Andrew Weil is responsible for popularizing integrative medicine. He says Victoria Maizes is an up-and-coming pioneer in the field.
Stacey Kalish | Jan/Feb 2009 issue
Members of any fellowship class at the Arizona Center of Integrative Medicine perform an initiation ritual. Students stand in a circle with one person holding a ball of yarn. That person explains why he or she is embarking on this course of study, wraps the yarn around his or her wrist and tosses the ball to a colleague. Each person in the circle does this—stating motives, wrapping the yarn, passing it on. At the end, an intricate, overlapping web connects them all. Then they cut the yarn and make bracelets, which many wear throughout the two-year program.
This little ritual could also serve as a description of Victoria Maizes’ mission. As executive director of the Arizona Center for Integrative Medicine, she wants to make connections—between body and mind, East and West, physician and patient—and bind the principles of integrative medicine to contemporary clinical practice. “There is both art and science in medicine,” says Maizes. “It is right brain and left brain and the need to be comfortable moving between them, weaving that paradox.”
Maizes has woven that paradox herself, starting out working for a large corporate health-care provider before shifting into integrative medicine, a holistic movement that combines conventional Western practices with alternative and complementary treatments.
Maizes, who completed her residency in family medicine at the University of California, San Francisco, has worked at the Center for more than 10 years, since entering its two-year fellowship course. Renowned physician and author Andrew Weil opened the Center in 1994, and invited Maizes to take over as the executive director soon after she completed her fellowship. She has since stewarded its growth from a small program educating four residential fellows per year to one that trains up to 130 professionals and has about 500 graduates.
The Center is housed in a cream Territorial-style building on the corner of a cactus-lined Tucson street. Maizes is fresh from a yoga class, her slim frame and poised demeanor hinting at veteran practice. She’s an eloquent speaker with intensely blue eyes and a wide smile. Sitting at a wooden conference table sipping green tea, she talks about the art of storytelling in medicine.
Stories are often the gateway to healing, she believes. She realized this early on in her medical training when she became more curious about finding out who a patient really was rather than just understanding his or her symptoms. To figure out what was wrong with part of a patient, she felt she needed to know each patient as a whole. “I became very interested in whether there was a connection between people’s stories and their condition. Why did Sally come in with diabetes and Frank come in with high blood pressure and Joe have something else? Was there something in their stories that could tell me?”
The room is cluttered with stories in the form of trinkets and gifts that cover the shelves and walls. Most intriguing are the hanging American-Indian drums with various objects stuck to them. Maizes explains they’re from the drum ritual, another initiation ceremony for incoming fellowship classes. After a brief drumming session, everyone is asked to pin something of personal symbolism to the drum’s skin. A red Frisbee was contributed by a doctor and avid Ultimate Frisbee player as a reminder to have fun in his approach to medicine. There are boxing gloves, hand-drawn caricatures of Weil, and a Nutcracker doll, to name a few. “They all have their stories,” says Maizes, laughing.
Integrative medicine, which draws on conventional Western medicine and a wide array of alternative and Eastern practices, is unfamiliar to many. But the movement is leaving its imprint on the nation’s hospitals, universities and medical schools. A landmark study on the use of complementary and alternative medicine (CAM) appeared in 1993 in the New England Journal of Medicine. It was led by David Eisenberg, the director of Complementary and Integrative Medical Therapies at Harvard University. The study showed that 34 percent of adult Americans had used a complementary or alternative therapy in the past year. The majority used unconventional therapy for chronic, as opposed to life-threatening, medical conditions.
In May of 2004, another study, by the National Center for Complementary and Alternative Medicine and the National Center for Health Statistics, also found that 36 percent of adults in the U.S. used some form of CAM. When megavitamin therapy and prayer, practiced specifically for health reasons, were included in the definition of CAM, that number rose to 62 percent.
Elite centers like the Mayo Clinic, Duke University Medical Center and the University of California, San Francisco now offer acupuncture, massage and other CAM services. Some 36 U.S. teaching hospitals are pushing to blend CAM with traditional care. A survey by the American Hospital Association found that 27 percent offered CAM in 2005, up from 8 percent in 1998.
But like all emerging fields, integrative medicine has its detractors. “There are still people who are quite opposed and who feel the science is not strong enough to introduce these therapies and that medicine should be based on only that which has excellent evidence,” says Maizes. But she points out that in conventional medicine, only an estimated 40 percent of practices are evidence based, meaning randomized trials support their use and meta-analyses support the randomized trials. “Much of what we do in conventional medicine is just that—convention,” Maizes adds.
Integrative medicine is a healing-oriented practice that takes account of the whole person—body, mind and spirit—and emphasizes the therapeutic relationship. “That is a shift from the idea that the body is a machine, and when that machine breaks, you fix it,” explains Maizes. “Rather, it acknowledges the amazing innate healing power of the body. Sometimes there are barriers and it doesn’t heal and we seek to understand it, but we acknowledge that the healing is not what we are doing externally; it is a function of the body.”
The practice consists of developing highly individualized patient approaches and integrating treatments. For example, a 44-year-old woman with breast cancer came to the Center for help with side effects from her chemotherapy. Due to her history of diabetes, she suffered severe complications that repeatedly landed her in intensive care. Her oncologist told her it was too risky to proceed with further chemotherapeutic treatment. When she arrived at the integrative medicine clinic, she implored, “I have four children; I need aggressive treatment to survive.” A treatment plan was developed that included weekly acupuncture and daily self-hypnosis to reduce the nausea and vomiting associated with chemotherapy. Using these adjunctive therapies, she was able to complete her chemotherapeutic regimen without further hospitalizations.
