Knoxville joins the alternative health-care revolution as scores of practitioners hang out their shingles

by Hillari Dowdle

Hal Ernest, 66, is a runner. A classic type-A personality, Ernest has for years started his morning at dawn making the four-mile run from his front door to the end of Cherokee Boulevard and back. An executive vice president for prominent local advertising agency Lavidge and Associates, he leads a life full of hard work, meetings, and deadline pressures. Running is his escape, his meditation, his one nod to stress relief.

Imagine his dismay, then, when he was stopped cold in his tracks one beautiful morning last spring by a searing pain in his buttocks. Regular runners like Ernest are used to pains and strains, pulled muscles and shin splints—it's just the price they pay for their sport. But this was no ordinary muscle pull—he knew that right away.

A consultation with his physician led to a diagnosis of a muscle tear and an appointment for a caudal block, a procedure in which numbing medication is injected into the lower back to reduce the pain and relax the muscles enough so that they can heal.

But for Ernest, the procedure didn't work. The caudal block did not touch his pain, nor did it seem to initiate any sort of healing process. So he was sent back for another...and another.

After the second and third caudal block failed to produce any significant result, Ernest's physician revised the diagnosis. "He said he thought I had sciatic nerve damage and that the only thing to cure it is surgery," Ernest recounts. "He said I'd be laid up for awhile. And I said there is no way—I have all these accounts, I have a lot of responsibilities, and there's nobody out there to back me up."

Ernest began to cast about for an alternative way to heal himself, turning to physician after physician and to a chiropractor—all without result. He found himself at the end of his rope, willing to try just about anything, which is why when a nurse overseeing the round-the-clock care being provided to his 97-year-old mother suggested acupuncture, Ernest was more than willing to give it a shot. "I had heard nothing but good things about acupuncture," Ernest says. "I have always been the sort of person who believes the body heals itself, which is interesting since my father owned a drug store [Ellis and Ernest, a fixture on the UT campus from 1926 to 1967]. Since the alternative was surgery, I thought I might as well give this a shot first."

So he began seeing local acupuncturist Susan Thompson, a master of Oriental Medicine and diplomat of acupuncture with a degree from New Mexico's noted International Institute of Chinese Medicine. After two-and-a-half months of twice-weekly treatments, Ernest was pain-free and able to resume his morning runs.

He's a believer now, along with scores of Knoxvillians who are seeking out alternative health-care treatments, giving rise to a thriving local industry that offers—as a cursory glance at the bulletin boards inside Zephyr or Nature's Pantry will inform—everything from acupuncture to cranial sacral manipulation to herbal therapy to Watsu, a newfangled form of massage that is performed in a special heated pool. Three alternative medicine centers have opened in the last year alone, and scores of alternative medical practitioners have hung out their shingles. Even the local medical establishment is jumping on the bandwagon—the Knoxville Academy of Medicine is planning a special alternative health conference next spring that will be open not only to the doctors it represents but to alternative practitioners and the community at large.

But is alternative health good medicine? Even the newly converted can't offer definitive testimony, it seems. "I don't know how to explain it," says Ernest of his brush with acupuncture, "except to say that it simply worked."

The Big Picture

Alternative medicine, in case you haven't picked up a magazine or newspaper or turned on the television over the last year or so, is big business these days. A recent Journal of the American Medical Association reported that one out of every three Americans has undergone or is undergoing some form of alternative healing. And what studies exist show that these Americans are well-educated and affluent. They'd have to be—few insurance plans in the country right now cover alternative care, so patients are paying out-of-pocket for their treatments, which generally run anywhere from $40 to $200 per session.

The field is an amorphous one—encompassing everything from therapies with thousands of years of history, like Ayurveda and Traditional Chinese Medicine (TCM), to more controversial treatments like hydrogen peroxide infusions and magnetic therapies. As such, it is difficult to say exactly how much money is being spent by Americans on alternatives to traditional Western (or allopathic) care, but estimates put it in the ballpark of $24 billion per year. In fact, a 1993 New England Journal of Medicine study reported that more Americans made trips to see "unconventional" practitioners (425 million visits) than to see conventional allopathic physicians (388 million visits).

Dr. Jorg Winterer, director of emergency medicine at Morristown's Lakeway Regional Hospital, thinks he knows why. Winterer, 56, is himself perhaps the best allopathic medicine has to offer—he holds an M.D. from Harvard University, a Ph.D. in nutrition from MIT, and a degree in public health from Johns Hopkins. He is, like Ernest, an athlete who is prone to injury in the normal course of things. And like Ernest, when he has tendonitis flare-ups and muscle tears, he turns not to his peers but to Susan Thompson for relief.

