Sanford C. Newmark, MD, medical director of the UCSF Osher Center for Integrative Medicine, explains what integrative medicine is (hint: it’s neither “alternative medicine” nor homeopathy) and how referred patients can benefit from its proven techniques. He enumerates Osher’s therapies to support adults and kids with chronic conditions and those undergoing cancer treatment, and describes how integrative and conventional practitioners collaborate to accelerate healing, boost wellness and improve quality of life.
OK. Hi, everybody. My name is Sandy Newmark. I am the uh clinical medical director at the Osher Center for Integrative Medicine. Which is part of the University of California, San Francisco. Um, just a little background, there's actually, uh, our center was founded in 1998 along with another center at, uh, Harvard. And, uh, now there are, um, 7 centers around the country, well, 6 in the country and 1 in, um, In Sweden for, uh, uh, where, which are Osher centers, and 2 more have just been named. So it's, uh, there, there will end up being 9 across the country. Uh, and the Osher Center is composed of, uh, a clinic where we see patients, um, a research center, we, uh, and, uh, Education. Uh, I'm gonna focus today on the clinical services we have, but if, if anybody's interested, you could go to the website and you'll see that we have a very strong research department and we have a fellowship and we teach medical students and we're highly involved in, in education at UCSF. So, these are some of the services we provide. And. I'm gonna talk a little bit more about uh uh uh some of them specifically, but basically, we're a consult service only. We don't do any primary care. And we consult for a wide variety of issues. We have, uh, physicians, we have nurse practitioners, we have traditional Chinese medicine doctors, you might think of as acupuncturists, massage therapists. And um, I'll go through a little of the specialties right now. But before that, I wanted to talk about what integrative medicine is since we're the Osher Center for Integrative Medicine. Many of you probably already know, but I wanted to make a distinction between integrative medicine and some other things. So, integrative medicine, this is a uh definition from Doctor Weil's Center. He was one of the pioneers of integrative medicine, Doctor Andrew Weil. So it's healing oriented medicine that takes account of the whole person, including all aspects of lifestyle. It emphasizes the therapeutic relationship between practitioner and patient. It's informed by evidence and makes use of all appropriate therapies. And the all appropriate therapies part is very important because integrative medicine doctors do not abandon conventional medicine. If conventional medical therapy is the most appropriate choice, then that's what we would use. Uh, or we might use it, uh, plus other interventions that are not, uh, necessarily conventional, that are maybe lifestyle interventions or interventions from other modalities. Um. And we try and be informed by evidence as much as possible. So, what integrative medicine is not, is just alternative or complementary medicine. Because those terms imply that there's no conventional medicine involved, and, and that's not so, as, as I was just saying. We're not functional medicine. Functional medicine is a type of alternative medicine or maybe uh modality that um is becoming extremely popular right now. It hinges uh very highly on a lot of uh laboratory testing, and um I think people at Osher do some of that. Um, But we are definitely not a primarily functional medicine clinic. Um, things like homeopathy, osteopathic medicine, and I could have listed craniosacral therapy and reiki, and all these other things. Those are all alternative types of medicine, which any particular practitioner at Osher may or may not use in any particular situation. Um, I guess osteopathic medicine, I should have written, uh, osteopathic manipulation cause osteopaths now are trained very much like, uh, traditional, uh, like, uh, medical doctors, traditional medical doctors. But, uh, osteopathic manipulation is a particular modality that we have at OSHA. Uh, we call it manual medicine, but, um, it may be something we refer to, but it's not primarily what we do. So that was just to kind of uh give you an idea of what we're really about there. Um, Oh So, um, we also, by the way, have online classes. Um, our biggest one is mindfulness-based, uh, stress reduction. We run 13, uh, 6 to 8-week classes a year in mindfulness-based stress reduction. And these classes are uh open to anyone. Uh, their, uh, private pay fee for service, uh, classes, and right now, they're all online. And they're extremely popular. We are actually filled up for the year, uh, uh, in these classes. We also, uh, offer restorative yoga and laughter yoga, and both of those, uh, programs are free. Uh, for any patient who would like to sign up. The laughter yoga has been going on for years, and it's, it's really, uh, highly popular, uh, program. And uh if, if any of you know anything about it, it, it, it's really fun and actually really restorative. Um, I thought I should get your insurance pretty upfront. Um, so the Usher Center as part of UCSF accepts all private insurance, all the physician specialties. Including Medicare and Medi-Cal. Now, the only um exception to that is psychiatry, which does not accept Medi-Cal. And that's for kind of complex reason, but basically, everybody at OSHA is uh, a member of a, a UCFF department. Like I'm in the pediatrics department. Somebody else may be an internal medicine. And the psychiatry department in uh OSHH uh does not accept medical. For reasons I'm not entirely clear about, but that means that our psychiatrist can't accept Medico. Obviously, we can only accept HMO patients who have an approved referral, um, because otherwise HMOs won't pay it. Um, our traditional medicine, Chinese medicine doctors, or acupuncturist uh accept insurance, uh, where the PPOs pay for insurance. And our massage is future for service. We do require a referral from even people who have uh PPOs. Um, but, um, Oh, it's all, all our, uh, all insurances are accepted basically. So you don't have to worry about that. So what about our general medicine consults? We see a wide variety of medical conditions, uh, internist or family medicine doctor trained in