Traditional medicine, natural medicine, complementary therapies, holistic medicine -- there are many ways to name the practices that are becoming increasingly common in HIV treatment. At the Community Forum on June 9, Pamela Miles, clinician, researcher, educator and writer in the field of natural medicine, and Robert Schmehr, a Certified Social Worker and the Manager of Complementary Therapy at the HIV/AIDS Center at St. Luke's-Roosevelt Hospital, discussed the usefulness of complementary therapies in promoting better health for people living with HIV.

Traditional Medicine in the Modern World

In her presentation, "Living Healthy with HIV," Pamela Miles provided an overview of several systems of traditional medicine and of the practices associated with each system. Traditional medical systems, such as Traditional Chinese Medicine (TCM), Tibetan Medicine, and Ayurveda (from the Indian subcontinent), existed long before the scientific medicine that is practiced in the United States today. Although Ms. Miles does not recommend the use of traditional medicine alone in the treatment of HIV, she reminded the audience that traditional systems have stood alone in the past and continue to stand alone today in many parts of the world.

Reductionism and Holism

Before learning about the specific practices associated with traditional medicine, it is important to understand the underlying philosophy. Scientific medicine takes a reductionist view, reducing the body to its various parts, and treating each of these parts as a separate entity. Traditional medicine does not divide the body in this manner. The practices of traditional medicine are holistic in that they address each person as an entire, whole individual. Although holistic approaches differ in their techniques, all share three tenets:

• All life is inter-connected;
• Each whole is more than the sum of its parts (this applies to the human body as well as to the population overall); and
• The subtle energy field is fundamental to healing.

While scientific medicine attempts to pinpoint a specific cause for an ailment of a specific part of the body, a holistic approach to health examines the way that mind, body, and spirit interact, and focuses on overall healing. Scientific medicine addresses the disease; natural medicine treats the person experiencing the disease.

To heal or to cure?

The goal of holistic medicine is to heal, while scientific medicine aims at cure. What are the differences between healing and curing, and what do these differences imply?

• Healing is improvement; cure is complete.
• Healing benefits the entire person; cure is disease-specific.
• Healing focuses on the experience of improving; cure focuses on the end result.
• Healing depends on individual participation in that healing; cure is more likely to be passive.
• And, most importantly, healing is always accessible, while cure may not be. Healing can provide immense comfort to people living with HIV for whom no cure is available.

These differences can be summarized by viewing health as either the absence of disease (conventional medical perspective) or by viewing health as a dynamic balance to be achieved and maintained (holistic perspective).

How do I get started?

Ms. Miles offered specific holistic techniques that can be used by people living with HIV in conjunction with medical treatments. All of these techniques can be incorporated into a busy life, and within one's budget. She suggested looking at how we take care of ourselves in several categories:

Food/Nurturance

• Use an individualized approach to nutrition. Different people have different nutritional needs, which change with circumstances. The Recommended Daily Allowances found on food labels are guides for healthy people to avoid illness and may not be appropriate for people with HIV.
• Use herbs as food. To receive the herb's full benefit, use raw herbs or whole herb products rather than standardized extracts of active ingredients.
• Some suggested herbal products: green tea (full of antioxidants); red tea (helps digestion); milk thistle (beneficial to the liver); turmeric with honey (good for sore throats); echinacea (use for up to 10 days; dose high at first signs of illness; do not take regularly for prevention).
• Chewing and savoring food is important for proper digestion; focus on chewing thoroughly.
• Fasting is generally not recommended for people with HIV.

Breathing and Subtle Energies

• Focus on breathing through the nose.
• Learn pranayama (hatha yoga breathing exercises) to address stress.
• Reiki (an energy healing facilitated by light touch which can be easily learned for self-treatment) can be used to relieve stress and balance subtle energies.

Movement

• Movement of any type aids circulation.
• Some suggestions: walking, running, dance, t'ai chi (improves balance), hatha yoga, labyrinth walking (a labyrinth is different from a maze in that the space is open and there is only one course to walk, no tricks or dead ends; it readily creates an environment for contemplative walking).
• Focus on long-term, moderate exercise for maximum benefits.

Touch/massage

• The benefits of massage have been extensively researched; massage increases circulation and relaxes muscles.
• There are a wide range of approaches: Swedish, rolfing, reflexology (massage of hands and feet that is especially useful when whole body massage is contraindicated), shiatsu, Ayurvedic marma point massage, and Ayurvedic self-massage with sesame oil.

Self expression

• There is no need to be an expert to reap the benefits of self-expression.
• Try movement, music, singing, visual art, writing (focus on connecting events and emotions).

Support

• Support from friends, family, health care providers (both holistic and conventional) is important.
• Support groups can provide community.
• Environmental support: Find strength in nature and create harmony in your immediate surroundings.
• Mental support: Have a healthy attitude; use affirmations and visualization.