"I don't take any Western drugs myself—they're too strong and have too many side effects," he explains. "I have unqualified endorsement for acupuncture for musculoskeletal complaints. It's based on 3,000 years of experience, and it's a pragmatic medicine that works.

"I think the narrow focus on high-tech and crisis intervention in Western medicine doesn't serve the average person very well," he says. "And the whole idea that you're being handed from specialist to specialist—that you're just a disease to your doctor and nobody really understands all your problems. People are looking for something more humane, more benign, and something they can really get involved in themselves."

Dr. Leon Bogartz, director of medical affairs at St. Mary's Health System and current president of the Knoxville Academy of Medicine, agrees. "People are embracing alternative therapies like never before right now because of their increasing visibility, availability, and the fact that you can access alternative care without having to be directed by a primary care doctor or insurance company," he says. "They can try it on their own, stop on their own. They don't need permission from an HMO."

Bogartz admits that he knows little about alternative medicine himself and says that few Knoxville physicians do. But he also notes that they should be highly motivated to learn. "Number one, from the perspective of the payer and provider, we know that people are spending millions of dollars on complementary medicines and alternative things," he says. "So from a purely financial point of view, we know we should be trying to bring these treatments into the system so that they can be controlled."

This is, he explains, why St. Mary's and its parent corporation, Catholic Health Partners, are taking the first steps toward exploring ways to pull alternative therapies into their system. But there's more to it than just the bottom line. "Most of what we know about alternative medicine is based on anecdotal information—but if there are enough people doing this, there is bound to be value," he notes. "Plus, traditional medical therapies fail in some areas, and we are desperate for solutions."

Newton v. Einstein

The failure of Western medicine is a topic that is intimately familiar to Patty Silver, a clinical integrative hypnotherapist and proprietor of the Shekhinah Center, one of the three new centers that opened last year. "A few years ago, I had thyroid toxicosis—I had a resting heart rate of 170, my legs were giving out from under me, I couldn't sleep," says Silver, who is married to Dr. Steven Silver, a local gastroenterologist. "At the time, the allopathic treatment was to burn out the thyroid—that's all they knew to do. But that meant that I would spend the rest of my life on thyroid medication, and I was not going to do that. So I traveled to Nashville to do hypnotherapy, and Asheville to do acupuncture, and it took about six months, but I brought the problem under control."

Silver's life-saving brush with alternative medicine led her to her current field of practice (she'd previously been a medical technician working in hospitals and in her husband's office). She founded the Shekhinah Center in a restored farmhouse in West Knoxville as a sort of metaphysical clinic, a place where she can practice her hypnotherapy and Reiki (an energy therapy that Christian practice might call "the laying on of hands"), and other local alternative practitioners, like Ayurvedic consultant and psychotherapist Mary Roberson, can see clients and hold workshops.

Alternative practitioners like Silver take what they call a "holistic" approach to health care. By holistic, they mean that they look at not only the symptoms manifested by the physical body itself but at emotional, mental, and spiritual needs as well. "I specialize in chronic and emotionally based illnesses," says Silver, whose clients tend to come in with problems like inflammatory bowel disease, neck and back problems, and syndromes that throw the immune system out of balance. "I believe that 80 to 90 percent of all the health problems we have are emotionally based. It's like our bodies are a hall of archives, storing every thought and every emotion we've ever had, and the cells themselves are where we store those memories."

Silver believes that by hypnotizing her clients, she can allow them to access those memories and thereby get to the actual root of the problem. And it is this getting to the root—the underlying cause—of illness that is the very raison d'être of alternative medicine.

Allopathic physicians tend to take a Newtonian view of the body—that is, they see it as a complex biomechanism made up of discrete pieces of matter. As such, they treat the body much as a mechanic might treat a machine. Most alternative practitioners take a more Einsteinian view. They see the body as being made up of energy, the kind of quantum physics-based approach popularized by Ayurvedic physician Deepak Chopra in his books Quantum Healing and Perfect Health.

Corinne Rovetti, 44, is perhaps the elder stateswoman of Knoxville's alternative medicine scene. She is a licensed nurse practitioner working at the Knoxville Center for Reproductive Health. She is also a homeopath who's been in practice in the Knoxville area since 1987. "Basically, homeopathy is a system of medicine based on the law of similars," she explains, noting that the goal is to stimulate the body to employ its own natural healing responses. "It uses natural substances that can cause particular symptoms in a healthy person to treat a person with those symptoms who is ill. For example, a bee sting will cause burning, stinging, pain, heat, and redness. So a remedy created using the venom of a bee might cause a healing response in an individual who has those symptoms."

Homeopathy is a highly complex form of treatment, one that offers 2,500 different naturally occurring remedies the practitioner selects based on the most minute of symptomologies. And it has been, since it was introduced in the U.S. in 1925, controversial. Critics claim that the remedies, which contain as little as one part in one million of the treating substance, are simply too diluted to have any effect at all. But Rovetti says they are missing the bigger picture.