integrative medicine. IBS, chronic fatigue, central sensitization syndromes, diabetes, just about any kind of chronic issue you can think of, we would see. But I do wanna say we're not a pain clinic. Um, patients who have really significant opioid requirements would not be appropriate referrals for us. We just don't have the, uh, the variety of, of, um, practitioners and the bandwidth to accept those, uh, kind of patients. Um, And so when you make a referral to OSHA, the referral will be, will be uh looked at by our, uh, our staff, and then, uh, the actual practitioners will go over the referrals to make sure they're appropriate. I don't know if any of you have access to kind of the Care Everywhere feature where you can, we actually have um Referrals that go through Apex, you know, uh, EEC, Apex, and we have, uh, standard referral kind of things there. I'm not sure if you have access, but if you do, then you can use those. Generally, what happens when you refer somebody is they'll get at least a two-visit consult if they're accepted. So that means they'll see somebody and uh for an hour, they'll probably be some kind of labs just ordered or maybe just medical records. And then a couple of weeks later, they'll be seen for another hour. And after that, it really varies. That could be the whole thing and then they'll be sent back to you. Or the patient could keep on seeing us at some, Uh, interval, uh, usually of months rather than weeks. Um, Like my active patients I see every 3 or 4 months, generally, maybe in 6 months. Um, And that just sort of depends on what, on the, you know, what we, what we're treating and what the patient feels like doing and what we feel like would be appropriate. So some of our patients we see for years. Now, the acupuncturists are a little different. When they start seeing the patients, they'll often see them every couple of weeks for quite a, a long period of time, uh, depending on uh their issues and, and, In China, acupuncturists will see people 2 or 3 times a week until the problem is resolved, and, but we don't have the bandwidth to do that. As, as I said before, we do some functional medicine, but we're not primarily a functional medicine clinic. We have integrative pediatrics. It's a little limited at Osher. Uh, I see kids with autism, ADHD, Tourette's syndrome, kind of behavioral problems. We have another pediatrician, Doctor Becker, who sees people with ADHD, a kind of somatic complaints, uh, some types of pain syndromes, depression, um. But then there's also at Mission Bay Hospital, there's a, a, a pediatric pain and palliative care service, where there's, they'll see kids for um a much wider variety of things if you're interested in uh sending uh children over. But uh my clinic is uh pretty much ADHD and autism. Oncology is one of our biggest, um, one of the things we do the most. We have two integrative oncologists who are part-time, uh, nurse prac integrative oncology nurse practitioner. And, uh, most of our, uh, traditional Chinese medicine doctors are acupuncturists are trained and work a lot with people with, uh, with, uh, oncological problems. Um, mostly this is, uh, We work really closely with conventional oncologists. In fact, our integrated oncologists are also members of UCSF's oncology department. In fact, Donald Abrahams, our most experienced one, was the chair of oncology at, at uh San Francisco General for many years. So in case anybody's worrying, we would never tell people not to get their chemotherapy, not to get their radiation, not to get surgery. But we're, we're really in, in this case, doing um working with patients on healing, on uh working with uh the side effects of chemotherapy, on nutritional programs for healing. Uh, and, uh, we mostly are very closely working with the conventional oncologists. And here, we're not only integrative in our approach, but integrative in the sense that, um, Many people who come see our integrated physician oncologist will then be referred to one of our acupuncturists, to our nutritionist, to uh massage therapy. So it'll be integrated in that sense as well. Um, our integrative psychiatry team is really great. They do individual therapy. We have group services, integrative psychiatry groups, and in fact, one of them is an integrative psychiatry Ayurvedic medicine group, so that's really interesting. Often, uh, the psychiatrists at Osher like to work in conjunction with their primary mental health, uh, practitioner. And, and the reason for that is, is that we don't have, um, 24 hour care. We have, we have, uh, one full-time psychiatrist and two part-time psychiatrists, and they don't have, uh, they don't have a network of care behind them. So we really, uh, especially if you have any kind of uh significant mental health issues, uh, uh, we really prefer working with the primary psychiatrist and then adding the kind of services that we offer onto that. Our psychiatrists do do therapy. They train people in meditation and, and guided imagery. They, uh, one of them has a, um, A group that works with uh expressive art therapy. So there's a lot of different modalities they use that are outside of the usual domain of, of conventional psychiatry. We don't treat schizophrenia or, you know, other severe mental illnesses uh for the same reason as I just mentioned, we just don't have the backup to do that. And right now, we don't have any pediatric psychiatry, which is a shame. So we have more traditional Chinese medicine, uh, practitioners. You might, some people just think of them as acupuncturists, but that's a little limiting than we have any other kind of practitioner. We have 4 highly trained practitioners, all of whom are working more than half-time, like 65, 70% of the time. Um, we have, one of them's full-time, we have another full-time practitioner coming. And, uh, even with that, we're, uh, overwhelmed with referrals and have a hard time accepting them and keeping them up. Um, as I said before, that many of them spend a lot of time with cancer patients. Especially getting them through their chemo and the healing period shortly afterwards, the chemo or the surgery or the radiation can be very, very, uh, helpful. Um, they treat chronic pain syndromes. And they're, they're all experts, not only at acupuncture, but Chinese herbal therapy and nutrition. So they're a really important part of uh what we do at OSU.
