specialized occupations--all helped swing society toward professional authority. By the 1950s AMA power over people's healing choices reached its zenith.
But no one tradition has ever fully explained the confusing relationship between human mind and human machine: an appendectomy can make you well even if you don't believe in it, and sometimes belief works wonders that physicians can't explain. So at the Holistic Center all--well, almost all--traditions get a shot. "Why does one person get well and another doesn't?" asks Edelberg, who was once expected to know the answer. "Nobody really understands healing."
Art accompanying story in printed newspaper (not available in this archive): photo/Peter Barreras.