"Every substance has a frequency to it, just as on a cellular level we are all vibrating," she says. "In illness, as we know from cancer research, chaos occurs. And so homeopathy is just another system that can help stimulate the cells to vibrate and function at a normal level—to cause a shift in the system. The remedies stimulate the body at the cellular level, producing a shift in the internal state so that the body may no longer need to create symptoms in its cry out for help."

Still, Rovetti is not ready to renounce allopathic medicine altogether—each has their time and place, she says, and she enjoys keeping one foot in each realm. But like Silver, she notes that allopathic medicine tends to overlook the more etheric aspects: "It's a little like peeling layers off an onion. We all have accumulated layers of illness and layers of emotional stuff. Whatever is the outside layer is what will be presenting, but there will always be an inside layer that needs to be treated as well."

Our Toxic Lifestyle

An emphasis on nutrition, too, is a common thread that ties most alternative therapies together. What is required to cause and facilitate healing in most people, they say, is not treatment with drugs and high-tech machines, but an overall lifestyle change. And for most of us living in a fast-paced Western society, this is a bitter pill to swallow.

Jennie Van Winkle, 42, found this out the hard way. Several years ago, while working as an interior designer in Atlanta, she was stricken by a mysterious and debilitating illness. "I had Epstein-Barr virus, fibromyalgia, and candida yeast, and all of that wore my immune system down so that I became allergic to the environment," she remembers. "It took me a year-and-a-half, but I finally found an herbalist in Atlanta to help me, and this is how I got well: by slowing down, taking herbs and vitamins, and changing my diet."

Like Silver, Van Winkle's efforts to heal herself led her to a new career—she apprenticed herself to the herbalist who helped her and moved to Knoxville to open The Herb Shop, where she practices iridology, looking at the iris to see where the body has disease and inherited weaknesses. In her estimation, poor health is generally due to the toxic lifestyles we all lead.

"Most of us are walking around so malnourished it's awful," she says. "I wish that our bodies were more sensitive, like a car. If you don't put the right oil and gas in a car, you ain't going anywhere. But our bodies can go, and go, and go on nothing. Plus, we drink water with chemicals, we eat food with pesticides, and all these chemicals get into the body and react with the chemicals that are already there and cause illness."

To remedy the situation, Van Winkle points to herbs, which are becoming more and more accepted as Americans jump on the St. John's wort, saw palmetto, gingko bilboa, and ginseng bandwagon. She makes recommendations based on her iridologies, or on the case histories she extracts from the customers who seek out her services. "Most people who come in here are curious, or maybe they've taken this or that to no avail—they haven't quite hit the nail on the head," she says. "You have to realize that there are thousands of herbs, and that every one isn't right for everybody. Every herb has its own chemical makeup. One might be high in iodine, and if you're depleted in iodine, that might be the herb for you. But it might not do a thing for another person."

Gary O'Shaughnessy, 45, is a D.O.—a doctor of osteopathy, a medical discipline that combines allopathic medicine with manual healing, like that practiced by chiropractors. Dr. O'Shaughnessy sees alternative healing therapies as the future itself and this year opened the East Tennessee Holistic Medicine Clinic in Farragut, where he combines Western approaches with herbalism, Reiki, acupuncture, tai chi, magnetic therapy, psychotherapy, and, of course, nutritional therapy.

"My big emphasis is on nutritional therapy and on getting the patient involved in his own care—I try to do anything but drugs," he says, noting that he much prefers to prescribe herbs, though they take longer to work. "Drugs are a quick fix, and drugs a lot of times cover symptoms but don't go after the underlying cause. But we're a quick-fix society. People are basically saying, 'Doc, give me a pill and make me better today. I don't want to change my lifestyle...I want to lay around, eat fast food, and smoke, but I want to feel great and look like Raquel Welch.' That doesn't work."

Word to the Wise

Maybe so. But alternative medicine—in all its forms—has more than its share of critics. After all, hard scientific data in America is largely lacking. The National Institutes of Health, in response to what it discerned as an overwhelming need in the country, formed the Office of Alternative Medicine (OAM) in 1991 to remedy that situation.

Still, even that initiative has come under heavy scrutiny. The New York Times last week ran a rather vitriolic editorial by Leon Jaroff (who was identified as the author of The New Genetics, a book he penned for Whittle Communications' Grand Rounds Press), which denounced the OAM as an embarrassment and called for our legislators to slash its $12.5 million annual budget. "The federal government has no business paying for bad science," it concluded. "Congress should cut its losses and shut down [the OAM]."

