January/February 2000

Integrating the best of both worlds
A conversation with Joan Borysenko
By Ravi Dykema

The worlds of allopathic and alternative medicine have long held an uneasy truce, with each side accusing the other of irresponsibility and ineffective techniques, and each side claiming exclusivity on health care. Allopathic medicine points to an abundance of data that support its effectiveness. Alternative therapies counter with data of their own. As both sides square off and roll up their sleeves for a final round, Joan Borysenko , PhD, says a showdown isn't the answer. The solution, she says, lies less in a point-by-point comparison of studies and more in a sense of good will, recognizing both alternative and allopathic medicine in a comprehensive healing paradigm, in a model she calls "integrative medicine."

Classically trained at Harvard as a cancer-cell biologist, Borysenko became involved in integrative medicine as early as 1980, when she established a mind-body clinic at Beth Israel New England Deaconess Hospital using meditation and relaxation techniques, yoga, nutrition and cognitive therapies to treat cancer and AIDS patients. "I was working in the holistic world, in a division of behavioral medicine, in a very straight Harvard teaching hospital," she says. "It was a bridge between two worlds." Borysenko shared more of her thoughts about integrative medicine with Ravi Dykema, publisher of Nexus, at her home in Boulder.

RD: To some of your audiences, you represent a bridge between the two worlds of allopathic and alternative or integrative medicine. 

JB: Precisely. I really like talking to hospitals, because I'm not preaching to the choir. I have a chance to share my excitement over something they might consider strange, threatening, unscientific. And when they leave the room saying, "This is not strange, this is very natural, there's a lot of scientific data for it and it's something we can look into and use in a hospital," I feel particularly happy. What I really like to do is make a connection with people and have my mind expanded by them and their minds expanded by me. That's what I consider a holy interaction.

RD: What would you say in your lecture to hospital personelle to make a bridge between the two worlds?

JB: The kind of lecture that I would give on integrative medicine would vary, of course, according to the setting and the desires. One recent lecture I gave, for example, was based on looking objectively at the data that we have in integrative medicine and in allopathic medicine. And I talk about how it is that allopathic becomes prejudiced against integrative medicine, and practitioners of integrative medicine develop prejudice against allopathic medicine.

RD: How do aficionados of allopathic medicine get prejudiced?
JB: Not everybody is, but some people are. Look at the fact, for example, that over 100,000 people die in United States hospitals every year from drug reactions, and that doesn't count. But find one example of somebody who is made ill by an herbal preparation, and suddenly that's big news. I consider that prejudice, because it's not looking fully at the data. Alternative medicine is also criticized for having "soft data." The fact is, a recent study showed that only 15 percent of all allopathic medical treatments are actually databased. The rest of them are based on anecdotes and treatments that have been handed down from Joe to Harry, from year to year to year.

RD: So it's a misnomer to call it scientific medicine?

JB: Well, in a way. What they deduced is the reason why there's so little database treatment available is that less than one percent of all articles in medical journals are true, double-blind randomized controlled studies [called "gold standard," in science].

RD: And the others are more anecdotal, or at least less gold standard?

JB: The others are less gold standard. When allopathy turns around and says "We will not accept anything other than the gold standard," that's what I consider prejudiced.

RD: But they themselves are basing their treatments on soft data, is that right?

JB: That's right. As a scientist, if I'm evaluating either allopathic data or data on alternative medicine, one thing I'm very aware of is that there is something called the experimenter effect. And that effect is we researchers tend to get what we think we're going to get. And we can't necessarily eliminate that in a double-blind study. Studies have shown that you can affect the physiology of another person at a distance. This is fascinating because it questions the idea of scientific objectivity. As soon as you begin to look at or interact with or to observe a test system, your observation actually changes the results. And what some studies suggest is that the expectation or intention of the experimenter actually can change the results. In other words, scientific studies may come out very differently, depending upon the expectation and intention of the experimenter.

RD: It draws into question the efficacy of scientific method itself, doesn't it? The double-blind study gives us a sense of objective reality, separate from the hypothesis of the experiment. But this throws a wrench in that theory.

JB: It's a rare scientific experiment where the experimenter is completely open-minded and not biased one way or the other. Most of science, of course, is generated through hypothesis, so you already have a bias in hopes that the hypothesis will be proven true or false. Our intention can make an enormous effect on a scientific study. So where's the objectivity in science? How are we really going to look at these things?

RD: Doesn't it make your concern about prejudice within the allopathic medical community a sinister thing? The prejudice would actually predispose allopathic medicine to keep confirming its results in spite of the reality being different from the one they're viewing.

JB: That's right. We're really talking about the power of intention and mind to act at a distance. And that's fascinating.

RD: The implications are profound for medicine, aren't they? And even for society-the intention of the Congress of the United States may have an effect on the populous.

