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Dr. Joan Fox is an internationally recognized NIH-funded research
scientist with more than 25-years experience in her field. Dr. Fox
serves on committees and advisory boards for organizations such
as the American Heart Association, American Society of Hematology,
and the National Institutes of Health.
Dr. Fox's research focuses on the way that cells communicate with
each other, producing molecules that affect other cells throughout
the body, turning genes on and off and changing the properties and
behaviors of cells.
As Director of the Center for Integrative Medicine at the Cleveland
Clinic Foundation, her interests include investigation of effective
prevention programs and ways in which intention and the power of
the mind can be harnessed to affect health.
In a recent interview Dr. Fox discusses some of the programs and
research taking place at the Clinic.
John: Dr. Fox would you like to tell us about
your program at the Cleveland Clinic?
Joan: Well the Center for Integrative Medicine
is primarily research and education. We have research grants to
look into things like Reiki, a major integrative area that we are
doing research on. We have some work on in-brain imaging and the
effects of focused intention both on physiology and on brain activity.
A number of different individuals are involved in this kind of research.
The educational efforts are both internal and external. We think
that before we can really be effective in offering integrated health
care, we have to have staff that is aware of how to offer it, the
different ways it can be offered, what it means, and how we can
integrate beneficial practices into the medical practice.
John: What is available to the consumer of the
Cleveland Clinic?
Joan: We are focusing on making alternative medicine
available throughout the Clinic rather than having a separate service
to give alternative medicine. Places like the Pain Management Center,
for example, offer acupuncture. Physicians who are comfortable with
the alternative approaches incorporate those into pain management
within the Pain Management Center. Psychology for a long time, actually,
has offered things like biofeedback, hypnosis and imagery. The Cancer
Center has a program called Reflections, which is a free hour-long
program for people undergoing treatment at the Clinic. All of that
is available for patients who might be undergoing radiation therapy
or chemotherapy, and they can have a session where they can choose
Reflexology, Massage, Reiki, or Imagery. These wellness sessions
can help patients with the symptoms of their treatments.
 John:
It's just amazing to me what a difference ten years makes. I don't
think any of this was available in the 1990's. This is really nice
that all of this is part of a major hospital.
Joan: Yes, and in the Heart Center we offer imagery
tapes prior to surgery. About 75% choose to use them. We have used
those tapes for quite a while now. There was a research study that
was done at the Cleveland Clinic to show that they had real benefits
in terms of post surgery pain and anxiety. The patients left the
hospital earlier if they had used these imagery tapes so we now
offer those to all the patients going in for surgery in the Heart
Center. This kind of thing is happening throughout the Clinic. It
is not like people can just call up and make an appointment to see
an alternative doctor or integrative medicine doctor. The wellness
sessions are just kept within the different departments.
John: So it is like you are weaving alternative
medicine into the fabric of the health care itself?
Joan: Yes, that's what we are trying to do.
John: Can you tell me more about the research
that is going into Reiki?
Joan: We have a grant to look at the potential
benefits of Reiki on anxiety and stress. We are looking at physiological
markers after an energy healing session to see whether there are
changes in cortisol or cytokine production by T-Cells. As a randomized
controlled research study, people volunteer and we divide them into
two groups - one gets the Reiki session and the others receive a
sham treatment. That is an ongoing study and it will probably be
awhile before we have enough people who have participated to put
the data together to analyze.
John: What is in-brain imagining?
Joan: An investigator in the department of bioengineering
at the Cleveland Clinic, Dr. Guang Yue has the in-brain imaging
grants. He is interested in the idea that we can use our focused
intention to change our physiology. Dr. Yue is specifically looking
at using the brain to increase muscle strength. For example, he
is using imaging to focus on the idea that you can increase the
strength of a muscle in your hand. Those that simply used focused
intention did almost as well in terms of the increased strength
after four weeks of practice than those that had actually practiced
by doing an exercise of the muscles. He is also looking at the brain
to see whether there are changes in the brain associated with this
increased strength in the muscles of the hand. He has found in his
early studies that when the brain is used to focus intention in
this way there are changes in the activity in the brain.
John: Does the position you have at the Cleveland
Clinic afford you the opportunity to network with other hospitals
and other departments such as yours around the country?
Joan: Yes, in as much as conferences that we attend
and speakers that we bring in. Those are the normal channels for
communication and networking with people doing the same sort of
thing.
John: Do you see this as a growing movement across
the country with hospitals?
Joan: It definitely is. I think it is consumer driven as much as
anything. There may be greater growth in places where hospitals
see that consumers are demanding this sort of integration. I think
there are a lot of growing pains in terms of what it means and how
to do it. There are financial issues and insurance issues that are
certainly not being totally resolved. I think other places have
tried things that have not worked because of financial reasons.
I think it is still very much in the stage of just kind of working
out what is going to work and what is not, and of course, whether
it's going to be feasible in the long run.
John: So the alternative practitioners do not
get covered by health care? But, if someone requests that as part
of their care at the Clinic, you mentioned Reflexology or Massage
during chemotherapy, how does that get covered?
Joan: The Cancer Center covers the individual who
is able to receive those treatments. Patients who are part of the
Cancer Center treatment plan can have this service to help them
with their symptoms. That's totally covered by the Cancer Center.
That is the same with the imagery tapes in the Heart Center. Imagery
tapes are just something the Heart Center chooses to provide for
their patients going into surgery. Things like that are added out
of the budget. In terms of the question, 'would we ever be giving
an hour-long massage to patients in the hospital and have to cover
that?' That's the kind of thing that various hospitals are trying
in different ways, and that is not covered by insurance. It gets
much more expensive to be covered by hospitals. In the future, I
see all kinds of models being tried in different places to resolve
these issues.
John: What about the activity with grant money?
You mentioned the Reiki experiment, that is a grant driven project,
correct?
Joan: Those are more research directed and what
we are doing, at this point, is not with patients, it is only with
volunteers.
John: The education program, does it move outside
the walls of the Cleveland Clinic into the community?
Joan: Yes. Certainly there is a lot of interest
and there are a lot of requests from the community to have speakers
go and talk to their various groups. We try to do that as much as
we can. We do have some educational programs that we have offered.
We promote these throughout the community for anyone who is interested
in attending. That is another way that the community members have
taken part in the educational initiatives we have going.
John: If the readers of Balanced Living would
like to find out more about those services, what number should they
call?
Joan: The number to call is (216) 444-8919.
John: Joan, thank you for taking this time for
us.
Joan: Thank you, and best wishes to your magazine
and your readers.
John Rehak L.P.C., CCDC III is a psychotherapist and director
of The Clear Mind - A space for personal growth. For more information
go to www.clearmind.net.
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