Compounding the problem is the fact that most alternative therapies and their practitioners fall under very little federal or state regulation. Tennessee licenses massage therapists and chiropractors, but that's about it—no herbalists, reflexologists, hypnotherapists, Ayurvedic consultants, or acupuncturists. This means, basically, that anyone can call themselves a healer so long as they do not claim to be an M.D. or make claims that natural remedies have pharmaceutical benefits. There is, in Tennessee anyway, no consumer protection whatsoever.

Acupuncturists, one of the better organized groups of alternative healers in the state, bonded together last year to introduce a bill in state legislature that would require that their profession be licensed. Though the bill never made it out of committee, they plan to reintroduce it when the new session begins this January.

"Right now, there is nothing to stop somebody from just ordering needles and doing it [acupuncture]," says acupuncturist Thompson, who has a background in biochemical research. "There's nothing that says you have to go to school or pass exams. There's nobody to come in and take things away from you if you're messing up. You do want those things—for the protection of the patient and the protection of the profession."

Susan Weissfeld, 43, is a registered nurse who in January founded the Alternative Medicine Center at Fort Sanders West, which offers acupuncture, therapeutic massage, yoga instruction, and nutritional counseling. Her idea, she says, was to address safety issues by pulling together several established practitioners under one roof, where their credentials could be established and checked and liability insurance provided.

"In some cases, it may be dangerous to see practitioners, especially when they're practicing in their homes, because you really don't know who that person is," she says. "When I hired my staff, they had to provide me with their certifications, licenses, degrees, and references. And my medical background helped me to know whether they knew what they were talking about. But most people don't even know how to check and see if their M.D. is board certified."

So how to tell if a practitioner is legit? Ask lots of questions, do your homework, and listen to your gut is the conventional wisdom. The Tennessee Medical Association does not keep tabs on alternative medical practitioners, but it does offer some advice to those who call looking for guidance. "As in [allopathic] medicine, you should always ask for a second opinion before you undertake an expensive treatment," says Russ Miller, TMA's spokesperson. "And know what you're getting into. Information is abundant, but most people do more research on automobiles than they do on their own health care."

Another way to ensure safety, says Dr. Bogartz, is to make sure you've had a good allopathic examination before you undertake any alternative therapy. "The application of alternative care to true, developed symptoms should come only after traditional evaluation," he says. "You need to know what you're up against. If you're having heaviness in your chest that comes with exertion, you need to know if you have coronary artery disease before you go hang garlic around your neck."

Fishing for Complements

But despite the potential risk of running smack dab into a quack, Americans are likely to keep seeking out alternatives. To Dr. Winterer, this is not only natural but necessary. "We're being asked not to write prescriptions for antibiotics every time someone comes in with a cough," he says. "Now all the infectious disease guys who have been telling us to write antibiotic prescriptions for 30 years are telling us not to, because we're seeing virulent strains of germs that are resistant to antibiotics. And Knoxville happens to be one of the cities with the highest rates of resistance of organisms to antibiotics. Doctors are beginning to understand that they are going to have to find other ways to treat illnesses.

"The alternative approach is to boost the immune system instead of try to poison the organism," he says. "That's what alternative medicine tries to do. It's a different philosophy."

Western medicine will always have its place, Winterer says. "Alternative medicine is not for crisis management. It's more regular maintenance than going in for a thrown rod."

A better way to look at it, he says, is a complementary medicine rather than alternative medicine. And Thompson, his acupuncturist, agrees. "Where Western medicine is strong, TCM is usually not so good—that would be surgery, emergencies, and physiological diagnoses," she says. "Where Western medicine is weak, TCM is strong—for chronic illnesses, things for which there is no symptomatic relief, and sub-clinical things doctors can't explain."

Hayat Ruh, 40, is the new acupuncturist on the block, having moved to Knoxville to start her practice at the Alternative Medicine Center just last month. Like so many alternative medicine practitioners, she too had an illness that confounded allopathy. "I was born with a rare bone disease, and when I was 20, I developed arthritis so badly in my hip joint that I couldn't walk," she explains. "I went to an orthopedic surgeon and begged him to help me, but he said he really couldn't do anything and told me to sit in a wheelchair. I said bleep-bleep you and began to seek out other alternatives. Some of the things I used were acupressure, acupuncture, nutritional therapy, homeopathy, and lifestyle changes. And within a year, the situation had reversed."

Ruh, like Thompson, says allopathic medicine is necessary; she underwent surgery earlier this year without which, she says, she'd have been right back to the wheelchair scenario. Still, she faults Western medicine for its inability to deal with the gray areas. "Doctors rely on their tests, on something black and white—something they can see and say, yes, this is what you have," she say. "If they can't find that, they cannot make a diagnosis.

"If you are told by a doctor that he can't do anything for you and your only option is to continue to suffer from it, go out there and educate yourself and find something else," she concludes. "Like I did."