“This exemplifies the use of integrative medicine as an effective adjunct to cancer care,” says Maizes. “Multiple strategies are available to mitigate the side effects of chemotherapy and allow patients to complete their chemotherapeutic course, which in turn enhances the likelihood of a cure.”
Maizes’ road down this path seems as organic as the food she advocates. As an undergraduate at Barnard College in New York City, she happened to take a class called Health and Society that focused on an area in which she took an immediate interest—how to help people be healthy. She designed her major around health, while taking pre-med classes. “So in some ways, I came to medicine with this orientation of wanting to help people live healthier lives,” she reflects.
In the 1980s, she worked for Kaiser Permanente in northern California, but after what she calls “the treadmill” of care started to speed up, she realized she no longer wanted to practice “fast medicine.” (Appointment times were kept very short so physicians could see as many patients as possible.) “I would sometimes have people come with charts two inches thick,” she recalls, “and they would have diabetes and congestive heart failure, a back problem, a rash and be depressed, and I just didn’t think you could do proper medicine with that kind of complex patient in that squeeze of time. I felt that in good conscience, I couldn’t practice like that anymore.” So when she found out about the integrative medicine program at the University of Arizona, she quickly convinced her husband they should up and move their three children to Tucson, where they remain today.
The Center has trained physicians in Japan, Canada, the United Arab Emirates, Korea, Israel and elsewhere. Their newest training is a 250-hour curriculum introduced at the medical school’s residency level. Eight universities have committed to having all their residents do this full curriculum as a required course. “Our goal is to shift medical education,” Maizes explains, “so that doctors have this knowledge and offer the patient a number of options. Some people may say, ‘Doc, I just want the pill,’ while others may say, ‘Wow, you mean if I can change my diet and start exercising, I may not need to go on that pill?’ And there is everything in between.”
Take the case of an 18-year-old high school student, “Bobby.” Bobby was an “A” student, a baseball player, an all-around athlete and an easygoing kid, according to his parents. He contracted a viral illness and sinus infection, during which time a violent sneeze caused a severe headache. He was given antibiotics that relieved his acute illness, but his headaches worsened. He was sent to a neurologist, the first of many specialists. He started missing school, was diagnosed with depression and developed a tic. By the time he came to the Arizona Center for Integrative Medicine three years later, he was on 12 medications, including antidepressants and anti-epilepsy and anti-psychotic meds. And he still had the same violent, nonstop headache.
After Bobby’s case was discussed in a patient conference at the Center—which employs integrative medicine physicians, naturopaths, acupuncturists, nutritionists, an energy healer, a shaman and a specialist in dreams and sleep, among others—the osteopath in the room said he wanted to assess Bobby. After his first treatment with the osteopath, Bobby’s pain decreased dramatically. After a second osteopathic treatment, his headache and tic completely vanished. He was able to go off all his medication and resume his normal life. “I am not saying the only treatment was the osteopathy,” says Maizes, “but if you are not familiar with manipulative techniques or other practices, your only strategy is pharmaceuticals or surgery. It’s an example of a man whose life could have gone off on a very different track if he hadn’t found an alternative to the pharmaceuticals.”
Maizes is done with the days of drive-through medicine. She now allows 90 minutes for a first-time patient consultation. “Integrative medicine is first and foremost about trying to understand the human being sitting across from you,” she says. It is out of this doctor-patient partnership that the opportunity for research grows. She quotes Weil, who has said, “Those observations that you get from these individual situations are really the nugget that leads to the research questions.”
Take the case of the cranberry juice. “I see a lot of patients with breast cancer. One of the side effects is lymphedema, which is swelling in the arm because the lymph nodes have been damaged or removed,” explains Maizes. “So one of my patients told me she had started drinking two ounces of organic cranberry juice a day and noticed her lymphedema had completely resolved. I didn’t know any data that supported that, and I had never seen a study for it, but when I would see other patients and they would tell me about their lymphedema I would say, ‘You know, I heard something that one of my patients did. There is no study to support it but it’s interesting so you may want to try it.’ And a number of them tried it and found it was helpful. Now I am not saying that organic cranberry juice is a cure because that certainly has not been proven, but I have shared this story with the nutritionist on our faculty and also on the faculty of the Arizona Cancer Center and think it would be great if we could get some funding for a study.”
One of the main aims of integrative medicine practitioners is to help individuals change their lifestyles. “We need a big societal shift that I think is coming but could be better supported by certain public health policies and changes,” says Maizes. She’s outspoken about America’s “very broken health-care system, [which] does not value long-term continuous relationships.”
She says educating younger generations about healthier diets, exercise and stress reduction is paramount. “I don’t think stress is going to go away and positive stressful things can be as tough on the health as negatively stressful events. Getting married ranks as high as getting divorced in terms of the stressors on our physiology. But it’s about finding ways to tone our nervous system so when we have the adrenaline rushes we also know how to relax and how to activate our parasympathetic nervous system—the opposite of ‘fight or flight,’ which is ‘rest and digest.’”
Practices such as yoga, meditation, tai chi, diaphragmatic breathing and even short walks in nature achieve this. “It’s about educating people on how to be quiet and center themselves when they have been thrown off-kilter,” she says.
Ultimately, Maizes’ goal is as simple as it is ambitious. “We hope at some point we won’t call it integrative medicine; we will just call it good medicine.”
“Victoria Maizes is an up-and-coming pioneer of integrative medicine, a leader in the transformation of medical education, medical practice and health care, with a growing international reputation. She is an excellent physician, a visionary, with the talent and training to convince people of the need for a transformation of medicine to embrace the natural healing power of human beings and effective treatments that are not dependent on expensive technology or pharmaceutical drugs.” -Andrew weil, the physician who popularized the concept of integrative medicine, a bestselling author of a number of books on the subject