JB: I think so. The truth is that we live in a time when people are really jaded. We've gotten to the point where people look around and say "You know, all of this great economic growth that we've had may have bought me a microwave and a better house, a car in a garage that may not have been there before, but I feel isolated. I feel stressed." As you speak to people, it's very rare to hear a person who's really happy. Most everyone rings their hands and says "Oh, God, I'm so stressed. I have no time." Things like that.

RD: They're looking for healing. That's partly why that word is so popular. JB: That's right. They're looking for balance. They're looking for a way to slow down. Except within the context of this culture, it's very difficult to actually create that. What's beginning to happen is two-fold. Number one, there is a thought form, an intention out there, which says "I'm so stressed, I'm dropping dead." And what happens is that the number of stress-related diseases increases because that intention works on us. I often tell people "Don't pray for me" for this very reason. People look at my schedule; they wring their hands, they say "My God, this is terrible. I'll pray for you." And I say, "Please don't, because in your prayer for me is the inherent understanding that I'm a poor stressed-out soul who's traveling all over. I don't want those sorts of thoughts sent to me, so just let it go out of your mind."

RD: That's the sort of under-belly of prayer.

JB: It is. It's about negative prayer.

RD: That's been my problem with prayer. Why would I assume that I'm lacking, when my belief is that this is what I incarnated for, this exact instant with everything in it. All the feelings, all the words, all the fuzziness, all the confusion-all of it.

JB: That's right. The positive, the negative, everything else. When I pray, it's usually more that my heart and mind can be open to that guidance that's always coming from within rather than a form of intercessory prayer which says, "Listen, give me this or don't give me that." In a certain sense, that's being a cosmic busy-body. And perhaps in the greater scheme of interdependent origination of all things, I might just be putting a monkey wrench in the works.

RD: Back to the questions about so-called scientific data: if we look objectively at the data for allopathic medicine and alternative medicine, what would the verdict be?

JB: I would say there's positive and negative in both. I think there are tremendous benefits for allopathic medicine. I'm fascinated by the action of drugs. Surgical and diagnostic techniques are incredible. I know that many of us would have been dead already without some of these interventions, and I'm probably one of them. I'm not one to say "Let's sit around in a medical emergency and try homeopathy first." I feel acute medical situations require allopathy.

RD: How does integrative medicine fit into that scenario?

JB: Once an acute situation is under control, we need to look at a number of other things, like is there a homeopathic that might work for this? What kind of food would be medicinal in this kind of circumstance? Is there a way that I can use my breath? What is there from yoga that I can use? What can I do with meditation? Will prayer help? That's what integrative medicine is. And integrative medicine has a greater belief in health promotion and prevention than pathology-it says, "Let's try to eliminate disease by maximizing the natural healing systems of the body, by looking for balance among the body, the mind, the spirit, the environment, every aspect of your life."

RD: If someone from the allopathic community were to survey the literature that you have surveyed without prejudice, do you think they would be intrigued by the results shown from alternative medical interventions?

JB: There's a lot of good, firm data there. And now that the Office of Alternative Medicine is expanding, that more than homeopathic levels of funding are being given to it, what I expect we're going to start seeing is data coming out on specific interventions in integrative medicine. It's just beginning, because there hasn't been any funding for it. There's big funding for a drug company to examine the effects of drugs, but nobody's going to fund a study on motherwort. Anybody can go out and pick it. There's no economic incentive there.

RD: The current state of affairs in health care, when we include alternative medicine within the whole view of health care, is that people are experimenting on themselves with relatively unproven supplements and methods. Critics suggest that people are using themselves as guinea pigs and that there should be regulations to restrict that, to save them from their own curiosity.

JB: There are a number of conversations here, and one of them simply has to do with personal freedom, in that we can't give up personal freedom in any way, to have our health regulated by some lobby somewhere. On the other hand, part of it is true. Yes, I want to know that the herbal preparation I buy has an active ingredient, that it wasn't like Aunt Sophie's mullein picked from six years ago that's been laying in the dusty basement, and somebody just crumbled it into capsules. Quality control is important. But if you want to see the long-term effects of something like yoga or meditation, they've been around since the beginning of time. These are time-honored techniques, and whatever difficulties are going to be arising out of them have already been found a long time ago. It takes years and years and years to figure out what the negative side effects are.

The same applies to medicine. For example, diethylstilbesterol (DES) used to be given to women in the late '40s all the way up through the early '60s to prevent miscarriages. As it turns out, when studies were done, not only did DES not prevent miscarriages, but it raised the miscarriage rate. And even after that was known, the drug companies wanted to sell it so much to every single woman and every single pregnancy, that it didn't get yanked off the market until 1961, by which time we had an awful lot of DES babies, who grew up into young women who might have infertility problems, cervical pathologies and things of that nature. As a medical consumer, if I've needed a drug, I would prefer an old one. We know penicillin works. It's been around for a long time. Give me that, not some new fifth-generation antibiotic that doesn't have a track record.

