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Monday, September 28, 2015

On 'Alternative Medicine' in Cleveland, Where 'Hospital Medicine' is the Prescription of the Day

Posted By on Mon, Sep 28, 2015 at 10:06 AM

In 1837, shortly after Cleveland incorporated, the City Hospital was born. While this early asylum for the ill and destitute hardly delivered “quality care,” it established Cleveland early on as a “medical town." 

These days, Cleveland medicine brings to mind the Cleveland Clinic, University Hospital or Metro, but the history of Cleveland—once a wild and wooly western town—includes far more mavericks and bold independents than many realize. And while these institutions get a larger share of the press, alternative and independent practice continues to thrive.

How does this enclave support the Cleveland community? And in what ways has it captured the enterprising spirit that brought Cleveland from swampy Cuyahoga backwater to thriving medical center? I asked a group of such practitioners to join me for an evening coffee—and what I learned brings that historic intrepid spirit into sharper focus.

Who chooses to work as an independent, integrative health practitioner? It’s a diverse group.

Tom Ockler, an alternative physical therapist, hails from Buffalo but has been practicing in the Cleveland area for 37 years (Alternative Healthcare Solutions).

Anne Kinchen of Cleveland Acupuncture began her practice in 1999 as one of the first 10 acupuncturists in Ohio. They represent those working longest in our community, but they are joined by some relative newcomers.

Marque Garaux, a climber and former Marine, practices, teaches and leads Mysore Ashtanga yoga at Harmony Studios in Willoughby (Yoga Marque). He has studied at the K. Patthbi Jois Ashtanga Yoga Institute in India, where yoga is understood as a whole body health practice.

Newest to Cleveland are Joseph Watts (Watts Integrative Manual Therapy) and Kari Watts, relocated from Lexington, Kentucky. Joe practices a unique form of manual therapy; more than massage, he uses techniques from lymphatic drainage to myoskeletal alignment. Kari works as a small-class Pilates instructor.

I had three main questions for these intrepid health professionals—first, why Cleveland? Second, what makes these practices “alternative”? And third, what are the benefits and challenges of independent practice?


“I love Cleveland,” Joseph Watts said. “Cleveland has such a diverse population, and it’s a city on the verge”—a sentiment echoed by Kari and Marque. But in addition, Cleveland’s role as a medical destination means a community that sees and hears a great deal about health. Marque added that Northeast Ohio generally is a great place to “teach and grow” the Mysore method (an individualized practice) because “we have such a huge population of health conscious people who are already practicing vinyasa and/or power yoga.”

At the same time, it’s a new market—currently, there are only two places in the Cleveland area to practice Mysore: Harmony Studios in Willoughby and Ashtanga Yoga in Berea. A health-minded population in the midst of the Emerald Necklace of parks and recreation means that Cleveland has a unique combination of diverse social networks and physical attractions. That combination, Kari said, proves invaluable to those interested in preserving health.

Anne and Tom were quick to point out that alternative practices have been thriving elsewhere, as well. “Clearly, there are more people interested in medical alternatives,” Anne said—but the hospital systems have taken up that cause, too, which is a kind of double-edged sword. Physical therapists and acupuncturists who work within the system necessarily have to abide by the rules of that system, and that means potentially compromising on a patient’s needs.

So what keeps long-time alternative health professionals practicing here? It's about meeting the needs of the underserved in Cleveland, Tom said. They are "health care mutants," therapists practicing in a way different from those at hospitals and clinics.


So what is this unique difference? As soon as I asked the question, I felt the energy of the room shift. Leaning forward in their chairs, the five practitioners eagerly shared: “Individualized attention.” “Getting to know the patient.” “Treating them as they need to be treated, not as time or insurance companies dictate.” Joe considered the difference to be threefold: Individual Orthopedic Testing, Time, and Self-Care.

Each client receives care based on their situation, and after treatment they are given individualized self-care exercises and self-massage techniques.

“As their body changes we will adapt the visits to meet them where they are in that moment," Joe said — something seconded by Tom as a physical therapist, teacher, and author. It’s about discovering what they need and seeing the whole person, he explained, their emotional as well as physical state.

This consideration of the individual appeared again and again. Anne reminded us that large group practices can lose by efficiency. She does therapy for infertility and other treatments for very specific conditions. How, she asks, can you treat 10 people at once—or learn a patient’s needs in only a few minutes? Kari confirmed the value of an individual’s goals, struggles, and desires to effective whole body practice. If you try and lead 30 people through Pilates, you are going to leave some behind, and the same is true of yoga.

Marque lamented that sweeping statements to a large class can do more harm than good. “Much of the yoga taught today in the west has become nothing more than an exercise routine,” Marque said, when in fact it is a health practice. Ashtanga yoga focuses on breath, and Mysore individualizes the experience. I know; I tried it—instead of a class of 30 in an aerobics speed-through, you get one-on-one time and go at your own pace. No pressure; posture and body movement are memorized over a long period of time, and the meditative sequence of movements and breaths set the tempo not just for the experience, but for living.

For all the practitioners, the point was healing patients. “It should never hurt you,” Joe said, shaking his head. Massage, acupuncture, physical therapy, yoga and Pilates: sometimes you may find it rough going and have to push yourself, but in the end, there should never be outright pain. It’s about healing the whole person, they explain. It’s about you.


The final question was the hardest—not just to ask, but to answer.

Individualized practice allows for a wonderfully different experience than many of us anticipate from over-worked practitioners at busy hospitals. At the same time, there are significant obstacles to be overcome by this enclave of independents. Back in the 1890s, 20 percent of doctors in Cleveland were homeopaths or practiced some other form of medicine now described as “alternative.” But when Anne and Tom began practicing, alternative therapy was not well understood—and could be hard to explain and to validate.

Today, with the advent of Cleveland Clinic’s Center for Integrative Medicine, “alternative” therapies have become better accepted by the mainstream, and yet by mainstreaming the therapies such centers have overshadowed what was originally “alternative” about them. The received narrative becomes potentially one-dimensional, and, after all, a practice that evolves in the hospital system will necessarily take on the character of that system. Moving out of that system provides freedom, but can be isolating. “I miss sharing with colleagues,” Tom explains—adding “I also miss days off!” We laugh. But it’s true. These independents work long hours to make what they do transparent, translatable, and understood. And yet, they are the unheard voices.

As Cleveland continues its rise as a medical city, some of its most foundational and hardest working members have been strangely overlooked. Some people likely don’t even consider massage—or yoga and Pilates—as therapies. Others might think acupuncture and physical therapy only work for the “believers.” And still others view independent practice with suspicion: surely “real” medicine belongs in a hospital…

History tells a different story. Looking back at the bizarre and brilliant tales that built our city—on doctors who took chances, who knew their patients as they knew their neighbors, and who sometimes went against the grain—I see Cleveland’s finest moments. Looking at this room of alternative practitioners, men and women working to heal the human at the center of medicine, I see our greatest inheritance.

Brandy Schillace is the public engagement fellow at the Dittrick Medical History Center and Museum and the managing editor of Culture, Medicine and Psychiatry.

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