Spirituality

• Access to inner resources through spiritual practice plays an important role in finding dynamic balance in life.
• Some suggested practices: meditation, contemplation, prayer, chanting, service to others, worship, ritual, gratitude, and acknowledgement.

Ask yourself the questions, "Could it be me? Can I be a long term survivor?" Believing that the answers are "YES" and living accordingly will be beneficial to you as you incorporate the tenets of holistic medicine into your life.

Reconciling Intuition Based Information and Sensory Based Information

In his presentation, Robert Schmehr highlighted the spiritual roots of contemporary western medicine, and addressed the need for the reincorporation of these roots into modern medical practices. One of the challenges of this reincorporation is achieving balance between intuition and sensory based information systems (e.g. empirical evidence observed by the senses).

Healing HIV, a recent book by Dr. Jon Kaiser, presents strategies for supporting the immune system as it fights infection. Dr. Kaiser recommends integrated health practices for people with HIV, including:

• nutritional counseling;
• antioxidant nutritional supplements;
• acupuncture;
• herb therapy;
• exercise;
• hormone balance;
• stress reduction; and
• standard medical antiretroviral therapies.

This model combines standard western medical practices and holistic practices, and provides us with one example of how to balance intuition and sensory based information systems for maximal benefits.

Local Resources

There are many ways to access holistic therapies in New York City, including hospital-based programs, private practice models, alternative therapy private practitioners, and programs through Community-Based Organizations (CBOs).

Hospital-based programs are convenient for individuals who wish to incorporate holistic techniques into their HIV treatment, as they are centralized, with most services available in one location, and affordable. The HIV Center at St. Luke's-Roosevelt Hospital educates patients to use mind-body medicine responsibly, and provides access to techniques of Asian medicine (including shiatsu, Reiki and hatha yoga), meditation training, integrative medicine counseling, and exercise and nutrition counseling. The Krueger Clinic at Beth Israel Medical Center also provides a variety of similar services weekly. For services at St. Luke's-Roosevelt, call (212) 523-6500. For services at the Krueger clinic, call (212) 420-2620.

Drs. George Kessler and Ben Kligler both provide primary care with a holistic component within the framework of private practice. They provide their patients with any of the services found in a hospital-based program, but the price of health care with a private physician may be limiting to some patients. These two practitioners, by incorporating holistic theory into their standard of care, are helping set new standards for western medicine. Dr. Kessler's office can be contacted by calling (212) 877-7043, and Dr. Kligler's office can be contacted by calling (212) 420-3068.

Another option is to visit a natural therapy private practitioner, such as Scott Gerson, M.D., a practitioner of Ayurveda. Dr. Gerson focuses on the therapeutic effects of detoxification in managing both the side effects of antiretroviral therapy and the symptoms of AIDS. Dr. Gerson recommends this treatment in conjunction with visits to a provider of standard western medicine. Dr. Gerson's office can be contacted by calling (212) 505-8971.

Community-Based Organizations are an excellent resource for people with HIV who seek access to complementary therapies, as the services are usually free and are quite comprehensive. In New York City, Friends in Deed offers solution-focused support services, specifically, psychospiritual support for people affected by terminal illness. Friends in Deed also offers yoga and Reiki, holistic pharmacology consultations, and nutrition counseling, among other services. Healing Works is another New York City CBO offering seminars and on-going classes at no charge. Friends in Deed can be reached by calling (212) 925-2009, and Healing Works can be reached at (212) 696-9144.

Training institutes are another resource for people with HIV. Training institutes in New York City include the Swedish Institute (for acupuncture and massage) and the Pacific College of Oriental Medicine. Contact the Swedish Institute at (212) 924-5900, and the Pacific College at (212) 685-3456.

A comprehensive listing of all services mentioned above can be found at the end of this summary.

In conclusion, Mr. Schmehr advised the audience to examine obstacles and then turn their focus inward to overcome them. HIV raises many questions and challenges, and it is important to face them working from a base of personal experience. Self-examination and self-knowledge can lead to better health and to better outcomes overall in the face of HIV.

Q&A

Q: I am taking Viramune® and Combivir® and experiencing back pain. Any suggestions?

A: Holistic therapies can be useful for managing the side effects of antiretrovirals as well as for general aches and pains. Massage and/or Reiki may alleviate your back pain. Always consult your primary care giver regarding symptoms and/or side effects that you are having.

Q: Does insurance pay for alternative therapies?

A: Sometimes. If you see a primary care provider who offers alternative therapies, you are usually charged on a fee-for-service basis, and your insurance company may not cover any or all of the services. Insurance companies are increasingly likely to cover acupuncture and massage, however. St. Luke's-Roosevelt receives private funding in order to provide patients with alternative therapies free-of-charges, as do CBOs.