RD: How about alternative medicine? Do you also tend to go for the older, traditional methods?

JB: Yes, I do, because of the same thing: they are known. And yet there are a number of new methods, everything from cranial-sacral therapy to a variety of energy medicine interventions. As a scientist I say, "Okay, your basic data gathering is anecdotal, and that's what alternative medicine is usually criticized for." But observation is the first thing we always look at, no matter what field we're in. Does it have positive or negative effects? And if I don't see negative effects, only positive ones, even if it's the placebo effect, I figure it's not harming anybody. And that, of course, is a major thing, to do no harm.

RD: So it's safe to experiment with yourself?

JB: With yourself. Here I am, a woman in the throes of perimenopause. Medical science, particularly the drug companies, would love me to be their guinea pig. Every time I turn around, there's somebody who's saying, "Oh, God, Joan, you could get rid of those hot flashes if you just took estrogen. Look at the literature." Well, the literature is such a confusing maze. It's positive, it's negative. Estrogen will give you breast cancer. Estrogen will prevent hot flashes. You need it for your bones. There's no evidence it helps the bones. What does that make me? It makes me a medical guinea pig. Personally, I'd want to wait. Maybe the next generation of women will have enough data to say hormone replacement therapy is something they want to do, because there's a track record. I would rather try natural techniques that have been around for a while first before I go to a drug therapy that could affect my whole body.

RD: And almost all the natural techniques you would be using are gentler than the hormonal ones, right?

JB: Of course. And I think that's always the principal, to do no harm, to work your way up. The philosophy is "Gentlest first, more intervention later."

RD: So people should first pursue alternative medicine, which is gentler, and allopathic later.

JB: Absolutely. But when you're talking about acute illnesses, you get exactly the reverse of that. Generally, in most acute illnesses, allopathic is going to be the first thing. And then to help the healing of the body, the alternative will come second. But we have to know what the balance of these things is.

RD: How soon do you think the medical world will be advising that-start gently with absolutely proven safe interventions, and then only later work your way up to the more powerful interventions that have potential side effects?

JB: In terms of allopathic medicine, I don't think that this message of going from gentler first is going to make big inroads any time soon, and that's because there's an economic infrastructure that's going to prevent that. Hospital beds have got to be filled. Drug companies have drugs to sell. And there is an enormous amount of persuasion that goes on, where drug companies will bring drugs to physicians and use little sound bites of research to help to sell their drugs. This is part of what keeps the allopathic medical ball rolling. However, new statistics show that up to 42 percent of the population is using some variety of alternative medicine. That's huge, and it's rising quickly. In 1993, it was more like 33 percent. As a result, what's happening is the medical system is being affected by the patients themselves, in a grassroots kind of movement.

RD: But you don't think medical care is going to respond much to that market demand?

JB: In a certain way, yes-I see more and more hospitals putting in, for example, mind/body clinics, but I don't see a change in the actual allopathic approach itself. At the same time, patients are taking more upon themselves. I know an awful lot of women whose doctors give them prescriptions for hormone replacement therapy, and they dump it in the trash when they leave the office. In fact, something like 60 percent of hormone replacement therapy prescriptions never get filled, as women decide to try something else first.

RD: That's a measure of distrust. 

JB: It's a measure of distrust in being guinea pigs, and I think people in general are feeling more and more that way. On the other hand, I would say that most people are highly in favor of life-saving allopathic medicine. But instead of looking at allopathy now as the be-all and end-all, they say "I'm so glad it's there when I need it. It can save my life. It can save the life of my children. But I'm not going to hit myself over the head with a sledgehammer to go to sleep-I'm going to try yoga first, or relaxation therapy, or failing that, maybe a little valerian or kava kava. And I won't give myself totally into the hands of another person, but instead hire them to become a member of my team." The good news is, what we're getting is really educated health care consumers.

RD: More out of necessity, since they have so many options. And they feel a need to choose for themselves rather than take the advice blindly of their doctors.

JB: That's definitely on the rise, and what else has to be on the rise is the ability to communicate with one's physician openly. Eisenberg's study showed that about 60 percent of the people who use alternative medicine never mention it to their physicians. That shows a lack of trust. When allopathy becomes open enough that a patient using alternatives feels free to talk about it, we're getting somewhere. When alternative medicine becomes open enough to say, "We're not the be-all and end-all either-we need some of these allopathic treatments," then we can all become partners in health care. That's really what my whole message is. We need all of these things. And we need the open-mindedness, the good heartedness, the scientific data to figure out how to use them all to our best advantage.